Stenosis and stenosis-like lesions in the submandibular duct: Detailed clinical and sialendoscopy-based analysis and proposal for a classification

Sialendoscopy Findings Associated with Positive Minor Salivary Gland Biopsy

OBJECTIVES

To determine the sialendoscopy findings associated with positive findings on minor salivary gland biopsy.

STUDY DESIGN

Single-center retrospective study.

METHODS

Patients ≥18 years old who underwent sialendoscopy from 2016 to 2022 and were evaluated for SS via labial minor salivary gland biopsy. Biopsy positive and negative patients were compared on the primary outcome measure of sialendoscopy findings. Data were abstracted from the sialendoscopy operative notes and included involved gland, location of ductal pathology, and the presence of scarring, stenosis, mucus plugs, webs, and dilations. Additional characteristics included demographics, presenting symptoms, caffeine or tobacco, use of drying medications, and need for additional treatments.

RESULTS

The final cohorts included 22 biopsy positive and 21 biopsy negative patients with a total of 42 glands in the biopsy positive and 37 glands in the biopsy negative groups. Biopsy positive patients were found to require dilation at the hilum and distal duct at significantly higher rates than biopsy negative patients (p < 0.0001). However, there was no statistical difference in scarring, stenosis severity, mucus, webs, or dilations between each group.

CONCLUSION

The outcomes of this study suggest that there are no distinct sialendoscopy findings associated with biopsy positive patients. The presence of significant distal stenosis on sialendoscopy may be associated with positive minor salivary biopsy. Other endoscopic parameters are likely more consistent with non-specific chronic sialadenitis.

LEVEL OF EVIDENCE

3 Laryngoscope, 134:1183-1189, 2024.

Ultrasound and Sialendoscopy Findings in Radioactive Iodine-Induced Sialadenitis: Comparative Analysis and Possible Impact on Management

BACKGROUND

To assess the correlation/association between ultrasound and sialendoscopy findings in radioactive iodine therapy-induced sialadenitis (RAIS).

METHODS

Patients presenting with RAIS were investigated with ultrasound and sialendoscopy. Four pathologic ultrasound parameters and seven pathologic sialendoscopy parameters were retrospectively assessed. Correlations/associations between ultrasound and sialendoscopy findings and associations between the changes between the first and last ultrasound and sialendoscopy findings were assessed separately for the parotid (PG) and submandibular glands (SMG).

RESULTS

Sixty-seven patients were included. In the first examination, 107 glands were investigated (PGs 88.8%, SMGs 11.21%), and in the last examination, 64 glands were investigated (90.6% PGs, 9.4% SMGs). Highly significant positive associations were observed between the severity or category of ultrasound and sialendoscopy findings for first and last examinations for PGs (both p = 0.0001) and SMGs (p = 0.002; p = 0.037). Duct dilation had a significant negative association with the sialendoscopy findings for PGs in the first and last examinations (both p = 0.0001), but not for SMGs. Comparison of changes in the ultrasound and sialendoscopy findings between the first and last examinations showed a significant positive association for PGs (p = 0.0001) but not for SMGs.

CONCLUSIONS

Ultrasound and sialendoscopy findings for the parenchyma and duct system in RAIS showed significant associations/correlations and can be useful for effective management in RAIS.

A comparative study of three-dimensional cone beam computed tomographic sialography and ultrasonography in the detection of non-tumoral salivary duct diseases

OBJECTIVES

To compare the overall diagnostic outcomes of 3D-CBCT sialography and ultrasonography (US) in the detection of sialolithiasis, ductal dilatation, and ductal stenosis.

METHODS

This retrospective monocentric study compared the two imaging modalities carried out in the same patients referred for salivary symptoms of the parotid and submandibular glands. The primary endpoint was the capacity of the imaging procedure to diagnose a lesion. The secondary objectives were the detection rates according to the type of lesion, analysis of the causes of failure, and the parameters of radiation exposure and safety (for 3D-CBCT sialography).

RESULTS

Of the 236 patients who received a 3D-CBCT sialography in our institution, 157 were ultimately included in the per-protocol analysis. 3D-CBCT sialography allowed detection of ductal lesions in 113 patients versus 86 with US. The two imaging modalities yielded congruent interpretations in 104 out of 157 subjects (66.2%). Higher sensitivity and negative predictive value were observed with 3D-CBCT sialography compared with US, irrespective of the lesions studied: 0.85 vs 0.65 and 0.70 vs 0.44, respectively. Regarding the sialolithiasis, both 3D-CBCT sialography and US allowed identification of lesions with high sensitivity and negative predictive value (0.80 vs 0.75 and 0.88 vs 0.78, respectively).

CONCLUSIONS

US remains the first-line examination for exploration of the salivary lesions. 3D-CBCT sialography is an alternative in case of inconclusive US, and prior to any endoscopic procedure.

Sialendoscopy-Based Analysis of Submandibular Duct Papillae with a Proposal for Classification

Identifying a submandibular (Wharton's) duct punctum often hinders sialendoscopy; however, there is a paucity of evidence on whether the appearance of Wharton's duct papilla impacts the sialendoscopic procedure. A classification of Wharton's duct papillae based on the macroscopic appearance, size of dilatation probes, and sialendoscopic approach was proposed herein. The classification describing four main types of papillae, A, B, C, and D, was prospectively evaluated on 351 Wharton's duct papillae in 315 patients. For each papillae type, the demographic/clinical data, intraoperative complications, and time required for sialendoscope introduction were analyzed. Estuary-like papilla (type A) was commonly seen after spontaneous stone extrusion, had no intraoperative complications noted, and had the shortest time required for the sialendoscope introduction. Normal papilla (type B) was the most frequently observed papilla (48.1%), reflecting diverse underlying pathology, while difficult papilla (type C) was often associated with unfavorable anatomical variations of the mandible or floor of the mouth. Substantially closed papilla (type D) had the highest rate of intraoperative complications, namely, perforation with a false passage, and required the longest time for the sialendoscope introduction. In seven patients (2.0%), the entrance into the duct was feasible only through the fistula, while the sialendoscope introduction failed in eight patients (2.3%). In conclusion, the appearance of Wharton's duct papillae may be influenced by the underlying pathology. Based on the proposed classification, papilla typology affects the duration of sialendoscope introduction and may influence the frequency of intraoperative complications.

Incorporating Sialendoscopy into the Otolaryngology Clinic

Simple sialendoscopy procedures may be performed in the outpatient clinic with few complications. This process spares patients the risks, increased cost, and time burdens of sialendoscopy under general anesthesia. Sialendoscopy procedures may be incorporated into the outpatient practice after gaining experience with these procedures in the operating room. Diagnostic sialendoscopy, dilation of stenosis, and endoscopic sialolithotomies of small, freely mobile stones are appropriate for in-office sialendoscopy in many instances.