Salivary Endoscopy Research Articles

1203 Sialendoscopy In Non-Stone Sialadenitis Is an Effective Therapeutic Approach

Abstract Introduction The aim of this retrospective case series was to investigate the therapeutic effectiveness of salivary endoscopy for non-stone related sialadenitis and obstructive symptoms. Method The records of 46 patients who underwent salivary endoscopy between September 2018 and December 2019 were reviewed. Included cases presented with at least one symptomatic major salivary gland, with no history or evidence of stone disease on clinical or radiologic examinations. Results A total of 22 patients (48%) and 26 glands were identified. These patients had a mean age of 50.8 years (range 27–74) and 73% were female. Most cases (19/26) involved the parotid gland. The primary imaging modality used was ultrasound, with sialography reserved for suspected strictures. The most common sonographic finding was ductal dilation (50%). Dexamethasone was instilled at completion of sialendoscopy in 23/26 cases. Outcomes included symptomatic improvement in 15/18 patients (4 patients have follow-up pending) with 5/15 experiencing complete symptom resolution. 2/18 patients did not have any symptomatic improvement, and 1/18 experienced acute infection that was treated with antibiotics. No patients required gland excision. Conclusions Salivary endoscopy is a minimally invasive and effective treatment for patients with non-stone sialadenitis that is refractory to conservative measures. Our review demonstrated 83% therapeutic benefit with gland preservation in all patients.

1341 Outcomes of Sialendoscopic Stone Retrieval Under Local Anaesthesia in The Outpatient Setting- A Single Surgeon’s Experience

Abstract Aim The aim of this retrospective case series was to investigate the success rate of sialendoscopic stone retrieval under local anaesthetic. Method The records of 52 patients who underwent salivary endoscopy between September 2018 and February 2020 were reviewed. Included cases presented with at least one symptomatic major salivary gland, and sonographic or radiographic evidence of stone disease. Results A total of 25 patients (48%) and 27 stones were identified. Most cases (19/25) involved the submandibular gland, with a virtually even division between left and right sides. 19/25 patients underwent stone retrieval under local anaesthetic (LA) in the first instance (two of these patients had two stones). 6/25 patients underwent stone retrieval under general anaesthetic (GA) in the first instance, and this was successful in 5/6 cases. The overall success rate of LA sialendoscopic stone retrieval was 18/21 (86%), with 14/21 stones (66%) being successfully removed at the first treatment session and a further four at the subsequent treatment session. Under LA, 13/18 stones were removed intact, while the remaining 5 underwent fragmentation with an intraoral salivary pneumatic lithotripter (Cook Medical). Conclusions Sialendoscopic stone retrieval is a minimally invasive and effective treatment for both submandibular and parotid duct stones. It is possible to remove most stones under local anaesthetic at the first treatment session, using intraoral lithotripsy as an adjunct when indicated. This treatment modality provides therapeutic benefit with 86% success of stone retrieval under local anaesthetic with gland preservation in the vast majority of patients.

1196 Sonographic Assessment Versus Direct Clinical Measurement of Sialolith Size and Its Influence on Modality of Endoscopic Removal

Abstract Aim The aim of this retrospective case series was to investigate the influence of sialolith size on the potential for endoscopic stone removal. Method The records of 52 patients who underwent salivary endoscopy between September 2018 and February 2020 were reviewed. Included cases presented with at least one symptomatic major salivary gland, and sonographic or radiographic evidence of stone disease. Results A total of 25 patients (48%) and 27 stones were identified. These patients had a mean age of 45.2 years (range 16–72); 52% were female. Most cases (19/25) involved the submandibular gland, with a virtually even division between left and right sides. The overall success rate of sialendoscopic retrieval was 23/27 (85%), with 17/27 stones removed intact and 6/27 undergoing fragmentation with an intraoral salivary pneumatic lithotripter (Cook Medical). Median (sonographic) stone size in the largest dimension for those stones removed intact was 4mm (range 3-12mm), while for those undergoing fragmentation it was 7mm (range 3-11mm). Ultrasound provided an accurate assessment of stone size in most cases, but underestimated diameter by an average of 1mm in 6/27 cases, and overestimated size by 1mm in a single case. Conclusions Sialendoscopic stone retrieval is a minimally invasive and effective treatment for sialolithiasis. It is possible to remove most stones using a basket, with intraoral lithotripsy employed for larger stones. Ultrasound is a reliable diagnostic tool for predicting stone size but may underestimate size in a small proportion of cases.

Radioiodine therapy induced sialadenitis versus chronic idiopathic sialadenitis-Presentation and outcomes.

This study explores the unique characters of high dose radioactive iodine (RAI) induced chronic sialadenitis. A retrospective study of patients having received salivary endoscopy and followed in our outpatient clinic. A total of 100 patients met the inclusion criteria, 75 were diagnosed with chronic idiopathic sialoadenitis and 25 with radio-iodine induced sialoadenitis (RIS). The main complaint in both groups was swelling of the parotid gland. Pain, dysphagia, and xerostomia were observed considerably more in the RIS group. During sialo-endoscopy, fibrosis of the Stensen's duct was more common in the RIS group (p=0.003). RIS patients group generally managed better with interventional endoscopic treatment alone (80% vs. 46%). RIS patients have distinct clinical characteristics. There may be a collateral muscular damage to the masticatory muscles. Fibrosis and parenchymal damage are major findings during sialendoscopy. Sialendoscopy is a safe and efficient treatment for RAI induced sialadenitis.

Study of Evaluation of Symptoms of Juvenile Recurrent Parotitis Prior to and After Sialendoscopy

Background: Juvenile recurrent parotitis(JRP) causes recurrent pain and swelling of one or both parotid glands in children. They are subjected to repeated courses of antibiotics and analgesics for this condition. Though self- limiting, some may progress to chronic parotitis which in some instances result in parotidectomy later on. But it does affect quality of life of the child with poor feeding during attacks and school absenteeism. Among various therapies, steroid lavage under endoscopic visualisation of the parotid salivary duct system has become popular after the advent of sialendoscopy. There are few studies comparing the response to conservative measures and salivary endoscopy. Objective: To evaluate the efficacy of sialendoscopy over medical management in JRP. Methodology: Twenty two patients of JRP between the age group 3 to 18 years were enrolled in this study. This retrospectively analysed the frequency of pain and parotid swelling after sialendoscopy. The results were compared to their pre intervention status when they were on medical management. Sialendoscopic management was offered only to those patients under medical treatment with symptoms of two or more attacks in 6 months. Results: Conservative measures as well as salivary endoscopy had good results, but latter fared better with regard to pain score and long remission. Majority were asymptomatic and the symptomatic patients experienced less pain with longer remission between attacks. Conclusion: Sialendoscopic visualisation and lavage seems to be a promising tool in the management of JRP. It appears that it contains the inflammatory process better and may prevent the progression to chronic parotitis.

Sialendoscopy for non-stone disorders: The current evidence.

ObjectiveReview the current literature on the use of sialendoscopy in the treatment of non‐stone disorders of the major salivary glands.Data SourcesEligible articles that reported on the use of sialendoscopy in the treatment of non‐stone disorders were identified using MEDLINE, Embase, and Google Scholar through May 2016. The search used key words sialendoscopy, salivary endoscopy, salivary scope, salivary duct stenosis, salivary duct stricture, Sjogren's disease, radioiodine sialadenitis, salivary duct obstruction, sialadenitis, chronic sialadenitis, juvenile recurrent parotitis, parotitis, and radiation sialadenitis.Review MethodsFull‐length prospective and retrospective original articles; systemic reviews; and meta‐analysis, including adults and children with adequate data for evaluating the sialendoscopy for non‐stone disorders, were included. Individual case reports were excluded.ResultsThere is an increasing trend for the use of sialendoscopy for salivary obstruction caused by a wide variety of non‐stone disorders worldwide. The studies of sialendoscopy for non‐stone disorders are often retrospective, of smaller sample size, and more subjective in measurement of patient outcome. The most common indications currently for the procedure are scars, juvenile recurrent parotitis, radioiodine sialadenitis, and Sjögren syndrome, respectively.ConclusionAlthough the initial evidence for the use of sialendoscopy for non‐stone disorders is not as established as that for stones, it remains a promising gland‐preserving tool in the management of non‐stone disorders of major salivary glands.

Epidural Tube: A Useful Device in Sialendoscopy Operations

Salivary endoscopy, which was first described in 1991, is a safe technique with few complications. The sialendoscopy operation has been developed and successfully offered as a minimally invasive and gland-preserving approach for the treatment of chronic obstructive sialadenitis. For many surgeons, entering the duct lumen of the salivary gland is the most difficult and time-consuming step of the sialendoscopy operation. This report introduces a timesaving and straightforward method for entering the duct lumen using an epidural tube, which is a plastic tube with a blunt tip.

Outcomes of Holmium Laser–Assisted Lithotripsy with Sialendoscopy in Treatment of Sialolithiasis

The purpose of the current study was to compare outcomes and complication rates of sialolithiasis treated with intracorporeal holmium laser lithotripsy in conjunction with salivary endoscopy with those treated with simple basket retrieval or a combined endoscopic/open procedure. Case-comparison study. Tertiary hospital. Review of prospectively collected data of patients who underwent treatment for sialolithiasis by the senior author during 2011 to 2013. Patient demographics, operative techniques, surgical findings, clinical outcomes, and complications were recorded. Additional information regarding symptoms and satisfaction with treatment was obtained via standardized telephone questionnaire at the time of the data analysis. Thirty-one patients were treated for sialolithiasis. Sialoliths averaged 5.9 mm in size (range, 2-20 mm) and were comparable between both groups. Sixty-eight percent were in the submandibular gland (n = 21), with the remaining 32% in the parotid gland (n = 10). Fifty-two percent of patients (n = 16) were treated endoscopically with intracorporeal holmium laser lithotripsy, while the remaining 48% (n = 15) were treated with salivary endoscopy techniques other than laser lithotripsy. Successful stone removal without additional maneuvers occurred in 81% of the laser cases and 93% of the nonlaser group. Patients in the laser group reported an average improvement of symptoms of 95% compared with 90% of the nonlaser group when adjusted for outliers. Complications in all patients included ductal stenosis (n = 2) and salivary fistula (n = 1). The results of our series show favorable results with the use of intracorporeal holmium laser lithotripsy for the endoscopic management of sialolithiasis with minimal adverse events.

Juvenile recurrent parotitis: A retrospective comparison of sialendoscopy versus conservative therapy

There are several therapeutic approaches to treat juvenile recurrent parotitis. The aim of this study was to compare sialendoscopy, including prophylactic cortisone irrigation, with observation and a conservative approach of antibiotic therapy alone. Retrospective study, tertiary clinical center. The charts of patients treated for juvenile recurrent parotitis between November 2004 and June 2011 were reviewed. Initial acute flares were always treated with a course of antibiotics. Subsequent treatment consisted of either salivary gland endoscopy including cortisone irrigation or additional pure antibiotic therapy. Patients treated with salivary endoscopy were compared to patients treated with antibiotics alone with regard to the number of inflammatory episodes and pain intensity pre- and posttreatment. Thirty-six patients were treated during the period of study, 15 with salivary endoscopy with cortisone irrigation and 21 with antibiotic therapy alone. A significant reduction in recurrent episodes and pain intensity following therapy was found in both groups. With respect to these two outcomes, the comparison showed two therapeutic options of equal merit. Salivary gland endoscopy is an option in the management of juvenile recurrent parotitis that helps in confirming the diagnosis and that also provides therapeutic intervention. However, although there are further advantages, the definitive value of salivary gland endoscopy requires ongoing evaluation in further prospective studies. 4.

Salivary endoscopy for idiopathic chronic sialadenitis

To describe the findings and therapeutic role of salivary endoscopy for idiopathic chronic sialadenitis. Retrospective case series. The records of 258 patients who underwent salivary endoscopy between November 2008 and May 2012 were reviewed. Included cases presented with recurrent inflammation and swelling of a single major salivary gland, without identifiable etiology on examination and imaging. A total of 51 cases (20%) were identified. These patients had a mean age of 54.4 years (range, 23-75) and 57% were female. Mean duration of symptoms was 22.8 months (range, 1-102), with most cases (75%) involving the parotid gland. The primary imaging modalities used were ultrasound (62%) and computed tomography (31%). The most common findings on imaging included ductal dilation (42%), enlarged lymph nodes (23%), normal glandular imaging (15%), and possible sialoliths (14%). The most common findings on salivary endoscopy included stenosis (57%), strictures (27%), and inflammatory debris (18%). Occult stones were the cause of sialadenitis in only 4 (8%) cases. Outcomes included complete symptom resolution in 31 patients (61%), improved but occasional symptoms in 14 patients (27%), and no improvement in 6 patients (12%) after a mean follow-up time of 20.0 months (range, 4-45). Excision of the involved gland was required in 2 (4%) patients. Salivary endoscopy is a minimally invasive technique that is effective in the management of idiopathic chronic sialadenitis refractory to medical therapy. It provides diagnostic information in most patients and offers a therapeutic intervention with gland preservation.

Salivary endoscopy in a pediatric patient with HLA-B27 seropositivity and recurrent submandibular sialadenitis

Patients with human leukocyte antigen (HLA)-B27 seropositivity have a genetic predisposition to form spondyloarthropathies, especially ankylosing spondylitis. Other related inflammatory or autoimmune disorders include reactive arthritis, uveitis, psoriatic arthritis, and Crohn's disease. Although juvenile recurrent parotitis is not uncommon, recurrent submandibular sialadenitis is rare in pediatric patients. Sialadenitis is typically caused by salivary stones, infection, or duct stricture. To our knowledge, there has not been report of HLA-B27 positivity and recurrent sialadenitis described previously. We describe a patient with HLA-B27 seropositivity and multiple episodes of left submandibular sialadenitis who underwent diagnostic and therapeutic sialendoscopy. Previous treatment included antibiotics, sialogogues, warm compresses, and hydration before he underwent definitive sialendoscopy treatment at a tertiary care medical center. Salivary endoscopy showed salivary stasis and sludging within the left submandibular gland duct, with no salivary stones. Topical steroid was applied to the duct. At one year following his surgery, he has not had any recurrent episodes of sialadenitis. HLA-B27 seropositivity is associated with many inflammatory disorders; we report a case in which the patient had coexisting recurrent sialadenitis. In the pediatric population, sialadenitis is traditionally managed with antibiotics and supportive care, however our patient underwent salivary endoscopy. Sialendoscopy is an emerging modality that potentially avoids radiation exposure from CT or sialography and should be considered as another preferred treatment option. More investigation is required to prove a possible correlation between existing HLA-B27 and the propensity to develop this clinical problem.

Endoscopic-Assisted Gland-Preserving Therapy for Chronic Sialadenitis<subtitle>A German and US Comparison</subtitle>

To determine whether unique patterns of care are evolving in the United States compared with Germany in endoscopic management of chronic sialadenitis. Comparison of consecutive series of patients. Academic tertiary salivary referral centers in Germany and the United States. A total of 446 patients having chronic sialadenitis treated with salivary endoscopy. To compare practice patterns and outcomes at each location, databases tracking patients having chronic sialadenitis treated with salivary endoscopy were searched for the following variables: age, sex, involved gland, radiographic studies, endoscopic findings, endoscopic-related complications, gland preservation rate, patient symptom control, and techniques for managing salivary stones and intraductal scar tissue. Significantly more patients in the US cohort had chronic sialadenitis of the parotid gland (P = .03) and multiple gland involvement (P < .001). Salivary endoscopy was regularly performed using local anesthesia in Germany and using general anesthesia in the United States (P < .001). Endoscopic-related complication rates were higher (10.9% vs 1.6%) and gland preservation rates lower (85.9% vs 98.4%) among US patients; however, patients with intact glands demonstrated similar rates of symptom control at both centers (92.7% in the United States vs 85.3% in Germany) at the last follow-up visit. The lower rate of gland preservation in the United States is largely because of lack of access to lithotripsy for larger salivary stones. Different patterns of care are emerging in the endoscopic management of chronic sialadenitis in the United States compared with Germany, where these techniques were largely developed. Nevertheless, patients with chronic sialadenitis at both locations who undergo endoscopic gland-preserving therapy have high rates of gland preservation and symptom control.

Endoscopic‐assisted management of chronic sialadenitis

Chronic sialadenitis is a relatively common disorder that is frequently referred to head and neck surgeons for diagnosis and management. The management of the disorder is rapidly evolving with the introduction of salivary endoscopy. The purpose of the present study was a review of the indications and techniques of endoscopic-assisted management of chronic sialadenitis at a single U.S. institution. This study is a retrospective case series of patients undergoing salivary endoscopy for chronic sialadenitis. Patient clinical information was reviewed to determine endoscopic findings, associated procedures, complications, rate of gland preservation, and early symptom control. A total of 51 patients underwent endoscopic-assisted salivary surgery over a 24-month period. Treatment indications included sialadenitis of unclear etiology (49%), sialadenitis with sialolithiasis (47%), and Sjögren syndrome (4%). Findings included obstructive stricture formation in 22 patients (43%). Associated procedures included sialodochoplasty (41%), steroid infusion (39%), and ductal stenting (8%). Gland preservation was achieved in 40 patients (78%). Of those who were treated with endoscopic-assisted techniques alone, 38 patients (84%) had symptomatic improvement whereas 7 patients (16%) did not improve. Minor complications were observed in 12% of the patients. Endoscopic-assisted management of chronic sialadenitis is both safe and effective and allows gland preservation with symptom control in the majority of patients.

Obstructive Parotitis Secondary to Masseter Muscle Hypertrophy

Results: Three female patients presented with symptoms consistent with obstructive parotitis, including glandular swelling and tenderness with meals and mastication. The 10year-old patient had unilateral facial swelling with mass formation within the masseter muscle and mandible on imaging studies. An acute kinking Stenson’s duct secondary to mass effect could be visualized on salivary endoscopy. The patient’s parotid swelling resolved following debulking of the masseteric space mass that was consistent with fibrous dysplasia on pathological examination. Two patients, ages 49 and 51 years, with bilateral parotid involvement had bilateral masseteric hypertrophy confirmed by imaging and dental wear facets consistent with bruxism on physical examination. Both patients had bilateral kinking of distal Stenson’s duct during jaw closure when visualized with salivary endoscopy. Both patients’ symptoms improved significantly following ultrasound-guided Botox injection of the masseter and nightly use of a bite guard.

Management of giant sialoliths: Review of the literature and preliminary experience with interventional sialendoscopy

To report our experience with management of giant salivary stones via a combined approach technique using salivary endoscopy (CA) and results of a review of current literature related to giant salivary stones. Retrospective case series. An institutional review board-approved chart review was performed on patients managed with a CA to treat giant salivary stones (≥15 mm). In addition, we reviewed the English literature from 1942 to 2009. Table 1 consists of 54 stones; 47 of which were identified during the review of literature and 7 from our case series. Of those 47 stones, 23 were hilar in location, 23 were glandular in location, and 1 stone was missing data. The gland preservation rate in the 47 reported stones was 57% (17/30). Among patients where gland resection was reported, the majority of the patients (12/13) had hilar glandular stones. Only one patient with a ductal stone had a gland resection. In our series, CA enabled a gland preservation rate of 86% (6/7). Among these patients, stone location was hilar glandular in six (86%) and ductal in one (14%). The mean size of stones from the literature review was 35 mm and from our series was 19 mm. Our review reflects current treatment recommendations for giant stones, i.e., transoral sialolithotomy for ductal stones and gland resection for hilar glandular stones. Our preliminary experience with CA for giant stones suggests improved gland preservation rates (86% vs. 57%) independent of stone location and with preservation of salivary function.

Salivary Endoscopy: For Beginners and Advanced Practitioners

Free accessAbstractFirst published online August 2010Salivary Endoscopy: For Beginners and Advanced PractitionersBarry Schaitkin, MD, moderator, Rohan Walvekar, MD, […], Ricardo Carrau, MD, Francis Marchal, MD, and Robert Irvine, MD, +2 -2Volume 143, Issue 2_supplhttps://doi.org/10.1016/j.otohns.2010.06.667

Giant Bilateral Submandibular Sialoliths and the Role of Salivary Endoscopy

Sialolithiasis is the most common disease of the salivary glands. Sialoliths that exceed 15 mm in any dimension are considered as giant. We present the first case of simultaneous bilateral giant sialoliths reported in the literature and the role of salivary endoscopy in this scenario. Salivary endoscopy allows duct exploration and retrieval of smaller intra-ductal fragments during combined approaches (external and endoscopic).

Bilateral giant submandibular sialoliths and the role for salivary endoscopy

Salivary stones larger than 15 mm are classified as giant sialoliths. They are uncommon in the practice of otolaryngology, and their management has always been a therapeutic challenge. Traditionally, when they cannot be retrieved by marsupialization, removal of the salivary gland has been advocated. Sialendoscopy and the recent development of combined endoscopic and external approaches for extraction of large stones with preservation of the major salivary glands are promising. We present the first case of simultaneous bilateral giant sialoliths, and the first report that associates giant sialoliths and the use of salivary endoscopy. In this case, both giant stones were removed with the assistance of a salivary endoscope and without removing the submandibular glands.

Salivary endoscopy: Advanced practice and controversies

Salivary endoscopy: Advanced practice and controversies