Long-Term Outcomes of Sialendoscopy in the Management of Sialolithiasis and Idiopathic Chronic Sialadenitis with Ductal Scars

Contemporary Review of Submandibular Gland Sialolithiasis and Surgical Management Options

One of the most common disorders of the salivary glands is obstructive sialolithiasis. Salivary gland obstruction is important to address, as it can significantly impact patient quality of life and can progress to extensive cellulitis and abscess formation if left untreated. For small and accessible stones, conservative therapies often produce satisfactory outcomes. Operative management should be considered when stones are inaccessible or larger in size, and options include sialendoscopy, laser lithotripsy, extracorporeal shockwave lithotripsy, transoral surgery, and submandibular gland adenectomy. Robotic approaches are also becoming increasingly used for submandibular stone management. The purpose of this review is to summarize the modern-day management of submandibular gland obstructive sialolithiasis with an emphasis on operative treatment modalities. A total of 77 articles were reviewed from PubMed and Embase databases, specifically looking at the pathophysiology, clinical presentation, diagnosis, and management of submandibular sialolithiasis.

Long-term outcome of a cohort of 272 patients undergoing sialendoscopy

OBJECTIVES

To assess the cohort of patients undergoing sialendoscopic intervention for improvement of symptoms and gland-related quality of life at long-term follow-up.

DESIGN

This is a retrospective review of medical records with a prospective follow-up by questionnaire.

SETTING & PARTICIPANTS

All patients undergoing sialendoscopy at the University Hospitals Leuven Department of Otorhinolaryngology, Head and Neck Surgery between March 2008 and June 2020.

MAIN OUTCOME MEASURES

The electronic files of the patients were searched for information about their sialendoscopic procedure and follow-up consultations. We also send the patients a questionnaire by mail to assess symptom control and gland-related quality of life at long-term follow-up.

RESULTS

Two hundred seventy-two sialendoscopies were performed in 221 patients. Median follow-up time was 37 months. The sialendoscopies were performed in 130 patients for lithiasis, in 66 for stenosis, in 14 for recurrent parotitis of childhood, in 8 for recurrent sialadenitis of unknown origin and in 3 for radioiodine-induced sialadenitis. Complications occurred in 11 of 272 sialendoscopies (4%). Those were iatrogenic perforations, temporary lingual nerve paresthesia and swelling of the floor of the mouth. 53% of patients returned the questionnaire, for a total of 146 evaluable sialendoscopies. The majority of the responders indicated that sialendoscopy had improved their symptoms (83.6%). Salivary glands could be preserved in 89% of the responder group. The highest percentage of patients reporting residual symptoms was found in the RPC group (81.3%) and the lowest in the lithiasis group (16.2%). Besides age, no statistical differences in demographic and pathological features between the responder and non-responder groups were found, supporting generalisation of the responders' results to the entire cohort.

CONCLUSIONS

This study confirms the good long-term outcomes of sialendoscopic interventions in patients with chronic sialadenitis of different aetiologies and a high rate of gland preservation.

The Need for Studies on Oral Corticosteroids After Sialendoscopy for Obstructive Salivary Gland Disease: Systematic Review

OBJECTIVES

This qualitative systematic review evaluates the evidence in support of the use of oral corticosteroids in patients undergoing sialendoscopy for the treatment of obstructive sialadenitis.

DESIGN

Qualitative systematic review.

METHODS

A literature search was conducted from January 1985 and September 2020. Inclusion criteria embraced peer-reviewed articles in which adult patients undergoing interventional sialendoscopy for obstructive salivary gland disease received oral corticosteroids. The results were initially screened based on title and abstract, and the remaining articles were reviewed for eligibility.

RESULTS

About 218 papers were selected by title and abstract, 96 were selected for full-text review, and 9 met the inclusion criteria. Eight published reports were retrospective observational studies and 1 was a prospective comparative study. Overall, the heterogeneity of clinical data stood out in this systematic review. The pooled success rate in the studies was 873/979 (89%). Only 5 studies described a rationale for oral corticosteroid use as part of the post-operative management. In 4 studies, a prednisone total daily dose of 40 to 50 mg was used. One study clearly showed a lower recurrence rate in patients who received oral steroids for more than 7 days in addition to sialendoscopy for management of ductal stenoses.

CONCLUSION

This systematic review showed that most centers that prescribe oral corticosteroids after sialendoscopy are unaware of the specific results with this treatment. For ductal stenoses, only 1 paper clearly showed the benefits of oral corticosteroids after sialendoscopy but more high-quality evidence is required in the form of a comparative study or randomized controlled trial, with appropriate long-term follow up.

Effectiveness of sialendoscopy on the symptoms of chronic obstructive sialadenitis and patient satisfaction degree

OBJECTIVES

The purpose of this study was to assess the effectiveness of sialendoscopy (SE) on the symptom severity of chronic obstructive sialadenitis (COS) and patient satisfaction by using the Chronic Obstructive Sialadenitis Symptoms (COSS) questionnaire and the Patient Satisfaction Scores (PSS).

PATIENT AND METHODS

COSS questionnaire was employed to 51 Turkish patients with COS before and three months after SE. Patients' satisfaction with SE was evaluated by analyzing the PSS.

RESULTS

Gland preservation rate of the SE operation was 96.2%. The sialolith extraction rate was 74.2%. A significant decrease in the COSS scores of all of the patients in the study sub-groups was observed (p < 0.05). The effectiveness of SE was more pronounced for patients with sialolithiasis and submandibular gland (SG) involvement (p < 0.001, p = 0.03, respectively). Totally extracted stone and symptom duration were the only independent factors that significantly affected the COSS score gain values in patients with and without sialolithiasis, respectively (p < 0.001). There was a statistically significant correlation between COSS score gain values and PSS values. (r = 0.786) CONCLUSION: The benefit of SE was more pronounced in patients with sialolithiasis and SG involvement. Successful stone extraction and symptom duration were two independent factors that influenced both clinical improvement and patient satisfaction for patients with and without sialolithiasis, respectively. COSS questionnaire results correlated with the PSS values; thus, this questionnaire can also be used to evaluate the patients' satisfaction with SE.

Surgical Treatment of Sialolithiasis Leads to Improvement in the Complete Blood Count

Simple Summary

Sialolithiasis is a disease in which inflammation and infection are caused in a salivary gland and its duct secretion system due to a formation of a sialolith (salivary stone) in the gland. Anemia of inflammation is a well described pathology where chronic inflammation causes a reduction in the red blood cell count is. In this study, we examined the complete blood count results of patients who underwent surgical removal of a sialolith and found that removal of the stone and cessation of the symptoms lead to an improvement in the complete blood count results. We believe that the improvement in blood count values after surgery is due to resolution of the anemia of inflammation. To our knowledge, this is the first report about the relationship between surgery for removal of a salivary stone and improvement in the wellbeing of patient expressed by blood count values.

Abstract

Sialolithiasis is a chronic disease in which a sialolith (salivary stone) causes recurrent inflammation of the affected salivary gland. Anemia of inflammation is a well-described pathology in which a chronic inflammatory disease leads to a reduction in the red blood cell count, hemoglobin and hematocrit values. In this retrospective cohort study, we aim to find whether removal of the sialolith and alleviation of the inflammation affect the complete blood count results. We examined data regarding forty-nine patients who underwent surgery for the removal of a submandibular gland sialolith using the duct-stretching technique. Complete blood counts two years before and after the surgical procedure were collected. The average pre-procedure and post-procedure values were calculated for each patient to establish the average blood profile. The pre- and post-procedure values were compared to evaluate the effect of the surgical treatment on the blood profile. We found that the average blood count values for patients with sialolithiasis were towards the lower end of the normal range. Post-surgery, a significant increase in hematocrit, hemoglobin and red blood cell count was observed, which was more pronounced in the older age group and in patients with co-morbidities. We conclude that sialolith removal surgery is associated with significant improvement in the complete blood count values, especially in the elderly and in patients and with co-morbidities. The speculated pathogenesis is relative anemia of inflammation.