Surgical management of drooling: a meta-analysis.
نویسندگان
چکیده
OBJECTIVE To review and assess the current published literature regarding the efficacy of surgical management of sialorrhea in pediatric patients. DATA SOURCES The MEDLINE database was systematically reviewed for articles reporting on the use of surgical procedures to treat sialorrhea published from January 1, 1963, to November 30, 2008. STUDY SELECTION Inclusion criteria included presence of data on the success of surgical treatment of sialorrhea, English language, sample size greater than 5, and presentation of extractable data regarding the subjective success of surgical management of sialorrhea. DATA EXTRACTION Data regarding demographic characteristics of study participants, follow-up duration, subjective success rates, and number and type of complications were extracted by blinded reviewers. DATA SYNTHESIS A total of 325 studies were identified on initial search. Abstract review reduced the sample to 46. Cross-referencing yielded an additional 4 articles, resulting in the final sample of 50 articles. Forty-seven studies were case series (Centre for Evidence-Based Medicine level 4 evidence), 2 were cohort studies (level 2), and 1 was a prospective cohort study (level 1b). Median sample size was 18 (range, 5-181), and median follow-up duration was 8.1 months (range, 0.1-50 months). Subjective success was reported in more than 50% of patients in 49 of 50 studies. Random-effects modeling estimated the overall subjective success rate for all procedures to be 81.6% (95% confidence interval, 77.5%-85.7%; P < .001). Bilateral submandibular gland excision and parotid duct rerouting appeared to have the highest subjective success rates at 87.8% (k = 8 studies; 95% confidence interval, 80.5%-95.1%; P <.001), and 4-duct ligation was the lowest at 64.1% (4 studies; 27.6%-100%; P = .001). CONCLUSIONS Most evidence regarding surgical outcomes of sialorrhea management is low quality and heterogeneous. Despite this, most patients experience a subjective improvement following surgical treatment.
منابع مشابه
Drooling and Various Therapeutic Modalities
ABSTRACT: Droolig or sialorrhea is a common stigmatizing problem in neurologically damaged child or adult. It is troublesome in perhaps one-third of children with cerebral palsy. Drooling occurs when there is a lack of coordinated control of facial, head and neck musculature. Various therapeutic modalities are advocated for the treatment of drooling ,such as surgical or non surgical, some of ...
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ورودعنوان ژورنال:
- Archives of otolaryngology--head & neck surgery
دوره 135 9 شماره
صفحات -
تاریخ انتشار 2009