Submandibular Gland Excision Successful for Surgical Management of Sialorrhea

What is the best procedure for surgical management of drooling?

Background: Surgical treatment for sialorrhea is considered when conservative measures fail. Options include sublingual gland excision, submandibular gland (SMG) duct ligation or rerouting, submandibular gland excision, parotid duct ligation or rerouting and combinations of these procedures. The authors reviewed the literature to compare efficacy, recognizing the limitation that surgical success is typically based on subjective caretaker reports.

Study Design: Meta analysis.

Setting: Department of Otolaryngology, Walter Reed Army Medical Center, Washington, D.C.

Synopsis: Data was extracted from 59 study subsets reported in 50 manuscripts, nearly all of which were case series (CEBM 4). The median study sample size was 18 (range, 8-181), and median minimum follow-up was eight months (2 m-43m). The overall caretaker-reported success rate was high at 82 percent.

The most common procedure performed was bilateral SMG rerouting (36 percent). The success rate was highest with bilateral SMG excision with bilateral parotid duct rerouting (Wilke procedure, 87.8 percent) and lowest with four duct ligation (64.1 percent, p=0.001). Recognizing limitations of such a review, the authors found that more invasive procedures targeting four major salivary glands were more effective than less invasive procedures.

Bottom Line: Overall, SMG excision combined with parotid duct rerouting or ligation has highest caretaker-reported success for surgical management of sialorrhea.

Citation: Reed J, Mans CK, Brietzke SE . Surgical management of drooling, a meta-analysis. Arch Otolaryngol. 2009;135:24-31.