Bilateral submandibular duct relocation by high-frequency radiosurgery

The aim of this study was to investigate the efficacy and safety of radiosurgical bilateral submandibular duct relocation in neurologically impaired children and young adults suffering from excessive drooling. The enrolled patients were referred with excessive drooling after the failure of 6 months of oral-motor training and conservative methods. The exclusion criteria were dental caries and recurrent aspiration pneumonia. During 2000–2007, 14 children and young adults with persistent drooling underwent radiosurgical bilateral submandibular duct relocation and sublingual gland excision. A retrospective case note review was performed and a questionnaire study was conducted. The oral-motor function was assessed on a 4-degree scale preoperatively, 4 months postoperatively and after an average follow up time of 8–26 months. A majority of the patients (79%) achieved a satisfactory reduction in sialorrhoea. The average time of onset of an improvement in the drooling was 3 weeks (ranging from immediately to 5 months). The parents of 10 (71%) patients were happy with the outcome and would recommend the procedure to the parents of other children. The complications included three cases of transient sublingual swelling in the early, and two cases of ranula in the late postoperative period. The average duration of surgery was 48 min, i.e., about 30% less than for the previously favoured cold knife technique. Radiosurgery furnishes a new therapeutic approach for neurologically disabled children suffering from excessive drooling. It combines the advantages of the cold knife and laser techniques: it is easy, safe, precise and effective, with excellent tactile and haemostatic features.