1 / 19

Drooling surgical options

Drooling surgical options. Watad waseem. Submandibular and Sublingual gland innervation. Superior salivatory nucleus - nervus intermedius - facial nerve - chorda tympani - lingual nerve - submandibular ganglion - submandibular/lingual glands. Parotid innervation.

lyndon
Download Presentation

Drooling surgical options

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Drooling surgical options Watad waseem

  2. Submandibular and Sublingual gland innervation • Superior salivatory nucleus - nervus intermedius - facial nerve - chorda tympani - lingual nerve - submandibular ganglion - submandibular/lingual glands

  3. Parotid innervation • Inferior salivatory nucleus - glossopharyngeal nerve - Jacobsen’s nerve - lesser superficial petrosal nerve - otic ganglion - auriculotemporal nerve

  4. Salivary gland innervation • Parasympathetic system stimulation causes an increase in saliva flow from all glands • Sympathetic system stimulation causes increase in saliva flow from submandibular gland but has no effect on parotid flow

  5. Treatment Options • Multidisciplinary approach • Non-invasive modalities • Trial of medication • Surgery

  6. Surgical options • Reduction of salivary flow • Relocation of salivary flow • combination

  7. Surgical options • Submandibular gland excision • Parotid duct ligation • Transtympanic neurectomy • Submandibular duct rerouting • Parotid duct rerouting

  8. Surgical indications • Age 5-6 • Failed non-surgical management > 6 months • Stable neurological status • Drooling with non-operative patient

  9. Surgical contra-indications • High risk for operation • unilateral HL for tympanic neurectomy • Rerouting of salivary duct in esophagus disoerder, ch. aspiration

  10. Pre-operative assessment • Lat neck x-ray , F.O for adenoids • adenoidectomy if necessary • Barium • audiometrey

  11. Wilke procedure - 1967 • Bil. submandibular gland exc. And bil. Parotd duct relocation. • Success rate 85% • Postoperative complication (35%) and high morbidity • Modification of the procedure

  12. Submandibular Gland Excision + partid duct ligation • High success rate(85 – 100%)- (Shot) • Very common • Low morbidity • Mild swelling of face, external scars, xerostomia , parotitis

  13. Parotid duct ligation • Location of the pappila , insert lacrimal probe • Elliptical incision made around the parotid duct. Duct dissected for 1 cm, suture ligated and resected. The buccal mucosa is then repaired.

  14. Rerouting of submandibular duct • Cuff of mucosa dissected around duct and marked medially and laterally • Duct dissected 3-4 cm or until gland reached • Tonsil used to create a tunnel just posterior to anterior tonsillar pillar and sutures passed with duct • Tonsillectomy performed if obstructive tonsils

  15. Rerouting of submandibular duct(cont’d) • relocation in base of ant. Pillar : no need for TE , less infection • Rate success 80-100% • Sublingual gland exc. • Advantages: Decreased xerostomia, problems with taste and dysphagia • Disadv: Ranula, sialoadenitis, sialolithiasis, aspiration pneumonia

  16. Studies on submandibular duct rerouting • Crysdale - 8% ranula rate • O’Dywer - 15 year follow -up study, 94% of parents stated their child benefited, 50% had complete cessation of drooling

  17. Transtympanic neurectomies • 80% success rate • Must take both chorda and tympanic plexus • Hypotympanic branch in 50% of patients • Low speed drill • Loss of taste in anterior 2/3 of tongue and xerostomia • Contraindicated in unilateral SNHL

  18. Transtympanic neurectomies • Recurrence of drooling – regeneration of tympanic nerves • Use for completion the surgery therapy for drooling

  19. Laser photocoagulation of parotid duct • No scars no xerostomia • 40/48 patient improvement (chang – 2001) • Swelling of parotis, hematoma, infection

More Related