{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T13:45:17Z","timestamp":1783604717774,"version":"3.55.0"},"reference-count":13,"publisher":"American Medical Association (AMA)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Otolaryngol Head Neck Surg"],"published-print":{"date-parts":[[2024,1,1]]},"abstract":"<jats:sec id=\"ab-ooi230076-4\"><jats:title>Importance<\/jats:title><jats:p>Refractory sialorrhea in children can result in pulmonary aspiration and irreversible lung damage. Despite many studies devoted to the surgical treatment of sialorrhea, there is a paucity of objective outcome measures after surgery, especially with regard to pulmonary health.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi230076-5\"><jats:title>Objectives<\/jats:title><jats:p>To assess whether bilateral submandibular gland excision and bilateral parotid duct ligation (\u201cDROOL\u201d procedure) is associated with reduced pulmonary inflammation in bronchoalveolar lavage (BAL) samples after surgery and to assess patient factors associated with improvement after surgery.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi230076-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This retrospective case series included all 112 patients undergoing the DROOL procedure at a single tertiary care pediatric children\u2019s hospital from January 1, 2012, to December 31, 2021. Statistical analysis was performed from March 30 to June 10, 2023, and August 20 to September 23, 2023.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi230076-7\"><jats:title>Exposure<\/jats:title><jats:p>DROOL procedure for refractory sialorrhea.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi230076-8\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>Degree of pulmonary inflammation (neutrophil percentage) according to BAL cytologic findings and overall bronchoscopy findings up to 12 months before and after the DROOL procedure. Secondary outcomes included number of annual hospitalizations, caregiver report of function before and after the procedure, and need for revision procedures and\/or additional operations for secretion management.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi230076-9\"><jats:title>Results<\/jats:title><jats:p>A total of 112 patients (median age, 3.4 years [IQR, 2.0-7.1 years]; 65 boys [58.0%]) underwent DROOL procedures and had both preoperative and postoperative BAL samples during the study period. Patients demonstrated objective improvement in pulmonary inflammation after surgery, with the median polymorphonuclear neutrophil percentage decreasing from 65.0% (IQR, 14.0%-86.0%) before the surgery to 32.5% (IQR, 3.0%-76.5%) after the surgery (median difference in percentage points, \u22129.0 [95% CI, \u221220.0 to 0.0]). Prior to the DROOL procedure, 34 patients (30.4%; 95% CI, 21.8%-38.9%) were hospitalized 2 or more times annually for respiratory illness, which decreased to 10.1% (11 of 109; 95% CI, 4.4%-15.7%) after surgery (3 patients did not have hospitalization data available following surgery). Most caretakers (73 [65.2%]) reported improved secretion management after the procedure.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi230076-10\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>This study suggests that patients with impaired secretion management who underwent a DROOL procedure demonstrated improvement in pulmonary inflammation and a reduction in hospitalizations after surgery. Caretakers were also likely to report subjective improvement in secretion management and quality of life. Additional research is necessary to guide optimal timing and patient selection for this procedure.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamaoto.2023.3670","type":"journal-article","created":{"date-parts":[[2023,11,27]],"date-time":"2023-11-27T04:30:32Z","timestamp":1701059432000},"page":"57","source":"Crossref","is-referenced-by-count":3,"title":["Pulmonary and Clinical Outcomes After Bilateral Submandibular Gland Excision and Parotid Duct Ligation for Refractory Sialorrhea"],"prefix":"10.1001","volume":"150","author":[{"given":"Ashley L.","family":"Miller","sequence":"first","affiliation":[{"name":"Division of Pediatric Otolaryngology\u2013Head and Neck Surgery, Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, Ohio"},{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio"},{"name":"Now with Department of Otolaryngology\u2013Head and Neck Surgery, Medical University of South Carolina, Charleston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik B.","family":"Hysinger","sequence":"additional","affiliation":[{"name":"Aerodigestive and Esophageal Center, Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, Ohio"},{"name":"Division of Pulmonary Medicine, Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, Ohio"},{"name":"Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meredith E.","family":"Tabangin","sequence":"additional","affiliation":[{"name":"Division of Biostatistics and Epidemiology, Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cherie","family":"Torres-Silva","sequence":"additional","affiliation":[{"name":"Aerodigestive and Esophageal Center, Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, Ohio"},{"name":"Division of Pulmonary Medicine, Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, Ohio"},{"name":"Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"de Alarcon","sequence":"additional","affiliation":[{"name":"Division of Pediatric Otolaryngology\u2013Head and Neck Surgery, Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, Ohio"},{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio"},{"name":"Aerodigestive and Esophageal Center, Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine K.","family":"Hart","sequence":"additional","affiliation":[{"name":"Division of Pediatric Otolaryngology\u2013Head and Neck Surgery, Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, Ohio"},{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio"},{"name":"Aerodigestive and Esophageal Center, Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"6","key":"ooi230076r1","doi-asserted-by":"publisher","first-page":"1181","DOI":"10.1016\/j.otc.2022.07.007","article-title":"Drooling and aspiration of saliva.","volume":"55","author":"Hughes","year":"2022","journal-title":"Otolaryngol Clin North Am"},{"issue":"1","key":"ooi230076r2","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1016\/j.ijporl.2006.10.001","article-title":"Salivary gland surgery for chronic pulmonary aspiration in children.","volume":"71","author":"Vijayasekaran","year":"2007","journal-title":"Int J Pediatr 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