Stensen's Duct Stenosis Balloon Dilatation: Long-term Evaluation of Clinical Outcomes and Quality of Life Impacts

OBJECTIVE

To conduct a long-term retrospective evaluation of the safety and effectiveness of sialographic balloon dilatation in Stensen's duct stenosis (SDS).

STUDY DESIGN

Retrospective cohort.

SETTING

Single-institution academic tertiary referral center.

METHODS

All SDS balloon dilatations (SSBDs) performed from 2011 to 2017 were monitored. Pain relief was evaluated by a numeric rating scale at 3-year follow-up at least. Long-term glandular swelling frequency patterns, quality of life (QoL), and drug consumption were retrospectively assessed. Procedure-related complications were recorded.

RESULTS

Twenty-one SSBD procedures were recorded (mean ± SD age, 55 ± 12 years), all performed under local anesthesia. SSBD led to complete dilatation in 7 patients (33%), residual stenosis in 8 (38%), and no dilatation (failure) in 6 (29%). Retrospective analysis of clinical outcomes was possible for 17 patients, 71% of whom presented with long-term pain relief, at a mean relief of 3.2 points on the numeric rating scale (P < .001). Long after SSBD, patients presented with a mean decrease of 15.4 glandular swellings per month (P < .001). Medical consumption was reduced to 18% of patients taking some drugs because of SDS after SSBD vs 71% before. SSBD showed an impact on QoL in >80% of patients, with mean improvements of 26% and 25% in the percentage point reduction of physical and mental QoL, respectively (P < .001). No complications were noted except temporary discomfort due to the procedure.

CONCLUSION

Despite the advent of sialendoscopy-guided techniques, SSBD should be considered for SDS treatment, as it is a safe procedure and provides sustained pain relief.

Breaking it down: Review and management of sialendoscopy device malfunctions

PURPOSE

The present study was aimed at determining common causes of sialendoscopy device malfunctions and identifying a uniform algorithm to manage device failures.

MATERIALS AND METHODS

The FDA Manufacturer and User Facility Device Experience (MAUDE) database was searched for various keywords related to sialendoscopy. Reports between the dates of December 1, 2009 to March 31, 2020 were downloaded for review and included in the study. Variables such as: device, the iatrogenic injury type, and subsequent surgical or medical intervention were collected and details of the malfunction were categorized based on the type of malfunction.

RESULTS

206 medical device reports were identified; 47 of them which met inclusion criteria (106 were duplicate cases and 53 were irrelevant to the present study). The majority of device malfunctions involved salivary stone extractor baskets (SSEBs), (40/47; 85.1%), followed by malfunctions of balloon dilators (3/47; 6.4%) and sialendoscopes (2/47; 4.3%). Retention of the SSEB was noted in 85% of the SSEB malfunctions.

CONCLUSIONS

Given that sialendoscopy is an increasingly popular technique that relies on devices, it is inevitable that device failures will occur for a multitude of reasons. Working to prevent these malfunctions from occurring is the most effective method of harm reduction. Though it is important that sialendoscopists have a discrete, algorithmic approach to manage them when they occur.

Sialendoscopy in Chronic Obstructive Sialadenitis Without Sialolithiasis: A Prospective Cohort Study

OBJECTIVES

To evaluate long-term chronic sialadenitis symptoms in patients without sialolithiasis following sialendoscopy-assisted salivary duct surgery (SASDS) compared to a control group managed conservatively.

STUDY DESIGN

Prospective cohort study.

SETTING

Tertiary care center.

METHODS

Thirty-six patients (52 glands) with chronic sialadenitis without sialolithiasis completed the Chronic Obstructive Sialadenitis Symptoms (COSS) questionnaire at presentation and at 3-month time intervals thereafter for 1 year. Lower COSS scores represent lower symptom severity. We compared 27 patients who underwent SASDS to 9 control patients who elected conservative management.

RESULTS

COSS gland-specific scores from 38 SASDS-treated glands (cases) and 14 control glands were similar at baseline. At 6 to 12 months (mean, 8.4 months), the surgically treated group had significantly lower scores and a greater score reduction from baseline compared to controls (mean score change [95% confidence interval] cases: 20.7 points [15.7-25.8]; controls: 11.7 points [4.9-18.4]; P = .04). There was a significant difference in scores between the 2 groups over time (P < .001). A greater proportion (72%) of cases reported partial or complete resolution of overall sialadenitis symptoms at 6 to 12 months compared to the controls (22%, P < .05).

CONCLUSION

Compared to patients electing for conservative management, patients with sialadenitis without sialolithasis treated with SASDS had improved symptom scores and a greater reduction of symptom severity after 6 months. With SASDS, patients had higher rates of significant overall symptom improvement. In evaluating chronic sialadenitis, assessment at multiple time points is necessary to capture the intermittent and cyclical pattern of obstructive symptoms.

Do Postoperative Oral Corticosteroids Improve Results After Sialendoscopy for Ductal Stenosis?

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.

Pediatric sialendoscopy: An 11-year study from a single tertiary care center

OBJECTIVES

To evaluate the suitability, benefits, and limitations of sialendoscopy for pediatric patients.

METHODS

We performed a retrospective analysis of all pediatric sialendoscopy patients (aged 16 years or younger) in our tertiary care institution between September 2007 and October 2018. We characterized patient data, procedure-related factors, complications, and outcomes.

RESULTS

In total, 55 sialendoscopies were performed on 42 patients. Among these, 36 were diagnostic endoscopies and 19 were interventional. Five endoscopies were performed under local anesthesia. We identified 16 sialolithiasis patients, where removal of a sialolith was possible in 11 (69%) cases; one case required a second endoscopy. We removed two sialoliths under local anesthesia. Among recurrent juvenile parotitis (RJP) patients, 18/20 (90%) were symptom-free after a single sialendoscopy, and all after a second endoscopy. The median follow-up time was 70 months. We achieved a 95% success rate in sialendoscopies, with a failure-to-treat rate of 15%. The complication rate for the study cohort was 2%, with prolonged parotid swelling the only complication encountered.

CONCLUSIONS

Sialendoscopy represented a safe and effective method to treat pediatric patients. Local anesthesia was successful in selected cases, even for sialolith removal. Sialendoscopy had a soothing effect on RJP and the majority of sialoliths were suitable for endoscopic removal.

Costs of sialendoscopy and impact on health-related quality of life

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.