Chronic Aspiration in Children

Abstract

Objective: To assess the efficacy of bilateral submandibular gland excision and bilateral parotid duct ligation in treatment of chronic aspiration in neurologically impaired children. Design: Retrospective chart review and telephone follow-up interview. Setting: Tertiary care center. Patients: All patients from 1986 through 1994 who underwent bilateral submandibular gland excision and bilateral parotid duct ligation and had evidence of at least 1 episode of aspiration pneumonia in the year prior to undergoing surgery. Main Outcome Measure: Two main outcomes measures were (1) the change in number of hospitalizations for pneumonia and total number of lower respiratory tract infections between 1 year before and 1 year after surgical intervention and (2) telephone assessment of patient outcome with respect to parental satisfaction, effect on quality of life, care requirements, amount of suctioning, and use of voice. Results: Sixteen patients aged 16 months to 18 years were included. After surgical intervention, there was a significant decrease in the mean (±SD) number of pneumonias (2.3±1.44 before surgery, 0.9±1.2 after surgery; P Conclusion: Bilateral submandibular gland excision and bilateral parotid duct ligation reduce the incidence of aspiration pneumonias and hospitalization, and decrease overall care requirements in a select group of neurologically impaired children. Because they are voice sparing, are efficacious, and have a low morbidity, they should be considered before laryngotracheal separation or tracheoesophageal diversion. Arch Otolaryngol Head Neck Surg. 1996;122:1368-1371