(286) Is 4-Duct Ligation Better Than 2-Duct Ligation for Anterior Drooling?

Introduction: Sialorrhea is a prevalent and disabling condition leading to serious psychosocial and health ramifications in affected individuals. Despite previous research efforts, gaps exist in the literature regarding the most effective treatment strategy for this patient cohort. The aim of this systematic review is to analyze the efficacy and safety of 4 versus 2 duct ligation in treating anterior drooling.

Methods: A systematic review of the CINAHL, Pubmed, and Embase databases was conducted from inception to December 13, 2022 with the help of a senior medical librarian. Screening was conducted by three independent reviewers. Inclusion criteria consisted of the analysis of both the success rate and complication rate of 2 or 4 duct ligation as a solitary intervention for anterior drooling. Data collection consisted of success rate, complication rate, and reported complications.

Results: Out of 20 articles screened, 4 studies fulfilled the inclusion criteria for 2 duct ligation, and 5 studies fulfilled the inclusion criteria for 4 duct ligation. The average success rates for 2 and 4 duct ligation were 61% and 74%, respectively. The overall complication rate was 29% for 2 duct ligation and 25% for 4 duct ligation. Reported complications were grouped into 7 categories: ranula, infection, bleeding, xerostomia, pain, swelling, anesthesia complications, and other. Infection was the most common complication for both 2 and 4 duct ligations.

Conclusions: Ductal ligation can be considered a first-line approach when surgical treatment is indicated for patients with anterior sialorrhea. The high success rate, low operative morbidity, and non-invasive nature of the procedure make it a favorable intervention. Based on the current review, 4-duct ligation is superior to 2 duct ligation with a higher success rate and a lower complication rate.