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Price EJ, Benjamin S, Bombardieri M, Bowman S, Carty S, Ciurtin C, Crampton B, Dawson A, Fisher BA, Giles I, Glennon P, Gupta M, Hackett KL, Larkin G, Ng WF, Ramanan AV, Rassam S, Rauz S, Smith G, Sutcliffe N, Tappuni A, Walsh SB. Executive summary: British Society for Rheumatology guideline on management of adult and juvenile onset Sjögren disease. Rheumatology (Oxford) 2024:keae218. [PMID: 38785300 DOI: 10.1093/rheumatology/keae218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 03/02/2024] [Indexed: 05/25/2024] Open
Affiliation(s)
- Elizabeth J Price
- Department of Rheumatology, Great Western Hospital NHS Foundation Trust, Swindon, UK
| | - Stuart Benjamin
- The Academy Library and Information Service, Great Western Hospital NHS Foundation Trust, Swindon, UK
| | - Michele Bombardieri
- Department of Rheumatology, Barts and The London School of Medicine and Dentistry, Barts Health NHS Trust, London, UK
- Centre for Experimental Medicine and Rheumatology, The William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Simon Bowman
- Department of Rheumatology, Milton Keynes University Hospital, Milton Keynes, UK
- Department of Rheumatology, University Hospitals Birmingham NHSFT, Birmingham, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Sara Carty
- Department of Rheumatology, Great Western Hospital NHS Foundation Trust, Swindon, UK
| | - Coziana Ciurtin
- Centre for Rheumatology, Division of Medicine, University College London, London, UK
| | - Bridget Crampton
- Patient Representative, Sjogren's UK helpline lead, Sjogren's UK (British Sjögren's Syndrome Association), Birmingham, UK
| | - Annabel Dawson
- Patient Representative, Sjogren's UK (British Sjögren's Syndrome Association), Birmingham, UK
| | - Benjamin A Fisher
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre and Department of Rheumatology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ian Giles
- Centre for Rheumatology, Division of Medicine, University College London, London, UK
| | - Peter Glennon
- General Practice, NHS Staffordshire & Stoke on Trent ICB, Stafford, UK
| | - Monica Gupta
- Department of Rheumatology, Gartnavel General Hospital, Glasgow, UK
| | - Katie L Hackett
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
| | | | - Wan-Fai Ng
- Translational and Clinical Research Institute & Newcastle NIHR Biomedical Research Centre, Newcastle University, Newcastle upon Tyne, UK
- Department of Rheumatology, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Athimalaipet V Ramanan
- Paediatric Rheumatology, Bristol Royal Hospital for Children, Bristol, UK
- Translational Health Sciences, University of Bristol, Bristol, UK
| | - Saad Rassam
- Haematology and Haemato-Oncology, KIMS Hospital, Maidstone, Kent, UK
| | - Saaeha Rauz
- Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham NHS Trust, Birmingham, UK
| | - Guy Smith
- Department of Ophthalmology, Great Western Hospital NHS Foundation Trust, Swindon, UK
| | | | - Anwar Tappuni
- Institute of Dentistry, Queen Mary University of London, London, UK
| | - Stephen B Walsh
- London Tubular Centre, University College London, London, UK
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Beumer LJ, Vissink A, Gareb B, Spijkervet FKL, Delli K, van der Meij EH. Success rate of sialendoscopy. A systematic review and meta-analysis. Oral Dis 2024; 30:1843-1860. [PMID: 37486613 DOI: 10.1111/odi.14662] [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: 04/18/2023] [Revised: 05/31/2023] [Accepted: 06/16/2023] [Indexed: 07/25/2023]
Abstract
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.
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Affiliation(s)
- L J Beumer
- Department of Oral and Maxillofacial Surgery, Medical Centre Leeuwarden, Leeuwarden, Netherlands
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - A Vissink
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - B Gareb
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - F K L Spijkervet
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - K Delli
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - E H van der Meij
- Department of Oral and Maxillofacial Surgery, Medical Centre Leeuwarden, Leeuwarden, Netherlands
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Oral and Maxillofacial Surgery and Oral Pathology, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, Netherlands
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Price EJ, Benjamin S, Bombardieri M, Bowman S, Carty S, Ciurtin C, Crampton B, Dawson A, Fisher BA, Giles I, Glennon P, Gupta M, Hackett KL, Larkin G, Ng WF, Ramanan AV, Rassam S, Rauz S, Smith G, Sutcliffe N, Tappuni A, Walsh SB. British Society for Rheumatology guideline on management of adult and juvenile onset Sjögren disease. Rheumatology (Oxford) 2024:keae152. [PMID: 38621708 DOI: 10.1093/rheumatology/keae152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 03/02/2024] [Indexed: 04/17/2024] Open
Abstract
Sjögren disease (SD) is a chronic, autoimmune disease of unknown aetiology with significant impact on quality of life. Although dryness (sicca) of the eyes and mouth are the classically described features, dryness of other mucosal surfaces and systemic manifestations are common. The key management aim should be to empower the individual to manage their condition-conserving, replacing and stimulating secretions; and preventing damage and suppressing systemic disease activity. This guideline builds on and widens the recommendations developed for the first guideline published in 2017. We have included advice on the management of children and adolescents where appropriate to provide a comprehensive guideline for UK-based rheumatology teams.
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Affiliation(s)
- Elizabeth J Price
- Department of Rheumatology, Great Western Hospital NHS Foundation Trust, Swindon, UK
| | - Stuart Benjamin
- The Academy Library and Information Service, Great Western Hospital NHS Foundation Trust, Swindon, UK
| | - Michele Bombardieri
- Department of Rheumatology, Barts and The London School of Medicine and Dentistry, Barts Health NHS Trust, London, UK
- Centre for Experimental Medicine and Rheumatology, The William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Simon Bowman
- Department of Rheumatology, Milton Keynes University Hospital, Milton Keynes, UK
- Department of Rheumatology, University Hospitals Birmingham NHSFT, Birmingham, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Sara Carty
- Department of Rheumatology, Great Western Hospital NHS Foundation Trust, Swindon, UK
| | - Coziana Ciurtin
- Centre for Rheumatology, Division of Medicine, University College London, London, UK
| | - Bridget Crampton
- Patient Representative, Sjogren's UK Helpline Lead, Sjogren's UK (British Sjögren's Syndrome Association), Birmingham, UK
| | - Annabel Dawson
- Patient Representative, Sjogren's UK (British Sjögren's Syndrome Association), Birmingham, UK
| | - Benjamin A Fisher
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre and Department of Rheumatology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ian Giles
- Centre for Rheumatology, Division of Medicine, University College London, London, UK
| | - Peter Glennon
- General Practice, NHS Staffordshire & Stoke on Trent ICB, Stafford, UK
| | - Monica Gupta
- Department of Rheumatology, Gartnavel General Hospital, Glasgow, UK
| | - Katie L Hackett
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
| | | | - Wan-Fai Ng
- Translational and Clinical Research Institute & Newcastle NIHR Biomedical Research Centre, Newcastle University, Newcastle upon Tyne, UK
- Department of Rheumatology, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Athimalaipet V Ramanan
- Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, Bristol, UK
- Translational Health Sciences, University of Bristol, Bristol, UK
| | - Saad Rassam
- Haematology and Haemato-Oncology, KIMS Hospital, Maidstone, Kent, UK
| | - Saaeha Rauz
- Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham NHS Trust, Birmingham, UK
| | - Guy Smith
- Department of Ophthalmology, Great Western Hospital NHS Foundation Trust, Swindon, UK
| | | | - Anwar Tappuni
- Institute of Dentistry, Queen Mary University of London, London, UK
| | - Stephen B Walsh
- London Tubular Centre, University College London, London, UK
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Salehzadeh F, Molatefi R, Mardi A, Nahanmoghaddam N. Juvenile idiopathic recurrent parotitis (JIRP) treated with short course steroids, a case series study and one decade follow up for potential autoimmune disorder. Pediatr Rheumatol Online J 2024; 22:8. [PMID: 38178123 PMCID: PMC10765850 DOI: 10.1186/s12969-023-00946-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 12/15/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Juvenile idiopathic recurrent parotitis (JIRP) in children is a condition characterized with recurrent episodes of idiopathic parotid gland inflammation. Since there are no definitive guidelines for diagnosis and management of this condition, we present a consecutive case series of patients with more than one decade follow up and their dramatic response to short course treatment by prednisolone. METHODS We conducted this study by retrospectively reviewed medical charts of children who were diagnosed with JIRP, from 1 January 2002 to 29 February 2023. We performed usual serological tests to exclude some possible background. We administered short course prednisolone on first day of episode as divided dosage (0.5 mg /kg). RESULTS In this case series of 10 patients (70%) were male, median age of onset was 5 years, duration of episodes 5 days, and the mean course of disease were 3.8 years. The average follows up of patients was near 10 years. In comparison with their natural course of disease all patients showed a dramatic response to treatment on the first day of administration of prednisolone (P Value 0.005). For ten years follow up there was not any additional accompanying autoimmune disorder. CONCLUSION Short course prednisolone on first day of each episode and its dramatic and meaningful response in our patients, introduce a new, effective, fast, and inexpensive regimen of therapy in patients with JIRP.
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Affiliation(s)
- Farhad Salehzadeh
- Pediatric Rheumatology, Pediatric Department, Bouali Children's Hospital, Ardabil University of Medical Sciences (ARUMS), Ardabil, Iran
| | - Rasol Molatefi
- Pediatric Allergy and Immunology, Pediatric Department, Bouali Children's Hospital, Ardabil University of Medical Sciences (ARUMS), Ardabil, Iran.
| | - Ali Mardi
- Pediatric Gastroenterology, Pediatric Department, Bouali Children's Hospital, Ardabil University of Medical Sciences (ARUMS), Ardabil, Iran
| | - Negin Nahanmoghaddam
- Pediatric Infectious Disease, Pediatric Department, Bouali Children's Hospital, Ardabil University of Medical Sciences (ARUMS), Ardabil, Iran
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Soriano-Martín D, García-Consuegra L, Junquera L, Reda S, Junquera S. Juvenile Recurrent Parotitis: Video-Documented Sialendoscopy. J Clin Med 2023; 12:6842. [PMID: 37959307 PMCID: PMC10649241 DOI: 10.3390/jcm12216842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/01/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023] Open
Abstract
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.
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Affiliation(s)
- David Soriano-Martín
- Department of Oral and Maxillofacial Surgery, Central University Hospital of Asturias, 33011 Oviedo, Spain
| | - Luis García-Consuegra
- Department of Oral and Maxillofacial Surgery, Central University Hospital of Asturias, 33011 Oviedo, Spain
| | - Luis Junquera
- Department of Oral and Maxillofacial Surgery, Central University Hospital of Asturias, 33011 Oviedo, Spain
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine and Health Sciences, University of Oviedo, C/. Catedrático Serrano s/n., 33006 Oviedo, Spain
| | - Sara Reda
- Department of Otolaringology, 12 de Octubre University Hospital, 28041 Madrid, Spain
| | - Sonsoles Junquera
- Department of Radiology, San Agustín University Hospital, 33401 Avilés, Spain
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6
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Kallas-Silva L, Azevedo MFD, de Matos FCM, Petrarrolha SP, Dedivitis RA, Kulcsar MAV, Matos LL. Sialendoscopy for treatment of major salivary glands diseases: a comprehensive analysis of published systematic reviews and meta-analyses. Braz J Otorhinolaryngol 2023; 89:101293. [PMID: 37487402 PMCID: PMC10382863 DOI: 10.1016/j.bjorl.2023.101293] [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: 05/20/2023] [Accepted: 07/07/2023] [Indexed: 07/26/2023] Open
Abstract
OBJECTIVES Sialendoscopy is a minimally invasive procedure used to diagnose and treat obstructive salivary gland diseases. Previous studies in the topic have shown mixed results. The present study aimed to evaluate the efficacy and safety of sialendoscopy through previous systematic reviews for different outcomes of several diseases. We also aimed to assess studies' methodological quality and heterogeneity. METHODS We conducted a comprehensive systematic literature search of Pubmed, Embase, Lilacs and Cochrane Library. We included systematic reviews and meta-analyses that used sialendoscopy to treat both lithiasic and alithiasic salivary glands diseases. Data extraction included studies' characteristics and results. We assessed studies' methodological quality using the AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews 2) tool. RESULTS 13 studies were included in the review, being 9 in adult populations and 4 in pediatric populations. Sialendoscopy proved to be effective at the treatment of different lithiasic and other obstructive diseases, but with important heterogeneity. The technique was also considered highly safe in most studies. However, studies had a critically low quality of evidence. CONCLUSIONS Most studies demonstrated high efficacy and safety of sialendoscopy, but with critically low quality of evidence. We still lack randomized studies in this field, and future systematic reviews on the topic should follow current guidelines to improve conduction and reporting.
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Affiliation(s)
- Lucas Kallas-Silva
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Serviço de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Maria Fernanda Dias Azevedo
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Serviço de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Fátima Cristina Mendes de Matos
- Universidade de Pernambuco (UPE), Pernambuco, PE, Brazil; Vice-presidente da Sociedade Brasileira de Cirurgia de Cabeça e Pescoço, Brazil
| | - Silvia Picado Petrarrolha
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Departamento de Cirurgia (Cirurgia de Cabeça e Pescoço), São Paulo, SP, Brazil
| | - Rogério Aparecido Dedivitis
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Departamento de Cirurgia (Cirurgia de Cabeça e Pescoço), São Paulo, SP, Brazil; Ex-presidente da Sociedade Brasileira de Cirurgia de Cabeça e Pescoço, Brazil.
| | - Marco Aurélio Vamondes Kulcsar
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Instituto do Câncer do Estado de São Paulo (Icesp), Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil; Presidente da Sociedade Brasileira de Cirurgia de Cabeça e Pescoço, Brazil
| | - Leandro Luongo Matos
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Instituto do Câncer do Estado de São Paulo (Icesp), Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil; Faculdade Israelita de Ciências da Saúde Albert Einstein, Clínica Cirúrgica, São Paulo, SP, Brazil; Diretor Científico da Sociedade Brasileira de Cirurgia de Cabeça e Pescoço, Brazil
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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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Alkusayer MM, Alshehri RS, Alkhoudairy RS, Alahmadi RM, Albdah AA. Juvenile Recurrent Parotitis: An Eight-Year-Old Boy With a Painful Acute Right-Sided Parotid Swelling. Cureus 2023; 15:e42632. [PMID: 37644943 PMCID: PMC10460917 DOI: 10.7759/cureus.42632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2023] [Indexed: 08/31/2023] Open
Abstract
Juvenile recurrent parotitis (JRP) is a rare recurrent non-obstructive inflammatory swelling of the parotid gland occurring most commonly in children aged three to six years. JRP is usually idiopathic and presents as a painful swelling recurring on either side of the face at least twice within six months. We report the case of an eight-year-old Saudi boy with a painful acute right-sided parotid swelling and a history of similar occurrences bilaterally at least four times a year for two years. The routine laboratory investigations were unremarkable. Ultrasonography of the parotid glands suggested parotitis with cervical lymphadenopathy. He was treated conservatively and remained asymptomatic for a year. Although rare, an accurate diagnosis of JRP is possible with adequate history, physical examination, and lab investigations, supplemented with radiographic findings.
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Affiliation(s)
| | - Reham S Alshehri
- College of Medicine, Princess Nourahbint Abdulrahman University, Riyadh, SAU
| | - Reema S Alkhoudairy
- College of Medicine, Princess Nourahbint Abdulrahman University, Riyadh, SAU
| | - Rawan M Alahmadi
- Otolaryngology, Head and Neck Surgery, Prince Sultan Military Medical City, Riyadh, SAU
| | - Abdullah A Albdah
- Otolaryngology, Head and Neck Surgery, King Saud Medical City, Riyadh, SAU
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Wilson J, Gorelik M, Gulliver J, Jaju A, Bhushan B, Rastatter J, Johnston D, Maddalozzo J. Superficial Parotidectomy for Juvenile Recurrent Parotitis. Laryngoscope 2023; 133:1495-1500. [PMID: 37158262 DOI: 10.1002/lary.30349] [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: 05/11/2022] [Revised: 07/29/2022] [Accepted: 08/02/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To investigate long-term outcomes, imaging, and pathologic findings in pediatric patients who underwent superficial parotidectomy for recalcitrant juvenile recurrent parotitis (JRP). METHODS Records for 20 children (23 parotidectomies; 9 females, 11 males; age at surgery of 8.6 ± 3.7 years) collected over a 10-year period (2012-2021) were reviewed. Parents were contacted via telephone to obtain extended follow-up. A simplified scoring system was used to assess imaging findings and an additional pathologic review was conducted to further clarify the underlying disease process. RESULTS All but one patient experienced resolution of their recurrent symptoms after superficial parotidectomy. Three of the patients studied required surgery on the contralateral side, and this could be predicted based on their imaging at the time of the initial surgery. Pathologic findings included ductal fibrosis, metaplasia, and dilatation as well as parenchymal atrophy and fatty deposition. There were no major surgical complications, however, the incidence of Frey's syndrome in this sample was 43.5% of surgical sites. CONCLUSION For patients with frequent recalcitrant symptoms or significant quality of life impairment related to JRP, superficial parotidectomy represents a potential treatment option with the noted reduction in symptom burden following surgery. Further longitudinal studies are needed. LEVEL OF EVIDENCE 4 Laryngoscope, 133:1495-1500, 2023.
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Affiliation(s)
- John Wilson
- Division of Otorhinolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A
| | - Michael Gorelik
- Division of Otorhinolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A
| | - Jessica Gulliver
- Department of Pathology and Laboratory Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A
| | - Alok Jaju
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A
| | - Bharat Bhushan
- Division of Otorhinolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A
| | - Jeffrey Rastatter
- Division of Otorhinolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A
| | - Douglas Johnston
- Division of Otorhinolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A
| | - John Maddalozzo
- Division of Otorhinolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, U.S.A
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Liljekvist MS, Foghsgaard J, Howitz MF. Sialendoscopy for pediatric salivary gland disorders: a study of safety and effect. Eur Arch Otorhinolaryngol 2023; 280:1927-1937. [PMID: 36478117 DOI: 10.1007/s00405-022-07747-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 11/07/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE Sialendoscopy has become the preferred modality for managing pediatric salivary gland disorders (PSGD) including juvenile recurrent parotitis (JRP) and sialolithiasis. The literature remains sparse, but several case series have reported good outcomes and few complications. The aim of this study was to investigate the safety and efficacy of sialendoscopy for PSGD in a Danish setting. METHODS From a national sialendoscopy database, we included records of children who had undergone sialendoscopy for PSGD at our clinic over a 6-year period. Clinical and intraoperative data, follow-up and e-mail surveys after 1, 3 and 5 years were retrieved for analysis. RESULTS We included 52 procedures on 50 glands (32 parotid, 18 submandibular) in 49 children. Of eligible patients, 90% attended clinical follow-up, 80% answered the survey after 1 year, 80% after 3 years and 60% after 5 years. JRP was diagnosed in 33 cases, obstructive causes in 18 cases. Complications noted were ductal perforation (2%), transient lingual nerve affection (4%) and infection (2%). For JRP patients, overall symptoms had improved for 96% after 3 months, 81% after 1 year and 83% after 3 years. For patients suffering from obstruction, overall symptoms were improved for 93% after 3 months and for 100% after 1 year. CONCLUSION Sialendoscopy is a safe procedure for PSGD, and effective for sialolithiasis and symptom reduction in JRP.
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Affiliation(s)
- Mads S Liljekvist
- Department of Ear, Nose, and Throat, Nordsjællands Hospital, Hillerød, Denmark.
| | - Jakob Foghsgaard
- Department of Ear, Nose, and Throat, Nordsjællands Hospital, Hillerød, Denmark
| | - Michael F Howitz
- Department of Ear, Nose, and Throat, Nordsjællands Hospital, Hillerød, Denmark
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11
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Epidemiologic, radiologic, and sialendoscopic aspects in chronic obstructive sialadenitis. Eur Arch Otorhinolaryngol 2022; 279:5813-5820. [PMID: 35680655 DOI: 10.1007/s00405-022-07473-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/27/2022] [Indexed: 02/01/2023]
Abstract
PURPOSE Chronic obstructive sialadenitis (COS) is a recurring inflammation of the salivary gland. To date, there are no known predisposing factors for COS. Given the advances seen in radiology and sialendoscopy, we must update our knowledge of COS, analyzing factors that can favor its development. METHODS We prospectively analyzed 333 patients who underwent sialendoscopy between 2012 and 2021. Epidemiologic, radiologic, and sialendoscopy-related factors were correlated. Suspected diagnosis was established based on the clinical and radiologic data. The final diagnosis was determined on the basis of sialendoscopic findings. RESULTS The most common etiology of COS was stricture (40.8%). Lack of papilla distensibility (LPD) was also described as an etiology. COS was related to patient gender and age. Submandibular gland involvement was significantly more associated with lithiasis and LPD, while COS of the parotid gland was most frequently caused by stricture. Radioiodine sialadenitis and Sjögren's syndrome were significantly associated with stricture. MR sialography (MR-Si) showed the best overall sensitivity and specificity. CONCLUSION In our series, stricture was the most common cause of COS. We describe LPD as a frequent cause of COS in this series; ours is the first study to report this finding. There was a significant association between the salivary gland involved, patient sex and age, and the cause of COS. MR-Si showed the greatest diagnostic yield.
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12
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Sialendoscopy in Management of Juvenile Recurrent Parotitis-A Single Centre Experience. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9111632. [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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13
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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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14
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Chafin JB, Bayazid L. Pediatric Salivary Gland Disease. Pediatr Clin North Am 2022; 69:363-380. [PMID: 35337545 DOI: 10.1016/j.pcl.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Salivary gland disease in the pediatric population is rare, yet it encompasses a wide spectrum of disease. It is estimated that 4.3% of salivary gland disease occurs in the pediatric population, with most classified as nonneoplastic. Further extrapolation reveals that 5% of salivary gland neoplastic diseases occur in patients younger than 20 years. Moreover, salivary gland tumors represent 1% of all head and neck tumors across all ages. Regardless, clinicians across all fields should be familiar with the workup of various pediatric salivary gland diseases and appropriate referral to a pediatric otolaryngologist.
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Affiliation(s)
- James Brett Chafin
- Department of Pediatric Otolaryngology-Head & Neck Surgery, Nemours Children's Health System, 807 Childrens Way 4th Floor, Jacksonville, FL 32207, USA.
| | - Leith Bayazid
- Department of Otolaryngology-Head and Neck Surgery, University of South Florida College of Medicine, 12901 Bruce B. Downs Boulevard, MDC 73, Tampa, FL 33612, USA
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15
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Benaim E, Fan T, Dash A, Gillespie MB, McLevy-Bazzanella J. Common Characteristics and Clinical Management Recommendations for Juvenile Recurrent Parotitis: A 10-Year Tertiary Center Experience. OTO Open 2022; 6:2473974X221077874. [PMID: 35187385 PMCID: PMC8848064 DOI: 10.1177/2473974x221077874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 01/07/2022] [Indexed: 12/18/2022] Open
Abstract
Objective Juvenile recurrent parotitis (JRP) is a rare disease that may adversely affect normal development and quality of life. The objective of this study was to report on the demographics, characteristics, and treatment outcomes of JRP and to offer evidence-based management recommendations. Study Design Retrospective review. Setting A single tertiary care pediatric teaching hospital. Methods Medical records, imaging studies, and laboratory findings over a 10-year period were retrospectively collected and reviewed, resulting in 41 patients with JRP between the ages of 8 months and 16 years. Results Black males aged 2 to 8 years were most commonly affected by JRP. Overall, 18 (44%) patients received ≥3 antibiotics, and 17 (42%) underwent sialendoscopy for treatment. Over 75% of patients had no JRP recurrences after 3 sialendoscopies. The most common imaging approach was computed tomography (42%), and the most frequent laboratory results were elevated amylase (83%) and C-reactive protein (82%). Atopy (61%) and excess weight (42%) were routinely associated with JRP, especially in severe cases. Conclusion JRP workup and treatment plans should begin with the least burdening modalities, including over-the-counter analgesics, minimal laboratory studies in the acute phase, and ultrasonography over computed tomography. Clindamycin is an effective initial antibiotic of choice, and severe recurrences may be controlled with sialendoscopy. Optimizing the health of patients with JRP includes managing comorbidities, especially of atopic and overweight origins, which are associated with more severe cases.
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Affiliation(s)
- Ezer Benaim
- Department of Otolaryngology–Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Timothy Fan
- Department of Otolaryngology–Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Anwesh Dash
- Department of Otolaryngology–Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - M. Boyd Gillespie
- Department of Otolaryngology–Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Jennifer McLevy-Bazzanella
- Department of Otolaryngology–Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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16
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Pomorska A, Świętoń D, Lieberman SM, Bryl E, Kosiak W, Pęksa R, Chorążewicz J, Kochańska B, Kowalska-Skabara J, Szumera M, Brzoznowski W, Jaworski R, Irga-Jaworska N. Recurrent or persistent salivary gland enlargement in children: When is it Sjögren's? Semin Arthritis Rheum 2021; 52:151945. [PMID: 35000785 DOI: 10.1016/j.semarthrit.2021.11.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/23/2021] [Accepted: 11/17/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To describe characteristic features in children with recurrent or persistent salivary gland enlargement and to propose a diagnostic algorithm with specific consideration for Sjögren's disease (SD). METHODS In this single-center, prospective study, 45 patients < 18 years, with recurrent or persistent salivary gland enlargement of unknown etiology were enrolled from 2006 to 2019. We collected detailed clinical information to characterize this group of patients including specific details of their major salivary gland signs and symptoms. We compared clinical, laboratory and radiological parameters between 4 groups based on the results of labial salivary gland biopsy (LSGB) and between patients who met existing SD criteria or not. RESULTS 44 patients, with a mean age of 6.8 years and female to male ratio 21:23 were observed over a mean of 3.8 years. Characteristics of salivary gland swelling episodes varied considerably between individuals, but the majority experienced ≤5 episodes per year, lasting ≤ 1 week, with swelling affecting either or both glands. Ocular and oral dryness symptoms were observed only in 25% and 59% patients, respectively. The majority were positive for ANA, but negative for SD-specific antibodies. A total of 75% patients fulfilled at least one of the existing SD criteria. CONCLUSION SD is a major cause of recurrent salivary gland enlargement in children. For children meeting adult criteria, the diagnosis of SD is clear. However, for the many children without dryness symptoms, objective dryness, or SD-specific antibodies, further workup including a combination of salivary gland imaging and histopathological examination can help establish the diagnosis of SD.
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Affiliation(s)
- Anna Pomorska
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdańsk, Dębinki 7, Gdańsk 80-952, Poland.
| | - Dominik Świętoń
- 2nd Department of Radiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Scott M Lieberman
- Division of Rheumatology, Allergy, and Immunology, Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa, IA, United States
| | - Ewa Bryl
- Department of Pathology and Experimental Rheumatology, Medical University of Gdańsk, Gdańsk, Poland
| | - Wojciech Kosiak
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdańsk, Dębinki 7, Gdańsk 80-952, Poland
| | - Rafał Pęksa
- Pathology Department, Medical University of Gdańsk, Gdańsk, Poland
| | | | - Barbara Kochańska
- Department of Conservative Dentistry, Medical University of Gdańsk, Gdańsk, Poland
| | | | - Małgorzata Szumera
- Department of Pediatrics, Gastroenterology, Hepatology and Nutrition, Medical University of Gdańsk, Gdańsk, Poland
| | | | - Radosław Jaworski
- Department of Pediatric Cardiothoracic Surgery, Children's Memorial Health Institute, Warsaw, Poland
| | - Ninela Irga-Jaworska
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdańsk, Dębinki 7, Gdańsk 80-952, Poland
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17
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Timeus F, Calvo MM, Caci AM, Gallone GO, Vittone F. IgG4-related chronic sclerosing sialadenitis in a child with recurrent parotitis: a case report. BMC Pediatr 2021; 21:586. [PMID: 34930210 PMCID: PMC8691005 DOI: 10.1186/s12887-021-03004-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 11/13/2021] [Indexed: 11/10/2022] Open
Abstract
Background IgG4-related disease (IgG4-RD) includes a group of immune-mediated diseases histologically characterized by lymphoplasmacytic infiltrate with a prevalence of IgG4-positive plasma cells, storiform fibrosis and obliterative phlebitis. Autoimmune pancreatitis, sialadenitis, dacryoadenitis and retroperitoneal fibrosis are the most frequent manifestations. IgG4-related sialadenitis usually affects submandibular glands and is very rare in children. Here we report the case of IgG4-related sialadenitis in a six-year-old patient previously diagnosed as juvenile recurrent parotitis. Case presentation A six-year-old patient was referred to our Centre for left parotid swelling of 4 × 3 cm, that was tender, soft in consistency, with overlying red and warm skin. His general condition was good but he was subfebrile; general examination revealed mild enlargement of left cervical lymph nodes. In the last 2 years he had had five episodes of parotitis, diagnosed by another pediatric Center as juvenile recurrent parotitis. On ultrasound examination the left parotid gland appeared enlarged, inhomogeneous, with a colliquative intraparotid lymph node and no evidence of sialolithiasis. Laboratory tests showed an increase of white blood cells and anti-VCA IgM and IgG positivity, with anti-EBNA e anti-EA I negativity. The patient was initially treated with oral antibiotics, but after 10 days the parotid became fluctuating, requiring surgical biopsy and drainage. Postoperative course was regular, with complete remission under oral antibiotic and steroid therapy. Microbiological tests, including cultures for aerobic and anaerobic bacteria, mycobacteria and Bartonella, were negative. Surprisingly, histology showed marked fibrosis and histiocytic and lymphoplasmacellular infiltrate with polyclonal plasma cells mostly expressing IgG4 immunoglobulins. Thus, the diagnosis of IgG4 related chronic sialadenitis in recurrent parotitis and recent EBV infection was made. Conclusions IgG4-related sialadenitis is very unusual in children. Histology plays a key role in diagnosis, considering that up to 30% of patients have normal serum IgG4 levels, as shown in our case. The lack of previous histological data makes it impossible to attribute our patient’s previous episodes of parotitis to IgG4-RD, though it is a very consistent possibility.
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18
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Dammak N, Berrezouga L, Raadani I, Selmi W, Khelifa MB. Juvenile recurrent parotitis in a 4-year-old patient: a case report. Pan Afr Med J 2021; 40:86. [PMID: 34909075 PMCID: PMC8607950 DOI: 10.11604/pamj.2021.40.86.27001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 09/01/2021] [Indexed: 11/11/2022] Open
Abstract
Juvenile recurrent parotitis (JRP) is a rare disease. It is most commonly occurring between the ages of 3 and 5 years, that classically resolves at adolescence. It is characterized by recurrent non-suppurative parotitis, with several acute inflammatory episodes per year. The parotid´s swelling tends to be unilateral, but it can occur bilaterally, with a more predominant side. The aim of this work was to present a case report that highlights signs and symptoms of this unusual condition and to stress on the value of ultrasonography as an aid to diagnosis.
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Affiliation(s)
- Nouha Dammak
- Department of Medicine and Oral Surgery, University Dental Clinic of Monastir, Monastir, Tunisia
| | - Latifa Berrezouga
- Department of Dental Medicine, Fattouma Bourguiba Teaching Hospital, Monastir, Tunisia
| | - Imen Raadani
- Department of Dental Medicine, Fattouma Bourguiba Teaching Hospital, Monastir, Tunisia
| | - Wissal Selmi
- Department of Dental Medicine, Fattouma Bourguiba Teaching Hospital, Monastir, Tunisia
| | - Mohamed Ben Khelifa
- Department of Dental Medicine, Fattouma Bourguiba Teaching Hospital, Monastir, Tunisia
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Vanden Daele A, Drubbel J, Van Lierde C, Meulemans J, Delaere P, Vander Poorten V. Long-term outcome of a cohort of 272 patients undergoing sialendoscopy. Clin Otolaryngol 2021; 47:138-145. [PMID: 34674373 DOI: 10.1111/coa.13882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/13/2021] [Accepted: 10/02/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the cohort of patients undergoing sialendoscopic intervention for improvement of symptoms and gland-related quality of life at long-term follow-up. DESIGN This is a retrospective review of medical records with a prospective follow-up by questionnaire. SETTING & PARTICIPANTS All patients undergoing sialendoscopy at the University Hospitals Leuven Department of Otorhinolaryngology, Head and Neck Surgery between March 2008 and June 2020. MAIN OUTCOME MEASURES The electronic files of the patients were searched for information about their sialendoscopic procedure and follow-up consultations. We also send the patients a questionnaire by mail to assess symptom control and gland-related quality of life at long-term follow-up. RESULTS Two hundred seventy-two sialendoscopies were performed in 221 patients. Median follow-up time was 37 months. The sialendoscopies were performed in 130 patients for lithiasis, in 66 for stenosis, in 14 for recurrent parotitis of childhood, in 8 for recurrent sialadenitis of unknown origin and in 3 for radioiodine-induced sialadenitis. Complications occurred in 11 of 272 sialendoscopies (4%). Those were iatrogenic perforations, temporary lingual nerve paresthesia and swelling of the floor of the mouth. 53% of patients returned the questionnaire, for a total of 146 evaluable sialendoscopies. The majority of the responders indicated that sialendoscopy had improved their symptoms (83.6%). Salivary glands could be preserved in 89% of the responder group. The highest percentage of patients reporting residual symptoms was found in the RPC group (81.3%) and the lowest in the lithiasis group (16.2%). Besides age, no statistical differences in demographic and pathological features between the responder and non-responder groups were found, supporting generalisation of the responders' results to the entire cohort. CONCLUSIONS This study confirms the good long-term outcomes of sialendoscopic interventions in patients with chronic sialadenitis of different aetiologies and a high rate of gland preservation.
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Affiliation(s)
- Arike Vanden Daele
- Otorhinolaryngology and Head & Neck Surgery, University Hospital Leuven, Leuven, Belgium.,Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | - Joekio Drubbel
- Otorhinolaryngology and Head & Neck Surgery, University Hospital Leuven, Leuven, Belgium.,Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | - Charlotte Van Lierde
- Otorhinolaryngology and Head & Neck Surgery, University Hospital Leuven, Leuven, Belgium.,Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | - Jeroen Meulemans
- Otorhinolaryngology and Head & Neck Surgery, University Hospital Leuven, Leuven, Belgium.,Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | - Pierre Delaere
- Otorhinolaryngology and Head & Neck Surgery, University Hospital Leuven, Leuven, Belgium.,Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | - Vincent Vander Poorten
- Otorhinolaryngology and Head & Neck Surgery, University Hospital Leuven, Leuven, Belgium.,Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
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20
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Thatayatikom A, Jun I, Bhattacharyya I, Berg K, Lee YJ, Kim Y, Adewumi A, Zhang W, Thatayatikom S, Shah A, Beal C, Modica R, Elder ME, Cha S. The Diagnostic Performance of Early Sjögren's Syndrome Autoantibodies in Juvenile Sjögren's Syndrome: The University of Florida Pediatric Cohort Study. Front Immunol 2021; 12:704193. [PMID: 34249010 PMCID: PMC8267463 DOI: 10.3389/fimmu.2021.704193] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 06/02/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives The aim of this study was to evaluate the clinical validity of early Sjögren's syndrome (SS) autoantibodies (eSjA), which were originally marketed for early diagnosis of SS, for juvenile SS (JSS) in a recently identified pediatric cohort. Methods A total of 105 symptomatic subjects with eSjA results available were evaluated at the Center for Orphaned Autoimmune Disorders at the University of Florida and enrolled for this study. JSS diagnosis was based on the 2016 ACR/EULAR SS criteria. Demographic/clinical/laboratory parameters were compared between JSS (n = 27) and non-JSS (n = 78) for % positivity, sensitivity, and specificity of eSjA (SP1, anti-salivary protein; CA6, anti-carbonic anhydrase VI; PSP, anti-parotid secretory protein) and classic SS-autoantibodies (cSjA; ANA, SSA/SSB, RF, and others) either alone or in combination. Associations between eSjA and diagnostic/glandular parameters were also determined by Fisher's exact test. Results Compared to non-JSS, JSS patients exhibited sicca symptoms demonstrating reduced unstimulated salivary flow rate (USFR) and abnormal glandular features revealed by salivary gland ultrasound (SGUS). Among cSjA, ANA demonstrated the highest sensitivity of 69.2%, while SSA, SSB, and RF showed around 95% specificities for JSS diagnosis. The % positive-SSA was notably higher in JSS than non-JSS (56% vs. 5%). Of eSjA, anti-CA6 IgG was the most prevalent without differentiating JSS (37%) from non-JSS (32%). Sensitivity and specificity of eSjA were 55.6 and 26.9%, respectively. Autoantibodies with potentially applicable specificity/sensitivity for JSS were seen only in cSjA without a single eSjA included. There were no associations detected between eSjA and focus score (FS), USFR, SSA, SGUS, and parotitis/glandular swelling analyzed in the entire cohort, JSS, and non-JSS. However, a negative association between anti-PSP and parotitis/glandular swelling was found in a small group of positive-SSA (n = 19, p = 0.02) whereas no such association was found between anti-PSP-positive compared to anti-PSP-negative. JSS and non-JSS groups differed in FS, USFR, and EULAR SS Patient Reported Index Dryness/Mean in CA6/PSP/ANA, SP1, and SSA-positive groups, respectively. Additionally, a higher FS was found in RF-positive than RF-negative individuals. Conclusions eSjA underperformed cSjS in differentiating JSS from non-JSS. The discovery of clinical impact of eSjA on early diagnosis of JSS necessitates a longitudinal study.
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Affiliation(s)
- Akaluck Thatayatikom
- Department of Pediatrics, Division of Allergy, Immunology, Rheumatology, College of Medicine, University of Florida, Gainesville, FL, United States.,Center for Orphaned Autoimmune Disorders (COAD), College of Dentistry, University of Florida, Gainesville, FL, United States
| | - Inyoung Jun
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, FL, United States
| | - Indraneel Bhattacharyya
- Center for Orphaned Autoimmune Disorders (COAD), College of Dentistry, University of Florida, Gainesville, FL, United States.,Division of Oral Pathology, Department of Oral and Maxillofacial Diagnostic Sciences, College of Dentistry, University of Florida, Gainesville, FL, United States
| | - Kathleen Berg
- Center for Orphaned Autoimmune Disorders (COAD), College of Dentistry, University of Florida, Gainesville, FL, United States.,Division of Oral Medicine, Department of Oral and Maxillofacial Diagnostic Sciences, College of Dentistry, University of Florida, Gainesville, FL, United States
| | - Yun Jong Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yoosik Kim
- Department of Chemical and Biomolecular Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, South Korea
| | - Abi Adewumi
- Department of Pediatric Dentistry, College of Dentistry, University of Florida, Gainesville, FL, United States
| | - Weizhou Zhang
- Department of Pathology, Immunology and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Sthorn Thatayatikom
- Department of Pediatrics, Division of Allergy, Immunology, Rheumatology, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Ankit Shah
- Department of Ophthalmology, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Casey Beal
- Department of Ophthalmology, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Renee Modica
- Department of Pediatrics, Division of Allergy, Immunology, Rheumatology, College of Medicine, University of Florida, Gainesville, FL, United States.,Center for Orphaned Autoimmune Disorders (COAD), College of Dentistry, University of Florida, Gainesville, FL, United States
| | - Melissa E Elder
- Department of Pediatrics, Division of Allergy, Immunology, Rheumatology, College of Medicine, University of Florida, Gainesville, FL, United States.,Center for Orphaned Autoimmune Disorders (COAD), College of Dentistry, University of Florida, Gainesville, FL, United States
| | - Seunghee Cha
- Center for Orphaned Autoimmune Disorders (COAD), College of Dentistry, University of Florida, Gainesville, FL, United States.,Division of Oral Medicine, Department of Oral and Maxillofacial Diagnostic Sciences, College of Dentistry, University of Florida, Gainesville, FL, United States
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21
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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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Lindburg M, Walvekar RR, Ogden A. Sialadenitis of Unknown Etiology. CURRENT OTORHINOLARYNGOLOGY REPORTS 2021. [DOI: 10.1007/s40136-021-00361-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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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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Deep Sedation for Pediatric Parotid Sialendoscopy in Juvenile Recurrent Parotitis. J Clin Med 2021; 10:jcm10020276. [PMID: 33451162 PMCID: PMC7828661 DOI: 10.3390/jcm10020276] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/08/2021] [Accepted: 01/11/2021] [Indexed: 12/14/2022] Open
Abstract
Sialendoscopy is a minimally invasive diagnostic and therapeutic tool for juvenile recurrent parotitis (JRP); the procedure is under general anesthesia, but local anesthesia has been used for sialendoscopy in children >8 years. Based on the experience in children with sedation for gastrointestinal endoscopy, we investigated the reliability and safety of deep sedation for sialendoscopy in JRP. Six children (3 females, 6-13 years) with episodes of parotid swelling underwent interventional (duct dilation and steroid irrigation) sialendoscopy with intravenous bolus of 1 mg/kg propofol and 1 mcg/kg fentanyl, and continuous infusion of 2 mg/kg/h propofol. Sialendoscopy under deep sedation was successfully performed in all the patients; the procedure was well tolerated, without any adverse effects. One event of full awakening was registered and promptly solved without needing to interrupt the procedure. Effectiveness of sialendoscopy under deep sedation was subjectively attested by high positive scores obtained at post-operative standardized questionnaires administered to the patients and their parents, and objectively by the lack of clinical recurrences during the follow-up. The combination of propofol and fentanyl seems to be a reliable and safe means of sedating children with JRP undergoing sialendoscopy.
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Iordanis K, Panagiotis D, Angelos C, Antonios M, Alexander D, Sofia A, Efimia PA. Unilateral Sialendoscopy for Juvenile Recurrent Parotitis: What Happens to the Other Side? Laryngoscope 2020; 131:1404-1409. [PMID: 33098313 DOI: 10.1002/lary.29187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/02/2020] [Accepted: 10/02/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVE/HYPOTHESIS Current literature has confirmed the benefits of sialendoscopy for the treatment of juvenile recurrent parotitis (JRP). However, this procedure is often performed unilaterally, although the disease can affect both sides. This article investigated the clinical course of the contralateral parotid (CL) gland in children requiring unilateral sialendoscopy with the goal of clarifying the necessity of primary bilateral sialendoscopy. STUDY DESIGN Prospective cohort study in a tertiary center. METHODS Over an eight-year period, 77 children with JRP underwent unilateral sialendoscopy. We observed the clinical course of the CL parotid over a minimum follow-up period of 24 months. New episodes of sialadenitis were recorded on both sides along with the need for a second sialendoscopy. These data were correlated with the preoperative symptoms of the contralateral side as well as ultrasound (U/S) findings at baseline assessment. RESULTS In total, six children required sialendoscopy on the CL side (7.8%), 62 children remained asymptomatic or with scarce swellings (80.5%), and nine children improved (11.7%). The preoperative U/S findings on the CL side positively correlated with the number of postoperative swellings. The proportion of children needing CL sialendoscopy was higher (21.4%) among children needing a second sialendoscopy on the operated side. CONCLUSIONS In the long term, the vast majority of children needing unilateral sialendoscopy do not require similar treatment of the CL parotid gland. However, a history of bilateral swellings along with U/S findings of parenchymal disorganization on the CL side significantly increases the risk of needing further sialendoscopy at a later time. LEVEL OF EVIDENCE 4 Laryngoscope, 131:1404-1409, 2021.
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Affiliation(s)
- Konstantinidis Iordanis
- 2nd Academic ORL Department, Papageorgiou Hospital, Aristotle University, School of Medicine, Thessaloniki, Greece
| | - Dogantzis Panagiotis
- 2nd Academic ORL Department, Papageorgiou Hospital, Aristotle University, School of Medicine, Thessaloniki, Greece
| | - Chatziavramidis Angelos
- 2nd Academic ORL Department, Papageorgiou Hospital, Aristotle University, School of Medicine, Thessaloniki, Greece
| | - Metzikofis Antonios
- 4th Department of Pediatrics, Aristotle University, School of Medicine, Papageorgiou Hospital, Thessaloniki, Greece
| | - Delides Alexander
- 2nd Academic ORL Department, Attikon Hospital, School of Medicine, National and Kapodistrian University, Athens, Greece
| | - Alataki Sofia
- 4th Department of Pediatrics, Aristotle University, School of Medicine, Papageorgiou Hospital, Thessaloniki, Greece
| | - Papadopoulou-Alataki Efimia
- 4th Department of Pediatrics, Aristotle University, School of Medicine, Papageorgiou Hospital, Thessaloniki, Greece
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Positive Effects of Local Botulinum Toxin Injection and Colchicine for Complicated Chronic Recurrent Parotitis: A Case Report. J Oral Maxillofac Surg 2020; 79:383-388. [PMID: 32910892 DOI: 10.1016/j.joms.2020.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/07/2020] [Accepted: 08/07/2020] [Indexed: 11/23/2022]
Abstract
Chronic recurrent parotitis (CRP) is a rare affliction of unknown cause characterized by recurrent episodes of unilateral or bilateral nonobstructive and nonsuppurative inflammation of the parotid glands. Management of CRP is not standardized, and attempts at treatment often fail. We report a case of a 29-year-old female patient with CRP for 13 years, with recurrent acute episodes, complicated with a collection and cutaneous fistula, refractory to repeated courses of corticosteroids and antibiotics. Injections of botulinum toxin in the parotid gland and maintenance treatment with oral colchicine lead to a rapid and sustained improvement. Local botulinum toxin injections associated with colchicine might represent a safe and noninvasive treatment of CRP. The possible beneficial effect of colchicine could be an argument for auto-inflammatory participation in the pathogenesis of CRP.
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Kanerva M, Tapiovaara L, Aro K, Saarinen R. Pediatric sialendoscopy: An 11-year study from a single tertiary care center. Int J Pediatr Otorhinolaryngol 2020; 131:109869. [PMID: 31972384 DOI: 10.1016/j.ijporl.2020.109869] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 01/06/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To evaluate the suitability, benefits, and limitations of sialendoscopy for pediatric patients. METHODS We performed a retrospective analysis of all pediatric sialendoscopy patients (aged 16 years or younger) in our tertiary care institution between September 2007 and October 2018. We characterized patient data, procedure-related factors, complications, and outcomes. RESULTS In total, 55 sialendoscopies were performed on 42 patients. Among these, 36 were diagnostic endoscopies and 19 were interventional. Five endoscopies were performed under local anesthesia. We identified 16 sialolithiasis patients, where removal of a sialolith was possible in 11 (69%) cases; one case required a second endoscopy. We removed two sialoliths under local anesthesia. Among recurrent juvenile parotitis (RJP) patients, 18/20 (90%) were symptom-free after a single sialendoscopy, and all after a second endoscopy. The median follow-up time was 70 months. We achieved a 95% success rate in sialendoscopies, with a failure-to-treat rate of 15%. The complication rate for the study cohort was 2%, with prolonged parotid swelling the only complication encountered. CONCLUSIONS Sialendoscopy represented a safe and effective method to treat pediatric patients. Local anesthesia was successful in selected cases, even for sialolith removal. Sialendoscopy had a soothing effect on RJP and the majority of sialoliths were suitable for endoscopic removal.
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Affiliation(s)
- Mervi Kanerva
- Department of Otorhinolaryngology, Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
| | - Laura Tapiovaara
- Department of Otorhinolaryngology, Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Katri Aro
- Department of Otorhinolaryngology, Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Riitta Saarinen
- Department of Otorhinolaryngology, Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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28
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Sjögren's syndrome in children with recurrent parotitis. Int J Pediatr Otorhinolaryngol 2020; 129:109768. [PMID: 31731017 DOI: 10.1016/j.ijporl.2019.109768] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 10/09/2019] [Accepted: 11/02/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Optimize the diagnosis of pediatric Sjögren's syndrome in children who present with parotitis. METHODS Twenty children presented to a pediatric otolaryngology or rheumatology clinic with recurrent parotitis. Presenting symptoms, serologies, sialendoscopy findings, and minor salivary gland biopsy pathology results were reviewed. RESULTS Twenty patients aged 3-17 years presented with recurrent parotitis. Ten percent of this cohort met the American-European Consensus Group adult diagnostic criteria for Sjögren's syndrome. Forty percent of this cohort met diagnosis of Sjögren's syndrome when utilizing Bartunkova's proposed pediatric criteria for diagnosis of Sjögren's syndrome. CONCLUSION Sjögren's syndrome is surprisingly common in pediatric patients who present with recurrent parotitis. Otolaryngologists who treat pediatric parotitis should have a high index of suspicion for Sjögren's syndrome. LEVEL OF EVIDENCE 4.
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Wu S, Wang B, Yu C, Wang Z, Xie L, Fu J, Shi H, Zheng L. Juvenile recurrent parotitis: Soft foods contribute to the delayed development of salivary glands. J Oral Rehabil 2019; 47:485-493. [PMID: 31828830 DOI: 10.1111/joor.12921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 10/29/2019] [Accepted: 11/29/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Juvenile recurrent parotitis (JRP) is the second-most common childhood disease of the salivary glands after mumps. Since popularisation of mumps vaccination, children suffered from JRP more often, and the aetiology remains unclear. Chinese children had the habit of soft foods due to the special dietary habit of Asia. OBJECTIVES To clarify whether mastication was related to the pathogenesis of JRP and whether the growth of salivary glands was influenced by soft diet. METHODS Investigation of dietary habit and masticatory efficiency from 2015 to 2018 of children diagnosed with JRP compared with the normal children by the dentition. Mice had been fed a soft diet beginning in their development phase. The gland weight, amount of saliva, salivary amylase, histological and ultrastructural observation and the expression levels of EGF, FGFr2 and Wnt3a had been tested. RESULTS The JRP children preferred soft foods and had a significantly lower masticatory efficiency than do normal children. When normalised by body weight, the gland weight, amount of saliva and amount of salivary amylase in the experimental group were significantly lower. The ultrastructural results showed that the acinar cells in the experimental groups were smaller and contained fewer electron-dense secretory granules than those in the control groups. The expression levels of EGF, FGFr2 and Wnt3a in the salivary glands of mice in the experimental groups were significantly lower than those of mice in the control groups. CONCLUSION The soft diet indeed influenced the salivary gland through insufficient mastication, which could be one of the primary factors inducing JRP.
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Affiliation(s)
- Shufeng Wu
- Department of Oral Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Baoli Wang
- Department of Oral Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Chuangqi Yu
- Department of Oral Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Zhijun Wang
- Department of Oral Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Lisong Xie
- Department of Oral Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Jiayao Fu
- Department of Oral Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Huan Shi
- Department of Oral Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Lingyan Zheng
- Department of Oral Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
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Juvenile Recurrent Parotitis: The Role of Sialendoscopy. Int J Inflam 2019; 2019:7278907. [PMID: 31662845 PMCID: PMC6791204 DOI: 10.1155/2019/7278907] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 09/02/2019] [Indexed: 01/12/2023] Open
Abstract
Juvenile recurrent parotitis (JRP) is a recurrent parotid inflammation of nonobstructive, nonsuppurative nature. It manifests in childhood and usually resolves after puberty but may also persist into adulthood. JRP is characterized by recurrent episodes of unilateral or/and bilateral parotid swelling with pain, reduction of salivary secretion, swallowing difficulty, fever, and malaise. The cause of this condition remains obscure. Throughout the last two decades, many therapeutic methods have been used in order to reduce the frequency and severity of JRP. During the acute episodes, conservative approaches (antibiotics, analgesics, sialogogues, massage of the parotid gland, and mouth rinses) are used. Parotidectomy has been suggested in rare selective occasions. Recently, a promising concept of sialendoscopy, which is a minimal invasive endoscopic technique, has been applied. This review outlines the literature on JRP focusing on methods and challenges in diagnosing JRP along with the differential diagnosis of JRP and the function of the parotid during JRP. In addition, we describe the treatment options for JRP, pointing out the importance of sialendoscopy as a diagnostic and treatment procedure that offers improvement in patients' daily life.
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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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