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Soriano-Martín D, García-Consuegra L, Junquera L, Rodríguez-Santamarta T, Olay S, Junquera-Olay S. Sialendoscopy approach in treating juvenile recurrent parotitis: a systematic review. J Otolaryngol Head Neck Surg 2023; 52:53. [PMID: 37598195 PMCID: PMC10440031 DOI: 10.1186/s40463-023-00658-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 08/12/2023] [Indexed: 08/21/2023] Open
Abstract
BACKGROUND Juvenile recurrent parotitis (JRP) is characterized by recurrent episodes of painful parotid swelling in children. The purpose of this systematic review was to determine the diagnostic and therapeutic effectiveness of sialendoscopy in children affected by JRP. METHODS A systematic literature search was performed in PubMed, EMBASE, Scopus and the Cochrane Library until April 2022, without language restrictions or specified start date. Quality assessment was performed using the Newcastle-Ottawa Scale (NOS). RESULTS Our review included 524 patients and 646 sialendoscopies. The sample sizes of the different studies ranged from 3 to 77 subjects. Most authors performed sialendoscopy under general anesthesia. The mean percentage of recurrences observed was 25.1% (95% confidence intervals) (CI 23.6-26.6). There was a statistically significant relationship between the number of attacks/year and recurrences (p < 0.05). The percentage of recurrences according to the type of irrigation/flushing used ranged from 22.2% to 25.2%, with no significant differences between the use of corticosteroids alone (25.2% of recurrences), corticosteroids plus antibiotics (25% of recurrences) or saline alone (22.2% of recurrences). Sialoendoscopy has proved in all cases to be a valid method for the diagnosis of JRP, but it does not allow a reliable differential diagnosis with other autoimmune parotitis such as Sjögren's syndrome. CONCLUSION According to our results, parotid sialoendoscopy was 74.9% effective as a primary treatment in the prevention of recurrent symptoms in JRP. The type of ductal irrigation used did not significantly influence the prognostic outcome.
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Affiliation(s)
- D Soriano-Martín
- Department Maxillofacial Surgery, Central University Hospital of Asturias, Avenida de Roma, 33011, Oviedo, Spain.
| | - L García-Consuegra
- Department Maxillofacial Surgery, Central University Hospital of Asturias, Avenida de Roma, 33011, Oviedo, Spain
| | - L Junquera
- Department of Surgery, Oviedo University, Julian Clavería, 33009, Oviedo, Spain
| | - T Rodríguez-Santamarta
- Department Maxillofacial Surgery, Central University Hospital of Asturias, Avenida de Roma, 33011, Oviedo, Spain
| | - S Olay
- Department of Surgery, Oviedo University, Julian Clavería, 33009, Oviedo, Spain
| | - S Junquera-Olay
- Department of Radiology, San Agustin University Hospital, 33410, Heros Avilés, Spain
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Pušnik L, Jerman A, Urbančič J, Aničin A. Sialendoscopy in Management of Juvenile Recurrent Parotitis-A Single Centre Experience. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1632. [PMID: 36360360 PMCID: PMC9688286 DOI: 10.3390/children9111632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 10/22/2022] [Accepted: 10/25/2022] [Indexed: 11/07/2022]
Abstract
Juvenile recurrent parotitis is a rare inflammatory disease of the parotid gland that shares diverse therapeutic management between institutions. Sialendoscopy has been demonstrated as an efficient diagnostics and therapeutic method with minimal complications; however, due to the rarity of the disease and limited data, there is a lack of universal guidelines on its optimal management. Herein, we retrospectively analysed patients with juvenile recurrent parotitis who had the sialendoscopy performed at our tertiary centre. Descriptive data were retrieved along with the number of swelling episodes one year before and after the sialendoscopy intervention. In the last decade, twenty-nine sialendoscopic procedures were performed at our clinics on twenty-one patients diagnosed with juvenile recurrent parotitis. Most of them underwent the procedure under general anaesthesia (86%). In the year before and after the sialendoscopic procedure, the patients had 3.9 ± 2.7 and 0.2 ± 0.4 episodes of swelling per year, respectively. The difference proved to be statistically significant (p < 0.0001). The complete resolution was noted in sixteen patients (76%); however, the procedure was not repeated on the same side of any patient. Solely one patient had a relapse of the disease reported more than twelve months after the sialendoscopy, nonetheless, one of his exacerbation episodes was already reported in the first year after the sialendoscopy. The mean follow-up period of patients was 48.6 months (range, 13−116 months). All things considered, this study emphasises sialendoscopy as an effective minimally invasive diagnostic and therapeutic tool for the management of juvenile recurrent parotitis.
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Affiliation(s)
- Luka Pušnik
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Anže Jerman
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Center Ljubljana, 1000 Ljubljana, Slovenia
| | - Jure Urbančič
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Center Ljubljana, 1000 Ljubljana, Slovenia
| | - Aleksandar Aničin
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Center Ljubljana, 1000 Ljubljana, Slovenia
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Grande-Moreillo C, Margarit-Mallol J, Fuentes-Carretero S, Torolla A, Martí-Camps M, Rodríguez-Molinero A. Parotid irrigation: A promising option for juvenile recurrent parotitis. Am J Otolaryngol 2022; 43:103398. [PMID: 35256205 DOI: 10.1016/j.amjoto.2022.103398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/06/2022] [Accepted: 02/13/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To study whether irrigating the parotid gland with saline solution through the parotid duct reduces the number of inflammatory episodes in patients with juvenile recurrent parotitis (JRP) over a 1-year period. METHODS This was a retrospective cohort study using the electronic clinical history data of patients with JRP that were treated with parotid irrigation under general anaesthesia at the Paediatric Surgery units of Consorci Sanitari Alt Penedès-Garraf and Hospital Universitari Mútua de Terrassa. The number of inflammation episodes in the year before and the year after treatment was analysed. RESULTS A total of 15 patients with JRP were evaluated, of whom 10 met the criteria for irrigation. Data from 9 patients were available. The procedure was performed without incident in all of the patients. There was no difficulty with probing the duct and no need for orifice dilation. No post-lavage complications were observed. Four patients had complete resolution of inflammation events (44.4%), and the remaining 5 patients had a decrease in the number of events. The Wilcoxon signed-rank test showed a statistically significant difference between the number of inflammation events before and after the intervention (p = 0.009). CONCLUSIONS Parotid irrigation with saline solution could be a safe and effective first-line technique for the treatment of JRP. LEVEL-OF-EVIDENCE IV.
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Affiliation(s)
- Carme Grande-Moreillo
- Pediatric Surgery Unit, Consorci Sanitari Alt Penedés i Garraf, Ronda Sant Camil s/n, 08810 Barcelona, Spain; Department of Pediatric Surgery, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, Plaça Doctor Robert 5, 08221 Terrassa, Spain.
| | - Jaume Margarit-Mallol
- Department of Pediatric Surgery, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, Plaça Doctor Robert 5, 08221 Terrassa, Spain
| | - Sara Fuentes-Carretero
- Department of Pediatric Surgery, Hospital Universitari Mútua Terrassa, Universitat de Barcelona, Plaça Doctor Robert 5, 08221 Terrassa, Spain
| | - Alina Torolla
- Department of Anesthesiology, Consorci Sanitari Alt Penedés i Garraf, Ronda Sant Camil s/n, 08810 Barcelona, Spain
| | - Montse Martí-Camps
- Department of Pediatric Surgery, Consorci Sanitari de Terrassa, Carretera Torrebonica 1, 08227 Terrassa, Spain
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Geisthoff UW, Droege F, Schulze C, Birk R, Rudhart S, Maune S, Stuck BA, Hoch S. Treatment of juvenile recurrent parotitis with irrigation therapy without anesthesia. Eur Arch Otorhinolaryngol 2021; 279:493-499. [PMID: 34117898 PMCID: PMC8739303 DOI: 10.1007/s00405-021-06928-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/01/2021] [Indexed: 11/17/2022]
Abstract
Purpose No standardized treatment regimen exists for juvenile recurrent parotitis (JRP). The investigators hypothesized that irrigation with saline only without local anesthesia will be an effective and beneficial option.
Methods Using a retrospective study design, a series of children with typical symptoms of JRP who were treated with at least one irrigation therapy were evaluated. This treatment consisted of irrigation of the affected gland with 3–10 ml saline solution without any type of anesthesia. The outcome variables were patient/parent satisfaction, frequency and duration of acute JRP episodes, and the need for antibiotics before and after irrigation therapy. Results The case series was composed of six boys aged 3.3–7.7 years who experienced one to eight sessions of irrigation therapy. The period of follow-up was 9–64 months. We observed a total resolution of symptoms in two children and an improvement in the other four. No relevant side effects were seen. Conclusion Our results suggest that irrigation therapy is a reasonable, simple, and minimally invasive treatment alternative for JRP. In contrast to sialendoscopy or sialography, there is no need for general anesthesia or radiation exposure.
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Affiliation(s)
- Urban W Geisthoff
- Department of Otolaryngology, Head and Neck Surgery, Philipps-University, Marburg, 35043, Baldingerstraße, Germany
| | - Freya Droege
- Department of Otorhinolaryngology, Essen University Hospital, Essen, Germany
| | - Cathrin Schulze
- Department of Otolaryngology, Head and Neck Surgery, Philipps-University, Marburg, 35043, Baldingerstraße, Germany
| | - Richard Birk
- Department of Otolaryngology, Head and Neck Surgery, Philipps-University, Marburg, 35043, Baldingerstraße, Germany
| | - Stefan Rudhart
- Department of Otolaryngology, Head and Neck Surgery, Philipps-University, Marburg, 35043, Baldingerstraße, Germany
| | - Steffen Maune
- Department of Otorhinolaryngology, Hospitals of the City of Cologne, Cologne, Germany
| | - Boris A Stuck
- Department of Otolaryngology, Head and Neck Surgery, Philipps-University, Marburg, 35043, Baldingerstraße, Germany
| | - Stephan Hoch
- Department of Otolaryngology, Head and Neck Surgery, Philipps-University, Marburg, 35043, Baldingerstraße, Germany.
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Juvenile recurrent parotitis: Review and proposed management algorithm. Int J Pediatr Otorhinolaryngol 2021; 142:110617. [PMID: 33421670 DOI: 10.1016/j.ijporl.2021.110617] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/31/2020] [Accepted: 12/31/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Despite being the second most common salivary disease in childhood, the aetiology and appropriate management of juvenile recurrent parotitis (JRP) remains uncertain. Consequently patients may be misdiagnosed, or even undergo indeterminate or potentially invasive procedures without benefit. This article reviews the current understanding of the epidemiology and pathophysiology of JRP, and to appraise the management options available. METHODS AND RESULTS Medline and Google Scholar databases were searched and peer reviewed journal articles assessed. The epidemiology of JRP remains uncertain, and the clinical presentation of JRP can vary widely in frequency and severity. Diagnosis is still largely based on clinical signs and symptoms including parotid swelling, pain and fever. Investigation typically focuses on the exclusion of other diseases and immunodeficiencies, however there are noted typical radiological findings on both ultrasound and magnetic resonance imaging. The ideal management of this condition still remains unclear, however symptoms typically resolve by puberty. Treatment focuses on minimally invasive procedures such as sialography and sialendoscopy to reduce the frequency and severity of acute episodes. CONCLUSIONS Acute episodes of JRP can occur up to 30 times per year and have a significant impact on the quality of life of an affected child. Consequently a management algorithm is proposed based on the exclusion of other pathology. There is increasing evidence for non-ablative, minimally invasive approaches such as sialography and sialendoscopy to reduce the impact of this disease.
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Tucci FM, Roma R, Bianchi A, De Vincentiis GC, Bianchi PM. Juvenile recurrent parotitis: Diagnostic and therapeutic effectiveness of sialography. Retrospective study on 110 children. Int J Pediatr Otorhinolaryngol 2019; 124:179-184. [PMID: 31202035 DOI: 10.1016/j.ijporl.2019.06.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/19/2019] [Accepted: 06/04/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Juvenile recurrent parotitis (JRP) is characterized by recurrent episodes of painful parotid swelling, generally associated with non-obstructive sialectasia of the parotid gland. The aim of this study was to evaluate the diagnostic and therapeutic effectiveness of sialography in children affected by JRP. METHODS Clinical records of 110 outpatients with a diagnosis of JRP followed up from 2008 to 2017 at the Unit of Paediatric Otorhinolaryngology, Surgery Department of the Bambino Gesù Children's Hospital of Rome, were retrospectively reviewed. Data on demographics, number of acute episodes/year, course of disease, site of symptoms and duration of follow up were collected. The inclusion criteria were: at least two or more episodes of intermittent swelling of the parotid glands on one side or both sides during the last 6 months, age <16 years. Exclusion criteria were: obstructive lesions, dental malocclusion, Sjogren syndrome, congenital IgA immunodeficiency, and relevant systemic diseases. Outcome of the procedure was measured by evaluating number and degree of episodes of parotid swelling before and after sialography. RESULTS Sialography has been shown in all cases to be a valid method in the diagnosis of JRP. Following the execution of the sialography, in 98 patients (89% of cases) there was a statistically significant improvement of disease with a mean reduction of 67.4% of episodes of parotid swelling (p < 0.05). In 75 patients there was marked improvement of the symptomatology (p < 0.05). In 23 patients partial resolution occurred (p < 0.05); in 12 patients there was no resolution or a reduction less than 30% of episodes (p > 0.05). There was a statistically significant relationship between the number of attacks/year and the degree of glandular function, pre and post-sialography in 2-way ANOVA test (p < 0.05). CONCLUSION Sialography is effective method not only as a diagnostic procedure but also as a therapeutic procedure in treatment of JRP. It is a method that can be carried out in ambulatory setting, without anaesthesia, with a minimum cost and with a very low rate of complications. In a disease with tendency to spontaneous resolution like JRP, sialography represent a therapeutic option alternative to more invasive treatment.
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Affiliation(s)
- Filippo Maria Tucci
- Surgery Department, Otorhinolaryngology Unit, Bambino Gesù Children's Hospital, Scientific Research Institute, 00100, Rome, Italy.
| | - Rocco Roma
- Surgery Department, Otorhinolaryngology Unit, Bambino Gesù Children's Hospital, Scientific Research Institute, 00100, Rome, Italy
| | - Alessandra Bianchi
- Surgery Department, Otorhinolaryngology Unit, Bambino Gesù Children's Hospital, Scientific Research Institute, 00100, Rome, Italy
| | - Giovanni Carlo De Vincentiis
- Surgery Department, Otorhinolaryngology Unit, Bambino Gesù Children's Hospital, Scientific Research Institute, 00100, Rome, Italy
| | - Pier Marco Bianchi
- Surgery Department, Otorhinolaryngology Unit, Bambino Gesù Children's Hospital, Scientific Research Institute, 00100, Rome, Italy
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Garavello W, Redaelli M, Galluzzi F, Pignataro L. Juvenile recurrent parotitis: A systematic review of treatment studies. Int J Pediatr Otorhinolaryngol 2018; 112:151-157. [PMID: 30055724 DOI: 10.1016/j.ijporl.2018.07.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 07/01/2018] [Accepted: 07/01/2018] [Indexed: 12/18/2022]
Abstract
Juvenile recurrent parotitis is a rare recurrent inflammation of the parotid glands occurring in children. The etiology remains obscure and the treatment is still debated. In the present study, we perform a systematic review of the literature with the purpose of identifying and discussing the treatment options emerged over the last 28 years in order to prevent recurrent episodes of parotitis. We ultimately included 24 studies. The definitions used for juvenile recurrent parotitis varied widely and none of the selected studies referred exactly to the same definition. Only one was a randomized controlled trial and it showed marked benefits with the use of Bear Bile and Huangqi, two traditional Chinese medicines. Two additional study on sialendoscopy included a control group but was not randomized. All the remaining contributions were case series or case reports. The vast majority (n = 19) of the selected studies reported on sialendoscopy. They all documented improvement of the condition following this intervention. An analysis grouping all these studies (corresponding to 336 children) showed that only 25.8% (95% Confidence Interval: 21.5-30.8) of the treated children had further recurrences. However, the only two controlled study on sialendoscopy showed a similar improvement in controls. The remaining four studies were on sialography (n = 2), on oral appliance in the specific group of children with concomitant dental malocclusion (n = 1) on ductal hydrocortisone infusion through catheter inserted in the parotid duct (n = 1). Improvements were documented in all four contributions. This systematic review of the literature did not consent us to draw definite conclusions on the most suitable treatment for juvenile recurrent parotitis. The available evidence is indeed weak and difficult to interpret because of the scarcity of randomized controlled trials, the heterogeneity of the definitions used and the high rate of spontaneous resolution. Future large and well-designed randomized controlled trials that will include children fulfilling a shared definition of the condition are warranted.
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Affiliation(s)
- Werner Garavello
- Department of Otorhinolaryngology, School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
| | - Monica Redaelli
- Department of Otorhinolaryngology, San Gerardo Hospital, Monza, Italy
| | | | - Lorenzo Pignataro
- Department of Otorhinolaryngology, Department of Clinical Sciences and Community Health, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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