Recurrence of drooling after submandibular gland surgery: increased severity or altered expectations?

Despite the over-all effectiveness of surgery for drooling in youth with neurodisabilities, a degree of recurrence of drooling is observed in part of the population. This study explores the recurrence after submandibular gland surgery. In addition, it compares patients who experience this with those with a durable effect to identify patient characteristics associated with recurrence.

This retrospective cohort study included patients aged 8-21 years at time of surgery who received non-rerouting surgery (submandibular gland excision or submandibular duct ligation) between 2000 and 2023. Data were collected at baseline, 8 weeks and 32 weeks post-surgery. Long-term (>1year) follow-up data were obtained with cross-sectional questionnaires. Strict definitions for durable effect, non-response and recurrence were developed based on the Visual Analog Scale (VAS) for drooling. Descriptive data and modified Poisson regression were used to identify patient characteristics associated with recurrence.

From the total of 160 patients who received submandibular gland surgery, 118 were included. After surgery, 19 participants reported a durable effect, 34 non-response, 43 recurrence, and 22 had a stable effect at 32-weeks but missing long-term data. Statistical analyses indicated that recurrence was significantly more prevalent among those with isolated anterior drooling, intact oral suction and propulsion, sustained school attendance, progression in developmental age and without medication changes.

Recurrence of drooling after submandibular gland surgery is common and may not be solely determined by the objective drooling severity, but also by subjective changes in patient or caregiver perspectives influenced by developmental and contextual factors over time.