Nowe spojrzenie na klasyfikację przewlekłego zapalenia dużych gruczołów ślinowych i algorytm postępowania

Algorithm changes in treatment of submandibular gland sialolithiasis

Our research was conducted to determine the algorithm changes during the treatment of submandibular sialolithiasis. Two time periods were compared between 2004-2008 and 2009-2012. The turning point was December 2008, when sialendoscopy procedure was introduced. In the first period, 48 patients were treated: 31 outpatient duct incisions with stone evacuation and 17 surgical excision of submandibular gland. In the second period, 207 sialendoscopy procedures were performed on 197 patients. Out of this particular group, 158 patients were diagnosed with pathological obstruction of salivary glands and 64 of them were confirmed to have sialolithiasis of submandibular gland. Deposits of calcifications in 40 individuals (62.5 %) affected by sialolithiasis were removed endoscopically; however, in 21 patients, due to the increased circumference of the stone, the intimate association of deposits within the wall of the duct along with its presence inside the deep portions of the gland, double approach (incision of the floor of the mouth in hilar area and sialendoscopy) was performed. Three individuals had their salivary glands totally removed due to the presence of calcified deposits within the glandular parenchyma. Our results allow us to affirm that sialendoscopy is the current treatment of choice for submandibular glands affected by sialoliths. Indication for a complete removal of the gland is becoming uncommon as a first line treatment although still indispensable in chosen cases.

[Sialendoscopy in treatment of sialolithiasis--our own experience based on group of 95 patients]

OBJECTIVES

The introduction of minimally invasive surgical procedures has significantly reduced the rate of major salivary gland removal due to sialolithiasis. The aim of the analysis was to assess the effectiveness of sialoendoscopy and combined approach in most difficult cases.

MATERIAL AND METHODS

prospective study, tertiary university centre (Department of Otorhinolaryngology, Head and Neck Surgery, Poznan), between XII 2008 and V 2012, 207 sialendoscopies were performed in 197 patients. In this number 158 patients had obstructive pathology of salivary glands, 95 confirmed gland or duct sialolithiasis: parotid - 31 and submandibular - 64.

RESULTS

In the group of submandibular lithaiasis in 40 cases (62.5%) stones were removed endoscopically. Double approach (sialendoscopy and incision of mucosa of the floor of the mouth with removal of the stone was performed in 21 cases (32.8%). Only in 3 cases removal of submandibular gland was necessary. In the group of parotid sialolithiasis in 17 cases (54%) endoscopy was the definite treatment, in 9 litothrypsy (ESWL) were necessary and in 5 combined approach. This five patients who failed SE were treated by combined transcutaneous (open surgery) and endoscopic procedure. We observed no incidence of salivary fistula after the incision of the duct; there was also no stenosis of the natural ostium due to the insertion of a stent.

CONCLUSIONS

Sialoendoscopy is method of choice with high rate of success and gland preservation in small and moderate stones. The combined approach is indicated for large stones, complications and where there is a contraindication to established minimally invasive procedures.