Use Of Sialendoscopy Research Articles

Juvenile Recurrent Parotitis: Video-Documented Sialendoscopy

Juvenile recurrent parotitis (JRP) is characterised by recurrent episodes of painful parotid swelling in children. JRP is the second most common cause of parotitis in childhood, behind only paramyxovirus. The prevention of recurrent attacks represents the most dramatic and serious aspect of this pathology. Since 2004, different authors have evaluated sialendoscopy for the diagnostic and therapeutic management of JRP. In this paper, we share our clinical experience of the use of sialendoscopy for the treatment of JRP. We document with video sialendoscopy the glandular pathology in four children with a mean age of 11.5 years, who had suffered from 3–6 episodes/year of inflammation prior to treatment. The use of sialendoscopy in our patients was effective in preventing recurrences. For the first time, the videosialendoscopy of a series of children diagnosed with JRP is documented in the literature.

Successful Intraductal Sialolithiasis Removal Using Sialendoscopy: A Case Report and Surgical Video Tips

Introduction: Sialolithiasis is major cause of the obstructive salivary gland disease, accounting for ~60% of all cases. Other etiologies include strictures, mucoid debris, anatomic ductal abnormalities, and scar tissue.1 About 80% to 95% of sialolithiasis cases occur in the submandibular gland, 5% to 20% in the parotid gland, and only 1% to 2% in the remaining glands. The treatment of the obstructive salivary gland has evolved in the past 25 years with the introduction of thin semiflexible endoscopes and microinstruments such as forceps, baskets, wires, lasers, and balloons. These advancements allow for sialendoscopy and other intraductal manipulations including stone removal, dilatation of strictures, and cleansing of mucus plugs.2 In addition, these procedures can be used in combination with minimally invasive external approaches.3 Sialendoscopy is the main option for effectively treating these obstructive conditions, leading to improvements in overall quality of life.4 The objective of the surgical video is to clarify the basic steps involved in effectively removing intraductal sialolithiasis. Materials and Methods: A 36-year-old man presented with complaints of pain, swelling, and difficulty swallowing during meals, in the right submandibular salivary gland area. The symptoms had been present for the past 2 years and had worsened progressively, with no improvements with analgesics. The patient had a history of drinking less water during the past 10 years, but otherwise had no remarkable medical history. During the neck clinical examination, the right submandibular gland was found to be smaller than the contralateral gland, and no atypical lymph nodes were detected. Intraoral examination revealed a palpable 8 mm sialolith in the right floor of the mouth, which caused a discharge of milky saliva on manipulation. The remaining mucosa appeared normal. A CT scan revealed a 9 mm elliptical sialolith in the middle third of the right submandibular duct, consistent with the clinical examination and suspicion of obstructive sialolithiasis. Laboratory tests were normal. As treatment, sialendoscopy was indicated. The procedure was conducted following the standards set by Marchal et al.5 The intervention was performed for both diagnostic and therapeutic interventions, using a semirigid modular sialendoscope (Karl Storz, Tuttlingen, Germany) with a diameter of 1.7 mm, along with working channel, salivary probes, conic dilatators, bougies, baskets for stones, dilatator balloons, and silastic stents to the main duct to maintain papilla patency.6 The sialolith was completely removed without any adverse events. Results: The patient recovered uneventfully postoperatively and was discharged the next day. Conclusion: Our findings support the use of sialendoscopy for obstructive sialolithiasis. Patients usually obtain a complete resolution of their clinical symptoms and the technology has a high success rate when performed by an experienced team. The patient who agreed to participate in the study has written and signed the informed consent statement. No competing financial interests exist. No funding was received for this article. Runtime of video: 4 mins 49 secs

Sialendoscopy for sialodocholithiasis following submandibular gland excision: six variations on a theme.

Sialendoscopy is a minimally invasive technique that facilitates the diagnosis and treatment of sialolithiasis. This case series presents the novel use of sialendoscopy to treat sialodocholithiasis in six patients with a non-functional or surgically absent submandibular gland by a single surgeon at the University of Pennsylvania Health System between March 2013 and December 2019. The four female and two male patients had a median age of 56 years and mean follow-up of 16.2 months (range 1–44.5). All stones were successfully removed using sialendoscopy, and in 5 patients a combined approach was utilized. All patients remain asymptomatic at last clinical follow-up. We conclude that sialendoscopy is a viable, minimally invasive method for managing sialodocholithiasis in patients with prior submandibular gland excision or atretic gland. It is also useful as an assistive tool when approaching complex transcervical or transoral procedures in previously instrumented patients.

Updated S2k AWMF guideline on obstructive sialadenitis

The update of this guideline was an important step to define standards for the use of sialendoscopy and other emerging minimally invasive techniques for the therapy of sialolithiasis and other obstructive salivary gland diseases. The current actualization was necessary to adapt the diagnostic and therapeutic algorithms to the current scientific knowledge. In this article they are presented in a shortened version with a focus on conservative therapeutic measures which are especially relevant for daily practice.

Sialendoscopy: A Four-Year Single Center Experience

Sialendoscopy is a relatively new technique designed to diagnose and treat benign obstructive salivary gland disease using a minimally invasive approach. The purpose of this study is to present our experiences regarding the use of sialendoscopy in the form of a 4-year, single center experience and to demonstrate its usefulness in oral and maxillofacial practice. We collected data on patients who underwent sialendoscopy at the Oral-Maxillofacial Surgery Department of UZ Leuven between November 2015 and August 2019, including age, gender, sex, initial clinical presentation and symptoms, gland involvement, type of diagnostic investigations, diagnosis, localization of the obstruction, therapeutic intervention, surgeon, type of anesthesia, materials used, complications, secondary treatment, duration of follow-up, and outcome. Statistical analyses were performed, chi-squared was used to compare the different variables with P < .05 being considered significant. During the 4-year timeframe, a total of 44 patients (31 female, 13 male) underwent sialendoscopy in a total of 47 procedures. The average age at time of sialendoscopy was 47.4 years. The most frequent cause of obstruction was sialolithiasis (70%). Cone-beam computed tomography (CBCT) was the most accurate preoperative investigation for the diagnosis of lithiasis (57%). Symptom improvement occurred in 57.9% of patients, with a complication rate of 11%. None of the complications were permanent. Sialendoscopy can be considered safe and effective for both the diagnosis and treatment of benign obstructive salivary gland disease, with a useful place in oral and maxillofacial surgical practice. We recommend the inclusion of CBCT and/or ultrasound in the diagnostic workup prior to endoscopy.

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

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

Efficacy of Sialendoscopy in the Management of Noncalculi-Related Sialadenitis

Sialendoscopy has effectively changed the paradigm for the treatment of sialolithiasis. Its effect on noncalculi-related recurrent sialadenitis is, however, unclear, especially regarding the long-term outcomes. The objectives of the present study were to evaluate the long-term efficacy of sialendoscopy for noncalculi-related recurrent sialadenitis and determine the clinical and intraoperative features that might be prognosticate outcomes. We performed a prospective cohort study of 33 consecutive patients who had undergone sialendoscopy for recurrent noncalculi-related sialadenitis by a single surgeon in a tertiary institution from January 2010 to December 2016. The patient-reported outcome measures were used as the primary determinant of treatment efficacy. The clinical features and endoscopic findings were evaluated as variables that might predict the treatment outcomes. The Fischer exact test was used to analyze the descriptive data, and a P value of<.05 was considered to indicate statistical significance. Of the 33 patients with recurrent noncalculi-related sialadenitis, 1 was lost to follow-up and thus excluded from the analysis. The mean and median follow-up period for the 32 patients was 27 and 21.5months, respectively. Of the 33 patients, 28 (87.5%) reported symptom improvement, and 19 patients (59.4%) were symptom free after a single sialendoscopic treatment. The chronicity of symptoms, younger patient age, and concurrent autoimmune disease were predictive of recurrent symptoms despite sialendoscopy. The use of sialendoscopy achieved sustained long-term improvements or resolution of symptoms for most patients with recurrent noncalculi-related sialadenitis. The data from our study support the benefits of sialendoscopy for patients with recurrent noncalculi-related sialadenitis.

Sialendoscopy in diagnosis and treatment of salivary gland disorders

Sialendoscopy is a relatively new and progressive procedure that allows endoscopic transluminal visualization of major salivary glands and offers a mechanism for diagnosing and treatment of both inflammatory and obstructive pathology related to the ductal system. Several authors have stressed the striking role of sialendoscopy in prevention of juvenile recurrent parotitis. However, the emerging use of sialendoscopy in juvenile recurrent parotitis has not been critically analysed. The objective of our review is to overview the existing literature with particular regards to diagnostic and therapeutic outcomes after the application of sialendoscopy.

Development of a poly-L-lactide salivary duct stent.

Obstructive salivary gland diseases are common conditions that arise following the disruption of the secretary ductal system and usually results in the swelling and pain of the affected gland(s). There has been an increase in the use of sialendoscopy for the treatment and diagnosis of obstructive salivary gland infection. If damage occurs to a duct or papilla following sialendoscopy, a stent may be necessary to prevent restenosis and for maintaining the salivary duct open after complete sialendoscopy. Currently, there are only non-biodegradable salivary duct stents available. The aim of the current study was to establish a methodology for the fabrication of a biodegradable poly-L-lactide (PLLA) salivary duct stent and to examine its function in an animal model. In the current study, PLLA was used to fabricate a salivary duct stent, which was compared with other commercially available non-biodegradable products. The mechanical tests revealed that the tensile strength of the PLLA stent was similar to that of the commercially available non-biodegradable stents. The Young's modulus, which measures the stiffness of a solid material, was significantly higher for the PLLA stent compared with the commercially available non-biodegradable stents. In addition, the current study demonstrated that the PLLA salivary duct stent was easily used with current sialendoscopy techniques, allowing accurate stent placement in an animal model.

Sialendoscopy in treating pediatric salivary gland disorders: a systematic review.

The primary aim of this study is to conduct a systematic review in order to evaluate the use of sialendoscopy in treating pediatric salivary gland disorders. Eligible articles were identified through a comprehensive search of electronic databases. Using predefined inclusion criteria, published articles on sialendoscopy in children were selected and reviewed. 17 articles including 323 pediatric patients and 424 salivary glands managed by sialendoscopy were identified. The most common salivary gland disorder affected was the parotid (83% of cases), followed by the submandibular gland (16.5% of cases). Juvenile recurrent parotitis (68.9%) was the most frequent diagnosis followed by sialolithiasis (14.7%). The most common complication was ductal perforation. During a pooled mean follow-up time of 18.3 months, recurrences were reported in 14.5% of patients mostly in patients diagnosed with juvenile recurrent parotitis. Sialendoscopy is a minimally invasive diagnostic and therapeutic tool for inflammatory salivary gland disorders in pediatric patients. Based on the current review, sialendoscopy can be successfully implemented in cases of pediatric salivary gland disorders.

Sialolithiasis removal under general anesthesia: A descriptive retrospective study in the maxillofacial surgery department in Lille University Hospital.

Since the beginning of the use of sialendoscopy and extracorporeal lithotripsy, recommendations have changed. The purpose of this retrospective study was to evaluate the efficiency of our treatment protocol, without a lithotripter, under general anaesthesia in the Stomatology and Maxillofacial Surgery Department of Lille University Hospital. The secondary goals were to evaluate patient tolerance and satisfaction. All patients treated with sialendoscopy alone, sialendoscopy with a combined surgical approach or a transoral approach (TOA) (sialolithotomy) between January 2013 and December 2015 were included. Efficiency was judged by the number and size of the extracted calculi compared to those found on the preoperative CTS, the symptoms mentioned during the one month postoperative examination and the recurrence within 6 months (telephone follow-up). Success was attained when the calculus was completely eliminated and the patient was symptom free after one month and without recurrence through six months. On the other hand, failure was attained when the calculus could not be completely removed, there was remaining debris, the patient was still symptomatic after one month or if there was a recurrence before six months. The sialendoscopy success rate was 78.57% for the submandibular gland and 92.3% for the parotid gland. We had a 100% success rate with the combined approach for the parotid gland, we had a 96.7% success rate with TOA and we had a 100% success rate with TOA assisted with sialendoscopy. Our results conform with the literature and prompt us to suggest a protocol without a lithotripter.

Role of sialendoscopy in juvenile recurrent parotitis (JRP)

Juvenile recurrent parotitis (JRP) is a rare disease of childhood occurring between the ages of 3 and 5 years, characterized by recurrent non-suppurative parotitis, spontaneously evolving towards parotid gland dysfunction. Clinically, JRP presents in the form of unilateral or bilateral, usually asynchronous, swelling of the parotid gland. The diagnosis is based on ultrasound characteristics. Widespread use of sialendoscopy has opened up new prospects for the management of this disease. This review of the literature evaluates the role of sialendoscopy in the management of JRP. A Medline search retrieved 68 articles, 18 of which concerned JRP. Standard treatment consists of antibiotics for at least 10 days at the acute phase of the disease. All studies demonstrated the diagnostic value of sialendoscopy by visualizing strictures, hypovascularization and whitish intraductal debris. Sialendoscopy is also useful for treatment, by allowing intraductal lavage and, when possible, dilatation of strictures. Lavage is performed with saline solution, hydrocortisone, antibiotics or a combination of these solutions, with no significant differences in terms of efficacy. The mode of administration with or without sialendoscopy also appears to provide similar results. Sialendoscopy appears to be a diagnostic and therapeutic option, although it has not been shown to be more effective than simple lavage. All lavage solutions appear to be effective.

Parotiditis crónica recurrente infantil: una revisión actualizada de la literatura

A bibliographic search was performed in PUBMED using the free terms and MESH terms: RCCP, recurrent parotiditis, chronic parotiditis and parotiditis. The filters used were human patients, up to 18 years old, with abstract. In SCIELO the free terms included were Parotiditis and chronic. Articles published in English, Spanish or Portuguese until 2017 were included. In PUBMED 119 articles were found and 44 were included. The exclusion of the remaining articles was due to language, access to the article or absence of relationship between the article and the proposed revision. In SCIELO 6 articles were found 6 of which 5 were selected. The multidisciplinary asses of patients with RCCP is considered the appropriate treatment. Its diagnosis is clinical but it relies on imaging tests, such as echography and sialography. The current treatment approach is conservative, and the best available evidence supports the use of sialendoscopy with irrigation and administration of antibiotics and/or corticosteroids via the parotid duct. However, there would be proper results with intraglandular lavage with physiological solutions without the need for a sialendoscope.

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.

Sialendoscopic treatment of recurrent juvenile parotitis: A South African case series.

Recurrent juvenile parotitis (RJP) is a well-recognised cause of parotitis in childhood. Sialendoscopy has been extensively used for the investigation and treatment of many benign salivary disorders, and now offers a minimally invasive approach to RJP. To investigate the epidemiology and disease profile of RJP, and review the efficacy of sialendoscopy for its investigation and treatment. The relevant literature on RJP was reviewed, and a retrospective folder review was performed for all patients who had undergone sialendoscopy for RJP at two South African (SA) hospitals between April 2013 and September 2015. Patients' epidemiological and clinical data were recorded, as well as the findings and outcomes of ultrasonography and sialendoscopy. In particular, the time following treatment without any further recurrences was recorded as a measure of success. Five children underwent sialendoscopic investigation and treatment for RJP. Their demographic and disease profiles and the results of investigations and treatments were in keeping with published literature. No surgical complications occurred, and no patients reported any further symptoms postoperatively, with an average follow-up of 22 months. Although small in sample size, this is the first reported case series in the SA literature on the use of sialendoscopy for RJP, and the results are consistent with internationally published data. Sialendoscopy is regarded as safe and effective for the diagnosis and management of RJP, and should be considered for patients who remain symptomatic after conservative management.

Beyond Stones: Other Indications for Sialendoscopy

Program Description: Sialendoscopy is recognized as a first-line option in the management of salivary stones. The role of sialendoscopy in nonstone disorders is less clear. This miniseminar focuses on the indications and applications of sialendoscopy for nonstone disorders including ductal scar and trauma, Sjogren disease, radioiodine sialadenitis, and recurrent juvenile parotitis. The moderator will present cases of nonstone disorders to a panel of experts in order to determine their use of sialendoscopy in the management of these disorders. The discussion will conclude with a brief overview of the current best evidence of the role of sialendoscopy in the management of nonstone disorders. Educational Objectives: (1) Recognize which nonstone salivary disorders may benefit from sialendoscopy. (2) Learn techniques for applying sialendoscopy to nonstone disorders. (3) Understand the outcomes and limitations of sialendoscopy in the management of nonstone disorders.

Learning Progression in the Use of Sialendoscopy for Sialolithiasis: Effect on Gland Preservation.

Evaluate how learning progression affects outcomes for the use of sialendoscopy for sialolithiasis. Case series with chart review. Academic tertiary care center. A retrospective chart review was conducted on 81 patients presenting with sialolithiasis between 2008 and 2012 who underwent surgical intervention on 85 salivary glands. Outcomes compared between the first 43 and subsequent 42 consecutive glands included successful removal, surgical method, and need for further intervention. For the first 43 patients (group A), mean age was 47.3 years (range, 15-77), and 44.2% were male. For the second 38 patients (group B), mean age was 49.9 (range, 23-76), and 50% were male. Mean stone size was similar in both groups; 8.3 versus 7.6 mm, respectively. In cases of stone visualization and removal, complete removal without gland excision was accomplished in 78.4% of cases in group A versus 94.3% in group B (P = .04). Endoscopic removal occurred in 24.3% of patients in group A, versus 45.8% in group B. A combined approach was used in 54.1% of patients in group A versus 48.6% in group B. In group A, 18.9% underwent gland removal as part of initial intervention versus 0% in group B (P = .007). Overall gland preservation was 81.4% in group A versus 97.6% in group B (P = .015). This study documents the effect of learning curve on sialendoscopy for the management of sialolithiasis. With experience, the success of sialendoscopy increases with a significant decrease in the number of gland excisions.

Sialendoscopy for the diagnosis and treatment of juvenile recurrent parotitis

The aim of the current study was to analyze the use of sialendoscopy for the diagnosis and treatment of juvenile recurrent parotitis (JRP), note possible complications, and the rate of disease recurrence. We believe that this cutting edge procedure may be very effective both for the diagnosis and treatment of JRP, with few complications and low rates of recurrence. A retrospective descriptive case study was conducted on a sample of patients presenting with JRP. Data was collected from the patient's medical records. Diagnostic sialendoscopy was performed to identify and classify the ductal pathology, treated by interventional therapeutic sialendoscopy. We carefully noted all complications and the disease recurrence rates. The patient sample included 50 children presenting with JRP (33M, 17F; age range: 2 to 16 years). Seven children presented with bilateral parotitis, the remaining 43 with unilateral parotitis. The study was conducted from 2003 to 2012. There was a statistically significant association between sialendoscopic data and the actual outcome. Seven children underwent additional sialendoscopy because of recurrence. They were all in the group of children presenting with unilateral parotitis. Our results validate the expected outcome. Sialendoscopy is an accurate technique for the diagnosis of JPR, and an effective tool for the treatment of JRP, with a low rate of complications and recurrence.

Learning Progression in the Use of Sialendoscopy for Sialolithiasis: Effect on Outcomes

Objectives: Evaluate how learning progression affects outcomes for the use of sialendoscopy for sialolithiasis. Methods: A retrospective chart review was conducted on 79 patients presenting with sialolithiasis between 2008 and 2012 who underwent sialendoscopy on 86 salivary glands at a tertiary medical center. Outcomes compared between the first 43 cases (40 patients) and second 43 cases (39 patients) included successful removal, surgical method, and any further need for intervention. Results: For the first 40 patients (group A), the mean age was 50.6 years (range, 21-87), and 55.8% were male. For the second 39 patients (group B), the mean age was 50.8 (range, 15-77), and 46.5% were male. Sialolithiasis was diagnosed based on physical exam or imaging. Mean stone size was similar in both groups: 8 versus 8.6mm, respectively. Where a stone was visualized, complete removal was accomplished in 88.6% of cases in group A versus 97.4% in Group B. Endoscopic removal occurred in 20.0% of the patients in group A, versus 35.9% in group B. A combined approach was used in 45.7% in group A versus 64.1% in group B. 34.3% in group A required gland removal versus 0.0% in group B ( P = 0.005). Seventeen point nine percent of patients in group A needed further intervention (medical or surgical) versus 9.3% in group B. Conclusions: This study documents a clear learning curve for sialendoscopy for the management of sialolithiasis. With experience, the success of sialendoscopy increases, and there is a significant decrease in the number of gland excisions.

The Use of Sialendoscopy for the Treatment of Multiple Salivary Gland Stones

The purpose of this study is to document our experience with sialendoscopy for the treatment of multiple calculi of the salivary ducts, as well as to discuss the technique and indications for the procedure. In this retrospective non-interventional study, 530 consecutive cases of sialolithiasis were investigated, and the cases with multiple calculi were selected for further analysis. These selected cases were analyzed from clinical and surgical aspects. Multiple calculi were detected in 37 of 530 consecutive investigated sialolithiasis cases. The gender distribution was 15 men and 22 women, with a mean age of 40.4 years. Among these patients, the submandibular gland was affected in 33 cases (right in 13 and left in 20) and the parotid gland was affected in 4 cases (right in 3 and left in 1). As for complications, 1 patient had a postoperative infection and 2 other patients had postoperative ranulas that were considered minor complications. Among all 37 cases, we had 3 cases in which preoperative imaging (sonography in 1 and radiography in 2) showed a single sialolith in the duct, but failed to show further sialoliths that were discovered later by sialendoscopy. The use of sialendoscopy allows a better diagnosis and minimally invasive treatment for multiple calculi. Interventional sialendoscopy allows the extraction of sialoliths in most patients, preventing open gland excision or surgical removal of the gland even in cases with multiple calculi. Sialendoscopy allows exploration of the ductal system in detail. This technique helps to discover additional stones in the ductal system that could not have been identified with the conventional imaging modalities available.