Optimizing minimally invasive surgery for drooling: a pilot study combining ethanol sclerotherapy with submandibular duct ligation

Surgical treatments for drooling in children with neurodevelopmental disabilities are often invasive and carry risks. Although submandibular duct ligation (SDL) is less invasive, recurrence is common. This pilot study evaluates an adapted technique combining ethanol sclerotherapy with SDL (E-SDL) to reduce recurrence. In a prospective single-arm pilot, five participants (≥10 years, moderate to severe anterior drooling, contraindications/rejection of SMDR) underwent E-SDL: bilateral injection of a 4:1 ethanol and contrast solution into the submandibular ducts, followed by ligation. Data on demographics, drooling, complications, and feasibility were collected. All procedures were completed as planned with successful ethanol injection and duct ligation. One participant developed a skin rash due to antibiotics; two non-serious adverse events occurred. Temporary swelling was common, with one case of persistent mild swelling. E-SDL appears feasible and safe for drooling management in this population. Larger studies and comparisons with standard treatments are needed to assess clinical benefits. • Less invasive surgical alternatives are demanded to treat drooling in children with neurodisabilities. • This pilot study demonstrates the feasibility and safety of an innovative minimally-invasive surgical method to treat drooling in children by combining submandibular duct ligation with ethanol sclerotherapy. • A larger sample and comparison with existing treatment modalities is required to determine the effect on drooling and its potential clinical benefits.