Surgical Approaches to Pediatric Sialorrhea: A Database-Driven Analysis

Introduction: Sialorrhea can have a significant negative impact on the lives of pediatric patients. Medical management is often the sole method of treatment, but patients with severe disease require procedural interventions. Existing research investigating these procedures has been limited by size and follow-up. This study aims to better understand the frequency and different risk profiles of these interventions.

Methods: A retrospective analysis was conducted using de-identified data from 117,065,877 patients in the last 20 years at 83 large healthcare organizations in the TriNetX global health research network. 29,558 pediatric patients with sialorrhea were identified. Frequency of procedure, rates of retreatment, and complications were compared for several procedural treatments alone and in combination.

Results: Of the 29,558 pediatric sialorrhea patients, 1,859 (6.3%) patients required procedural treatment. The most common interventions were: botox/chemodenervation (CD) (81%), submandibular gland excision (SMGE) + CD (4.8%), SMGE alone (4.4%), SMGE + salivary duct ligation (SDL) (3.4%), SMGE + CD + SDL (3.35%), and SDL alone (1.8%). The mean ages of treatment were not significantly different (CD: 8 yrs, SMGE: 9.6 yrs, SDL: 10 yrs).

Retreatment was required in more CD cases (46.7%) than SMGE (12.4%) (p < 0.0001), but not more frequently than in SDL (30.3%). SMGE performed alone was not more likely to require retreatment than SMGE combined with any other procedure. No significant difference was seen in the rates of xerostomia (CD: 14.4%, SMGE: 23.5%, SDL: 30.3%). Sialadenitis was seen in significantly more SDL cases (30.3%) than SMGE cases (0%) (p < 0.0001).

Conclusions: To our knowledge, this is the largest study on procedural management of pediatric sialorrhea to date. It clarifies the rate of certain complications and of retreatment for these interventions. It also suggests that less involved procedures, like SMGE alone, may be as effective as combined approaches. This data is invaluable in helping patients, families, and providers better understand the role of procedures in managing pediatric sialorrhea.