Application of Magnetic Resonance Virtual Endoscopy as a Presurgical Procedure Before Sialoendoscopy

Rare Parotid Gland Diseases

The differential diagnosis for "rare" parotid gland diseases is broad and encompasses infectious, neoplastic, autoimmune, metabolic, and iatrogenic etiologies. The body of knowledge of parotid gland diseases has grown owing to advances in imaging and pathologic analysis and molecular technology. This article reviews rare parotid diseases, discussing the respective disease's clinical presentation, diagnosis, imaging, pathogenesis, treatment, and prognosis.

Modern management of juvenile recurrent parotitis

Aims:

To evaluate modern diagnostic and therapeutic management of juvenile recurrent parotitis, and to show the benefits of operative sialoendoscopy on the basis of our experience in 14 patients and the results of others.

Results:

Ultrasonography is sensitive in detecting the pathological features of juvenile recurrent parotitis. Interventional sialoendoscopy is a safe and effective method of treating the disease. In our case series, after a mean follow-up time of 30 months only 5 patients experienced recurrence of symptoms, with a mean symptom-free period of 20 months.

Conclusion:

The use of modern, minimally invasive diagnostic tools such as colour Doppler ultrasonography, magnetic resonance sialography and sialoendoscopy represents a new frontier in the management of juvenile recurrent parotitis. Operative sialoendoscopy also has the important therapeutic benefit of reducing the number of recurrences of acute episodes of parotitis, thus giving patients a better quality of life until puberty.

Sialoendoscopic secondary intervention after failure of open sialolithectomy

PURPOSE

Traditionally, sialoadenectomy was always indicated when open sialolithectomy failed. The aim of the present study was to investigate the role of sialoendoscopy as the secondary intervention after failure of open sialolithectomy.

PATIENTS AND METHODS

A consecutive series of 15 patients with obstructive salivary gland disease with failure of open sialolithectomy were prospectively recruited for our study. All these patients underwent sialoendoscopy under local anesthesia. The reasons for the failure of open sialolithectomy were analyzed, and secondary interventions were performed using sialoendoscopy.

RESULTS

Failure of open sialolithectomy resulted from 4 main causes. Small stones could not be found after the duct was incised (n = 3); the stones were pushed posteriorly during open surgery (n = 4); the stones located in the anterior part of the duct were removed, but the hilar stones were left untouched (n = 5); and radiolucent stones were missed (n = 3). All the patients were treated successfully by sialoendoscopy. No symptoms or signs of recurrence developed during a median follow-up period of 16 months.

CONCLUSIONS

Sialoendoscopy can be recommended as an effective secondary intervention after failure of open sialolithectomy.

CT virtual sialendoscopy versus conventional sialendoscopy in the visualization of salivary ductal lumen: an in vitro study

OBJECTIVES/HYPOTHESIS

To evaluate the feasibility of computed tomographic (CT) virtual sialendoscopy and its performance characteristics for the visualization of salivary ductal lumen as compared with conventional sialendoscopy.

STUDY DESIGN

An in vitro study.

METHODS

Conventional sialendoscopy was performed in 16 submandibular glands in vitro and the surgical findings were recorded. Then a contrast agent was injected into the Wharton's duct via orifice. After CT scanning, the CT data were transferred to an independent workstation and were postprocessed with commercially available software to generate three-dimensional reconstructive and virtual sialendoscopic images. Finally, the plastination of submandibular glands was performed with 20% perchloroethylene ethyl acetate plastics filler to make cast specimens. CT three-dimensional reconstruction of the ductal system was compared with the cast specimen, and the performance of conventional sialendoscopy and CT virtual sialendoscopy for the visualization of salivary ductal lumen was also compared.

RESULTS

The CT data acquisition and postprocessing protocol were feasible. CT three-dimensional reconstruction enabled clear visualization of the ductal system from any directions and angles, which showed close resemblance to the cast specimens. And CT virtual sialendoscopy created clear endoluminal views of salivary ducts simulating those obtained with conventional sialendoscopy.

CONCLUSIONS

Our initial experience shows that CT virtual sialendoscopy has the potential to be an attractive imaging technique for the visualization of salivary ductal lumen.

Comparative Ultrasonographic, Magnetic Resonance Sialographic, and Videoendoscopic Assessment of Salivary Duct Disorders

Objectives:

Salivary duct disorders are the second most common cause of obstruction after calculi. Magnetic resonance sialography has been recently proposed as a means of diagnosing a heterogeneous group of salivary disorders, and so we compared it with sialoendoscopy in evaluating stenoses and sialectasia in 24 patients with obstructive symptoms and ultrasonographic results negative for calculi or masses.

Methods:

All of the patients (19 of whom had recurrent unilateral or bilateral swollen parotid glands and 5 of whom also had recurrent swollen submandibular glands) underwent dynamic color Doppler ultrasonography and dynamic magnetic resonance sialography with lemon juice stimulation of saliva; 18 patients also underwent diagnostic sialoendoscopy.

Results:

Ultrasonography and color Doppler ultrasonography showed duct dilatation in all patients (bilateral in 5 with parotid stenosis). Magnetic resonance sialography confirmed duct dilatation and stenosis in all of the patients, and revealed the simultaneous presence of calculi in 4 cases. A parotid sialocele was found in 4 cases. The magnetic resonance sialographic findings were confirmed in the patients who underwent sialoendoscopy. No side effects were observed.

Conclusions:

Magnetic resonance sialography following prediagnostic ultrasonography allows an adequate diagnosis of salivary duct disorders such as stenosis and sialectasia, as confirmed by objective sialoendoscopic assessment. Magnetic resonance sialography also makes it possible to visualize the salivary duct system up to its tertiary branches and, in this regard, may be considered a valid, noninvasive method for the evaluation of salivary duct disorders.