Surgical Management of Drooling by Submandibular Duct Transposition

Sialorrhoea is a potentially debilitating problem that may arise with neurologic disorders, such as cerebral palsy. Chronic drooling may cause serious quality of life problems. Various medical and surgical procedures have been proposed for the treatment of chronic sialorrhoea. Each procedure has its own advantages and disadvantages. The present study comprised 19 children complaining from chronic sialorrhoea due to cerebral palsy. They were subjected to a preoperative and a postoperative assessment protocol that included history taking, clinical examination and assessment of the severity of sialorrhoea using a visual analogue score (VAS). Bilateral submandibular duct transposition was performed to treat the drooling of the patients. Submandibular duct transposition is critically analyzed as regards the surgical technique, success rate, advantages, disadvantages and complications. Submandibular duct transposition is a procedure that involves the dissection and relocation of the submandibular ducts from the oral cavity to the tonsillar fossa. The principle of the operation is redirection of the flow of saliva so that it is easily swallowed as the problem of drooling in cerebral palsy patients is not due excessive production of saliva, but due to inability to swallow the saliva. Submandibular duct transposition is a safe and highly successful procedure that significantly controls drooling and improves the quality of life of the neurologically impaired children. The procedure does not require external neck incision and is associated with relatively low morbidity.