Sialoendoscopy and Sialography: Strategies for Assessment and Treatment of Salivary Gland Obstructions

Introducing Sialendoscopy in a Veteran Population: Effect on Benign Salivary Disease Treatment

OBJECTIVE

To compare rates of sialadenectomy in a veteran population before and after introduction of sialendoscopy.

MATERIALS AND METHODS

All Veterans Affair (VA) Northern California Healthcare System (NCHS) encounters from 2006 to 2021 for benign obstructive salivary etiologies were identified using International Classification of Disease 9/10 codes. This cohort was then cross referenced with Current Procedural Terminology codes to identify patients who underwent a procedure for their salivary pathologies. The rates of sialadenectomy and minimally invasive procedures were measured before and after sialendoscopy was introduced to the VA NCHCS in 2016. Data was obtained via chart review and demographic information, diagnosis, and procedure type were extracted. Rates of sialadenectomy, minimally invasive procedures, and other patient and procedural characteristics were compared between the Pre-Sialendoscopy Era (PSE) and Sialendoscopy Era (SE). Statistical analysis was performed using Microsoft Excel (Microsoft, version 16.66).

RESULTS

An increasing number of patients per year sought care for benign obstructive salivary pathology in the SE when compared to the PSE cohort and a higher rate of female patients were treated in the SE cohort. A simultaneous reduction in sialadenectomy rates and increase in minimally invasive procedure rates was observed in the SE. Sialendoscopy represented most of the increase in minimally invasive techniques, but there was a slight increase in other procedure types. Submandibular gland obstructive pathologies required the most procedures and resulted in the most gland excisions.

CONCLUSION

This retrospective review strongly suggests introducing sialendoscopy reduced the incidence of sialadenectomy for benign non-tumor obstructive pathology in this VA NCHS population. Further prospective studies are needed to evaluate this in a more generalized setting.

Advantages of submandibular gland preservation surgery over submandibular gland resection for proximal submandibular stones

OBJECTIVES

This study sought to compare surgical outcomes after the removal of submandibular gland (SMG) stones via 2 different surgical methods.

MATERIALS AND METHODS

From June 2015 to July 2016, a total of 40 patients with SMG stones were selected from the Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University (Shenyang, China), and were randomly assigned to 2 groups. Twenty patients underwent sialendoscopy-assisted stone removal via extraoral incision with preservation of the SMG, and 20 patients underwent traditional SMG resection. The outcomes of the 2 surgical procedures were assessed.

RESULTS

The operation time and hospital stay were shorter in the SMG preservation group than the SMG resection group. There were no significant differences in stone size or location between the groups. The mean visual analog scale (VAS) score was lower in the SMG preservation group than the SMG resection group. All patients in the SMG resection group exhibited varying degrees of scarring and concave deformity on the face and neck, whereas all patients in the SMG preservation group retained intact facial morphology.

CONCLUSIONS

Sialendoscopy-assisted stone removal with preservation of the SMG exhibited many advantages relative to traditional SMG resection.

Chronic Recurrent Non-specific Parotitis: A Case Report and Review

Background

Chronic recurrent non-specific parotitis is characterized by recurrent episodes of swelling and pain of unknown etiology in the parotid gland. Sialography is a hallmark in the diagnosis of salivary gland disorders; newer imaging modalities like CT-Sialography, sialoendoscopy and MRI can be used. Various treatment modalities have been tried, from conservative approach to surgical excision depending on the recurrence rate and severity of the condition. Although symptomatic treatment with antibiotics and analgesic, injection of intraductal medicament, aggressive treatment like duct ligation or excision of gland are some of the treatment modalities, there is no established algorithm as to which treatment method should be opted in such clinical situation.

Case Detail

A 20 years old male patient reported with pain and salty taste in the mouth that had began before a week. Examination revealed an elevated right parotid papilla; ropy, cloudy appearing saliva was oozing out on milking the gland. Unstimulated and stimulated whole salivary flow rate was assessed using drooling method. Sialography was used as a diagnostic and a therapeutic aid. In our case, sialography as a treatment showed a good response with no recurrence after two years of follow-up. We highlighted the role of sialography as a therapeutic aid.

Conclusion

Recurrent attacks significantly affect the quality of life and also lead to progressive gland destruction. Preventing or reducing the frequency of recurrence remains the goal of therapeutic procedure. Hence, conventional sialography is useful in the diagnosis and also effective as a therapeutic aid in recurrent parotitis.

Combined approach sialendoscopy for management of submandibular gland sialolithiasis

PURPOSE

Sialolithiasis is the primary cause of obstructive sialadenitis, affecting the submandibular gland in 80-90% of cases. Sialendoscopy has dramatically changed the diagnosis and management of salivary gland diseases. However, in cases in which endoluminal removal via sialendoscopy is not successful, a combined approach using a limited intraoral incision under guidance of sialendoscopy can facilitate stone removal. We reviewed our institution's experience with combined approach sialendoscopy and evaluated its role in managing sialolithiasis of the submandibular gland.

MATERIALS AND METHODS

Retrospective study of the treatment of sialolithiasis in the submandibular gland via combined approach sialendoscopy from January 2010 through March 2014. Demographics, clinical data, intraoperative findings and post-operative course were reviewed.

RESULTS

Most sialoliths (56.5%) were over 10 mm in size and were in the hilus of the gland (56%). The success rate of the combined approach was 87%. No significant complications were documented. Symptoms resolved in 75.7% of patients; however, this did not correlate with placement of an intraductal stent (p=0.7) or steroid irrigation (p=0.1). An overall gland preservation rate of 94.9% was achieved.

CONCLUSIONS

Combined approach sialendoscopy offers a minimally invasive technique for treating refractory sialolithiasis not amenable to removal via sialendoscopy alone. The procedure is well-tolerated, performed under local anesthesia with low morbidity and a high success rate.

Iatrogenic submandibular duct rupture complicating sialography: a case report

INTRODUCTION

Sialolithiasis is the most common disease of salivary glands. Sialography is particularly important for the assessment of the outflow tract and in diagnosing obstructive salivary gland lesions including calculi.

CASE PRESENTATION

We report on a 38-year-old female with sialolithiasis whom had Wharton's duct perforation, complicating the sialography. She was treated conservatively with a course of co-amoxiclav, oral prednisolone for three days and pain-killers. The patient was clinically well on follow-up reassessments at the end of the first week and three weeks post procedure.

CONCLUSIONS

Perforation of salivary duct complicating the sialography is rare. Awareness of this potential complication and utilizing a good sialography technique need to be advocated amongst radiologists. Response to treatment by conservative management is preferred as illustrated in this case.

A comparative study of the diagnostic capabilities of 2D plain radiograph and 3D cone beam CT sialography

OBJECTIVE

The aim of this study was to compare the diagnostic capabilities of two-dimensional sialography with a novel three-dimensional technique using cone beam CT (CBCT).

METHODS

47 subjects underwent parotid or submandibular gland sialography over a 2 year period using both plain imaging and CBCT. Both image sets were anonymized and independently reviewed by three certified oral and maxillofacial radiologists blinded to the clinical data. McNemar's χ(2) test was used to determine differences between the two modalities for feature visualization and interpretation.

RESULTS

CBCT outperformed plain imaging with respect to visualization of the gland parenchyma (p < 0.001) and identification of sialoliths (p = 0.02). Plain imaging outperformed CBCT for the identification of strictures (p = 0.04); however, the negative per cent agreement ("specificity") between the two imaging modalities was 100%. Although both imaging modalities performed equally in identifying normal and abnormal sialographic examinations, CBCT demonstrated a high negative per cent agreement for normal glands and a high positive per cent agreement ("sensitivity") for abnormal glands with inflammatory changes.

CONCLUSION

CBCT sialography allowed better visualization of gland parenchyma and identification of sialoliths. The high negative per cent agreement for strictures suggests that, if strictures are identified on CBCT images, then obstruction can be ruled in. Relative to plain images, the high negative per cent agreement for normal glands suggests that, if an abnormal finding is detected on CBCT images, then disease can be ruled in, and the high positive per cent agreement for glands with inflammatory changes suggests that inflammation can be ruled out if these changes are not seen on CBCT images.

Intraoral approach for removal of large sialolith in submandibular gland

Sialolithiasis is a benign pathology that occurs most frequently in the submandibular salivary gland due to its anatomic features. Depending on the size and degree of calcification, a sialolith can be visible in radiographic examinations. Patients commonly experience pain and/or edema when the ducts are obstructed. The authors report two cases of sialolithiasis of the submandibular gland after searching for the source of swelling in the submandibular region. The diagnosis was confirmed by clinical and tomographic examinations. Despite the considerable size of the sialoliths, treatment consisted of the removal of the calcified mass using an intraoral surgical approach. The prognosis is often good and there is generally no recurrence of the condition.