Experience with the Wilkie procedure for sialorrhea

Area of Science:

• Otolaryngology
• Pediatric Surgery
• Neurology

Background:

• Sialorrhea, or drooling, is a common challenge in children with neurological impairments like cerebral palsy.
• Existing surgical interventions for sialorrhea include gland excision, nerve section, and duct manipulation.

Purpose of the Study:

• To evaluate the long-term efficacy and safety of the Wilkie procedure for severe sialorrhea in children.

Main Methods:

• Eighteen pediatric patients (ages 5-17) with severe sialorrhea due to cerebral palsy or mental retardation underwent bilateral submandibular gland excision and Stensen's duct rerouting.
• Follow-up was conducted over 7 years to assess sialorrhea control and complications.

Main Results:

• The Wilkie procedure achieved satisfactory sialorrhea control in 16 out of 18 patients (89%) after 7 years.
• The primary complication observed was xerostomia (dry mouth) in one patient.
• Persistent drooling in one case was potentially linked to unfavorable head and mandibular posturing.

Conclusions:

• Bilateral submandibular gland excision with parotid duct retropositioning (Wilkie procedure) is an effective surgical option for managing severe pediatric sialorrhea.
• The procedure offers a high success rate with a low incidence of major complications.
• Careful patient selection and consideration of anatomical factors may further optimize outcomes.