Submandibular duct ligation after botulinum neurotoxin A treatment of drooling in children with cerebral palsy.

29 children were studied retrospectively, and treatments were compared within the same children, so the design cannot prove which treatment caused the change. Children were included because they had stopped repeated botulinum toxin A injections, often due to inadequate drooling control, side effects, or wanting a longer-term solution, creating possible selection bias. Only the latest botulinum toxin A injection before surgery was analysed, and the mean interval between injection and surgery was 9.7 months, so carryover from injection effects may have influenced surgery results. Caregiver-rated drooling may have been affected by dissatisfaction with previous injections, burden of treatment, or expectations for a permanent solution. Objective drooling quotient follow-up was incomplete at 32 weeks after botulinum toxin A, with a 93.1% rate, and 97% after duct ligation. The study followed children only to 32 weeks after duct ligation, so it does not show whether surgery effects last long term. The surgery technique changed during the study, from sutures in 3 children to metal clips in 26 children. Surgery was performed under general anaesthesia and followed by antibiotics for 7 days and diclofenac for 5 days, so the effect of duct ligation alone cannot be separated from the surgical care given around it. Participants had different diagnoses and severe drooling, so results may not apply to every child with drooling.

Do not conclude that duct ligation is proven better than botulinum toxin A for drooling. This was a retrospective within-participant comparison in 29 children who chose surgery after injections, and the directly observed drooling quotient did not differ between the two treatments.