One‐year outcomes of sialendoscopic‐assisted salivary duct surgery for sialadenitis without sialolithiasis

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

OBJECTIVE

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).

STUDY DESIGN

Prospective, cohort.

SETTING

Tertiary-care center.

METHODS

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.

RESULTS

Seventy-nine patients 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 vs 17.1 ± 9.6, P = .02) and functional/psychosocial impact subscores were greater in the stenosis versus sialolithiasis groups (18.0 ± 10.9 vs 11.3 ± 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 versus stenosis 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.

CONCLUSION

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.

Success rate of sialendoscopy. A systematic review and meta-analysis

OBJECTIVE

To perform a systematic review and meta-analysis on the efficacy and safety of sialendoscopy in the treatment of obstructive diseases of the major salivary glands.

MATERIALS AND METHODS

We searched four databases for literature. The primary outcome assessed was the success rate. Secondary outcomes included the use of supportive devices, number of sialadenectomies and complications. Risk of bias was assessed. Meta-analyses with subgroup analysis were performed.

RESULTS

In total, 91 studies were included, comprising 8218 patients undergoing 9043 sialendoscopic procedures. The majority of studies had a medium or high risk of bias. The incidence of sialadenectomy varied from 0% to 14%. No major complications were reported. Meta-analysis revealed a weighted pooled success rate of 80.9%. Subgroup analyses showed the weighted pooled success rate in patients with sialoliths (89.6%), stenoses (56.3%), submandibular glands (88.3%), parotid glands (81.2%), patients treated by an endoscopic-assisted transoral removal of a sialolith (86.3%), patients treated by a combined approach of the parotid gland (78.2%), patients with JRP (67.0%) and with RAIS (45.8%).

CONCLUSION

The success rate of sialendoscopy did not considerably change in the last 9 years. Sialendoscopy is an efficient and safe procedure for the treatment of major salivary gland obstructive disease.

Ultrasonographic Features of Salivary Glands after Radioiodine Therapy in Patients with Thyroid Cancer

OBJECTIVE

Chronic sialadenitis is the most common complication of radioactive iodine (RAI) treatment. The aim of the study was to ascertain sonographic features of the major salivary glands in patients with papillary thyroid cancer (PTC) treated with RAI.

METHODS

The database of a tertiary medical center was retrospectively searched for consecutive patients who underwent total thyroidectomy for PTC in 2011-2020 with ultrasound follow-up after 1 year. Changes in ultrasound features of the major salivary glands were compared between patients treated or not treated with RAI postoperatively.

RESULTS

The cohort included 158 patients, of whom 109 (69%) were treated postoperatively with RAI (mean dose, 131 mCi) and 49 were not (control group). Sonographic changes were observed in the major salivary glands in 43% of the study group and 18% of the control group (p = 0.002), including coarse echotexture, decreased echogenicity, fibrosis, and atrophy. Higher RAI doses were significantly correlated with the prevalence and severity of glandular changes (p < 0.0001).

CONCLUSION

RAI treatment following thyroidectomy is associated with a dose-response effect and adverse changes in the major salivary glands and should be prescribed carefully.

LEVEL OF EVIDENCE

4 Laryngoscope, 133:1271-1275, 2023.

Treatment Strategy for Chronic Obstructive Parotitis Related to Diabetes: A Retrospective Analysis of 12 Cases

Objectives: The aim of this study was to describe our experience in treating chronic obstructive parotitis (COP) related to diabetes.

Methods: Twelve patients with COP related to diabetes were selected for the study. A sialendoscope was introduced from the orifice to investigate the ductal wall and lumen. During the operation, chymotrypsin and gentamicin were injected. All patients were followed up for 6 months. Preoperative and postoperative visual analog scale (VAS) evaluations and salivary gland scintigraphy (SGS) examinations were applied to evaluate the therapeutic effect; differences were considered statistically significant at p < 0.05.

Results: A sialendoscope was successfully used under local anesthesia in all members of the cohort. As shown by the endoscope, mucus plugs were the most common feature. Some adhered tightly to the ductal wall. We also found ductal congestion in some cases. The postoperative VAS scores and SGS counts were both significantly lower than the preoperative values (p < 0.05).

Conclusion: Chymotrypsin administration during interventional sialendoscopy is significantly effective in the treatment of diabetes-related COP.

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

OBJECTIVE

To evaluate salivary gland chemodenervation with botulinum toxin in chronic parotid sialadenitis.

METHODS

Patients 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.

RESULTS

Sialadenitis 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.

CONCLUSION

Parotid 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.

Prognostic Factors for the Outcome of Salivary Gland Holmium: YAG Laser Intraductal Lithotripsy

OBJECTIVES

Holmium: YAG laser has gained its popularity throughout the years and is used to treat sialolithiasis, which helps to overcome the limitations of traditional sialendoscopic lithotripsy for larger-sized salivary stones. However, little information is available regarding factors predicting the success rate of Holmium: YAG laser intraductal lithotripsy. The purpose of this study is to investigate the factors affecting the success rates of Holmium: YAG laser lithotripsy for salivary stones treatment in a tertiary care hospital.

METHODS

A retrospective study conducted in patients receiving sialolithiasis surgery under sialendoscopy from May 2013 to March 2015 at Mackay Memorial Hospital, Taiwan. Data on various factors, including patients' age, gender, glands, size of largest stone, multiple stones (≥2 stones), location of the stone (distal duct, middle duct, proximal duct, and hilum), and operative time. The success of the surgery defined as patients without any complaints such as swelling or tenderness. Logistic regression and Fisher exact tests were employed to examine these factors on the success rate.

RESULTS

Fifty-four patients who received sialendoscopy surgery with a mean age of 35.74 years old recruited. Logistic regression identified the operation time exceeding 210 minutes showed 23.497 folds higher odd ratio of having a result of operation failure (P < .05).

CONCLUSION

The prolonged operation time is the sole independent factor affecting the successful outcome for salivary gland intraductal laser lithotripsy. We recommend operative time be no more than 210 minutes to increase the success rate in salivary gland Holmium: YAG laser intraductal lithotripsy.

Allergy-Related Sialodochitis: A Preliminary Cohort Study

OBJECTIVES/HYPOTHESIS

To explore the clinically feasible diagnosis criteria and treatment outcomes of allergy-related sialodochitis (ARS).

STUDY DESIGN

Prospective Cohort Study.

METHODS

Ninety-six consecutive patients were enrolled by the following criteria: 1) recurrent swelling of ≥2 large salivary glands that lasted for ≥3 months; 2) with mucus plug exudations; 3) with atopic diseases; 4) ductal stenosis and/or ectasia. Sixty-four patients with elevation of peripheral blood eosinophil (PBE) and/or serum IgE level comprised group A (highly-suspected ARS group), while the remaining 32 comprised group B (patients without confirmed evidence of ARS). These patients were treated with interventional endoscopy. A chronic obstructive sialadenitis symptom (COSS) questionnaire was used to quantify the treatment outcomes.

RESULTS

In group A, Serum IgE was elevated in 84.4% of patients and PBE was elevated in 34.4% of patients. Percentage of submandibular gland involvement was higher in group A than group B (48.4% vs. 18.8%). On sialograms, the snowflake changes of branch ducts were seen in higher percentage of group A compared with group B (59% vs. 35% for parotid glands, 27% vs. 8% for submandibular glands, respectively). Mucus plug smears showed abundant eosinophils in 14 group A patients. Biopsy of five group A patients revealed significant eosinophil infiltration around the main and interlobular ducts. During follow-up, the COSS scores were significantly decreased in both groups, and group B was improved better than group A.

CONCLUSION

PBE and serum IgE are important diagnostic indexes of ARS. Mucus plug smear or histopathology verifies the diagnosis. Interventional endoscopy is helpful for ARS cases.

LEVEL OF EVIDENCE

3 Laryngoscope, 131:2030-2035, 2021.

Success of minimally invasive salivary gland surgery-Quality of life, prognostic factors

OBJECTIVE

Goal of this study was to investigate, whether sialendoscopy in obstructive salivary gland disorders affects patients' oral health-related quality of life compared to healthy individuals, and to determine factors that might influence this relationship.

STUDY DESIGN

Retrospective observational study.

SETTING

University of Kiel, Department of Otorhinolaryngology, Head and Neck Surgery.

SUBJECTS AND METHODS

A group of 130 patients, undergoing sialendoscopy between 01/2004 and 06/2017 was considered. Oral health-related quality of life was assessed using the OHIP-G14 (Oral Health Impact Profile) in combination with a custom-made questionnaire on satisfaction and success in relation to sialendoscopy.

RESULTS

Oral health-related quality of life of patients without dentures or with removable dentures was significantly worse than in the healthy population, whereas the necessity of multiple additional follow-up treatments was associated with worse oral health-related quality of life. No essential predisposing factors were identified. Average satisfaction with the intervention was observed to be x̅ = 4.33 (SD = 3.69) on a visual analogue scale from 1 (=very satisfied) to 10 (=very unsatisfied). A longer follow-up period and a higher patients' age were positively related, whereas removal of salivary gland during follow-up was negatively related to satisfaction. In 113 cases (86.9%) long-term preservation was accomplished and 115 (88.5%) patients would repeat a sialendoscopy in case needed.

CONCLUSION

In summary, sialendoscopy resulted in long-term high subjective and objective success rates. However, oral health-related quality of life scores did not reach those levels found in the healthy population.

Sialendoscopy in Chronic Obstructive Sialadenitis Without Sialolithiasis: A Prospective Cohort Study

OBJECTIVES

To evaluate long-term chronic sialadenitis symptoms in patients without sialolithiasis following sialendoscopy-assisted salivary duct surgery (SASDS) compared to a control group managed conservatively.

STUDY DESIGN

Prospective cohort study.

SETTING

Tertiary care center.

METHODS

Thirty-six patients (52 glands) with chronic sialadenitis without sialolithiasis completed the Chronic Obstructive Sialadenitis Symptoms (COSS) questionnaire at presentation and at 3-month time intervals thereafter for 1 year. Lower COSS scores represent lower symptom severity. We compared 27 patients who underwent SASDS to 9 control patients who elected conservative management.

RESULTS

COSS gland-specific scores from 38 SASDS-treated glands (cases) and 14 control glands were similar at baseline. At 6 to 12 months (mean, 8.4 months), the surgically treated group had significantly lower scores and a greater score reduction from baseline compared to controls (mean score change [95% confidence interval] cases: 20.7 points [15.7-25.8]; controls: 11.7 points [4.9-18.4]; P = .04). There was a significant difference in scores between the 2 groups over time (P < .001). A greater proportion (72%) of cases reported partial or complete resolution of overall sialadenitis symptoms at 6 to 12 months compared to the controls (22%, P < .05).

CONCLUSION

Compared to patients electing for conservative management, patients with sialadenitis without sialolithasis treated with SASDS had improved symptom scores and a greater reduction of symptom severity after 6 months. With SASDS, patients had higher rates of significant overall symptom improvement. In evaluating chronic sialadenitis, assessment at multiple time points is necessary to capture the intermittent and cyclical pattern of obstructive symptoms.