{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T18:08:15Z","timestamp":1790014095520,"version":"4.0.1"},"reference-count":27,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2021,5,16]],"date-time":"2021-05-16T00:00:00Z","timestamp":1621123200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100007865","name":"Stichting Rotterdams Kinderrevalidatie Fonds Adriaanstichting","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100007865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Develop Med Child Neuro"],"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:sec><jats:title>Aim<\/jats:title><jats:p>To compare the effect of bilateral submandibular duct ligation and botulinum neurotoxin A (BoNT\u2010A) on drooling severity and its impact on daily life and care in children and adolescents with moderate\u2010to\u2010severe drooling.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>This was a randomized, interventional, controlled trial in which 53 children and adolescents (31 males, 22 females, mean age 11y, range 8\u201322y, SD 2y 10mo) with cerebral palsy (58.5%) or other non\u2010progressive developmental disorders (41.5%) were randomized to BoNT\u2010A (<jats:italic>n<\/jats:italic>=26) or bilateral submandibular duct ligation (<jats:italic>n<\/jats:italic>=27). A parent questionnaire on the severity of drooling in specific positions and daily activities and the impact of drooling on daily life and care was filled out at baseline and 8 and 32 weeks posttreatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Both BoNT\u2010A and bilateral submandibular duct ligation had a positive effect on daily care, damage to electronic equipment and\/or furniture, social interactions, and self\u2010esteem. However, bilateral submandibular duct ligation had a significant greater and longer\u2010lasting short\u2010 (8wks) and medium\u2010term (32wks) effect on daily care, reducing damage to electronic devices, and improving social interactions and satisfaction with life in general.<\/jats:p><\/jats:sec><jats:sec><jats:title>Interpretation<\/jats:title><jats:p>This randomized controlled trial confirms reduced drooling by both BoNT\u2010A and bilateral submandibular duct ligation, but provides new evidence on improved well\u2010being through a reduction in drooling. Even though there is a greater risk of complications and morbidity after bilateral submandibular duct ligation, compared to BoNT\u2010A there was a significantly greater and longer\u2010lasting positive effect on most outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:label\/><jats:p>\n<jats:boxed-text content-type=\"box\" position=\"anchor\"><jats:caption><jats:title>What this paper adds<\/jats:title><\/jats:caption><jats:p>\n<jats:list list-type=\"bullet\">\n\n<jats:list-item><jats:p>Bilateral botulinum neurotoxin A (BoNT\u2010A) and submandibular duct ligation had a positive effect on the well\u2010being of individuals with moderate\u2010to\u2010severe drooling.<\/jats:p><\/jats:list-item>\n\n<jats:list-item><jats:p>Bilateral submandibular duct ligation had a greater effect on the impact of drooling during daily care than BoNT\u2010A.<\/jats:p><\/jats:list-item>\n\n<jats:list-item><jats:p>Bilateral submandibular duct ligation reduced damage to electronic devices and improved social interactions and satisfaction with life.<\/jats:p><\/jats:list-item>\n<\/jats:list>\n<\/jats:p><\/jats:boxed-text>\n<\/jats:p><\/jats:sec>","DOI":"10.1111\/dmcn.14924","type":"journal-article","created":{"date-parts":[[2021,5,17]],"date-time":"2021-05-17T05:12:10Z","timestamp":1621228330000},"page":"1351-1359","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Surgery versus botulinum neurotoxin A to reduce drooling and improve daily life for children with neurodevelopmental disabilities: a randomized controlled trial"],"prefix":"10.1111","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8330-9243","authenticated-orcid":false,"given":"Stijn","family":"Bekkers","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology and Head and Neck Surgery Radboud University Medical Center Nijmegen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9439-5626","authenticated-orcid":false,"given":"Ineke M J","family":"Pruijn","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology and Head and Neck Surgery Radboud University Medical Center Nijmegen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan J W","family":"van der Burg","sequence":"additional","affiliation":[{"name":"Department of Pediatric Rehabilitation Sint Maartenskliniek Nijmegen the Netherlands"},{"name":"School of Pedagogical and Educational Science Radboud University Nijmegen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9456-3450","authenticated-orcid":false,"given":"Karen","family":"van Hulst","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Radboud University Medical Center Donders Institute for Brain, 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