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Chen YC, Viet-Nhi NK, Dang LH, Su CH, Hung SH. Efficacy of Office-Based Salivary Ductal Steroid Irrigation for Managing Post-Irradiation Xerostomia in Head and Neck Cancer Patients: A Retrospective Study. Biomedicines 2024; 12:1033. [PMID: 38790995 PMCID: PMC11117565 DOI: 10.3390/biomedicines12051033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/04/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024] Open
Abstract
Post-irradiation xerostomia remains a significant quality of life concern for patients with head and neck cancers. Conventional therapies offer limited effectiveness. This study aims to investigate the therapeutic potential of office-based salivary ductal steroid irrigation in patients with post-irradiation xerostomia. This single-center observational study recruited 147 head and neck cancer patients suffering from post-irradiation xerostomia between November 2020 and October 2022. All included subjects received at least one round of successful salivary ductal cannulation and irrigation. The primary measure of efficacy was improvement in subjective xerostomia and objective salivary amylase levels. A logistic regression was employed to evaluate factors affecting treatment responsiveness. The response rate among nasopharyngeal cancer (NPC) patients was 74.8%, and that among non-NPC cancer was 65.6%, without significant intergroup differences. The statistical analysis revealed no significant influence of age, gender, or disease stage on treatment responsiveness. Post-treatment salivary amylase levels were significantly higher in responsive non-NPC patients. In conclusion, salivary ductal steroid irrigation emerged as a promising therapeutic modality for the management of post-irradiation xerostomia in head and neck cancer patients. While no explicit factors were predictive of responsiveness, the high rate of symptom improvement suggests that this therapy may be a viable alternative for patients that are refractory to standard treatments.
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Affiliation(s)
- Yen-Chun Chen
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan;
- Department of Otolaryngology, Taipei Medical University Hospital, Taipei 110301, Taiwan
- Department of Otolaryngology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan;
| | - Nguyen-Kieu Viet-Nhi
- International Master/Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan;
| | - Luong Huu Dang
- Department of Otolaryngology, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 700000, Vietnam;
| | - Chin-Hui Su
- Department of Otolaryngology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan;
- Department of Otolaryngology, Mackay Memorial Hospital, Taipei 104217, Taiwan
| | - Shih-Han Hung
- Department of Otolaryngology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan;
- International Master/Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan;
- Department of Otolaryngology, Wan Fang Hospital, Taipei Medical University, Taipei 116079, Taiwan
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Amiel T, Shauly O, Istoyler EG, Alterman M, Keshet N, Mazor S, Pikovsky A, Aframian DJ, Joskowicz L, Nadler C. The anatomical pattern of ductal arborization in parotid glands using cone-beam computerized sialography. Clin Anat 2024. [PMID: 38270271 DOI: 10.1002/ca.24136] [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: 10/19/2023] [Revised: 12/26/2023] [Accepted: 01/02/2024] [Indexed: 01/26/2024]
Abstract
Cone-Beam Computed Tomography-Sialography (Sialo-CBCT) is used to demonstrate salivary ductal structure. This study aimed to conduct a volumetric analysis of the anatomical morphology of Normal-Appearing Glands (NAGs) in parotid sialo-CBCT. Our retrospective study included 14 parotid sialo-CBCT scans interpreted as NAGs in 11 patients with salivary gland impairment. The main duct length and width, as well as number and width of secondary and tertiary ducts were manually evaluated. We found that the main parotid duct showed an average width of 1.39 mm, 1.15 mm, and 0.98 mm, for the proximal, middle and distal thirds, respectively. The arborization pattern showed approximately 20% more tertiary (average number 11.1 ± 2.7) than secondary ducts (average number 9.0 ± 2.4) and approximately 8% narrower tertiary ducts (average width 0.65 ± 0.11 mm) compared to the secondary ducts (average width 0.77 ± 0.14 mm). Our anatomical analysis of NAGs in parotid sialo-CBCT demonstrated progressive narrowing of the main duct and increasing arborization and decreasing lumen size starting from the primary to the tertiary ducts. This is the most updated study regarding the anatomy of the parotid glands as demonstrated in sialo-CBCT. Our results may provide clinicians with the basic information for understanding aberration from normal morphology, as seen in salivary gland pathologies as well facilitate planning of treatment strategies, such as minimally invasive sialo-endoscopies, commonly practiced today.
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Affiliation(s)
- Tevel Amiel
- Oral Maxillofacial Imaging, Department of Oral Medicine, Sedation and Imaging, Faculty of Dental Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Oren Shauly
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ella Gilenson Istoyler
- Oral Maxillofacial Imaging, Department of Oral Medicine, Sedation and Imaging, Faculty of Dental Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michael Alterman
- Oral Maxillofacial Surgery Department, Hadassah Medical Center, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Naama Keshet
- Department of Oral Medicine, Sedation and Imaging, Faculty of Dental Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sigal Mazor
- Community Dentistry Department, Hadassah Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Anna Pikovsky
- Oral Medicine Unit, Oral Maxillofacial Surgery Department, Barzilai Medical Center, Ashkelon, Israel
| | - Doron J Aframian
- Department of Oral Medicine, Sedation and Imaging, Faculty of Dental Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Leo Joskowicz
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Chen Nadler
- Oral Maxillofacial Imaging, Department of Oral Medicine, Sedation and Imaging, Faculty of Dental Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
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Assy Z, Thomson WM, Brand HS, Cha S, Susam MM, Weisman GA, Vissink A, Bikker FJ, Jager DJH. The minimally important difference for the Xerostomia Inventory among Sjögren's disease patients. Oral Dis 2023:10.1111/odi.14841. [PMID: 38148483 PMCID: PMC11199375 DOI: 10.1111/odi.14841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/24/2023] [Accepted: 12/03/2023] [Indexed: 12/28/2023]
Abstract
OBJECTIVE Until now, the clinically relevant improvement for the Xerostomia Inventory (XI) has not been defined. Therefore, our aim was to determine the Minimally Important Difference (MID) of the XI for improvement in dry-mouth symptoms in SjD patients. METHOD The study recruited 34 SjD patients who underwent sialendoscopy of major salivary glands and 15 SjD patients in a nonintervention control group. XI scores were assessed at several time points. The MID was determined from the mean difference in XI scores between the groups with and without improvement. RESULTS In the control group, no significant XI score changes were seen. In the sialendoscopy group, a clinically relevant XI score change of four scale points was identified after 1 week. For a prolonged duration (≥16 weeks), a minimum reduction of seven scale points in the XI score was required to indicate clinically relevant improvement. CONCLUSION In SjD patients, a minimum change of four points in the XI score indicates a clinically relevant improvement for evaluating short-term effects. For prolonged effects, a clinically relevant improvement requires a MID of seven points. The determination of the MID in XI could assist in future studies that evaluate changes in xerostomia.
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Affiliation(s)
- Zainab Assy
- Department of Oral Biochemistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, the Netherlands
| | - William Murray Thomson
- Sir John Walsh Research Institute, University of Otago Faculty of Dentistry, Dunedin, New Zealand
| | - Henk S. Brand
- Department of Oral Biochemistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, the Netherlands
| | - Seunghee Cha
- Department of Oral and Maxillofacial Diagnostic Sciences, Center for Orphaned Autoimmune Disorders, University of Florida, 1395 Center Drive, 32610 Gainesville, Florida, USA
| | - Merve M. Susam
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, Location Vrije Universiteit Amsterdam, De Boelelaan 1117, 1018 HV Amsterdam, Noord-Holland, The Netherlands
| | - Gary A. Weisman
- Department of Biochemistry, Christopher S. Bond Life Sciences Center, University of Missouri, 1201 Rollins St., Columbia, 65211, Missouri, USA
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, Groningen, The Netherlands
| | - Floris J. Bikker
- Department of Oral Biochemistry, Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, the Netherlands
| | - Derk Jan H.J. Jager
- Department of Oral and Maxillofacial Surgery/Oral Pathology, Amsterdam UMC, Location Vrije Universiteit Amsterdam, De Boelelaan 1118, 1081 HV, Amsterdam, Noord-Holland, the Netherlands
- Amsterdam Institute for Infection and Immunity, Inflammatory Diseases, De Boelelaan 1118, 1081 HV Amsterdam, Noord-Holland, the Netherlands
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4
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Borner U, Caversaccio M, Wagner F, Marchal F, Anschuetz L. First evaluation of an ovine training model for sialendoscopy. Laryngoscope Investig Otolaryngol 2023; 8:903-911. [PMID: 37621264 PMCID: PMC10446307 DOI: 10.1002/lio2.1116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 06/08/2023] [Accepted: 07/03/2023] [Indexed: 08/26/2023] Open
Abstract
Objective Sialendoscopy is a minimally invasive diagnostic and therapeutic technique used in the treatment of various salivary gland diseases. To date, there are very few suitable training models other than the pig's head, which has been used at the European Sialendoscopy Training Center for 22 years. The goal of this study was to describe an ovine model for sialendoscopy training and compare the ovine model's to the human anatomy. We propose a step-by-step approach for sialendoscopy training using this ex-vivo model. Methods The anatomy of the ovine salivary ducts and glands was assessed by magnetic resonance imaging using one fresh ovine head. Thereafter, the model was designed during dissection by an experienced sialendoscopist. The various steps were then validated during consecutive dissections using a Likert-scale questionnaire. Results The full model was described in the form of a dissection guide and allowed reliable diagnostic sialendoscopy in 10/10 Stenson's and in 5/10 Wharton's ducts. Moreover, interventional sialendoscopy was simulated to provide a training model for the removal of sialoliths in the Stenson's duct. The human and ovine anatomy are quite similar allowing a training experience close to reality. Conclusion We developed and evaluated an ovine model with the goal of improving training in diagnostic and interventional sialendoscopy. In particular, the Stenson's duct can be successfully prepared, probed and subjected to sialendoscopy. The realistic anatomical environment and excellent tissue quality created a life-like training experience for an experienced sialendoscopist. Further studies with beginners are necessary to validate this model as a training model. Level of Evidence 4.
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Affiliation(s)
- Urs Borner
- Department of Otorhinolaryngology – Head and Neck Surgery, InselspitalBern University Hospital and University of BernBernSwitzerland
- European Sialendoscoy Training CenterGenevaSwitzerland
| | - Marco Caversaccio
- Department of Otorhinolaryngology – Head and Neck Surgery, InselspitalBern University Hospital and University of BernBernSwitzerland
| | - Franca Wagner
- Department of Diagnostic and Interventional Neuroradiology, InselspitalUniversity Hospital Bern and University of BernBernSwitzerland
| | - Francis Marchal
- European Sialendoscoy Training CenterGenevaSwitzerland
- Department of Otolaryngology – Head and Neck SurgeryUniversity Hospitals of GenevaGenevaSwitzerland
| | - Lukas Anschuetz
- Department of Otorhinolaryngology – Head and Neck Surgery, InselspitalBern University Hospital and University of BernBernSwitzerland
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Yura Y, Hamada M. Outline of Salivary Gland Pathogenesis of Sjögren's Syndrome and Current Therapeutic Approaches. Int J Mol Sci 2023; 24:11179. [PMID: 37446355 DOI: 10.3390/ijms241311179] [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: 06/04/2023] [Revised: 06/30/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023] Open
Abstract
Sjögren's syndrome (SS) is an autoimmune disease characterized by the involvement of exocrine glands such as the salivary and lacrimal glands. The minor salivary glands, from which tissue samples may be obtained, are important for the diagnosis, evaluation of therapeutic efficacy, and genetic analyses of SS. In the onset of SS, autoantigens derived from the salivary glands are recognized by antigen-presenting dendritic cells, leading to the activation of T and B cells, cytokine production, autoantibody production by plasma cells, the formation of ectopic germinal centers, and the destruction of salivary gland epithelial cells. A recent therapeutic approach with immune checkpoint inhibitors for malignant tumors enhances the anti-tumor activity of cytotoxic effector T cells, but also induces SS-like autoimmune disease as an adverse event. In the treatment of xerostomia, muscarinic agonists and salivary gland duct cleansing procedure, as well as sialendoscopy, are expected to ameliorate symptoms. Clinical trials on biological therapy to attenuate the hyperresponsiveness of B cells in SS patients with systemic organ involvement have progressed. The efficacy of treatment with mesenchymal stem cells and chimeric antigen receptor T cells for SS has also been investigated. In this review, we will provide an overview of the pathogenesis of salivary gland lesions and recent trends in therapeutic approaches for SS.
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Affiliation(s)
- Yoshiaki Yura
- Department of Oral & Maxillofacial Oncology and Surgery, Osaka University Graduate School of Dentistry, Osaka 565-0871, Japan
| | - Masakazu Hamada
- Department of Oral & Maxillofacial Oncology and Surgery, Osaka University Graduate School of Dentistry, Osaka 565-0871, Japan
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Capaccio P, Gaffuri M, Canzi P, Pignataro L. Recurrent obstructive salivary disease after sialendoscopy. A narrative literature review. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2023; 43:S95-S102. [PMID: 37698106 PMCID: PMC10159639 DOI: 10.14639/0392-100x-suppl.1-43-2023-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 01/12/2023] [Indexed: 09/13/2023]
Abstract
Over the last 20 years, interventional sialendoscopy has become the therapy of choice for the management of obstructive salivary disorders, favouring a significant reduction in the number of patients undergoing traditional sialadenectomy. The overall success rate of sialendoscopy is around 90% as reported by the largest case series published; recurrence is expected in about 10% of cases, and the patient should be informed about the possibility to undergo further conservative procedures to improve symptoms. Adequate pre-operative assessment, based on ultrasonography, cone beam 3D CT and MR-sialography, is mandatory to reduce the risk of unsuccessful procedures and, therefore, recurrence of obstructive sialadenitis; moreover, in case of recurrence, the surgeon should be experienced enough to manage these cases and be able to perform additional interventions, such as transoral/transfacial sialendoscopy-assisted procedures and imaging-assisted procedures in case of difficult anatomical situations. Botulinum toxin injection and traditional sialadenectomy would be considered as possible salvage treatments in case of failure of all conservative approaches.
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Affiliation(s)
- Pasquale Capaccio
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Italy
| | - Michele Gaffuri
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Pietro Canzi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Department of Otorhinolaryngology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Lorenzo Pignataro
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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7
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Wiriyakijja P, Niklander S, Santos-Silva AR, Shorrer MK, Simms ML, Villa A, Sankar V, Kerr AR, Riordain RN, Jensen SB, Delli K. World Workshop on Oral Medicine VIII: Development of a Core Outcome Set for Dry Mouth: A Systematic Review of Outcome Domains for Xerostomia. Oral Surg Oral Med Oral Pathol Oral Radiol 2023:S2212-4403(23)00068-8. [PMID: 37198047 DOI: 10.1016/j.oooo.2023.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/11/2022] [Accepted: 01/25/2023] [Indexed: 03/08/2023]
Abstract
OBJECTIVE The purpose of this study was to identify all outcome domains used in clinical studies of xerostomia, that is, subjective sensation of dry mouth. This study is part of the extended project "World Workshop on Oral Medicine Outcomes Initiative for the Direction of Research" to develop a core outcome set for dry mouth. STUDY DESIGN A systematic review was performed on MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials databases. All clinical and observational studies that assessed xerostomia in human participants from 2001 to 2021 were included. Information on outcome domains was extracted and mapped to the Core Outcome Measures in Effectiveness Trials taxonomy. Corresponding outcome measures were summarized. RESULTS From a total of 34,922 records retrieved, 688 articles involving 122,151 persons with xerostomia were included. There were 16 unique outcome domains and 166 outcome measures extracted. None of these domains or measures were consistently used across all the studies. The severity of xerostomia and physical functioning were the 2 most frequently assessed domains. CONCLUSION There is considerable heterogeneity in outcome domains and measures reported in clinical studies of xerostomia. This highlights the need for harmonization of dry mouth assessment to enhance comparability across studies and facilitate the synthesis of robust evidence for managing patients with xerostomia.
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Douglas JE, Wen CZ, Thomas WW, Elrakhawy M, Rassekh CH. Management of Chronic Sialadenitis due to Sjogren's Syndrome and Radioactive Iodine Therapy Using Sialendoscopy. ORL J Otorhinolaryngol Relat Spec 2023; 85:7-11. [PMID: 35817018 DOI: 10.1159/000525217] [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: 11/24/2021] [Accepted: 04/10/2022] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Sialendoscopy is a minimally invasive technique for the management of salivary gland disease. This work characterizes its utility for treating chronic sialadenitis due to Sjogren's syndrome and radioactive iodine (RAI) therapy. METHODS A single-center, retrospective review of patients undergoing sialendoscopy between March 2013 and May 2019 for the treatment of chronic sialadenitis due to Sjogren's or prior RAI therapy was performed. RESULTS Thirty-four patients with Sjogren's and 25 patients who received RAI were identified, undergoing a total of 86 procedures. Median age at presentation was 53 years with mean follow-up time of 14.3 months. Seventy-two procedures were performed on the parotid gland, four on the submandibular gland, and ten on both glands. Corticosteroid injection and duct dilation were performed most commonly. Sixteen patients required repeat procedure. All patients were symptomatically improved at follow-up visit. DISCUSSION/CONCLUSION These results support the idea that sialendoscopy offers symptomatic benefit for patients with chronic sialadenitis due to Sjogren's or RAI.
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Affiliation(s)
- Jennifer E Douglas
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Christopher Z Wen
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA,
| | | | - Mohamed Elrakhawy
- Department of Otolaryngology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA
| | - Christopher H Rassekh
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
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Goyal M, Singh PP, Batra A. Role of Sialendoscopy in Non-neoplastic Parotid Diseases: A Prospective Study of 241 Patients in Indian Population. J Maxillofac Oral Surg 2022; 21:715-724. [DOI: 10.1007/s12663-020-01472-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/14/2020] [Indexed: 10/23/2022] Open
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Zandonella Callegher S, Giovannini I, Zenz S, Manfrè V, Stradner MH, Hocevar A, Gutierrez M, Quartuccio L, De Vita S, Zabotti A. Sjögren syndrome: looking forward to the future. Ther Adv Musculoskelet Dis 2022; 14:1759720X221100295. [PMID: 35634352 PMCID: PMC9131387 DOI: 10.1177/1759720x221100295] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 04/26/2022] [Indexed: 12/25/2022] Open
Abstract
Primary Sjögren’s syndrome (pSS) is a heterogeneous disease characterised by a wide spectrum of manifestations that vary according to the different stages of the disease and among different subsets of patients. The aim of this qualitative literature review is to summarise the recent advances that have been reported in pSS, ranging from the early phases to the established disease and its complications. We analysed the diagnostic, prognostic, and management aspects of pSS, with a look into future clinical and research developments. The early phases of pSS, usually antedating diagnosis, allow us to investigate the pathophysiology and risk factors of the overt disease, thus allowing better and timely patient stratification. Salivary gland ultrasound (SGUS) is emerging as a valid complementary, or even alternative, tool for histopathology in the diagnosis of pSS, due to a standardised scoring system with good agreement and performance. Other promising innovations include the application of artificial intelligence to SGUS, ultrasound-guided core needle biopsy, and a wide array of novel diagnostic and prognostic biomarkers. Stratifying pSS patients through the integration of clinical, laboratory, imaging, and histopathological data; differentiating between activity-related and damage-related manifestations; and identifying patients at higher risk of lymphoma development are essential steps for an optimal management and individualised treatment approach. As new treatment options are emerging for both glandular and systemic manifestations, there is a need for a more reliable treatment response evaluation. pSS is a complex and heterogeneous disease, and many distinct aspects should be considered in the different stages of the disease and subsets of patients. In recent years, efforts have been made to improve our understanding of the disease, and certainly in the coming years, some of these novelties will become part of our routine clinical practice, thus improving the management of pSS patients.
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Affiliation(s)
| | - Ivan Giovannini
- Rheumatology Clinic, Department of Medicine, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Sabine Zenz
- Division of Rheumatology and Immunology, Medical University Graz, Graz, Austria
| | - Valeria Manfrè
- Rheumatology Clinic, Department of Medicine, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Martin H. Stradner
- Division of Rheumatology and Immunology, Medical University Graz, Graz, Austria
| | - Alojzija Hocevar
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Marwin Gutierrez
- Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico
- Rheumatology Center of Excellence, Mexico City, Mexico
| | - Luca Quartuccio
- Rheumatology Clinic, Department of Medicine, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Salvatore De Vita
- Rheumatology Clinic, Department of Medicine, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Alen Zabotti
- Rheumatology Clinic, Department of Medicine, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy
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11
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Borner U, Anschuetz L, Caversaccio M, von Werdt M, Panosetti E, Keghian J, Remacle M. A Retrospective Analysis of Multiple Affected Salivary Gland Diseases: Diagnostic and Therapeutic Benefits of Interventional Sialendoscopy. EAR, NOSE & THROAT JOURNAL 2022:1455613221081911. [PMID: 35324340 DOI: 10.1177/01455613221081911] [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] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Multiple affected salivary gland diseases are rare compared to single gland diseases and represent a major diagnostic challenge. These cases are commonly neglected in the scientific literature, despite the considerable suffering of these patients. The aim of this retrospective study was to report disease characteristics, diagnostic pathways, and therapeutic options, including sialendoscopic treatment of multiple affected salivary gland disorders. METHODS Patients experiencing multiple affected salivary gland diseases treated between 2013 and 2020 were consecutively identified. Data regarding demographics, clinical presentation, disease characteristics, treatment, complications, and follow-up were analyzed retrospectively. RESULTS In total, 71 patients were identified with these diseases and included obstructive disease without sialolithiasis (n = 22), inflammation (n = 15), immune disease (n = 19), radioiodine-induced sialadenitis (RAI) (n = 5), sialadenosis (n = 2), and juvenile recurrent parotitis (JRP) (n = 8). Diagnostic and therapeutic sialendoscopy was performed on 113 salivary glands in 42 patients, leading to completely (n = 27, 64.3%) or partially (n = 11, 26.2%) improved symptoms in most cases. In total, 4 patients did not improve after interventional therapy. CONCLUSIONS Multiple affected salivary gland diseases are rare and diagnostically challenging. Interventional sialendoscopy offers an effective and safe therapeutic option and should be considered in this specific cohort.
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Affiliation(s)
- Urs Borner
- Department of Otorhinolaryngology - Head and Neck Surgery, 27252Inselspital, Bern University Hospital, Bern, Switzerland
- Department of Otorhinolaryngology, Head and Neck Surgery, 37464Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Lukas Anschuetz
- Department of Otorhinolaryngology - Head and Neck Surgery, 27252Inselspital, Bern University Hospital, Bern, Switzerland
| | - Marco Caversaccio
- Department of Otorhinolaryngology - Head and Neck Surgery, 27252Inselspital, Bern University Hospital, Bern, Switzerland
| | - Moritz von Werdt
- Department of Otorhinolaryngology - Head and Neck Surgery, 27252Inselspital, Bern University Hospital, Bern, Switzerland
| | - Eugène Panosetti
- Department of Otorhinolaryngology, Head and Neck Surgery, 37464Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Jérôme Keghian
- Department of Otorhinolaryngology, Head and Neck Surgery, 37464Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Marc Remacle
- Department of Otorhinolaryngology, Head and Neck Surgery, 37464Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
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12
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Karagozoglu KH, Vissink A, Forouzanfar T, de Visscher JGAM, Maarse F, Brand HS, van de Ven PM, Jager DHJ. Sialendoscopy increases saliva secretion and reduces xerostomia up to 60 weeks in Sjögren's syndrome patients: a randomized controlled study. Rheumatology (Oxford) 2021; 60:1353-1363. [PMID: 32949144 PMCID: PMC7937027 DOI: 10.1093/rheumatology/keaa284] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 04/21/2020] [Indexed: 11/18/2022] Open
Abstract
Objective To assess the effect of sialendoscopy of the major salivary glands on salivary flow and xerostomia in patients with Sjögren’s syndrome (SS). Methods Forty-five patients with SS were randomly assigned to a control group (no irrigation, control, n = 15), to irrigation of the major salivary glands with saline (saline, n = 15) or to irrigation with saline followed by corticosteroid application (triamcinolone acetonide in saline, saline/TA, n = 15). Unstimulated whole saliva flow (UWSF), chewing-stimulated whole saliva flow (SWSF), citric acid-stimulated parotid flow, Clinical Oral Dryness Score (CODS), Xerostomia Inventory (XI) and EULAR SS Patient Reported Index (ESSPRI) scores were obtained 1 week before (T0), and 1, 8, 16, 24, 36, 48 and 60 weeks after sialendoscopy. Data were analysed using linear mixed models. Results Irrespective of the irrigation protocol used, sialendoscopy resulted in an increased salivary flow during follow-up up to 60 weeks. Significant between-group differences in the longitudinal course of outcomes were found for UWSF, SWSF, XI and ESSPRI scores (P = 0.028, P = 0.001, P = 0.03, P = 0.021, respectively). UWSF at 60 weeks was higher compared with T0 in the saline group (median: 0.14 vs median: 0.10, P = 0.02) and in the saline/TA group (median: 0.20, vs 0.13, P = 0.035). In the saline/TA group SWSF at 48 weeks was higher compared with T0 (median: 0.74 vs 0.38, P = 0.004). Increase in unstimulated salivary flow was also reflected in improved CODS, XI and ESSPRI scores compared with baseline. Conclusion Irrigation of the major salivary glands in patients with SS increases salivary flow and reduces xerostomia.
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Affiliation(s)
- K Hakki Karagozoglu
- Department of Maxillofacial Surgery and Oral Pathology, Amsterdam University Medical Centers (Amsterdam UMC, Location VUmc) and Academic Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Tim Forouzanfar
- Department of Maxillofacial Surgery and Oral Pathology, Amsterdam University Medical Centers (Amsterdam UMC, Location VUmc) and Academic Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jan G A M de Visscher
- Department of Maxillofacial Surgery and Oral Pathology, Amsterdam University Medical Centers (Amsterdam UMC, Location VUmc) and Academic Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Oral and Maxillofacial Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Floor Maarse
- Department of Maxillofacial Surgery and Oral Pathology, Amsterdam University Medical Centers (Amsterdam UMC, Location VUmc) and Academic Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Henk S Brand
- Department of Oral Biochemistry, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, Amsterdam University Medical Centers (Amsterdam UMC, Location VUmc), Amsterdam, The Netherlands
| | - Derk H Jan Jager
- Department of Maxillofacial Surgery and Oral Pathology, Amsterdam University Medical Centers (Amsterdam UMC, Location VUmc) and Academic Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Van Cleemput T, Vanpoecke J, Coropciuc R, Politis C. Sialendoscopy: A Four-Year Single Center Experience. J Oral Maxillofac Surg 2021; 79:2285-2291. [PMID: 34331872 DOI: 10.1016/j.joms.2021.06.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/15/2021] [Accepted: 06/15/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Sialendoscopy is a relatively new technique designed to diagnose and treat benign obstructive salivary gland disease using a minimally invasive approach. The purpose of this study is to present our experiences regarding the use of sialendoscopy in the form of a 4-year, single center experience and to demonstrate its usefulness in oral and maxillofacial practice. METHODS We collected data on patients who underwent sialendoscopy at the Oral-Maxillofacial Surgery Department of UZ Leuven between November 2015 and August 2019, including age, gender, sex, initial clinical presentation and symptoms, gland involvement, type of diagnostic investigations, diagnosis, localization of the obstruction, therapeutic intervention, surgeon, type of anesthesia, materials used, complications, secondary treatment, duration of follow-up, and outcome. Statistical analyses were performed, chi-squared was used to compare the different variables with P < .05 being considered significant. RESULTS During the 4-year timeframe, a total of 44 patients (31 female, 13 male) underwent sialendoscopy in a total of 47 procedures. The average age at time of sialendoscopy was 47.4 years. The most frequent cause of obstruction was sialolithiasis (70%). Cone-beam computed tomography (CBCT) was the most accurate preoperative investigation for the diagnosis of lithiasis (57%). Symptom improvement occurred in 57.9% of patients, with a complication rate of 11%. None of the complications were permanent. CONCLUSION Sialendoscopy can be considered safe and effective for both the diagnosis and treatment of benign obstructive salivary gland disease, with a useful place in oral and maxillofacial surgical practice. We recommend the inclusion of CBCT and/or ultrasound in the diagnostic workup prior to endoscopy.
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Affiliation(s)
- Tim Van Cleemput
- OMFS IMPATH research group, Faculty of Medicine, Clinical intern, Department of Imaging & Pathology, KU Leuven, Leuven, Belgium; Professor and Chairperson, Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.
| | - Jasper Vanpoecke
- OMFS IMPATH research group, Faculty of Medicine, Clinical intern, Department of Imaging & Pathology, KU Leuven, Leuven, Belgium; Professor and Chairperson, Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Ruxandra Coropciuc
- OMFS IMPATH research group, Faculty of Medicine, Clinical intern, Department of Imaging & Pathology, KU Leuven, Leuven, Belgium; Professor and Chairperson, Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Constantinus Politis
- OMFS IMPATH research group, Faculty of Medicine, Clinical intern, Department of Imaging & Pathology, KU Leuven, Leuven, Belgium; Professor and Chairperson, Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
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14
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Chen YC, Dang LH, Chen LC, Chang CC, Han DY, Hsu CH, Ding YF, Su CH, Hung SH. Office-based salivary gland ductal irrigation in patients with chronic sialoadenitis: A preliminary study. J Formos Med Assoc 2020; 120:318-326. [PMID: 33148453 DOI: 10.1016/j.jfma.2020.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/22/2020] [Accepted: 10/07/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND/PURPOSE To evaluate the therapeutic responsiveness of office-based salivary gland ductal irrigation in patients with chronic sialoadenitis. METHODS Between August 2017 and April 2019, 55 patients comprising the following three disease groups were enrolled: Sjogren's syndrome: 39 patients; postradiotherapy sialoadenitis: ten patients; and post-RAI sialoadenitis: six patients. Quantitative salivary scintigraphy was recorded, and a formulated questionnaire including the Summated Xerostomia Inventory was utilized to assess acute/chronic symptoms. All patients received at least three serial salivary gland ductal irrigations with a one-month interval in our outpatient department. RESULTS The general response rates for each disease groups are as follows: Sjogren's syndrome: 61.5% (24/39); postradiotherapy: 60% (6/10); and post-RAI: 83.3% (5/6). Among the patients with Sjogren's syndrome, the parotid scintigraphic Tmin showed a significant positive correlation with the responsiveness of salivary irrigation (P = 0.046), whereas the treatment tended to be irresponsive in patients who previously took medicine for their related discomfort (P = 0.009). In the postradiotherapy and post-RAI groups, no significant factors were found to be associated with the responsiveness of irrigation. CONCLUSION Simple salivary ductal irrigation without complex equipment can be performed as an outpatient procedure to alleviate glandular swelling or xerostomia in patients with Sjogren's syndrome, postradiotherapy sialoadenitis or post-RAI sialoadenitis, and it can be considered an alternative management approach for patients refractory to conventional strategies.
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Affiliation(s)
- Yen-Chun Chen
- Department of Otolaryngology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Luong Huu Dang
- International Master/Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Lung-Che Chen
- Department of Otolaryngology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chi-Ching Chang
- Division of Rheumatology, Immunology and Allergy, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Deng-Yu Han
- Department of Nuclear Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chung-Huei Hsu
- Department of Nuclear Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Yi-Fang Ding
- Department of Otolaryngology, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chin-Hui Su
- Department of Otolaryngology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Shih-Han Hung
- International Master/Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Otolaryngology, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Otolaryngology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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15
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Coca KK, Gillespie MB, Beckmann NA, Zhu R, Nelson TM, Witt RL. Sialendoscopy and Sjogren's Disease: A Systematic Review. Laryngoscope 2020; 131:1474-1481. [PMID: 33141438 DOI: 10.1002/lary.29233] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 10/19/2020] [Accepted: 10/21/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS This study is a systematic review of the literature which seeks to estimate the expected treatment outcomes of a patient with Sjogren's syndrome (SS) undergoing therapeutic sialendoscopy. STUDY DESIGN Systematic Review. METHODS PubMed, Scopus, and Cochrane library databases were used to search for studies published as of August 2020 regarding the treatment outcomes of SS with sialendoscopy. The key search terms included "Sjogren's syndrome" and "sialendoscopy." Only studies in the English language involving more than one human patient were included. PRISMA guidelines were followed in study inclusion and data extraction. The primary outcome assessed was improvement in patient symptoms. RESULTS Six studies met criteria and were analyzed in this review, including 125 patients undergoing sialendoscopy of parotid and/or submandibular glands as well as 25 controls. Of these patients, 90% were female with an age range of 18 to 79 years. There was significant diversity in outcome reporting tools. The outcomes of symptom improvement were pooled qualitatively based on improvement noted in each study. Outcomes were defined as partial improvement if the measured outcomes improved and complete improvement if measured outcomes resolved entirely. Despite the limited number of studies on this topic, this meta-analysis suggests that a similar study of therapeutic sialendoscopy could expect to provide at least temporary improvement of symptoms 90% to 99% of the time. CONCLUSIONS This review provides support for the application of sialendoscopy in the treatment of SS salivary disease. Larger studies with consistent outcome reporting tools and control groups are needed to validate these results and provide a consistent therapy protocol. Laryngoscope, 131:1474-1481, 2021.
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Affiliation(s)
- Kimberly K Coca
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, U.S.A
| | - M Boyd Gillespie
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, U.S.A
| | - Nicholas A Beckmann
- Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, U.S.A
| | - Rongshun Zhu
- Division of Biostatistics - Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, U.S.A
| | - Tamara M Nelson
- Medical Library Research and Learning Services, University of Tennessee Health Science Center, Memphis, Tennessee, U.S.A
| | - Robert L Witt
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.,Delaware ENT-Head and Neck Surgery, Christiana Care, Wilmington, Delaware, U.S.A
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16
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de Paiva Leite SH, Morton RP, Ahmad Z, Marchal F. Do Postoperative Oral Corticosteroids Improve Results After Sialendoscopy for Ductal Stenosis? Laryngoscope 2020; 131:E1503-E1509. [PMID: 32990331 DOI: 10.1002/lary.29111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/26/2020] [Accepted: 09/11/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES This study aims to review the effects of short- and long-term oral administration of postoperative corticosteroids in patients undergoing sialendoscopy for the treatment of obstructive sialadenitis due to ductal stenosis. STUDY DESIGN Prospective comparative study. METHODS A prospective observational study was conducted at Manukau Surgical Center in Auckland, New Zealand, where patients undergoing sialendoscopic surgery for recurrent obstructive sialadenitis due to ductal stenoses were reviewed. Univariable and multivariable analysis, and also logistic regression were performed to identify variables correlated with the likelihood of the need for revision surgery for persistent or recurrent symptoms. RESULTS In this study, sialendoscopy was performed in 142 patients: 162 parotid glands (86.6%) and 25 submandibular glands (13.4%). Postoperative oral steroids were prescribed for 48 patients (34%); 19 (13%) were prescribed for less than 7 days and 29 (20%) for more than 7 days. In total, 33 patients (23.2%) required a revision sialendoscopy during follow-up due to recurrence of symptoms. Oral steroids prescribed for more than 7 days after a sialendoscopy reduced the likelihood of a revision procedure by 93% when compared with patients who did not receive this medication, and by 96% when compared with patients who received steroids for less than 7 days. CONCLUSION The results showed that in our population oral administration of corticosteroids for more than 7 days after sialendoscopy for the treatment of recurrent obstructive sialadenitis due to ductal stenosis markedly reduced the need for later revision surgery. Routine use of corticosteroids for more than 7 days is recommended after sialendoscopy in patients with ductal stenosis. LEVEL OF EVIDENCE II Laryngoscope, 131:E1503-E1509, 2021.
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Affiliation(s)
- Sandro Henrique de Paiva Leite
- Department of Otolaryngology-Head and Neck Surgery, Counties Manukau District Health Board, Auckland, New Zealand.,Middlemore Clinical Trials, Auckland, New Zealand
| | - Randall P Morton
- Department of Otolaryngology-Head and Neck Surgery, Counties Manukau District Health Board, Auckland, New Zealand.,University of Auckland, Auckland, New Zealand
| | - Zahoor Ahmad
- Department of Otolaryngology-Head and Neck Surgery, Counties Manukau District Health Board, Auckland, New Zealand.,University of Auckland, Auckland, New Zealand
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17
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van Ginkel MS, Glaudemans AW, van der Vegt B, Mossel E, Kroese FG, Bootsma H, Vissink A. Imaging in Primary Sjögren's Syndrome. J Clin Med 2020; 9:E2492. [PMID: 32756395 PMCID: PMC7463854 DOI: 10.3390/jcm9082492] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 07/29/2020] [Accepted: 07/30/2020] [Indexed: 12/14/2022] Open
Abstract
Primary Sjögren's syndrome (pSS) is a systemic autoimmune disease characterized by dysfunction and lymphocytic infiltration of the salivary and lacrimal glands. Besides the characteristic sicca complaints, pSS patients can present a spectrum of signs and symptoms, which challenges the diagnostic process. Various imaging techniques can be used to assist in the diagnostic work-up and follow-up of pSS patients. Developments in imaging techniques provide new opportunities and perspectives. In this descriptive review, we discuss imaging techniques that are used in pSS with a focus on the salivary glands. The emphasis is on the contribution of these techniques to the diagnosis of pSS, their potential in assessing disease activity and disease progression in pSS, and their contribution to diagnosing and staging of pSS-associated lymphomas. Imaging findings of the salivary glands will be linked to histopathological changes in the salivary glands of pSS patients.
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Affiliation(s)
- Martha S. van Ginkel
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (E.M.); (F.G.K.); (H.B.)
| | - Andor W.J.M. Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands;
| | - Bert van der Vegt
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands;
| | - Esther Mossel
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (E.M.); (F.G.K.); (H.B.)
| | - Frans G.M. Kroese
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (E.M.); (F.G.K.); (H.B.)
| | - Hendrika Bootsma
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (E.M.); (F.G.K.); (H.B.)
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
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18
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Toward better outcomes in Sjögren's syndrome: The promise of a stratified medicine approach. Best Pract Res Clin Rheumatol 2020; 34:101475. [PMID: 32005417 DOI: 10.1016/j.berh.2019.101475] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Sjögren's syndrome is a systemic autoimmune disease defined by its targeted inflammation of the salivary and lacrimal glands, resulting in dry mouth and eyes in the majority and persistent or recurrent salivary gland enlargement in a minority of those affected. Involvement of major organs, an increased risk of lymphoma, and autoantibodies against ubiquitous cellular ribonucleoproteins define some of its systemic features. Those affected have a high symptom burden and the development of disease-modifying therapies is thus an urgent need. A stratified medicine approach offers promise as a means of targeting specific therapies to patients for whom the mechanism of action is most relevant. Implementation of this approach will require an understanding of the pathophysiological processes underlying different patient subsets, and then identifying or developing a drug that targets this pathway. Such therapies would be most effective if implemented early in the disease course before the advent of adverse outcomes or glandular damage. This review will provide a disease overview followed by an analysis of the feasibility of a stratified medicine approach, focusing on the disease heterogeneity, predictors of disease progression and adverse outcomes, and recent advances in the development of relevant outcome measures and new therapies.
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19
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Canzi P, Capaccio P, Marconi S, Conte G, Preda L, Avato I, Aprile F, Gaffuri M, Occhini A, Pignataro L, Auricchio F, Benazzo M. Feasibility of 3D printed salivary duct models for sialendoscopic skills training: preliminary report. Eur Arch Otorhinolaryngol 2019; 277:909-915. [DOI: 10.1007/s00405-019-05763-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 12/07/2019] [Indexed: 10/25/2022]
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20
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Costs of sialendoscopy and impact on health-related quality of life. Eur Arch Otorhinolaryngol 2018; 276:233-241. [PMID: 30430242 PMCID: PMC6338794 DOI: 10.1007/s00405-018-5196-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 11/02/2018] [Indexed: 12/28/2022]
Abstract
Purpose To analyse costs related to the diagnosis and treatment of patients with sialolithiasis and sialadenitis managed with sialendoscopy, and to prospectively evaluate the impact of sialendoscopy on health-related quality of life (HRQoL) in a longitudinal follow-up study. Methods All patients undergoing sialendoscopy or sialendoscopy-assisted surgery at a tertiary care university hospital between January 2014 and May 2016 were identified from a surgical database, and the direct hospital costs were retrospectively evaluated from 1 year before to 1 year after the sialendoscopy. The 15D HRQoL questionnaire and a questionnaire exploring the use of health care services during the preceding 3 months were mailed to the patients before sialendoscopy as well as at 3 and 12 months after the operation. Results A total of 260 patients were identified. Mean total hospital costs, costs related to the sialendoscopy, and complications were significantly higher in sialolithiasis patients than in patients with other diagnoses. 74 patients returned the baseline 15D questionnaire, and 51 patients all three 15D questionnaires. At baseline, the dimensions “discomfort and symptoms” and “distress” were lower in patients than in age- and gender-standardised general population, but the total 15D score did not differ significantly. The dimension “discomfort and symptoms” improved significantly at 3 and 12 months postoperatively, and the mean total HRQoL score improved in patients with sialolithiasis at 3 months postoperatively. Conclusions The costs related to sialendoscopy are substantial and the cost-effectiveness of sialendoscopy warrants further studies. However, sialendoscopy seems to reduce patients’ discomfort and ailments and to improve HRQoL at least in patients with sialolithiasis.
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Karagozoglu KH, Vissink A, Forouzanfar T, Brand HS, Maarse F, Jager DHJ. Sialendoscopy enhances salivary gland function in Sjögren's syndrome: a 6-month follow-up, randomised and controlled, single blind study. Ann Rheum Dis 2018; 77:1025-1031. [PMID: 29475854 DOI: 10.1136/annrheumdis-2017-212672] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 02/02/2018] [Accepted: 02/03/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To assess the effect of sialendoscopy of the major salivary glands on salivary flow and xerostomia in patients with Sjögren's syndrome (SS). METHODS Forty-nine patients with SS were randomly assigned to a control group (n=15) and two intervention groups: irrigation of the major glands with saline (n=16) or with saline followed by triamcinolone acetonide (TA) in saline (n=18). Unstimulated whole saliva flow (UWS), chewing-stimulated whole saliva flow (SWS), citric acid-stimulated parotid flow (SPF), Clinical Oral Dryness Score (CODS), Xerostomia Inventory (XI) score and the European League Against Rheumatism (EULAR) SS Patient-Reported Index (ESSPRI) were obtained 1 week (T0) before, and 1 (T1), 8 (T8), 16 (T16) and 24 (T24) weeks after sialendoscopy. RESULTS Median baseline UWS, SWS and SPF scores were 0.14, 0.46 and 0.22 mL/min, respectively. After intervention, significant increases in UWS and SWS were observed in the saline group (at T8 (P=0.013) and T24 (P=0.004)) and the saline/TA group (at T24 (P=0.03) and T=16 (P=0.035)). SPF was increased significantly in the saline/TA group at T24 (P=0.03). XI scores declined after sialendoscopy in both intervention groups. Compared with the control group, CODS, XI and ESSPRI improved in the intervention groups. UWS, SWS and SPF were higher in the intervention groups compared with the control group, but these differences were not significant except for SPF in the saline/TA group at T24 (P=0.005). CONCLUSIONS Irrigation of the major salivary glands in patients with SS enhances salivary flow and reduces xerostomia up to 6 months after sialendoscopy.
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Affiliation(s)
- K Hakki Karagozoglu
- Department of Oral and Maxillofacial Surgery and Oral Pathology, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Tim Forouzanfar
- Department of Oral and Maxillofacial Surgery and Oral Pathology, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Henk S Brand
- Department of Oral Biochemistry, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, Netherlands
| | - Floor Maarse
- Department of Oral and Maxillofacial Surgery and Oral Pathology, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Derk Hendrik Jan Jager
- Department of Oral and Maxillofacial Surgery and Oral Pathology, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Department of Oral Health Sciences, KU Leuven & University Hospitals Leuven, Leuven, Belgium
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22
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Jokela J, Haapaniemi A, Mäkitie A, Saarinen R. Sialendoscopy in treatment of adult chronic recurrent parotitis without sialolithiasis. Eur Arch Otorhinolaryngol 2017; 275:775-781. [PMID: 29290052 DOI: 10.1007/s00405-017-4854-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 12/21/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The aim of this prospective study was to evaluate the efficacy of sialendoscopy in the management of adult chronic recurrent parotitis without sialolithiasis. In addition, preliminary results of an initial randomized placebo-controlled trial of single-dose intraductal steroid injection given concurrently with sialendoscopy, are presented. METHODS Forty-nine adult patients with chronic recurrent parotitis without sialoliths were included in this study. They underwent sialendoscopy and were randomized to receive either a concurrent intraductal injection of isotonic saline solution or 125 mg of hydrocortisone. Symptom severity was evaluated with visual analogue scale (VAS) and by recording symptom frequency and course with a multiple-choice questionnaire completed preoperatively and at 3, 6, and 12 months after the procedure. RESULTS The mean VAS score was 5.6 preoperatively and dropped to 2.9 at 3 months, 3.0 at 6 months, and 2.7 at 12 months after the procedure. The VAS score and the frequency of symptoms were significantly lower at 3 (p < 0.001), 6 (p < 0.001) and 12 (p < 0.001) months after the procedure when compared with the preoperative scores indicating that sialendoscopy reduces the symptoms of recurrent parotitis. However, complete permanent resolution of symptoms was rare. Single-dose steroid injection concomitant to sialendoscopy provided no additional benefit, but the current study is not sufficiently powered to determine a clinical difference between the steroid and non-steroid groups. CONLUSION Sialendoscopy appears to reduce the symptoms of chronic recurrent parotitis. While total permanent symptom remission is rare, sialendoscopy can be considered a safe and relatively efficacious treatment method for this patient group.
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Affiliation(s)
- Johanna Jokela
- Department of Otorhinolaryngology, Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, P.O. Box 263, 00029 HUS, Helsinki, Finland.
| | - Aaro Haapaniemi
- Department of Otorhinolaryngology, Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, P.O. Box 263, 00029 HUS, Helsinki, Finland
| | - Antti Mäkitie
- Department of Otorhinolaryngology, Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, P.O. Box 263, 00029 HUS, Helsinki, Finland.,Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska Hospital, Stockholm, Sweden
| | - Riitta Saarinen
- Department of Otorhinolaryngology, Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, P.O. Box 263, 00029 HUS, Helsinki, Finland
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Su C, Hung S. Easy insertion into the duct: The use of an angiocatheter as a sialendoscopy applicator. Laryngoscope 2017; 128:1392-1394. [DOI: 10.1002/lary.27007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 10/10/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Chin‐Hui Su
- Department of OtorhinolaryngologyMackay Memorial HospitalTaipei Taiwan
- Department of Otolaryngology, School of Medicine, College of MedicineTaipei Medical UniversityTaipei Taiwan
| | - Shih‐Han Hung
- Department of Otolaryngology, School of Medicine, College of MedicineTaipei Medical UniversityTaipei Taiwan
- Department of OtolaryngologyTaipei Medical University HospitalTaipei Taiwan
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Cung TD, Lai W, Svider PF, Hanba C, Samantray J, Folbe AJ, Shkoukani M, Raza SN. Sialendoscopy in the Management of Radioiodine Induced Sialadenitis: A Systematic Review. Ann Otol Rhinol Laryngol 2017; 126:768-773. [DOI: 10.1177/0003489417732795] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: Salivary gland dysfunction as a consequence of radioiodide ablation is present in as many as two-thirds of patients, and unfortunately, many of these individuals do not respond to conservative measures. Sialendoscopy as a minimally invasive therapeutic modality may have utility in the treatment of radioiodide induced sialadenitis (RAIS). Our aim was to explore whether sialendoscopy resulted in clinical improvement in patients with RAIS. Methods: A systematic review of studies on sialendoscopy for RAIS was conducted using MEDLINE database, Embase, and Cochrane Library. The outcomes of interest included the proportion of patients demonstrating clinical improvement after intervention, patient demographics, radiation dose, specific procedural variations, specific salivary gland, failure rate, and recurrence. Results: Eight studies met inclusion criteria. Data reviewed showed an increased predilection of parotid sialadenitis relative to submandibular gland sialadenitis. All but 2 studies employed sialendoscopy only after failure of conservative measures. An overall rate of clinical improvement ranging from 75% to 100% was reported. Conclusion: This systematic review encompassing 122 patients represents the largest pooled sample to date of patients undergoing sialendoscopy for RAIS. Sialendoscopy represents an invaluable minimally invasive modality that may obviate the need for more invasive surgery as intervention was associated with a high success rate.
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Affiliation(s)
- Thai-Duong Cung
- Department of Otolaryngology–Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Wanda Lai
- Department of Otolaryngology–Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA
- Division of Endocrinology, Diabetes, and Metabolism, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Peter F. Svider
- Department of Otolaryngology–Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Curtis Hanba
- Department of Otolaryngology–Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Julie Samantray
- Division of Endocrinology, Diabetes, and Metabolism, Wayne State University School of Medicine, Detroit, Michigan, USA
- Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, USA
| | - Adam J. Folbe
- Department of Otolaryngology–Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA
- Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, USA
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Mahdi Shkoukani
- Department of Otolaryngology–Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA
- Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, USA
- Surgical Service, Section of Otolaryngology, John D. Dingell VA Medical Center, Detroit, Michigan, USA
| | - Syed Naweed Raza
- Department of Otolaryngology–Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA
- Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, USA
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