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Parotid duct ligation for treatment of drooling in children with neurological impairment

  • R L Heywood (a1), L A Cochrane (a1) and B E J Hartley (a1)



Multiple surgical procedures have been advocated for the management of problematic drooling in neurologically impaired children. Parotid duct ligation is a quick and simple operation conducted via an intra-oral approach and usually performed simultaneously with other procedures. In this study, we aimed to evaluate the effectiveness of parotid duct ligation as a discrete procedure.


All children who underwent bilateral parotid duct ligation as the solitary operative intervention at that time, between February 2003 and September 2006, were included in the study.


Ten children were studied. Surgery was successful in 80 per cent of cases. One patient (10 per cent) had a post-operative wound infection.


Bilateral parotid duct ligation is an effective yet conservative operation for drooling in neurologically impaired children. It requires minimal surgical dissection and has a low morbidity rate. It should be considered as a potential first-line procedure in children who aspirate, and as a further surgical option in anterior droolers or those who continue to drool unacceptably following prior surgical intervention.


Corresponding author

Address for correspondence: Miss R Heywood, Department of Otolaryngology, Great Ormond Street Hospital for Children, London WC1N 3JH, UK. E-mail:


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1 Crysdale, WS, Raveh, E, McCann, C, Roske, L, Kotler, A. Management of drooling in individuals with neurodisability: a surgical experience. Dev Med Child Neurol 2001;43:379–83
2 Bailey, CM, Wadsworth, PV. Treatment of the drooling child by submandibular duct transposition. J Laryngol Otol 1985;99:1111–17
3 Mankarious, LA, Bottrill, IN, Huchzermeyer, PM, Bailey, CM. Long-term follow-up of submandibular duct rerouting for the treatment of sialorrhea in the pediatric population. Otolaryngol Head Neck Surg 1999;120:303–7
4 Shirley, WP, Hill, JS, Woolley, AL, Wiatrak, BJ. Success and complications of four duct ligation for sialorrhea. Int J Ped Otorhinolaryngol 2003;67:16
5 Stern, Y, Feinmesser, R, Collins, M, Shott, SR, Cotton, RT. Bilateral submandibular gland excision with parotid duct ligation for treatment of sialorrhea in children. Arch Otolaryngol Head Neck Surg 2002;128:801–3
6 Klem, C, Mair, E. Four duct ligation. A simple and effective treatment for chronic aspiration from sialorrhea. Arch Otolaryngol Head Neck Surg 1999;125:796800
7 Crysdale, WS. The management of drooling. In: Bluestone, CD, Stool, SE, Alper, CM, Arjmand, EM, Casselbrant, ML, Dohar, JE, Yellon, RF eds. Pediatric Otolaryngology, 4th edn. Philadelphia: Saunders, 2002:1138–48
8 Lim, M, Mace, A, Reza Nouraei, SA, Sandhu, G. Botulinum toxin in the management of sialorrhoea: a systematic review. Clin Otolaryngol 2006;31:267–72
9 Scott, J, Liu, P, Smith, PM. Morphological and functional characteristics of acinar atrophy and recovery in the duct-ligated gland of the rat. J Dent Res 1999;78:1711–19
10 Wilson, SW, Henderson, HP. The surgical treatment of drooling in Leicester: 12 years experience. Br J Plast Surg 1999;55:335–8
11 Ceriati, E, De Peppo, F, Ciprandi, G, Marchetti, P, Silveri, M, Rivosecchi, M. Surgery in disabled children: general gastroenterological aspects. Acta Paediatrica 2006;95:34–7
12 Chang, C, Wong, AM. Intraductal laser photocoagulation of the bilateral parotid ducts for reduction of drooling in patients with cerebral palsy. Plast Reconstr Surg 2001;107:907–13
13 Camp-Bruno, JA, Winsberg, BG, Green-Parsons, AR, Abrams, JP. Efficacy of benztropine therapy for drooling. Dev Med Child Neurol 1989;31:309–19
14 Jongerius, PH, van den Hoogen, FJA, van Limbeek, J, Gabreëls, FJ, van Hulst, K, Rotteveel, JJ. Effect of botulinum toxin in the treatment of drooling: a controlled clinical trial. Pediatrics 2004;114:620–7
15 Bertram, U. Xerostomia. Clinical aspects, pathology and pathogenesis. Acta Odontol Scand 1967;25(suppl 49):1126
16 Bailey, CM. Management of the drooling child. Clin Otolaryngol Allied Sci 1988;13:319–22
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The Journal of Laryngology & Otology
  • ISSN: 0022-2151
  • EISSN: 1748-5460
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