Removing the salivary glands under the jaw reduces drooling and the risk of choking 'This is the preferred treatment for severely drooling children with cerebral palsy who choke on saliva'

Children with cerebral palsy often have difficulty swallowing. This can lead to drooling and choking, resulting in pneumonia, for example. Removal of the salivary glands under the jaw leads to less drooling and reduces the risk of choking on saliva. This is evident from PhD research by Corinne Delsing of Radboud university medical center.

We produce about one and a half liters of saliva per day, most of which comes from the large salivary gland under the jaw. It is therefore not surprising that we sometimes choke, but that rarely causes problems. This is different in children with cerebral palsy, usually caused by a lack of oxygen surrounding birth. They have great difficulty swallowing. As a result, up to half of children with cerebral palsy drool. 

Drooling is undesirable from a social, emotional and cosmetic point of view, but it also causes damage. This includes electronic aids, wheelchairs and tablets that break. It is also dangerous: because these children choke on saliva much more often, they are at greater risk of pneumonia. Corinne Delsing investigated the effectiveness of an operation to remove the salivary glands under the jaw in children with cerebral palsy.

Less drooling

In the first part of her PhD research, Delsing shows that the operation had a beneficial effect on drooling in two-thirds of the children. That is, both the degree and severity of drooling decreased after surgery. However, for some of the children, satisfaction with the results decreased over time. Some therefore needed additional treatment. 

Delsing also looked at other aspects of the operation. This procedure causes a scar in the neck. However, her research shows that almost all parents of the children found the scar acceptable. ‘The scars therefore present no problem for this treatment’, says Delsing. ‘We are now taking these results into account in discussions with parents about the choice for this operation.’

Preferred treatment

The second part of the thesis is about the effect of the operation on the risk of choking. ‘This was hardly studied at all’, said Frank van den Hoogen, the head and neck surgeon who led the PhD project. ‘And do not underestimate the consequences: children who have difficulty swallowing have a significantly greater risk of death.’

Delsing compared removal of the salivary glands with two alternatives: closing the gland's duct and Botox injections into the gland. The effect was greatest upon removal of the salivary glands and also lasted the longest. There were no lasting disadvantages, such as a dry mouth. Delsing therefore concludes: ‘In children with cerebral palsy who often choke on saliva, removal of the gland is the preferred treatment.’

More information about this PhD thesis defense

PhD thesis defense of Corinne Delsing on November 22nd at 12.30 p.m. Title of dissertation: Surgery on the submandibular salivary gland for anterior and posterior drooling in children and adolescents with neurodevelopmental disorders (available online after 22 November). Supervisors: dr. F.J.A. van den Hoogen, dr. C.C. Erasmus and dr. C.C.M. van Hulst. The defense can be followed via this livestream.

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