The surgical management of drooling

As with all branches of surgery, selection of the appropriate operative procedure for a particular patient involves careful weighing of all the alternatives and full discussion with the patient and carers. Each of the procedures described has its devotees and detractors. For an individual patient, however, the risks of each, the likely postoperative course and the results of the surgery--both in terms of the expected chance of improvement in drooling and the presence or otherwise of residual scarring or taste--must be balanced to determine the optimum plan for treatment. The long-term results of submandibular duct transposition for drooling in the author's own institution have recently been reported. An initial improvement in the drooling of all patients was maintained for at least two years in 17 of 20 patients. Only two patients experienced complications requiring further surgery (ranulas in each case). It is suggested that these very satisfactory results, achieved without external scarring and without compromising the sense of taste, support the contention that submandibular duct transposition is the surgical treatment of choice for children and young people with cerebral palsy who drool excessively.