Long-Term Outcomes of Surgical Drooling Treatment in Individuals with Neurodevelopmental Disabilities: A Retrospective Cohort Study.

Abstract

To compare the long-term treatment outcomes of submandibular duct relocation (SMDR), submandibular gland excision (SMGE), and submandibular duct ligation (SDL) for the treatment of anterior drooling in individuals with neurodevelopmental disabilities. A retrospective cohort study was conducted with patients from the Netherlands who received surgery for drooling. All participants received follow-up after 8 and 32 weeks. A questionnaire was completed at least 1 year postsurgery for long-term follow-up. Visual analog scale (VAS) for drooling was the primary outcome. Secondary outcomes included the Drooling Quotient and the Drooling Severity and Frequency Scale. Repeated measures ANOVA was employed to assess the outcomes within and between each type of surgery. A total of 255 patients who visited the Saliva Control Clinic between 2000 and 2021 were included in this study. For the VAS at long-term follow-up, a mean reduction was observed of 44.9 points for SMDR (P < .001), 27.2 for SMGE (P < .001), and 25.4 for SDL (P < .001). VAS increased by within-surgery difference at long-term compared with 32 weeks for SMGE (8.6, P = .036) and SDL (8.5, P = .047), but not for SMDR (2.9, P = .46). When comparing the three types of surgery, the outcomes after SMDR remained stable in the long term, while the VAS increased for SMGE (mean difference 18.9, P = .011) and SDL (mean difference 18.5, P = .013). VAS for drooling, Drooling Quotient, and Drooling Severity Frequency Scale decreased after all surgical procedures. SMDR showed superior outcomes over SMGE and SDL in the long term. Our data suggest partial recurrence of drooling after SDL and SMGE.