Parotitis and Sialendoscopy of the Parotid Gland

Can chatbots enhance the management of pediatric sialadenitis in clinical practice?

OBJECTIVE

The purpose of this study was to assess how well ChatGPT, an AI-powered chatbot, performed in helping to manage pediatric sialadenitis and identify when sialendoscopy was necessary.

METHODS

49 clinical cases of pediatric sialadenitis were retrospectively reviewed. ChatGPT was given patient data, and it offered differential diagnoses, proposed further tests, and suggested treatments. The decisions made by the treating otolaryngologists were contrasted with the answers provided by ChatGPT. Analysis was done on ChatGPT response consistency and interrater reliability.

RESULTS

ChatGPT showed 78.57% accuracy in primary diagnosis, and 17.35% of cases were considered likely. On the other hand, otolaryngologists recommended fewer further examinations than ChatGPT (111 vs. 60, p < 0.001). For additional exams, poor agreement was found between ChatGPT and otolaryngologists. Only 28.57% of cases received a pertinent and essential treatment plan via ChatGPT, indicating that the platform's treatment recommendations were frequently lacking. For treatment ratings, judges' interrater reliability was greatest (Kendall's tau = 0.824, p < 0.001). For the most part, ChatGPT's response constancy was high.

CONCLUSIONS

Although ChatGPT has the potential to correctly diagnose pediatric sialadenitis, there are a number of noteworthy limitations with regard to its ability to suggest further testing and treatment regimens. Before widespread clinical use, more research and confirmation are required. To guarantee that chatbots are utilized properly and effectively to supplement human expertise rather than to replace it, a critical viewpoint is required.

[Sialendoscopy : Indications and treatment]

There is plethora of treatment options for surgeons dealing with salivary stones. During recent decades, emphasis has been laid on gland-preserving minimally invasive techniques for stone removal. In this context, visualization of salivary ducts with semirigid endoscopes for diagnostic and therapeutic purposes, the so-called sialendoscopy, has become increasingly important. This article gives an overview of indications for sialendoscopy and how the procedure is performed. Furthermore, sialendoscopy is discussed in the context of other modalities for salivary stone treatment.

Acute parotiditis after cesarean section; case report

The enlargement of the parotid gland develops in inflammatory or stenotic conditions but after Cesarean section the symptomatology is unusual. A 38 year old patient with no obstetrical history referred to our clinic for pregnancy, which followed our national program of prenatal care. The outcome of the pregnancy was favorable for both mother and fetus. During labor the fetus developed bradycardia and the patient delivered by Cesarean section a 3400 g baby-boy with 8 Apgar Score; the anesthesia was spinal. 18 hours after delivery the patient presented mild respiratory distress. The symptomatology was caused by the enlargement of the parotid gland. The treatment was supportive and the remission occurred 10 hours after the onset. The initial discussion that raised this case was caused by the viral, infection and stenotic cause of the parotiditis. All these reasons had no medical argument. It was also debated about the anesthesia but, until now, the medical literature didn’t report any case of association between parotiditis and spinal anesthesia. It is also impossible to correlate the parotiditis with IVF procedure. As a conclusion, this case is unique because it represents the parotiditis without unknown case that appeared after Cesarean section and spinal anesthesia in a healthy woman.

Development of acute parotitis after non-invasive ventilation

A 90-year-old woman underwent laparoscopic exploratory laparotomy for evaluation of suspected mesenteric ischemia. She was promptly extubated postoperatively and transferred to the intensive care unit, where on the first postoperative day she developed hypoxemia necessitating initiation of noninvasive ventilation (NIV) with bilevel positive airway pressure (BiPAP). After 8 hours of BiPAP, she was noted to have swelling, erythema and tenderness in the right preauricular area. Ultrasound evaluation demonstrated an enlarged right parotid gland. With discontinuation of BiPAP and supportive measures, parotitis resolved within 6 days. The mechanism of NIV-induced acute parotitis likely involves transmission of positive pressure to the oral cavity, causing obstruction to salivary flow within the parotid (Stensen) duct. Conditions that increase salivary viscosity and promote salivary stasis, such as advanced age, dehydration, and absence of salivary gland stimulation due to restriction of oral intake, may render patients more susceptible to this complication. As NIV will continue to be a commonly-used modality for the treatment of acute respiratory failure, clinicians should be aware of this phenomenon.

Gland Preservation in Patients Undergoing Sialoendoscopy

Objective Sialoendoscopy is a minimally invasive technique for the treatment of obstructive sialadenitis. We aim to describe treatment considerations and report our ultimate rate of gland preservation. Study Design Case series with chart review. Setting Academic tertiary hospital. Subject and Methods A total of 128 consecutive sialoendoscopy cases for obstructive sialadenitis between 2009 and 2015 were evaluated. Procedures included endoscopic stricture dilation, basket-assisted stone retrieval, Holmium laser lithotripsy, and combined endoscopic transoral stone excision. Resolution of symptoms, need for additional procedures, and rate of subsequent adenectomy were investigated. Results Sialoendoscopy was completed in 120 of 128 patients (94%). There were 87 parotid gland cases and 41 submandibular gland cases. Endoscopic stricture dilation was attempted in 97 patients and successful in 99%. A sialolith was identified in 31 cases and removed by basket-assisted stone retrieval (10 cases), Holmium:YAG laser stone fragmentation (10 cases), and combined endoscopic transoral stone extraction (4 cases). In 8 cases overall, sialoendoscopy failed, with immediate adenectomy. At a mean follow-up of 18 months, 39 patients (33%) reported recurrence of symptoms, with 90% in the stricture group. For the entire cohort, gland preservation occurred in 112 of 128 patients (88%). Conclusions Sialoendoscopy is an effective technique, with few patients requiring additional procedures. Newer interventional approaches allow for stone retrieval without adenectomy. Patients in the stricture group were more likely to have recurrent symptoms as compared with the sialolithiasis group but often benefit from additional sialoendoscopic procedures, leading to a high overall rate of long-term gland preservation of 91%.