Salivary gland ablation: introducing an interventional radiology treatment alternative in the management of sialorrhea

Abstract

Background Sialorrhea is common in children with neurological disorders and leads to social isolation, aspiration pneumonia and increased caregiver burden. Sialorrhea management includes anticholinergic medications and a variety of surgeries, but these are limited by side effects, recurrence and risks. Objective We present our method of salivary gland ablation, an interventional radiology treatment for sialorrhea, and report safety and efficacy data from pediatric patients who underwent salivary gland ablation. Materials and methods Salivary gland ablation uses image-guided sotradecol and ethanol dual-drug injection into the salivary glands. Submandibular and sublingual glands are injected percutaneously using ultrasound. Parotid glands are injected retrograde through Stensen ducts using fluoroscopy. We conducted a retrospective review of the medical records of patients who underwent salivary gland ablation at our institution between 2005 and 2019. Pre-and post-procedure Drooling Frequency and Drooling Severity (DFDS) scale scores were compared and caregiver satisfaction was assessed. We devised two cohorts, one to study patient safety and a subcohort to study clinical efficacy using DFDS scores. Results One hundred and seventy salivary gland ablation procedures were performed in the 99 patients comprising the safety cohort. Of the procedures, 88.8% resulted in no or minimal complications. Respiratory difficulty, temporary nerve palsy and infection represent the majority of the 11.2% of patients who experienced periprocedural complications. There were no complications resulting in permanent sequelae. Twenty-seven patients met our inclusion criteria for the efficacy subcohort with a mean follow-up time of 5.4 years. DFDS at follow-up decreased from a median score of nine to a seven post-procedure (P=0.000018). The proportion of caregivers who were satisfied with the procedure increased as more glands were ablated, which suggests a causal link between the number of glands ablated and the outcome. Conclusion Salivary gland ablation is a safe and effective procedure with the potential for permanent decrease in symptoms related to sialorrhea.

Examining the Role of Sublingual Atropine for the Treatment of Sialorrhea in Patients with Neurodevelopmental Disabilities: A Retrospective Review

“…These typically include behavioral interventions, pharmacologic treatments, targeted salivary gland injections with botulinum toxin, and finally, surgeries, which include salivary duct ligation, re-routing, or gland excision [ 10 ]. Ultrasound-guided salivary gland ablation using ethanol is an emerging intervention [ 11 ]. Treatment appears to be effective with all agents, but studies are heterogeneous, with generally low-level evidence and inconsistency in outcome measures [ 10 , 11 , 12 , 13 , 14 , 15 ].…”

“…Ultrasound-guided salivary gland ablation using ethanol is an emerging intervention [ 11 ]. Treatment appears to be effective with all agents, but studies are heterogeneous, with generally low-level evidence and inconsistency in outcome measures [ 10 , 11 , 12 , 13 , 14 , 15 ].…”