MR Sialography Research Articles

MR sialographic assessment of the masseter muscle and the ductal kinking in patients with recurrent parotitis

Dysfunction of the masseter muscle may cause pathological kinking of the parotid duct leading to parotitis; MR sialography is a non-invasive radiological examination that allows to evaluate dynamically the ductal system of the parotid glands. In the present study we aimed to assess the relationships between Stensen’s duct and masseter muscle and their implications in the aetiopathogenesis of recurrent parotitis secondary to masseter muscle dysfunction. Forty-one patients with recurrent unilateral parotitis and nine with bilateral recurrent parotitis, all with a clinical suspicious of masseter muscle hypertrophy due to bruxism were enrolled. They underwent ultrasonography as a first line examination and then MR sialography and sialendoscopy. Different anatomical features were studied. Involved parotid glands had a wider duct compared to contralateral unaffected parotid glands of patients with recurrent parotitis (p = 0.00134); male subjects with parotitis had a longer duct compared to the salivary glands of healthy patients (p = 0.00943 for affected glands and p = 0.00629 for the contralateral). A concordance between the evidence of an acute duct angle during sialendoscopy and a wider duct in patients with parotitis was observed although not statistically significant. These initial findings suggest that the masticatory muscle dysfunction related to bruxism seems to condition alteration of parotid duct course and anatomy thus favouring the occurrence of recurrent parotitis. A specific diagnostic iter based on clinical evaluation, dynamic ultrasonography and MR sialography, is therefore, mandatory to confirm the relationship between masseter muscle anatomy and parotid duct anomalies; this is the premise for an adequate therapeutic approach to underlying masticatory muscle disorder.

Epidemiologic, radiologic, and sialendoscopic aspects in chronic obstructive sialadenitis.

Chronic obstructive sialadenitis (COS) is a recurring inflammation of the salivary gland. To date, there are no known predisposing factors for COS. Given the advances seen in radiology and sialendoscopy, we must update our knowledge of COS, analyzing factors that can favor its development. We prospectively analyzed 333 patients who underwent sialendoscopy between 2012 and 2021. Epidemiologic, radiologic, and sialendoscopy-related factors were correlated. Suspected diagnosis was established based on the clinical and radiologic data. The final diagnosis was determined on the basis of sialendoscopic findings. The most common etiology of COS was stricture (40.8%). Lack of papilla distensibility (LPD) was also described as an etiology. COS was related to patient gender and age. Submandibular gland involvement was significantly more associated with lithiasis and LPD, while COS of the parotid gland was most frequently caused by stricture. Radioiodine sialadenitis and Sjögren's syndrome were significantly associated with stricture. MR sialography (MR-Si) showed the best overall sensitivity and specificity. In our series, stricture was the most common cause of COS. We describe LPD as a frequent cause of COS in this series; ours is the first study to report this finding. There was a significant association between the salivary gland involved, patient sex and age, and the cause of COS. MR-Si showed the greatest diagnostic yield.

The role of magnetic resonance imaging and magnetic resonance sialography in the evaluation of salivary sialolithiasis: radiologic-endoscopic correlation.

PurposeTo evaluate the role of magnetic resonance imaging (MRI) and MR sialography in salivary gland calculi in correlation with sialendoscopy.Material and methodsIn this prospective study, pre-therapeutic MRI was performed for patients with clinically suspected sialolithiasis. In addition, sialendoscopy with or without surgery was performed. The detectability, number, size, and location of calculi (distance of obstruction from the ostium and masseter line) and the condition of the main duct at MRI were reported. Agreement between the 2 readers was confirmed for all MRI findings. Data regarding the detectability, number, and size of calculi were correlated with endoscopy.ResultsThere was excellent agreement between the 2 readers regarding the detection and number of calculi at MR sialography (κ = 1, p < 0.001). As regards MRI measurements, excellent interclass correlation was found between the 2 readers regarding size of calculi, distance of calculi from the ostium, and distance from the masseter line (κ = 0.98, 0.98, 0.97, respectively; p < 0.001). In correlation with sialendoscopy, MRI was false negative in 1 patient, and it missed 1 calculus in 3 patients with multiple calculi. There was no statistically significant difference between the size of calculi detected by MRI and true size of calculi retrieved by sialendoscopy.ConclusionMR sialography is an accurate modality for diagnosis of the presence, size, and location of sialolithiasis and offers accurate ductal mapping for sialendoscopists.

Comparison of salivary gland MRI and ultrasonography findings among patients with Sjögren's syndrome over a wide age range.

ObjectivesThis retrospective study compared MRI and US findings among patients with SS over a wide age range.MethodsNinety patients with SS aged 8–84 years who had undergone both MRI and US examinations were divided into four groups according to age, as follows: <18 years (juvenile SS, JSS), 9 patients; 18–39 years, 12 patients; 40–69 years, 53 patients; >69 years, 16 patients. Imaging findings of parotid glands (PGs) and submandibular glands (SMGs) were compared among the four groups. Furthermore, the relationships within and between imaging findings and various clinical findings were examined.ResultsOn MRI, patients with JSS commonly exhibited multiple high-intensity spots in the PGs on MR sialography and fat-suppressed T2-weighted imaging. With increasing SS group age, the frequencies and numbers of the high-intensity spots were lower. Fat areas on MRI and hyperechoic bands on US were rarely observed in the PGs and SMGs of patients with JSS, whereas they were more common in patients with adult SS. In addition, the presence of hyperechoic bands on US, the presence of fat areas on MRI, and decreased salivary flow were associated with one another.ConclusionSalivary gland imaging findings in patients with JSS were characterized by punctate sialectasis, whereas those findings in patients with adult SS were characterized by fatty degeneration. Distinct findings in patients with JSS and adult SS are likely to reflect differences in glandular lesion stage. MRI and US are presumably useful for evaluation of glandular lesion severity during follow-up.

Sialendoscopy Combined With Transoral Sialodochoplasty for the Treatment of Parotid Duct Stenosis With a Megaduct.

This study aimed to analyze the surgical outcomes of sialendoscopy combined with transoral sialodochoplasty for the treatment of patients with parotid duct stenosis with megaduct. This study included 13 patients with chronic obstructive sialadenitis caused by type 2 parotid duct stenosis who underwent transoral sialodochoplasty. All patients completed a three-point Likert-type rating scale at 3 months after surgery. Six (46.2%) glands showed complete resolution, and seven (53.8%) showed partial resolution of obstructive symptoms. Megaduct diameter between pre- and postoperative MR sialography significantly decreased after transoral sialodochoplasty (8.05 ± 2.67 vs. 4.15 ± 2.4, P = 0.028). Saliva excretion was improved after the transoral sialodochoplasty, as the distal ducts were visualized with a sialagogue postoperatively. Type 2 parotid duct stenosis can be successfully treated with sialendoscopy combined with sialodochoplasty. In cases of large megaduct, transoral sialodochoplasty appears to offer benefits of reducing the diameter of dilated megaducts and improving salivary outflow.

First Report of Sublingual Gland Ducts: Visualization by Dynamic MR Sialography and Its Clinical Application.

This study was done to determine whether the sublingual gland ducts could be visualized and/or their function assessed by MR sialography and dynamic MR sialography and to elucidate the clinical significance of the visualization and/or evaluation of the function of sublingual gland ducts by clinical application of these techniques. In 20 adult volunteers, 19 elderly volunteers, and 7 patients with sublingual gland disease, morphological and functional evaluations were done by MR sialography and dynamic MR sialography. Next, four parameters, including the time-dependent changes (change ratio) in the maximum area of the detectable sublingual gland ducts in dynamic MR sialographic images and data were analyzed. Sublingual gland ducts could be accurately visualized in 16 adult volunteers, 12 elderly volunteers, and 5 patients. No significant differences in the four parameters in detectable duct areas of sublingual glands were found among the three groups. In one patient with a ranula, the lesion could be correctly diagnosed as a ranula by MR sialography because the mass was clearly derived from sublingual gland ducts. This is the first report of successful visualization of sublingual gland ducts. In addition, the present study suggests that MR sialography can be more useful in the diagnosis of patients with lesions of sublingual gland ducts.

Current status of imaging of Sjogren's syndrome.

Primary Sjögren's syndrome (pSS) is an autoimmune disease, which involves salivary glands (SG) and extra glandular organs. Today, Sjögren's patients' diagnosis is based on classification criteria taking into account five objective tests, including histology, immunology, two ophthalmological tests, and salivary flow evaluation. To date, the challenge is to find the right imaging tool for diagnosis, follow up, and prognosis of pSS. The objective of this review is to describe as to what are these imaging modalities and particularly the place and validity of salivary glands ultrasonography (SGUS) in the diagnosis and follow-up strategy of patients with suspected pSS. Moreover, new noninvasive tools are emerging, including elastography, a new ultrasonography technique that provides an estimate of tissue elasticity, MRI, MR sialography, and 18 fluorodeoxyglucose-positron emission tomography. Although new imaging opportunities are available, SGUS should be the first-line choice in pSS because of its accessibility, feasibility over time, and sensitivity to change.

Recommended Imaging for Salivary Gland Disorders

Imaging modalities useful in the contemporary evaluation of salivary gland disorders are discussed. Salivary gland ultrasound—due to its wide applicability, versatility, availability, and low cost—is supported as a frontline evaluation and is frequently done as an in-office procedure by the treating surgeon. Contrast-enhanced CT may be as accurate as non-contrast CT in detecting sialolithiasis. Although conventional sialography (fluoroscopic salivary gland evaluation with ductal dilation and radiocontrast insufflation) was initially designed as a diagnostic procedure, more recently, reported experience has demonstrated it to result in improved salivary function for several disorders—including its use as treatment of juvenile recurrent parotitis. Conventional sialography remains the most accurate method to assess the full ductal anatomy and is superior to MRI sialography which fails to adequately image the more proximal ducts. For benign salivary tumors, US may obviate the need for further imaging and provide reliable estimation of tumor location. Salivary gland disorders are most efficiently imaged with in-office ultrasound. In settings where US cannot be performed, CT (with or without contrast) remains a reliable initial method to detect salivary gland abnormalities including sialolithiasis. MR sialography has become a useful modality for evaluating stenosis and may be considered when conventional sialography is not available.

Feasibility of 3D printed salivary duct models for sialendoscopic skills training: preliminary report.

To explore the feasibility of 3D printed salivary duct models for the sialendoscopic skills training. Healthy volunteers and patients affected by obstructive salivary gland disorders were submitted to 3 Tesla MR sialography. The MR data underwent an image segmentation process to produce the 3D printed salivary duct prototypes. Sialendoscopies were carried out by three groups of investigators with different levels of endoscopic experience. Realism, usefulness of the training process and potential advantages of the 3D printed models in the preoperative surgical planning were evaluated by means of a specific survey. Four cases were included in our study: one healthy parotid, one submandibular gland, one case of lithiasis and one of stenosis involving the parotid gland. In all cases, the three groups of investigators successfully explored the salivary ducts up to the tertiary branches, detected the cause of obstruction and correctly treated it. Seven untoward events occurred during the operative sialendoscopies. Overall, the questionnaire score was about 79.3%, reflecting a positive impression regarding the models on behalf of all the investigators. 3D printed salivary duct models resulted feasible for the sialendoscopic skills training. The opportunity to reproduce the patient-specific anatomy may add further information useful in the preoperative decision making. These positive results should be verified by further researches and experiences.

Parotid MR Sialography, Can it Help in Patients with Hepatitis C Virus Related Sicca Syndrome?

AbstractBackground: The Hepatitis C Virus (HCV) related sicca syndrome occurs in association with HCV infection in a range of 4-57%. Salivary gland chronic inflammation and B cell proliferation is triggered by HCV. MR sialography is a non-invasive method for salivary glands complex duct system combined with their parenchymal evaluation through conven-tional MR T2 images and source images.Aim of Study: To identify changes in parotid magnetic resonance sialography (MR Sialography) in HCV related sicca syndrome patients.Patients and Methods: Prospective study included 64 HCV related sicca syndrome patients (38 female, 26 male, mean age 44.6±10.5 years). All patients had performed parotid MR sialography. Severity of the disease was correlated with presence or absence of vasculitis and HCV disease duration.Results: MR sialography changes were found in 25% of patients, (12/32 and 4/32 in patients with and without vasculitis, respectively). Among patients with vasculitis, those with abnormal MR sialography had longer disease duration along with more severe form of the disease.Conclusion: Amongst HCV patients with vasculitis and longer disease duration, abnormal changes are identified on MR sialography.

Alternative Approach to Traumatic Stensen’s Duct Injuries Accompanied by Glandular Involvement: Botulinum Toxin Injection to the Gland in Conjunction with Microsurgical Repair of the Duct in an Acute Setting

There is high tendency to ignore the diagnosis as the incidence of the injury of parotid gland and its duct is relatively rare. In order to prevent the long-term complications such as facial deformities, sialoceles, cutaneous fistulae, salivary gland cysts and gustatory sweating (Frey’s syndrome) and to restore the parotid gland functions, it is important for the duct injuries to be diagnosed and treated immediately. 3 patients consulted to Plastic Surgery Clinic from the Emergency Room of Hacettepe University following maxillofacial trauma was reviewed in this study. Exploration of the facial nerve and Stenon duct was planned for all patients within the first 72 hours following the injury. Following intraoral catheterization of the Stenon duct through the papilla with an epidural catheter, microsurgical end-to-end anastomosis was performed. Concurrently, 100 Units of botulinum toxin A was injected at standardized 8 points on the parotid gland. Postoperative MR sialography revealed patency in all patients at the end of postoperative first year. The mean postoperative parotid volume of the injured and non-injured sides were 19,82±10,55 and 17,79±10,98 respectively and the results were found to be comparable. Fibrillation potentials in the postoperative electromyography recordings and clinical examination demonstrated the nerve regeneration. In conclusion, botulinum toxin A is appears to be effective in both treatment of the injuries of the duct accompanied by glandular involvement in the acute setting, as well as prevention of the long term complications.

Evaluation of magnetic resonance sialography and ultrasonography findings in salivary glands of patients with xerostomia

Abstract: Objectives : The aim of the study was to assess MR sialography and Ultrasonography as objective tools to examine salivary glands in patients with xerostomia. Methods : In this Cross-sectional descriptive study,MR sialography using salivary secretion stimulation was performed in 16 patients (with the chief complaint of xerostomia) and 11 healthy volunteers.Visibility of the main duct and ductal branches were evaluated before and after stimulation in axial and oblique sagittal plans, and were classified in to three grades (poor,fair & good). Patients and volunteers were also examined by ultrasonography;their parenchymal homogeneity of the salivary glands was graded from 0 to 5 and their echogenicity was divided to three levels:hypoecho, isoecho and hyperecho. Size of the salivary glands was also measured.Dependent T-test and independent T-test ,Spearman and Chi-square analysis were performed to analyze the results. Results : In this study the results showed no significant difference in the visibility of salivary glands ducts before and after salivary secretion stimulation in healthy volunteers.In the patients group, however, significant difference was seen in the visibility of salivary glands ducts after stimulation in sagittal planes of right and left parotid glands(P-Value=0.033)as well as left submandibular glands(P-Value=0.035). No significant difference in the visibility of salivary glands ducts was observed between healthy volunteers and patients,except in sagittal plan of left parotid glands (P-Value=0.004).In addition, there was no significant difference in parenchymal characteristics and size of salivary glands in ultrasonography results in the two groups. No Significant correlation could be established between MR Sialography and Ultrasonography findings. Conclusion : Achieving no significant difference in imaging results between patients and volunteers suggests that MR sialographic images and US features may not serve as suitable diagnostic criteria in patients with xerostomia. Key words : Ultrasonography - MR Sialography -Xerostomia -Salivary Glands

Salivary Gland Imaging: A Pictorial Essay

The major salivary glands are parotid, submandibular and sublingual glands. Imaging has an important role to play in detection, diagnosis, aiding biopsy and differentiating benign from malignant pathology. The traditional imaging modalities include plain radiography and sialography. With the advent of modern imaging methods like high resolution ultrasound with color doppler, contrast enhanced CT, MRI and MR sialography, the imaging has become increasingly reliable in making a confident diagnosis. A wide variety of conditions including obstructive, infectious, autoimmune and neoplastic pathologies affect the salivary glands, thus resulting in a wide imaging spectrum. This article is aimed at presenting the imaging appearances of common salivary gland diseases.

SP0083 The Role of US for Diagnosing SjÖGren's Syndrome - Practical Aspects

Primary Sjögren's syndrome (pSS) is a chronic autoimmune disorder characterized by lymphocytic infiltrates in the lachrymal and salivary glands. Dryness of the eyes (keratoconjunctivitis sicca) and mouth (xerostomia) are the...

MRI features of the parotid gland in Sj?gren syndrome

Objective To investigate MR imaging features of parotid gland in Sj?gren′s syndrome ( SS).Methods Twenty-seven cases of xerostomia patients were collected and divided into SS group ( n=21) and non-SS group (n=6) according to the international classification (diagnosis) criteria for SS.Ten healthy volunteers were recruited as the control group.All the subjects underwent conventional MRI of parotid gland and MR sialography ( MRS).Standard deviation of T 1 WI and T2 WI signal intensity among 3 groups was observed, meanwhile, grading was made according to parotid glands , fat signal and parotid duct expansion degree respectively.With clinical diagnosis as the gold standard , diagnostic value of conventional MRI , MRS and their combination used in SS was compared.One-way ANOVA was used in comparison of standard deviation of parotid gland′s signal intensity among 3 groups , and Chi-square test was applied in comparison of conventional MRI and MRS diagnostic value.Moreover , Kappa value was calculated to assess the consistency of two grading results in SS.Results Signal intensity of parotid glands in control group and non-SS group was homogeneous.However , bilaterally diffused and heterogeneous high signal intensity on both T1WI and T2WI was found in SS patients, which was depressed on T2WI fat suppression sequences.Forty-two parotid glands were graded by fat signal:Grade 0 (n=2 glands), Grade 1 (n=10), Grade 2 (n=10), Grade 3 (n=6) and Grade 4 (n=14).Parotid peripheral ducts of control group and non-SS group were unexpanded , while bilaterally expanded parotid peripheral ducts were shown in SS patients.The grading of 42 parotid glands by expansion degree of parotid duct , Grade 0 was rated in 12, Grade 1 in 8, Grade 2 in 10, Grade 3 in 5, and Grade 4 in 7.Standard deviation of T1WI signal intensity of parotid glands among SS group , non-SS group and control group were 124.1 ±30.0, 81.8 ±27.6, and 86.3 ±35.0 respectively;and standard deviation of T 2 WI signal intensity were 115.1 ±35.2, 69.8 ±23.5, and 80.1 ±31.4 respectively; the standard deviation of T 1 WI and T2 WI signal intensity of SS group was higher than both non-SS group and control group′s ( F value =13.780 and 13.301, respectively, P 0.05).Among 42 parotid glands with SS, conventional MRI and MRS showed parotid gland lesions in 40 and 30 respectively , and the difference was statistically significant (χ2 =13.04, P=0.013).There was no false positive result.The combination of the two methods detected all 42 lesions.The consistency of detecting parotid abnormalities with SS between conventional MRI and MRS was poor (Kappa=0.12, P=0.092).Conclusions Diffuse fatty infiltration on conventional MRI and diffuse peripheral duct dilatation on MRS in the parotid gland are characteristic features of SS , and conventional MRI could be used as the preferred technique for the SS.combination with MRS may improve diagnostic accuracy. Key words: Sj?gren′s syndrome ; Parotid gland ; Magnetic resonance imaging ; Sialography ;

Catheterization of post-traumatic parotid duct sialocele

IntroductionParotid duct sialocele is a salivary cavity arising at the expense of the parotid duct. Many cases of parotid sialocele have been published, but very few cases of parotid duct sialocele have been reported. Case reportWe report a case of post-traumatic parotid duct sialocele that was assessed by MR sialography. The parotid duct was catheterized via the oral cavity and the catheter was left in place for ten days. No recurrence was observed. DiscussionPublished cases of parotid duct sialocele are rare, as only seven cases were identified in the literature. Several treatment options are available for sialocele involving the parotid gland or parotid duct. Subcutaneous injection of botulinum toxin is commonly used, with good results. Parotid duct catheterization has also been reported, mainly for parotid gland sialoceles. To the best of our knowledge, apart from the present case, the use of this technique for parotid duct sialocele has only been reported once before. This technique is minimally invasive, with very low morbidity and good results.

Magnetic Resonance Sialography Findings of Submandibular Ducts Imaging

Purpose. We aimed to assess the problem solving capability of magnetic resonance sialography (MR sialography), a noninvasive method for imaging submandibular gland ducts and determining duct-related pathologies, by comparing diseased and healthy cases. Materials and Methods. We conducted radiological assessment on a total of 60 submandibular glands (mean age 44.7) in 20 cases and 10 volunteers. MR sialography examinations were conducted with single-shot fast spin-echo sequence by using a surface coil placed on the submandibular gland. Each gland was evaluated in terms of the length, width and stricture of the main duct, as well as the difference between the intraparenchymal duct width, and the main duct width. Statistical analysis was performed. Results. In the MR sialography the primary duct mean length was determined as 51 mm (40–57 mm) in all submandibular glands. On the MR sialography imaging, the visualization ratio of the ductal system of submandibular gland was evaluated in the cases and volunteers. Conclusion. MR sialography is an effective and a noninvasive method in imaging submandibular gland ducts, demonstrating the presence, location and degree of stricture/dilatation, and elucidating the disease etiology.

Diagnostic accuracy of MR sialography in sialolithiasis and salivary ductal stenosis

ObjectivesThe purpose of this study is to determine the diagnostic accuracy of MR sialography in the examination of patients with salivary duct disease. Patients and methodsTwenty-eight patients (twenty males and eight females, average age, 47years), with symptoms related to the salivary glands, underwent both conventional sialography and MR sialography. The latter was performed using heavily T2-weighted, two dimensional, fast spin-echo techniques and a neck coil. Contiguous 3-mm axial images with frequency-selective fat suppression were acquired through the symptomatic gland. The MR sialography findings were compared with the final diagnoses determined by conventional sialography, and with surgery in the case of those who underwent surgical intervention. Ultrasound examination was performed using 7.5MHz transducer. Conventional sialography was performed with the use of 0.012–0.021inch sialographic catheter and an injection of 0.3–1.5ml Ultravist 300mg/ml. ResultsFinal diagnosis included sialolithiasis in eleven cases, sialolithiasis and stenosis in four cases, stenosis without lithiasis in ten cases and normal salivary glands in three cases. (The normal cases were excluded from the study). ConclusionIt is concluded that MR sialography with a heavily T2-weighted sequence is highly successful in the noninvasive visualization of the ductal system of major salivary glands in cases that could not be examined by conventional sialogram. It is useful for diagnosing sialolithiasis and ductal stenosis. However, normal MR sialographic findings do not allow the exclusion of small calculi. Thus in patients with strong clinical suspicion of calculi and normal MR sialographic findings, conventional sialography should still be performed.

Does MR Sialography Have A Greater Diagnostic Accuracy Than Conventional X-Ray And Digital Subtraction Sialography In Detecting Salivary Glands Disease? A Literature Review

Aim: The main aim was to determine the diagnostic accuracy of MR Sialography as compared to conventional x-ray and digital sialography in detecting salivary gland diseases on the basis of research evidences available in the literature. Description: It is noticed that almost all people develop illness of salivary glands at some stage of their lives. The major effects on salivary glands become evident as stones; infection tumors which may also involve related organs. Imaging methods like Ultrasound, Computed Tomography (CT) and Digital subtraction sialography (DSS) are used for assessment of parotid, sub-mandibular and sub-lingual glands in addition to conventional x-ray sialography which is marked as a gold standard for salivary glands assessment. Due to the non-invasive nature and level of comfort, MR Sialography is now being considered as an advanced technique for the detection of stones and tumor spread in the soft tissues with no risk of radiation exposure. Methods and Results: Different databases which include Science direct, CINAHL, Ebesco Host, PubMed, Swetswise, Wiley Interscience, sage pub, and The Cochrane library were explored to get published literature. Total 10 studies were included and critically appraised under critical appraisal skills programme (CASP) tool. Conclusion: The review proposed that though the use of MRS as the only diagnostic examination is useful but X-ray sialography remains the standard investigation tool due to its higher spatial resolution. MRS can be utilized as an alternative imaging technique by using special MR sequences such as 3D CISS and RARE where x-ray sialography cannot be performed. DOI: http://dx.doi.org/10.3126/njr.v1i1.6329 Nepalese Journal of Radiology Vol.1(1): 70-77

Nowe spojrzenie na klasyfikację przewlekłego zapalenia dużych gruczołów ślinowych i algorytm postępowania

Approximately 5% of patients visit the ENT doctors with major salivary gland complaints. Chronic sialadenitis is one of the major disorders that can cause salivary hypofunction and correct diagnosis and management is essential for its recovery. The classification of this pathological condition have changed in the past eight decades and nowadays was revised and modified, for new diagnostic (high resolution ultrasonography, CT and MR sialography and sonoelastography) and therapeutic methods (sialoendoscopy) were introduced. was to revive the past classifications of chronic inflammatory diseases of the major salivary glands and present the current one with implications for diagnostic and treatment schedule. 20 patients with parotid and 44 with submandibular gland sialadenitis were treated in Otolaryngology, Head and Neck Surgery Department Poznań Medical University in the years 2007–2010. Two periods of time: 2007–8 and 2009–10 were compared, the turn point was December 2008, when sialoendoscopy was introduced. 25 out of 50 patients with parotid and 73 out of 95 with submandibular sialadenitis suffered from lithiasis. Surgical evacuation of the stone was performed in 10 cases in 2007–08, and in 4 between 2009 and 10. In this last period 94 sialoendoskopies was performed, in this number in case 38 submandibular and 7 parotid lithiasis. Stensens duct stenosis was diagnosed in 7 and Wharton duct in 12 patients. To conclude, authors underline that the prompt diagnosis is indispensible for the proper further treatment. The recommended treatment of chronic and obstructive sialadenitis obtains the novel technique, sialoendoscopy.