Does the activity of the remaining salivary glands change after removal of one gland or ductal ligation?
CPS ePoster Library. Ibrahim F. Jun 25, 2015; 99103; 40
Dr. Farid Ibrahim
Dr. Farid Ibrahim
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INTRODUCTION: Sialorrhea in children leads to complications such as choking, aspiration and skin breakdown as well as psychosocial disability (e.g. isolation). In case of failure of conservative treatment, management usually consists of either duct ligation or surgical removal of one of the submandibular glands. It is unknown if the efficacy of this approach might be limited by a compensatory increase in the activity of the remaining salivary glands.

OBJECTIVE: To determine the functional compensation of salivary flow by the remaining glands after duct ligation and/or removal of one submandibular gland. The salivary flow was measured using a diagnostic method based on isotope tracing.

METHODS: We retrospectively reviewed the clinical charts of drooling patients managed with duct ligation and/or submandibular gland excision performed between 2006 and 2013. The clinical manifestation, salivary gland scintigraphy with technetium-99m (99mTc) -pertechnetate pre- and post-surgery are reported.

RESULTS: Eight cases were included with follow-up times ranged from 12 to 36 months. There were 3 females and 5 males, ages between 5 to 18 years old. The post-surgical salivary gland scintigraphy reported a dynamic increase in the parotid glands and the remaining submandibular gland in all cases of surgical excision. However, three out of five patients with duct ligation, sialorrhea was controlled post-excision of the one submandibular glands.

CONCLUSION: We report a case series of eight patients showing for the first time physiological compensation after ligation or removal of a submandibular gland for drooling. Identifying the mechanism responsible for this phenomenon may contribute to improve the management of drooling patients. Importantly, duct ligation did not appear to be as effective as surgical removal. Combined management treatment may be recommended
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