Abstract
PurposesReporting our experience in treating chronic obstructive sialadenitis with a protocol consisting of sialoendoscopy and intraductal instillation of antibiotics, steroids and n-acetyl-cysteine (NAC) solution.MethodsProspective study of patients with chronic obstructive sialadenitis with no apparent lithiasic obstructions, with recurrent non-lithiasic sialoadenitis and patients with lithiasic sialoadenitis not solved with sialoendoscopy. In all cases, a sialoendoscopy was performed. All the patients affected by lithiasic sialoadenitis where the chronic inflammation was resolved with sialoendoscopy were excluded from the study. The mid-term follow-up was performed at 12 months via phone interview, to understand whether patients had developed any further symptoms after the treatment.ResultsThis study included 26 patients. All the patient without sialolithiasis have not reported any symptoms during the follow-up period. Two of those with sialolithiasis have not shown any signs of recurrence. The remaining three patients with non-resolved sialolithiasis had a recurrence of symptoms which were treated again with 1 intraductal administration of betamethasone, gentamicine and NAC, showing immediately a regression of the symptoms.ConclusionsIntraductal administration of gentamicin + NAC + betamethasone seemed effective for the therapy of chronic obstructive sialoadenitis. Our protocol seemed effective also in that cases where it was not possible to remove or detect endoscopically an obstruction. In all these cases we have noticed an increase in the symptom-free time even in cases where it was not possible to remove the stones.
Highlights
Chronic sialadenitis is a localized condition of the salivary gland characterized by repeated episodes of swelling, pain and inflammation
We report our experience in treating obstructive chronic sialadenitis with sialoendoscopy and a pharmaceutical protocol consisting of intraductal instillation of antibiotics, steroids and NAC which, as several studies have highlighted, have an inhibiting and degrading action on the extracellular polysaccharides (EPS) that forms the biofilm, allowing the antibiotic to reach the bacteria
The following categories of patients were enrolled in this study: patients with no apparent lithiasic obstructions, according to imaging studies and sialoendoscopy; patients with recurrent non-lithiasic sialoadenitis and patients with lithiasic sialoadenitis not solved with sialoendoscopy
Summary
Chronic sialadenitis is a localized condition of the salivary gland characterized by repeated episodes of swelling, pain and inflammation. The trigger factor is usually salivary duct obstruction, resulting in salivary stasis, which predisposes the patient to recurrent episodes of infection and inflammation. Sialolithiasis represents the most common cause of ductal obstruction, followed by mucus plugs deposition, stenosis of the ducts, neoplastic extrinsic compression, congenital dilatation and foreign bodies [1]. Chronic sialadenitis is characterized by recurrent episodes of sudden swelling of the affected salivary gland, associated with food intake. The skin surface may appear normal or slightly inflamed with varying degrees of tenderness. Patients frequently report an initial episode of acute suppurative sialadenitis, followed by silent periods
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