Saying no to surgery for drooling: long-term drooling outcomes and developmental maturation after declining surgery

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Assess long-term changes in drooling severity among patients who declined surgery and their reasons to decline. This retrospective cohort study combined prospectively collected data of the Saliva Control Clinic (Radboud University Medical Center) with a cross-sectional follow-up questionnaire. Primary outcome was change in Visual Analogue Scale (VAS) for drooling between baseline and follow-up. Secondary and tertiary outcomes included characteristics associated with clinically relevant improvement (≥50% VAS reduction), and reasons for declining surgery. Forty-five participants were included in the study (median age = 10.3; median VAS = 80.0). Drooling VAS scores significantly decreased over time (median age = 22.7; median VAS: 60.0; p < 0.001). A clinically relevant reduction in drooling was observed in 16 participants (39.0%). This noninterventional improvement of drooling was associated with a lower baseline VAS, ambulatory status, developmental age ≥ 4 years, and absence of intractable epilepsy, severe dysphagia, or frequent tongue protrusion. The burden of surgery and concerns about potential complications were rated as the most important factors regarding the decision to decline surgical intervention. A clear distinction emerged between patients who experienced a clinically relevant reduction in drooling and those who did not, with notably different clinical profiles observed between the two groups. These findings underscore the potential for noninterventional improvement of drooling in adolescence. Non-interventional improvement of drooling is observed during adolescence in children with neurodevelopmental disabilities.Baseline patient characteristics, including lower drooling severity, ambulatory status, higher developmental age, and the absence of comorbidities like epilepsy, severe dysphagia, and frequent tongue protrusion, are associated with non-interventional drooling improvement.The expected burden of the drooling surgery and its potential complications are the most critical determinants for declining surgery. Non-interventional improvement of drooling is observed during adolescence in children with neurodevelopmental disabilities. Baseline patient characteristics, including lower drooling severity, ambulatory status, higher developmental age, and the absence of comorbidities like epilepsy, severe dysphagia, and frequent tongue protrusion, are associated with non-interventional drooling improvement. The expected burden of the drooling surgery and its potential complications are the most critical determinants for declining surgery.

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