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Salivary gland surgery for chronic pulmonary aspiration in children
Shyan Vijayasekaran1, Faruk Unal, Scott A Schraff
1Princess Margaret Hospital for Children, Perth, WA, Australia. shyan@entkids.com.au
Insights
Salivary gland surgery for chronic aspiration in neurologically impaired children did not significantly reduce lower respiratory tract infections overall. However, it improved oxygen saturation, especially in children under three years old.
Area of Science:
- Pediatric Surgery
- Neurology
- Pulmonology
Background:
- Chronic aspiration in neurologically impaired children leads to significant morbidity and healthcare costs.
- Sequelae of aspiration include increased hospitalizations and physician visits.
Purpose of the Study:
- To evaluate the effectiveness of salivary gland surgery in managing chronic aspiration in pediatric patients.
- To assess the impact of salivary gland surgery on lower respiratory tract infections and oxygen saturation.
Main Methods:
- Retrospective chart review of 62 pediatric patients undergoing salivary gland surgery over six years.
- Surgical procedures included duct ligation and/or gland excision.
- Outcomes measured were the rate of lower respiratory tract infection (LRTI) and baseline oxygen saturation pre- and post-surgery.
Main Results:
- Overall, salivary gland surgery did not significantly reduce the LRTI rate (1.2/year pre-op vs. 0.7/year post-op, p=0.6).
- A significant improvement in baseline oxygen saturation was observed post-surgery (92.8% pre-op vs. 94.3% post-op, p=0.003).
- Children under 3 years showed reduced LRTI rates (2.1 vs. 0.7 episodes/year, p=0.04) and improved oxygen saturation (p=0.001).
- Patients with cerebral palsy showed no significant improvement in LRTI rates or oxygen saturation.
Conclusions:
- Salivary gland surgery may improve lung function, as indicated by enhanced oxygen saturation, in neurologically impaired children with chronic aspiration.
- The procedure showed particular benefit for children under three years of age, improving both LRTI rates and oxygen saturation.
- No significant benefits were observed in the cerebral palsy subgroup.
Introduction:
Chronic aspiration in the neurologically impaired child has a considerable morbidity and occasional morbidity. Hospitalization, physician visits and health costs associated with the sequelae of aspiration are considerable.
Aim:
To assess the efficacy of salivary gland surgery to treat chronic aspiration in children.
Setting:
Tertiary pediatric center.
Study Design:
A 6 year retrospective chart review of all patients undergoing salivary gland surgery to treat chronic aspiration.
Outcome Parameters:
(1) Rate of lower respiratory tract infection (LRTI); (2) baseline oxygen saturation pre- and post-surgery.
Results:
Sixty-two patients aged 7-279 months (mean 68 months) underwent four duct ligation or bilateral submandibular gland excision with unilateral or bilateral parotid duct ligation. The mean rate was 1.2/year pre-operatively and 0.7/year post-operatively (p=0.6). There was, however, a significant improvement in the baseline post-operative oxygen saturation (mean 94.3%) when compared to the pre-operative baseline oxygen saturation (mean 92.8%, p=0.003). Analysis of the cerebral palsy subgroup was performed (n=13). In this group there was no difference between mean pre- and post-operative LRTI rate (p=0.5) nor change in baseline oxygen saturation (p=0.83). Children under 3 years of age showed a reduction in the LRTI rate (mean of 2.1 versus 0.7 episodes per year, p=0.04) and an improvement in the post-operative baseline oxygen saturation (p=0.001) following surgery.
Conclusions:
Unlike a previous publication from this institution, when evaluating the population sample as a whole, there was no significant improvement in the rate of LRTI following salivary gland surgery, however, there was an improvement in baseline oxygen saturation, possibly reflecting an improvement in lung function. There was an improvement in neither outcome parameter in children with cerebral palsy and improvements in both outcome measures in children under the age of 3.
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