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Download Bilateral Submandibular Duct Transposition (BSMDT) Great Ormond Street Hospital for Children NHS Trust: Information for Families Bilateral submandibular duct transposition (BSMDT) This information sheet explains about the bilateral submandibular duct transposition (BSMDT) operation, what it involves and what to expect when your child comes to Great Ormond Street Hospital (GOSH) for the operation. What is a What is bilateral submandibular duct? submandibular duct Saliva is a substance produced by the transposition (BSMDT) body to help with swallowing and and why does my child digestion of food. It can also help with need one? oral hygiene – that is, keeping the mouth clean. Saliva is produced by the A bilateral submandibular duct salivary glands. There are three major transposition (BSMDT) is a surgical salivary glands: the parotid gland at the procedure that moves the ducts on both back of the cheek, the submandibular sides of the tongue further back in the gland in the floor of the mouth and the mouth. This makes excess saliva easier sublingual gland under the tongue. Saliva to swallow so reduces dribbling and passes from these glands into the mouth drooling. Dribbling and drooling can be through narrow tubes called ducts. The a problem with various neuromuscular submandibular duct opens into the floor diseases, such as cerebral palsy. of the mouth either side of the tongue. sublingual gland parotid gland submandibular gland Sheet 1 of 4 Ref: 2011F1155 © GOSH NHS Trust November 2011 What happens Are there any risks? before the operation? Every anaesthetic carries a risk of You will already have received complications but this is small. After an information about how to prepare your anaesthetic, children sometimes feel sick child for the procedure in your admission and vomit, may have a headache, sore letter. You may need to come to GOSH throat or feel dizzy. These side effects are before the procedure so that your child usually short-lived. There is a small risk can have a pre-admission assessment to that the nerve supplying sensation to the check that they are well enough. The tongue could be damaged during the appointment may involve taking blood operation. Any surgery carries a risk of samples and other tests. infection. Your child will have a course of antibiotics after the operation to reduce On the day of the operation, you will this risk. meet the surgeon who will explain the operation in detail, discuss any worries you may have and ask you to give Are there any alternatives? permission for the operation by signing Medicines can be used to ‘dry up’ your a consent form. An anaesthetist will also child’s saliva but it can be difficult to see you to explain your child’s anaesthetic achieve a good balance between drying in more detail. If your child has any your child up too much and not giving medical problems, like allergies, please an adequate dose. Injections with tell the doctors. botulinum toxin into the salivary glands may also be suggested. Salivary gland What does the injections with botulinum toxin are not a permanent solution to excessive dribbling operation involve? and drooling and they are not effective While your child is under general for every child. If they are effective, you anaesthetic, the surgeon will disconnect should notice a reduction in your child’s the ducts from their original position dribbling and drooling about two weeks and tunnel them under the lining of the after the injections. The effects of the mouth towards the back of the mouth. injections last between three and six The incisions are closed with dissolvable months so the procedure may need to be stitches. The surgeon will inject some repeated in future. local anaesthetic into the area during the operation so it is not too uncomfortable when your child wakes up from the general anaesthetic. The operation lasts between one and two hours. Sheet 2 of 4 Ref: 2011F1155 © GOSH NHS Trust November 2011 What happens Going home after the operation? Most children stay overnight after the After the operation, your child will operation to make sure that they are recover from the anaesthetic in the recovering well. Before you leave GOSH, recovery room. When they are more we will advise you about aftercare and awake, your child will be moved back to give you antibiotics and pain relief to the ward. continue at home. The effects of the operation will usually show two to three Your child will usually have a cannula weeks after the operation – that is, your (thin plastic tube) in their hand or foot so child will not dribble or drool as much as that they can be given intravenous fluids before. We will send you an outpatient or medication if they need it. We will appointment for around six to eight make sure that your child has regular pain weeks after the operation. relief so that eating and drinking is more comfortable. We will encourage your child You should call the hospital or your to start to eat and drink again once they family doctor (GP) if: feel able. We will give your child a seven- Your child has difficulty swallowing or day course of antibiotics to prevent any chewing infection after the operation. Please make Your child is in a lot of pain and pain sure your child takes the entire course, relief does not seem to help even if they are feeling better. Your child has a temperature of 38°C or higher If you have any questions, please telephone 020 7405 9200 and ask for the ward from which your child was discharged Notes Compiled by Peter Pan Ward in collaboration with the Child and Family Information Group Great Ormond Street Hospital for Children NHS Trust Great Ormond Street, London WC1N 3JH www.gosh.nhs.uk Sheet 3 of 4 Ref: 2011F1155 © GOSH NHS Trust November 2011.
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