Endoscopic management of salivary gland obstructive diseases in patients with Sjögren's syndrome.

Abstract

To evaluate, on the basis of our clinical experience, the reliability of an endoscopic approach to the management of obstructive salivary diseases related to Sjögren's syndrome. A retrospective review of all patients affected by Sjögren's syndrome who were followed up at the Maxillo-Facial Unit of the Second University of Naples Hospital and referred from the Reumatology Unit of the same hospital from September 2007 to July 2012 for chronic obstructive sialadenitis unresponsive to medical therapy. A total of 34 patients (29 women and 5 men) were recruited for this study. After the detection of the impaired gland, under local anesthesia with lidocaine 2% to the orifice region and a gradual dilation of the duct orifice, the diagnostic unit was introduced into the duct and was advanced forward until reaching the ductal system, with continuous lavage with isotonic saline solution. The plaques were washed out, and any strictures were dilated. Mucus plugs and debris were removed with irrigation or with a forceps if necessary. Our cohort included 34 patients with a mean age of 51.76 years. A total of 60 parotid glands and 25 submandibular glands were explored and treated. Strictures were found in 38 glands (38 of 85; 45%), mucus plugs in 47 glands (47 of 85; 55%), mucus plugs and strictures together in three glands (3 of 85; 4%), and kinks in two glands (2 of 85; 2%). In 32 parotid glands (32 of 60; 53%) the Stensen duct was affected, in two (2 of 60; 3%) only secondary ducts, and in 18 (18 of 60; 30%) both. In submandibular glands explored, strictures and mucus plugs were mainly observed in Wharton ducts. Symptomatic improvement was achieved in 29 patients (29 of 34; 85%), in a follow-up period ranging from 5 months to 3 years. Interventional sialoendoscopy is a viable technique to treat acute symptomatology in patients with obstructive salivary gland diseases related to Sjögren's syndrome and refractory to conventional management.