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Related Experiment Video

Updated: Feb 3, 2026

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Pediatric Sialorrhea: Submandibular Duct Rerouting and Intraparotid Botulinum Toxin A Injection With Literature

Omer Faruk Calim1, Hasan N H Hassouna1, Yavuz Selim Yildirim2

  • 11 Faculty of Medicine, Department of Otolaryngology, Head and Neck Surgery, Bezmialem Vakif University, Istanbul, Turkey.

The Annals of Otology, Rhinology, and Laryngology
|October 30, 2018
PubMed
Summary

This study shows that combining surgery with botulinum toxin A injections effectively treats pediatric sialorrhea, with 95.5% success and minimal complications. This combined approach offers a promising solution for drooling in children.

Keywords:
botulinum toxindroolingsialorrheasubmandibular duct reroutingtreatment

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Area of Science:

  • Pediatric Otolaryngology
  • Neurology
  • Gastroenterology

Background:

  • Sialorrhea, or excessive drooling, is a common challenge in children with neurological and developmental disorders.
  • Existing treatments for pediatric sialorrhea include surgical interventions and botulinum toxin A injections, but their combination has not been widely reported.

Purpose of the Study:

  • To evaluate the effectiveness and safety of a combined treatment approach for pediatric sialorrhea.
  • The treatment combines bilateral submandibular duct relocation, bilateral sublingual gland excision, and botulinum toxin A injections into the parotid glands.

Main Methods:

  • A cohort of pediatric patients with sialorrhea underwent the combined surgical and injection treatment.
  • Outcomes were assessed using validated scales such as the Drooling Severity Scale and Teacher Drooling Scale.
  • Data on bib changes and saliva wiping frequency were collected, along with complication monitoring, at least 6 months post-procedure.

Main Results:

  • The combined treatment demonstrated a high success rate of 95.5% in reducing drooling.
  • Significant improvements were observed in drooling severity, frequency, bib changes, and saliva wiping.
  • A low complication rate of 4.5% (postoperative bleeding in one patient) was noted, with no recurrence.

Conclusions:

  • The combination of bilateral submandibular duct relocation, bilateral sublingual gland excision, and botulinum toxin A injection is a highly effective treatment for pediatric sialorrhea.
  • This multidisciplinary approach offers a safe and successful option with minimal complications and no recurrence.
  • Further research with larger cohorts and longer follow-up periods is recommended to solidify these findings.