Current Evidence and Future Directions in 2- Versus 4-Duct Ligation for Anterior Drooling

Drooling is a prevalent and disabling condition leading to serious psychosocial and health ramifications. The aim of this study is to analyze the efficacy and safety of 4- versus 2-duct ligation in treating anterior drooling.

A systematic review of the CINAHL, PubMed, and Embase databases was conducted from inception to September 13, 2025. Inclusion criteria were the analysis of both the success rate and associated complications of 2-duct ligation or 4-duct ligation as an independent treatment strategy for anterior drooling.

4-duct ligation showed a higher success rate risk difference (RD) 0.47 (95% CI [0.25, 0.68]), risk ratio (RR) 2.99 ([2.15, 4.15]) than 2-duct ligation with a comparable or lower complication rate. Reported complications included ranula, infection, bleeding, dryness, pain and swelling, anesthesia complications, and others. The most common complication seen in both types of duct ligation was infection.

Ductal ligation serves as a safe and effective surgical treatment option for patients with anterior drooling. The high success rate, low operative morbidity, and non-invasive nature of the procedure make it a favorable intervention. Due to the small and variable sample sizes of each intervention, an accurate comparison for efficacy and safety cannot be made between 2- and 4-duct ligations.