Etiology, diagnosis, and surgical management of obstructive salivary gland disease

Abstract

: Obstructive salivary gland disease (OSGD) represents a large subset of salivary gland entities that affect a significant number of patients every year. Many different pathologic processes such as sialoliths, mucous plugs, strictures, and ductal stenosis can present with nearly identical obstructive symptoms, making diagnosis and treatment challenging. Current management of OSGD revolves around resolution of acute infection, targeted imaging, and definitive surgical management of the causal obstruction. Technological advances and improved diagnostic methods over the last two decades have led to a paradigm shift in management of these disorders, with an emphasis on gland-sparing and minimally-invasive therapies. Imaging for obstructive salivary gland disorders has shifted away from traditional sialography and plain film radiography in favor of ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI). Rehydration, gland massage, and antibiotics continue to be the mainstay of medical management. The use of sialendoscopy represents a minimally-invasive method to treat most OSGD without the morbidity associated with sialoadenectomy or other open procedures. The development of multiple adjunct treatment methods such as mechanical lithotripsy, laser lithotripsy, and extracorporeal shock wave lithotripsy have added to the overall effectiveness of minimally-invasive treatments for OSGD. This paper presents a review on the four main etiologies of salivary gland obstruction, appropriate diagnostic workup, and medical and surgical management of these disorders.