Bilateral Parotid Duct Ligation Research Articles

Surgical management of chronic salivary aspiration

Aim of the studySialorrhoea and chronic salivary aspiration are a major problem in many neurologically impaired children causing embarrassment, skin issues and recurrent lower respiratory tract infections (LRTI). The aim of this study was to assess the efficacy of salivary gland surgery in the treatment of chronic salivary aspiration in such children. ObjectivesTo compare admission rates for LRTI per annum before and after surgical intervention. MethodsRetrospective review of all patients who underwent salivary management surgery for chronic aspiration under Princess Margaret Hospital's (PMH) Otolaryngology department from 2006 until 2013. ResultsTwelve patients were included in this review. Their ages ranged from 3 to 21 years (mean=11.4). Their genders were equally distributed. Two patients had underlying congenital disorders; one had an acquired brain injury, while the majority (n=9, 75%) had cerebral palsy secondary to a sustained perinatal injury.Most patients (n=11, 91.7%) had bilateral submandibular gland excision and parotid duct ligation as a primary procedure. One patient had a laryngotracheal separation. Two patients went on to have a second procedure. The mean follow up time was five years. Using Wilcoxon Signed-Rank test we showed that the median rate of admission per annum for LRTI pre-operatively was 1.0. This was reduced to 0.5 post-operatively, which was statistically significant (p≤0.05). ConclusionsWe hypothesize that the combination of bilateral submandibular gland excision and bilateral parotid duct ligation is effective in reducing admissions with aspiration pneumonia in neurologically impaired children, and therefore improves the quality of life in these patients.

Salivary gland surgery for control of chronic pulmonary aspiration in children with cerebral palsy

To evaluate the outcome of surgical saliva reduction to decrease pulmonary aspiration in children with cerebral palsy and its repercussions in respiratory infection control. Twenty-nine children with neurological impairment and diagnosis of chronic pulmonary aspiration were submitted to bilateral submandibular gland excision and bilateral parotid duct ligation at the Association for the Welfare of Physically Handicapped Children, from December 2001 to December 2004. Postoperative frequency of lower respiratory tract infection, hospitalization rate due to pulmonary infection and airway secretion level after the surgery were compared to preoperative period. Twenty-nine children with cerebral palsy aged 18 months to 9 years were submitted to submandibular glands excision and parotid ducts ligation. All children had gastrostomy and no oral intake. There were no major complications; two children had reopening of one parotid duct. Frequency of lower respiratory tract infections, rate of hospitalization for treatment of pulmonary infections and level of airway secretion were statistically reduced. Preoperative mean rate of lower respiratory tract infection was 6.9/year; in postoperative period, rate was 2.4/year (p<0.001). Pneumonia hospitalization mean rate was 63.4 days/year preoperatively and 17.5 days/year postoperatively (p<0.001). There was also a significant improvement in the need for suctioning of upper airway secretion (mean 11 times/day in preoperative period and 3.1 times/day in the postoperative period; p<0.001). In children with cerebral palsy, surgical saliva reduction by submandibular glands excision and parotid ducts ligation is an effective and safe technique for frequency reduction of lower respiratory tract infection and level of airway secretion.

Parotid duct ligation for treatment of drooling in children with neurological impairment

Multiple surgical procedures have been advocated for the management of problematic drooling in neurologically impaired children. Parotid duct ligation is a quick and simple operation conducted via an intra-oral approach and usually performed simultaneously with other procedures. In this study, we aimed to evaluate the effectiveness of parotid duct ligation as a discrete procedure. All children who underwent bilateral parotid duct ligation as the solitary operative intervention at that time, between February 2003 and September 2006, were included in the study. Ten children were studied. Surgery was successful in 80 per cent of cases. One patient (10 per cent) had a post-operative wound infection. Bilateral parotid duct ligation is an effective yet conservative operation for drooling in neurologically impaired children. It requires minimal surgical dissection and has a low morbidity rate. It should be considered as a potential first-line procedure in children who aspirate, and as a further surgical option in anterior droolers or those who continue to drool unacceptably following prior surgical intervention.

Salivary gland surgery for chronic pulmonary aspiration in children

Chronic aspiration in the neurologically impaired child has a considerable morbidity and occasional morbidity. Hospitalization, physician visits and health costs associated with the sequelae of aspiration are considerable. To assess the efficacy of salivary gland surgery to treat chronic aspiration in children. Tertiary pediatric center. A 6 year retrospective chart review of all patients undergoing salivary gland surgery to treat chronic aspiration. (1) Rate of lower respiratory tract infection (LRTI); (2) baseline oxygen saturation pre- and post-surgery. Sixty-two patients aged 7-279 months (mean 68 months) underwent four duct ligation or bilateral submandibular gland excision with unilateral or bilateral parotid duct ligation. The mean rate was 1.2/year pre-operatively and 0.7/year post-operatively (p=0.6). There was, however, a significant improvement in the baseline post-operative oxygen saturation (mean 94.3%) when compared to the pre-operative baseline oxygen saturation (mean 92.8%, p=0.003). Analysis of the cerebral palsy subgroup was performed (n=13). In this group there was no difference between mean pre- and post-operative LRTI rate (p=0.5) nor change in baseline oxygen saturation (p=0.83). Children under 3 years of age showed a reduction in the LRTI rate (mean of 2.1 versus 0.7 episodes per year, p=0.04) and an improvement in the post-operative baseline oxygen saturation (p=0.001) following surgery. Unlike a previous publication from this institution, when evaluating the population sample as a whole, there was no significant improvement in the rate of LRTI following salivary gland surgery, however, there was an improvement in baseline oxygen saturation, possibly reflecting an improvement in lung function. There was an improvement in neither outcome parameter in children with cerebral palsy and improvements in both outcome measures in children under the age of 3.

Chronic Aspiration in Children

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

Chronic aspiration in children. When are bilateral submandibular gland excision and parotid duct ligation indicated?

To assess the efficacy of bilateral submandibular gland excision and bilateral parotid duct ligation in treatment of chronic aspiration in neurologically impaired children. Retrospective chart review and telephone follow-up interview. Tertiary care center. 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. 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. 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 < .001) and hospitalizations (1.2 +/- 0.8 before surgery, 0.4 +/- 0.8 after surgery; P < .005). Six patients had a tracheostomy at the time of surgery, and 1 required a tracheostomy 2 years after surgery. No individual required laryngotracheal separation. Eleven families were able to be contacted by telephone. Caretakers reported that in 8 of 11 patients, quality of life was improved and care requirements decreased. Seven patients used voice for at least some degree of communication. Three patients had postoperative complications involving the parotid glands; all resolved after further therapy. 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.

Surgical Management of Sialorrhea

Sialorrhea is a distressing problem in children with cerebral palsy, in children with other neurologic disorders, and in normal children. The constant need for clothing or bib changes in handicapped patients frequently results in further social isolation and causes normal children to be viewed as "impaired." The surgical treatment of sialorrhea at Children's Hospital Medical Center, Cincinnati, Ohio, has evolved over the past 5 years. Since 1981, 70 surgical procedures have been performed for drooling at this institution; follow-up information is available on 52 patients. The surgical procedures performed included submandibular rerouting alone, submandibular duct rerouting with bilateral tympanic neurectomy with bilateral submandibular gland excision, and bilateral submandibular gland excision with bilateral parotid duct ligation. Our review indicates that bilateral submandibular gland excision with parotid duct ligation is the only procedure in which consistent control of sialorrhea can be expected. Postoperative complications after this procedure were minimal and only one parent complained that the child had a dry mouth after the procedure. Postoperative hospitalization after bilateral submandibular gland excision and bilateral parotid duct ligation was not significantly different from that required after any of the other procedures. In conclusion, this surgical procedure appears to be the most effective surgical treatment for sialorrhea and precludes the need for multiple operative procedures for this problem.

Submandibular gland resection and bilateral parotid duct ligation as a management for chronic drooling in cerebral palsy.

The control of chronic drooling in cerebral palsy has been difficult in the past. Previous methods to control drooling include the Wilkie procedure, which diverts the salivary flow from the parotid glands by means of surgically created tunnels to the tonsillar fossa, along with submandibular gland resection. An alternative is submandibular gland resection with bilateral parotid duct ligation. Previous published studies using this method have resulted in good to excellent results, but population sizes were felt to be too small to be conclusive. Since 1979, a total of 58 patients have been treated by parotid duct ligation with submandibular gland resection, and 86 percent have shown good to excellent results. These results compare favorably with those published by Wilkie. Also, parotid duct ligation is technically easier, associated with less postoperative morbidity, and has shown a decreased duration of hospitalization compared to parotid duct transposition.

Submandibular Gland Resection and Bilateral Parotid Duct Ligation as a Management for Chronic Drooling in Cerebral Palsy

Submandibular Gland Resection and Bilateral Parotid Duct Ligation as a Management for Chronic Drooling in Cerebral Palsy

Surgical Management of Sialorrhea

At the annual meeting of the American Academy of Otolaryngology–Head and Neck Surgery in Washington, DC, Sally R. Shott and colleagues of the Children's Hospital Medical Center, Cincinnati, reported their results with the surgical management of sialorrhea. In a retrospective telephone interview of parents and caretakers, they found none of six patients improved by submandibular duct rerouting alone; five of 20 patients improved by submandibular duct rerouting, bilateral tympanic neurectomy, and unilateral chorda tympani division; none of two patients improved by bilateral tympanic neurectomy and bilateral submandibular gland excision; and 11 of 14 patients improved by bilateral submandibular gland excision and bilateral parotid duct ligation. The latter procedure is now their treatment of choice in the surgical management of sialorrhea. This marks a change in policy since a 1981 publication from the same institution identifying bilateral submandibular duct rerouting as their procedure of choice. With the new procedure they report

Surgical treatment of drooling by bilateral parotid duct ligation and submandibular gland resection: D. F. Dundas and R. A. Peterson. Plast Reconstr Surg 64:47–51, (July), 1979

Surgical treatment of drooling by bilateral parotid duct ligation and submandibular gland resection: D. F. Dundas and R. A. Peterson. Plast Reconstr Surg 64:47–51, (July), 1979

Surgical Treatment of Drooling by Bilateral Parotid Duct Ligation and Submandibular Gland Resection

We have followed 14 patients for up to 6 years after they had submaxillary gland resections and parotid duct ligations for drooling. Good to excellent results were found in more than 85 percent of them in the control saliva, and there have been no recurrences or fistulae. This procedure is technically simple to do, and it is associated with less morbidity than surgical relocation of the parotid ducts.

Phosphorus homeostasis in sheep. I. Effects of ligation of parotid salivary ducts

The effects of bilateral parotid duct ligation upon calcium and phosphorus concentrations in blood plasma and upon phosphorus excretion in urine and faeces have been examined. Five Merino wethers were used, of which three were given a phosphorus-deficient diet (0.304 g phosphorus/day) and two a phosphorus-sufficient diet (1.454 g phosphorus/day) for 32 days prior to ligation of the parotid ducts. Blood samples were taken every 6 hours for 2 days before and 4 days after parotid duct ligation followed by less frequent sampling for a further 3 days. Parotid duct ligation caused an increase in plasma inorganic phosphorus levels after the first day in the phosphorus-supplemented sheep and in one of the deficient animals. Plasma calcium concentrations tended to be inversely related to plasma phosphorus levels and showed marked variations on the fourth day following duct ligation, coinciding with a sudden fall in plasma phosphorus levels of 30-50 %. Urinary phosphorus excretion in the phosphorus-sufficient animals was increased 20 to 50-fold following ligation and reached a peak of about 600 mg/day on the fourth day, but there was no significant change in phosphorus balance. Marked alterations in the daily urinary output of phosphorus tended to be associated with a change in plasma phosphorus levels in the reverse direction. Four of the sheep were re-examined 22 months after duct ligation and the elevated urinary output of phosphorus was found to have persisted in three of the four animals. It appears that there is a relationship between the salivary secretion of phosphorus to the gut and the urinary phosphorus excretion which contributes towards maintenance of the phosphorus homeostasis in sheep.