Salivary Obstruction Research Articles

Comparison of Chronic Sialadenitis Symptom Burden in Patients With Sialolithiasis Versus Stenosis Before and After Sialendoscopy.

To define symptomatology and responses to treatment in chronic sialadenitis from sialolithiasis versus duct stenosis and establish a minimal clinically significant difference (MCID) in the validated Obstructive Salivary Problem Impact Test (SPIT). Prospective, cohort. Tertiary-care center. Patients completed the SPIT questionnaire at presentation and 3 to 6 months after surgery. SPIT scores and domains were compared between patients with symptomatic sialolithiasis and those with stenosis of a major salivary gland. Seventy-ninepatients completed the SPIT, including 43 (54%) with sialolithiasis and 36 (46%) with stenosis. Stenosis patients displayed greater baseline scores compared to sialolithiasis patients (45.4 ± 19.9 vs 33.3 ± 18.5, P < .013). Frequency and severity of gland swelling and pain (21.9 ± 8.9 vs17.1 ± 9.6, P = .02) and functional/psychosocial impact subscores were greater in the stenosis versussialolithiasis groups (18.0 ± 10.9 vs11.3 ± 9.4, P < .01). For 43 patients who underwent surgical intervention, SPIT scores improved at 3 to 6 months postoperatively in all domains (-18.6 ± 19.4, P < .01). Degree of improvement did not differ between sialolithiasis versusstenosis groups (-22.0 ± 20.9 vs-13.3 ± 15.8, P = .13). The MCID in SPIT score was found to be -13 points. A postoperative SPIT score of less than 10 suggested symptom resolution. When compared to sialolithiasis, chronic salivary obstruction from stenosis is associated with greater baseline SPIT scores, indicating poorer sialadenitis-related quality of life due to greater symptom frequency and functional impact. Based on SPIT survey outcomes, a score decrease of 13 points or SPIT score <10 represent significant symptom improvement.

Quality of life after sialendoscopy: prospective non-randomized study

BackgroundThe symptomatic (swelling and pain) salivary gland obstructions are caused by sialolithiasis and salivary duct stenosis, negatively affecting quality of life (QOL), with almost all candidates for clinical measures and minimally invasive sialendoscopy. The impact of sialendoscopy treatment on the QOL has been little addressed nowadays. The objective is to prospectively evaluate the impact of sialendoscopy on the quality of life of patients undergoing sialendoscopy due to benign salivary obstructive diseases, measured through QOL questionnaires of xerostomia degree, the oral health impact profile and post sialendoscopy satisfaction questionnaires.Result37 sialendoscopies were included, most young female; there were 64.5% sialolithiasis and 35.4% post-radioiodine; with 4.5 times/week painful swelling symptoms and 23.5 months symptom duration. The pre- and post-sialendoscopy VAS values were: 7.42 to 1.29 (p < 0.001); 86.5% and 89.2% were subjected to sialendoscopy alone and endoscopic dilatation respectively; 80.6% reported improved symptoms after sialendoscopy in the sialolithiasis clinic (p < 0.001). The physical pain and psychological discomfort domain scores were mostly impacted where sialendoscopy provided relief and improvement (p < 0.001). We found a positive correlation between sialendoscopy and obstructive stone disease (p < 0.001) and no correlation in sialendoscopy satisfaction in xerostomia patients (p = 0.009).ConclusionsWe found improved symptoms with overall good satisfaction after sialendoscopy correlated with stones; and a negative correlation between xerostomia. Our findings support the evident indication of sialendoscopy for obstructive sialolithiasis with a positive impact on QOL and probably a relative time-dependent indication for stenosis/other xerostomia causes that little improved QOL satisfaction.Level of evidence2b—Prospective non-randomized study.Trial registration: WHO Universal Trial Number (UTN): U1111-1247-7028; Brazilian Clinical Trials Registry (ReBeC): RBR-6p8zfs.

Botulinum toxin for chronic parotid sialadenitis: A case series and systematic review.

ObjectiveTo evaluate salivary gland chemodenervation with botulinum toxin in chronic parotid sialadenitis.MethodsPatients who underwent parotid gland chemodenervation for chronic sialadenitis due to duct stenosis refractory to siaendoscopy were reviewed (case series). Additionally, a systematic review of the literature on botulinum toxin injection for chronic parotid sialadenitis was performed. Inclusion criteria included studies containing original data on botulinum toxin injections in patients with chronic sialadenitis symptoms.ResultsSialadenitis symptoms from 10 patients with 13 affected parotid glands were examined. All had duct stenosis diagnosed on sialendoscopy, refractory sialadenitis symptoms, and received parotid onabotulinum toxin injection(s) (median dose 65U). Of patients with 3‐month follow‐up, 78% reported significant improvement in symptoms. Mean Chronic Obstructive Sialadenitis Symptoms (COSS) Score improved at 3 months post‐injection (47‐25.9, P = .039) with significant reduction in gland pain frequency and gland swelling severity. No patients had a facial nerve paralysis or increased xerostomia. With the systematic review, 518 abstracts were reviewed and 11 studies met inclusion criteria and included case series or case reports with a total of 40 patients treated with botulinum toxin for chronic parotitis. Thirty‐four out of a total of 35 patients in the studies (97%) reported complete (9, 26%) or partial (25, 71%) improvement in sialadenitis symptoms with minimal complications.ConclusionParotid gland chemodenervation with botulinum toxin is a minimally invasive treatment option for symptomatic chronic sialadenitis refractory to medical treatment or sialendoscopy. Botulinum toxin injections alleviate gland pain and swelling associated with salivary obstruction and provide an alternative to parotidectomy for recurrent sialadenitis.Level of evidence: 4.

Clinical Entities that Mimic Salivary Inflammatory Disease

Sialadenitis due to salivary obstruction is associated with characteristic intermittent pain and swelling of the affected gland. Common etiologies of adult salivary obstruction include salivary duct stones or duct stenosis. However, various pathologic processes can mimic obstructive salivary gland symptoms. This is a case-based review of pathologies that may present similar to the signs and symptoms of salivary obstruction with gland inflammation. Multiple cases with pathologies mimicking inflammatory salivary gland disease have been reported and described. This review uses a case-based approach to highlight the clinical presentation, exam, and imaging findings of disorders that imitate sialadenitis in order to describe approaches for achieving accurate diagnoses. Cases involving nonobstructive salivary pathology are presented to demonstrate a broad differential diagnosis for facial and salivary gland swelling.

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.

Advances in imaging of obstructed salivary glands can improve diagnostic outcomes

Obstruction of the major salivary glands is a relatively common condition defined as the blockage of the salivary outflow in the glandular ductal system. It can however mimic more aggressive pathology. The most common cause of salivary obstruction is sialolithiasis, followed by ductal strictures. Salivary obstruction is clinically characterized by a food-related painful swelling of the affected gland, known as 'mealtime syndrome'. When obstruction is clinically suspected, the role of imaging consists of confirming the obstruction, identifying its cause, evaluating the position and extent of the obstruction and evaluating for associated complications. However, if imaging shows up signs of a tumour or other pathology which can mimic an obstructed gland clinically instead, the radiologist can alert the clinician accordingly to change the course and plan of treatment. Several imaging techniques are available for investigating the obstructed salivary glands. This review looks at the causes of obstruction and the use, diagnostic performance and practicality of the various imaging modalities. Importantly, an imaging approach algorithm for the evaluation of the obstructed salivary gland is also proposed.

Sialographie 3D en cone beam : étude préliminaire

Stones, stenosis and inflammatory lesions are the main causes of mealtime syndrome. The aim of paraclinical exam is to find the cause of these obstructive symptoms. Ultrasound is often sufficient to confirm the lithiasic origin of salivary gland swelling. Non-lithiasic salivary obstructions are more difficult to diagnose. We studied the feasibility and quality of a new medical imaging device: three-dimensional (3D) sialography using the technique of cone beam with flat panel (CPCT). Five patients were included, referred for diagnostic management of non-lithiasic salivary gland parotid colic. It was performed for each patient in the angiography room, conventional sialography and 3D CPCT. Images were compared to conventional sialography. None of catheterization failure or side effects were observed in five patients. 3D CPCT sialography enabled to view gland ducts until their fifth or sixth division. Compared to conventional sialography, 3D CPCT improves signal and contrast to noise ratio. This technique allows an anatomic resolution and signal/noise ratio unmatched. It also allows to reduce metallics artefacts. Its main drawback is those associated with ductal catheterization, exposure to ionizing radiation and potential allergy to iodinated contrast agents.

Diagnosis and Minimally Invasive Treatment of Salivary Gland Obstruction

Salivary obstruction is usually due to either calculi or strictures. These may be diagnosed using a combination of sialography and high resolution ultrasound. Minimally invasive techniques such as fluoroscopy guided basket retrieval of calculi or balloon dilation of strictures are successful techniques and may be carried out in a general hospital setting. These techniques may be developed for use under ultrasound guidance.

Salivary duct strictures: nature and incidence in benign salivary obstruction

The aim of this study was to establish the incidence and character of salivary duct strictures by carrying out a 10 year retrospective review. Salivary gland obstruction is most commonly caused either by salivary calculi or duct strictures. These strictures or stenoses develop secondarily to inflammation in the duct wall and may be single or multiple. All reports of sialographic examinations performed on patients referred to the Dental Radiology Department in a London Dental Hospital between 1995 and 2004 were reviewed and those patients with symptoms of salivary obstruction identified. In total, 1362 sialograms using the conventional hand injection technique with water-soluble contrast media were performed on 1349 patients with obstructive symptoms during the 10-year period. Of the 1362 sialograms performed, the reports revealed that 877 (64.4%) showed evidence of benign intraductal obstruction. The remaining 485 (35.6%) were normal. 642 of the cases (73.2%) revealing obstruction were reported to be due to salivary calculi, 198 due to duct strictures (22.6%) and the remaining 37 (4.2%) were considered to be due to mucous plugs. Detailed analysis of the patients with strictures showed they were more common in women with a mean age of 52 years. Single strictures were evident in 66.7% of cases while 33.3% showed multiple stenoses. Strictures were more common in the parotid duct (75.3%). 7% of patients presented with bilateral stenoses. This is the largest review of duct strictures to be reported. It has shown that ductal stricture formation accounts for almost 25% of cases of benign salivary obstruction and appears to have been an under-recognized condition. Strictures more commonly affect parotid ducts and are typically found in the fourth, fifth or sixth decades, particularly in women.

Chorda tympani neurectomy--a new approach to submandibular salivary obstruction.

Abstract Fifteen cases of chorda tympani neurectomy for the treatment of submandibular salivary gland obstruction have been under detailed observation for a minimum of 3 years. Complete relief of symptoms has been obtained in all the cases and there have been no significant complications. The operation is indicated in all cases hitherto regarded as requiring surgical extirpation of the gland, with the very rare exception of neoplasia.

Reconstruction of the Palate Following Removal of Palatal Salivary Gland Tumors

take miniaturized baskets and forceps for retrieval of stones under direct vision. To complement these developments new surgical techniques have been developed to retrieve stones by leaving a functioning gland intact. Used in combination these techniques can reliably relieve obstruction of salivary glands by stone or stricture and provide an alternative to gland excision for obstructive disease. Experience with gland preserving techniques in a series of 455 patients indicates that in at least 76% of cases stones and obstructions can be eradicated and only 2% of patients required gland removal. This is a radical deviation from current practice. A further advantage is that many of the techniques used in this series can be performed under local anesthetic or on an outpatient basis with low morbidity. The intra-oral removal of submandibular stones can also be undertaken under local anesthetic for appropriate patients but most stones are retrieved on a day case basis under general anesthetic. The scintigraphy results suggest that although gland function improves following treatment it does not return to normal values. However there is accumulating data to show significant gland regeneration following obstruction and with a medium follow-up of 4 years there is no evidence that patients are developing chronic sialoadenitis. Our results as well as others suggest that the optimum management of salivary obstruction should focus on gland preserving techniques.

Diagnosing, managing, and preventing salivary gland disorders.

Salivary function provides host protection, assists in the initiation of food and fluid intake, and enables communication through speech. Without adequate salivary output, oral and pharyngeal health declines along with a person’s quality of life. The complaint of a dry mouth (xerostomia) and the objective finding of salivary dysfunction are common occurrences in older individuals, producing transient and permanent oral and systemic problems. Salivary dysfunction, however, is not a normal consequence of growing older, and is due to systemic diseases, medications, and head and neck radiotherapy. Diagnosis of salivary disorders begins with a careful medical history, head, and neck examination. While complaints of xerostomia may be indicative of a salivary gland disorder, salivary diseases can present without symptoms. Therefore, routine examination of salivary function must be part of any head, neck, and oral examination. Therapies are designed to prevent the development of oral and pharyngeal sequelae of salivary hypofunction. Current xerostomia-based treatments include replacement therapies and gustatory, masticatory, and pharmacological stimulants. Healthcare professionals can play a vital role in identifying patients at risk for developing salivary dysfunction, and should provide appropriate preventative and interventive techniques that will help preserve a person’s health, function, and quality of life.