Management Of Salivary Gland Disease Research Articles

Outcome of the Management of Salivary Gland Diseases by Sialendoscopy: A University Hospital's Experience

Sialendoscopy is a minimally invasive procedure for the treatment of salivary gland diseases. The purpose of this study was to review a series of the patients undergoing sialendoscopy and to present our experience regarding the management and outcome of obstructive sialadenitis treated by this procedure. This study was a case series. We collected data on patients who underwent sialendoscopy in our institute between January 2016 and July 2019. The data included patients' demographics, involved salivary glands, diagnostic investigation, types of anesthesia, endoscopic findings, materials used, complications, adjunctive treatment, duration of follow-up, and therapeutic outcome. Descriptive statistics were used to analyze the surgical findings and outcome. There were 61 patients involving 76 glands (48 submandibular and 29 parotid glands). There were 43 females and 18 males with the median age 45years at the time of sialendoscopy. The median duration of follow-up was 6months. The most dominant symptom was pain with swelling (59.20%). The 2 most common sialendoscopic findings were ductal stenosis and sialolithiasis. We observed a success rate in achieving a complete relief of 77.6% at the first procedure and 96.7% at the last follow-up. We did not have any cases with postoperative complication or recurrence. Our study supports sialendoscopy as a safe and successful procedure that plays a dual role in diagnostics and in relieving symptoms of patients with obstructive sialadenitis with or without sialolithiasis. It should be advised for patients with non-neoplastic salivary duct obstruction either for diagnosis or therapeutic intervention.

Management of Chronic Sialadenitis due to Sjogren’s Syndrome and Radioactive Iodine Therapy Using Sialendoscopy

Introduction: Sialendoscopy is a minimally invasive technique for the management of salivary gland disease. This work characterizes its utility for treating chronic sialadenitis due to Sjogren’s syndrome and radioactive iodine (RAI) therapy. Methods: A single-center, retrospective review of patients undergoing sialendoscopy between March 2013 and May 2019 for the treatment of chronic sialadenitis due to Sjogren’s or prior RAI therapy was performed. Results: Thirty-four patients with Sjogren’s and 25 patients who received RAI were identified, undergoing a total of 86 procedures. Median age at presentation was 53 years with mean follow-up time of 14.3 months. Seventy-two procedures were performed on the parotid gland, four on the submandibular gland, and ten on both glands. Corticosteroid injection and duct dilation were performed most commonly. Sixteen patients required repeat procedure. All patients were symptomatically improved at follow-up visit. Discussion/Conclusion: These results support the idea that sialendoscopy offers symptomatic benefit for patients with chronic sialadenitis due to Sjogren’s or RAI.

Classification of Salivary Gland Disorders

To offer a fresh perspective on the evolving management of salivary gland disease by introducing a sequence of articles organized by a classification system grouping disorders by etiology. Sialendoscopy has been successful in improving the management of salivary gland disease. This endoscopic approach to imaging and instrumentation of the salivary duct system has been a focal point of recent discussion. The overall management of salivary pain and swelling as well as xerostomia and sialorrhea has improved through additional treatment options including increased application non-surgical office techniques ranging from intraductal infusions to botulinum toxin injections. Refinements in radiographic as well as serologic and histopathologic assessment have restructured the understanding of and the approach to these clinical problems. A classification system organized by etiology of salivary gland swelling provides structure to a collection of articles offering updates. Contemporary knowledge addressing underlying pathophysiology is provided through separate articles organized into a classification system designed to demystify the confusing assortment of terms that describe salivary disorders. This review additionally identifies the emergence of a subspecialty populated by salivary gland experts who have mastered the complex equipment, technology, and knowledge base required to provide state-of-art management.

Intraductal injection as an effective drug delivery route in the management of salivary gland diseases.

While conservative approaches for chronic sialoadenitis are in current use, the utility of intraductal injection therapy remains unclear. The purpose of this study is to provide evidence that substances delivered through intraductal injection of the salivary gland are able to be effectively distributed throughout the gland. Methylene blue dye (0.1%) was injected intraductally into a porcine parotid gland (5ml) of one group and the porcine submandibular gland (1 or 2ml, n=6 for each preparation) of another group. After the injection, the ductal systems were evaluated, sectioned, and observed microscopically. Color area analysis was performed on submandibular gland sections, and the infiltration ratio of the dye was calculated. The papillae of both Stensen's and Wharton's duct openings were easily identified with intraductally delivered methylene blue dye. The dye infiltration began from the central ductal region of the gland and could be easily observed to gradually disperse to the peripheral regions in each acinar. There were no statistically significant differences in infiltration ratios between anterior, midline, and posterior section of the submandibular gland. Also, there were no statistically significant differences in the ratios between 1 and 2ml injections at all the three section positions. This study demonstrated that desired substances can be evenly delivered throughout the salivary gland through intraductal injections. The use of intraductal injections might serve as a potential therapeutic procedure in the management of salivary gland diseases.

Sialendoscopy, a minimally invasive diagnostic and interventional tool in the management of salivary gland diseases

AbstractIntroduction. Sialendoscopy is a novel branch of minimally invasive surgery, which allows diagnostic and interventional procedures deep in the ductal systems of salivary glands. Clinical Department of Otorhinolaryngology and Cervicofacial Surgery Ljubljana is a joint otorhinolaryngological sialendoscopy center, representing in that field both Slovenian University Medical Centers.Patients and methods. Since 2011, from among more than 200 patients with unexplained swelling of the salivary glands, we have submitted 118 patients to sialendoscopy and sialendoscopy-assisted interventions and performed 131 operations (78.6% under local anesthesia), with an attempted examination of a total of 137 salivary glands. The patients had mainly submandibular problems (66%).Results. Our rate of failed sialendoscope introductions is 2.9% so far, which is comparable to the best results abroad. The most common interventional procedure was sialendoscopy-assisted combined approach salivary stone removal (36 cases). Adding 16 cases of wire basket stone retrievals, we reached a total of 52 successful stone extraction procedures. We found ductal strictures without sialolithiasis in 40 patients, mostly of parotid systems (24 patients), and in 19 of them, dilatation was performed, followed by a temporary stent insertion in 11 cases. In three patients with submandibular papillary stricture, we performed microsurgical ductostomy; our experience supports its recognition as a specific clinical entity. With no serious complications, the practice of sialendoscopy at our department reduced salivary gland resections because of obstructive disease by 90 %.Conclusions. We believe that sialendoscopy is a new minimally invasive approach paradigm that fundamentally changes the treatment of obstructive salivary gland diseases.

Learning curve in diagnostic and interventional sialendoscopy for obstructive salivary diseases.

SUMMARYSialendoscopy is a new diagnostic and surgical tool for management of salivary gland diseases that offers the opportunity to treat selected pathologies less invasively and with better results compared to previous techniques. As with any new technique, an adequate training programme involving a gradual learning curve is mandatory to quickly obtain results similar to those reported in the literature. This includes an appropriate diagnostic programme, correct patient selection and knowledge of possible pitfalls. In this retrospective study, the outcomes of the first 141 procedures (74 on the parotid gland and 67 on the submandibular gland) performed with this technique in our Department from 2009 to 2013 were compared with those reported in the literature. Patients were divided into three groups: Group A (the first 49 procedures performed), Group B (the next 50 procedures), and Group C (the last 42 procedures). There were no statistically significant differences relative to mean procedure times, recurrence of symptomatology after treatment, need for further treatments and rates of minor complications between groups. No major complications were seen. The increase in experience resulted in an increased number of interventional sialendoscopies performed under local anaesthesia instead of general anaesthesia (51% vs 18% vs 14%). In only three of 130 glands treated (2.3%) was gland resection required. We also evaluated which technique had been used for stone removal and rate of failure, which was similar in all groups (13.6% vs 15% vs 15%). Our results do not substantially differ from those reported in the literature. Initial difficulties in catheterising the papilla could be overcome with practise on fresh human specimens or fresh pig heads. Lack of precision regarding diagnostic imaging techniques was remedied by improving the competence of the surgeon in performing pre- and postoperative ultrasound. The creation of specialised centres capable of treating up to 1 to 2 million people would be desirable in order to better stratify pathologies, validate the investment in equipment and gain the necessary experience in the various surgical techniques.

Combined approach sialendoscopy for management of submandibular gland sialolithiasis

PurposeSialolithiasis 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 methodsRetrospective 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. ResultsMost 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. ConclusionsCombined 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.

Review of salivary papers published in the British Journal of Oral & Maxillofacial Surgery during 2009–2010

The management of salivary gland disease forms an appreciable part of the work undertaken by our specialty. Fast-track and one-stop clinics for head and neck lumps allow for early diagnosis of salivary gland tumours in most units, and for the sharing of cases between our ear, nose and throat (ENT) colleagues. The emphasis on benign salivary gland disease is very much on outcome after operation, and there have been improvements in surgical technique, particularly in relation to minimal dissection of salivary adenomas and sialendoscopy. This article continues a series of reviews, which aim to provide readers with a quick overview and update of recent publications in the British Journal of Oral and Maxillofacial Surgery ( BJOMS) within a particular subspecialty.

Recent advances in the management of salivary gland disease

The management of salivary gland disease forms a considerable part of the work done by oral and maxillofacial surgeons. Fast track and one-stop head and neck lump clinics allow for early diagnosis of salivary gland tumours in most units, the emphasis being on outcome after operation for benign disease. There have been limited advances in salivary gland surgery in recent years. Most recent publications have compared outcome of new methods of treatment with conventional techniques. This article reviews papers related to diseases of the salivary glands published in the British Journal of Oral and Maxillofacial Surgery (BJOMS) over a two-year period (2007–2008), and includes other relevant articles to bring readers up to date about salivary gland disease.

Sialolithiasis of the Submandibular Salivary Gland Treated with the 810- to 830-nm Diode Laser

Surgical management of salivary gland diseases has always been challenging because it carries a considerable risk of nerve damage. This study evaluates an innovative ambulatory laser-aided technique that may be an alternative to traditional treatment, and presents our 5-y experience of salivary gland excision. Twenty-five submandibular salivary gland excisions were performed with an 810- to 830-nm diode laser. The diagnosis was sialolithiasis with stones in the salivary gland duct above the glandular hilum. A 320-microm flexible delivery fiber was used in continuous wave mode at 2.5 W power. The procedure consisted of locating the stone, isolating the duct from the surrounding tissues, introducing a button probe, ductal incision above the stone, sialolithotomy, and checking duct patency. The overall success rate was 92%. The largest stone removed was 4.5 cm in size. In 1 patient (4%), an additional undetected stone was diagnosed by endoscopy after removal of the stone from the duct, and in 1 patient (4%), synechiae formed in the duct during healing and duct patency had to be restored with a probe. We had no cases of transient palsy or paresis of the mandibular branch of the facial or lingual nerves. Use of the 810-nm laser is safe for this type of surgical procedure, carries a low complication rate, and is a valid alternative to traditional surgery. It is indicated as the procedure of choice in cases of stones located in the duct above the kink leading into the mylohyoid muscle, and above the glandular hilum.

Preservation of the superficial lobe with tumours of the deep-lobe of the parotid

There is a trend for operations on benign tumours of the parotid gland to be less radical, with the use of techniques such as partial superficial parotidectomy and extracapsular dissection. 1 Leverstein H. van der Wal J.E. Tiwari R.M. van der Waal I. Snow G.B. Surgical management of 246 previously untreated pleomorphic adenomas of the parotid gland. Br J Surg. 1997; 84: 399-403 Crossref PubMed Scopus (138) Google Scholar , 2 Snow G.B. The surgical approaches to the treatment of parotid pleomorphic adenomas. in: McGurk M. Renehan A.G. Controversies in the management of salivary gland disease. Oxford University Press, Oxford2001: 57-65 Google Scholar The technique of selective deep-lobe parotidectomy was described by Leverstein et al. 1 Leverstein H. van der Wal J.E. Tiwari R.M. van der Waal I. Snow G.B. Surgical management of 246 previously untreated pleomorphic adenomas of the parotid gland. Br J Surg. 1997; 84: 399-403 Crossref PubMed Scopus (138) Google Scholar in 1997 and preserves the superficial parotid when the tumour lies mainly deep to the facial nerve. Sixteen patients were successfully treated using a conventional cervical approach. There was minimal facial deformity and a low incidence of Frey's syndrome. This technique, combined with an aesthetic face-lift, was recently reported in nine patients by Hussain and Murray. 3 Hussain A. Murray D.P. Preservation of the superficial lobe for deep-lobe parotid tumors: a better aesthetic outcome. Ear Nose Throat J. 2005; 84 (520–4): 518 PubMed Google Scholar The skin was left attached to the superficial lobe of the parotid on several occasions, presumably to minimise the dissection and reduce the risk of devascularisation. However, this is not our practice as access through the face-lift incision is a little more restricted. Over the last two years the author (CA) has treated four patients with benign deep-lobe tumours using this technique.

Controversies in the Management of Salivary Gland Disease

‘Controversies in the management of salivary gland disease’ should alert the non-specialist of the existence of such problems. What better way to publicize this than to bring together leading expon...

The Surgical Management of Salivary Gland Disease of the Sublingual Gland and Floor of Mouth

The Surgical Management of Salivary Gland Disease of the Sublingual Gland and Floor of Mouth

SALIVARY GLAND PATHOLOGY IN CHILDREN

SUMMARY Salivary gland diseases in children represent an uncommon disease entity. When viral sialadenitis is excluded these disorders are quite rare. Inflammatory disorders and viral and bacterial sialadenitis occur most commonly in the pediatric population. Salivary gland neoplasms in children are very uncommon and account for less than 5% of all salivary gland neoplasms. Pediatric salivary gland neoplasms occur most often in the parotid gland. Hemangiomas, lymphangiomas, and pleomorphic adenomas are the most common neoplasms, with malignant neoplasms following in frequency. The presentation and management of salivary gland diseases generally parallel those found in adults. However, the incidence of diseases varies greatly.