Subtotal functional sialoadenectomy vs four‐duct ligation for the treatment of drooling in neurologically impaired children: Long‐term follow‐up

2020 ◽  
Vol 46 (1) ◽  
pp. 222-228
Author(s):  
Francesco De Peppo ◽  
Romina Caccamo ◽  
Maria Carmen Garganese ◽  
Emanuela Ceriati ◽  
Paola Marchetti ◽  
...  
Keyword(s):  
Neurologically Impaired ◽  
Neurologically Impaired Children ◽  
Duct Ligation ◽  
Long Term Follow Up ◽  
Impaired Children

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

2009 ◽  
Vol 123 (9) ◽  
pp. 997-1001 ◽  
Author(s):  
R L Heywood ◽  
L A Cochrane ◽  
B E J Hartley
Keyword(s):  
Surgical Intervention ◽  
Neurological Impairment ◽  
Morbidity Rate ◽  
First Line ◽  
Neurologically Impaired ◽  
Neurologically Impaired Children ◽  
Parotid Duct ◽  
Duct Ligation ◽  
Oral Approach ◽  
Impaired Children

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

scholarly journals Long-Term Analysis of Respiratory-Related Complications Following Gastrostomy Placement with or without Fundoplication in Neurologically Impaired Children: A Retrospective Cohort Study

Children ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. 22
Author(s):  
Elisa Zambaiti ◽  
Calogero Virgone ◽  
Silvia Bisoffi ◽  
Roberta Stefanizzi ◽  
Francesco Fascetti Leon ◽  
...  
Keyword(s):  
Hospital Admissions ◽  
Respiratory Complications ◽  
Long Term Outcomes ◽  
Neurologically Impaired ◽  
Respiratory Problems ◽  
Adequate Food ◽  
Impaired Children ◽  
Term Analysis

Gastrostomy placement is crucial in neurologically impaired (NI) children to ensure an adequate food intake and a safe route for drugs administration and to reduce the risk of primary aspiration. NI patents are more prone to gastroesophageal reflux. The association with fundoplication is deemed to reduce reflux-related respiratory complications. However, long-term benefits of this approach are not clear. We therefore aimed to compare long-term reflux-related respiratory complications of gastrostomy only (GO) to gastrostomy with fundoplication (GF). We retrospectively reviewed 145 consecutive NI children managed from 2008 to 2018. As long-term outcomes, we analyzed number and length of hospital admissions (Reflux-Related-Hospitalization, RRH) and emergency department accesses (Reflux-Related-Accesses, RRA) due to respiratory problems. Results were analyzed with appropriate statistical method. Median age at referral and at gastrostomy placement were 2.2 and 3.4 years (SD 5.6), respectively. Median follow-up was four years (range 1–12). Anti-reflux procedures were performed in 26/145 patients (18%); tracheotomy in 23/145 (16%). RRH following surgery showed lower number of admissions/year (0.32 vs. 1 for GO vs. GF, p < 0.005) and days hospitalization/year (3 vs. 13, p = 0.08) in GO compared to GF; RRA was similar (0.60 vs. 0.65, p = 0.43). Gastrostomy placement alone appeared not to be inferior to gastrostomy plus fundoplication with respect to long-term respiratory-related outcomes for NI children in our center.

Therapy and prevention for mental health: What if mental diseases are mostly not brain disorders?

2019 ◽  
Vol 42 ◽  
Author(s):  
John P. A. Ioannidis
Keyword(s):  
Mental Health ◽  
Mental Disease ◽  
Brain Disorders ◽  
Social Stressors ◽  
Labor Education ◽  
Mental Diseases ◽  
Long Term Follow Up ◽  
Political Decisions

AbstractNeurobiology-based interventions for mental diseases and searches for useful biomarkers of treatment response have largely failed. Clinical trials should assess interventions related to environmental and social stressors, with long-term follow-up; social rather than biological endpoints; personalized outcomes; and suitable cluster, adaptive, and n-of-1 designs. Labor, education, financial, and other social/political decisions should be evaluated for their impacts on mental disease.

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