87 An evaluation of predictors for success of 2-duct ligation for drooling in neurodisabilities 4 INTRODUCTION When drooling in children with neurodisabilities is not adequately managed with conservative treatment or Botulinum Neurotoxin A (BoNT-A), and age progresses, surgery is advocated in our institution.1 In cases of isolated anterior drooling (visible drooling), the treatment of choice is Submandibular Duct Rerouting (SMDR). Although SMDR is effective for >80% of patients, it is an extensive procedure with approximately 8% risk for Serious Adverse Events (SAE) and in one cohort studied a mean of 4.4 days admission.2 Submandibular Gland Excision (SMGE) is commonly advised when SMDR is contraindicated. Although the response to treatment is good, the risk for nerve damage, an external scar, and longer admission and surgical/anesthetic time make the procedure unappealing.3-6 2-DL was recently presented as an alternative procedure that is effective in > 60% of patients with specific advantages over SMDR and SMGE.7 2-DL is a more limited and shorter procedure that can be used for both anterior and posterior drooling. There is no external scar, and limited SAE. Unfortunately, drooling proves refractory to 2-DL in approximately 40% of children.8 Drooling is multifactorial and dependent on various clinical variables (poor gross motor function, dental malocclusion, poor posture, etc).9-11 However, thus far, clinical variables predicting treatment failure are sparse,9,2 so current surgical decision making is based on either age, contraindications for SMDR or expert opinion. Moreover, to date it remains unrevealed why some patients respond well to surgery while some recur and others are non-responders. For this study, we aim to find the predictors for treatment success of 2-DL.
RkJQdWJsaXNoZXIy MjY0ODMw