97 An evaluation of predictors for success of 2-duct ligation for drooling in neurodisabilities 4 motor control, and swallowing disorders preventing effective salivary swallowing, poor posture, lack of speech, lack of mouth closure, epilepsy, poor gross motor function)9-11, it has until now been unknown which of these are predictive factors of treatment success in 2-DL. Previous studies on predictive factors for other treatments have shown variable results; a previous study on predictors for the effect of intraglandular BoNT-A revealed no significant clinical variables.9 Another study from the same research group identified both age (younger than 12 years) and poor posture (anteflexion) to be associated with SMDR treatment failure.2 Anteflexion as negative predictor for SMDR is logical, as anteflexion interferes with the relocation of salivary flow. Interestingly, anteflexion and age are also associated with 2-DL treatment failure. There are many possible explanations why increasing age is associated with a higher response rate to surgery. With increasing maturity (and corresponding developmental age), patients might learn to better manage their saliva (either due to increasing awareness of swallowing or wiping of saliva), leading to improved outcomes. There could be ongoing motor development, or more mature patients might 1) be more motivated, and 2) be more aware of drooling in specific, social circumstances. Another possibility is that more severely affected patients undergo surgery at a younger age. This is, however, not supported by the data. Lastly, younger patients exchange teeth which could lead to increased salivation, so this might temporarily influence treatment effect. A VSSD, defined as no speech, anarthria or very severe dysarthria, is associated with treatment failure. VSSD occurs in patients with impaired oro-motor function (anarthria or very severe dysarthria), insufficient intellect (no speech), or both (impaired oro-motor function is associated with insufficient intellect16). In contrast, children with better speech capacities have better outcomes after 2-DL. These children have more oral motor capabilities and the cognitive level to benefit from reduced saliva. Our definition for VSSD makes it impossible to distinguish between oromotor disorders and impaired intellect as specific predictive factors for treatment failure. Nevertheless, speech is an easily definable clinical characteristic.
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