Exploring the potential of Chat-GPT as a supportive tool for sialendoscopy clinical decision making and patient information support

INTRODUCTION

Sialendoscopy has emerged in the last decades as a groundbreaking technique, offering a minimally invasive approach for exploring and managing salivary gland disorders. More recently, the advent of chatbots, powered by advanced natural processing language and artificial intelligence algorithms, has revolutionized the way healthcare professionals and patients access and analyze medical information and potentially will support soon the clinical decision-making process.

MATERIALS AND METHODS

A prospective, cross-sectional study was designed to assess the level of agreement between Chat-GPT and 10 expert sialendoscopists aiming the capabilities of Chat-GPT to further improve the management of salivary gland disorders.

RESULTS

The mean level of agreement was 3.4 (SD: 0.69; Min: 2, Max: 4) for Chat-GPT's answers while it was 4.1 (SD: 0.56; Min: 3, Max: 5) for the group of EESS (p < 0.015). The overall Wilcoxon signed-rank test yielded a significance level of p < 0.026 when comparing the level of agreement between Chat-GPT and EESS. The mean number of therapeutic alternatives suggested by Chat-GPT was 3.33 (SD: 1.2; Min: 2, Max: 5), while it was 2.6 (SD: 0.51; Min: 2, Max: 3) for the group of EESS; p = 0.286 (95% CI - 0.385 to 1.320).

CONCLUSION

Chat-GPT represents a promising tool in the clinical decision-making process within the salivary gland clinic, particularly for patients who are candidates for sialendoscopy treatment. Additionally, it serves as a valuable source of information for patients. However, further development is necessary to enhance the reliability of these tools and ensure their safety and optimal use in the clinical setting.

Introducing Sialendoscopy in a Veteran Population: Effect on Benign Salivary Disease Treatment

OBJECTIVE

To compare rates of sialadenectomy in a veteran population before and after introduction of sialendoscopy.

MATERIALS AND METHODS

All Veterans Affair (VA) Northern California Healthcare System (NCHS) encounters from 2006 to 2021 for benign obstructive salivary etiologies were identified using International Classification of Disease 9/10 codes. This cohort was then cross referenced with Current Procedural Terminology codes to identify patients who underwent a procedure for their salivary pathologies. The rates of sialadenectomy and minimally invasive procedures were measured before and after sialendoscopy was introduced to the VA NCHCS in 2016. Data was obtained via chart review and demographic information, diagnosis, and procedure type were extracted. Rates of sialadenectomy, minimally invasive procedures, and other patient and procedural characteristics were compared between the Pre-Sialendoscopy Era (PSE) and Sialendoscopy Era (SE). Statistical analysis was performed using Microsoft Excel (Microsoft, version 16.66).

RESULTS

An increasing number of patients per year sought care for benign obstructive salivary pathology in the SE when compared to the PSE cohort and a higher rate of female patients were treated in the SE cohort. A simultaneous reduction in sialadenectomy rates and increase in minimally invasive procedure rates was observed in the SE. Sialendoscopy represented most of the increase in minimally invasive techniques, but there was a slight increase in other procedure types. Submandibular gland obstructive pathologies required the most procedures and resulted in the most gland excisions.

CONCLUSION

This retrospective review strongly suggests introducing sialendoscopy reduced the incidence of sialadenectomy for benign non-tumor obstructive pathology in this VA NCHS population. Further prospective studies are needed to evaluate this in a more generalized setting.

Non-neoplastic salivary gland diseases in children: a 10-year review at a tertiary center

OBJECTIVES

Non-neoplastic salivary gland diseases are rare in children. This paper aims to present the spectrum of encountered non-neoplastic salivary gland diseases at a tertiary center by describing the demographics, clinical characteristics, and outcomes in this patient population.

METHODS

A review of electronic medical records was performed from 2010 until 2020. Relevant data were retrieved and charted according to the type of salivary gland disease. A comparison between diseases was made for demographics, presenting symptoms, treatment, and outcomes.

RESULTS

Fifty patients with 11 different non-neoplastic salivary gland diseases were identified. Sialolithiasis was the most prevalent condition (12/50), with 83% localized in the submandibular gland. In contrast to gender, age, and symptoms, the location of pathology was significantly associated with the diagnosis (p < 0.001). In patients with sialolithiasis, a hybrid procedure (combined endoscopy and lithotomy) resulted in 100% resolution of symptoms. For (plunging) ranula, marsupialisation had a relative risk of recurrence of 9.6 compared to (partial) extirpation of the sublingual gland.

CONCLUSIONS

Children with salivary gland diseases present with overlapping symptoms, making clinical diagnosis challenging. The present study may aid physicians and specialists in diagnosing the most prevalent conditions in children. Although no gold standards exist for their treatment, hybrid procedures (sialolithiasis) and subglingual gland extirpation (ranula) showed superior results over alternatives.

Tongue Mucoceles: a retrospective clinic-pathological evaluation of 240 cases

BACKGROUND

Minor salivary glands can be found in the ventral and anterior part of the tongue; these glands can rarely develop mucoceles that, due to their rarity and their unusual clinical appearance, may present an interesting differential diagnosis. Mucoceles appear as an exophytic, sometimes pedunculated, lesion, which is a feature that is due to the absence of a capsule; thus, the glands are right beneath the mucosa and over the muscle tissue. The aim of this article is to retrospectively present and discuss the anatomy, pathology, clinical features and therapy of several cases of Blandin-Nunh mucoceles collected from two different institutions.

METHODS

A retrospective case review was carried out in two university institutions, retrieving all cases of tongue mucoceles from 1999 to today. Two oral pathologists reviewed all the slides, confirming the diagnosis. Demographic data of the patient, anatomic location and clinical appearance were retrieved from clinical charts, together with the type of surgical procedure and possible relapses.

RESULTS

A total of 240 cases of tongue mucoceles were gathered from the archives: the mean age was 22 years (DS = 14,7; Range 2-83), 126 were females (52,5%, mean age 22,7 years, DS = 16,5; Range 2-83), and 114 were males (47,5%, mean age 20,9 years, DS = 12,4; Range 3-73); in all cases, a history of trauma was reported. The ventral surface was the most frequent location (224 cases - 93,3%), and in the great majority (235 cases - 97,9%), pathology revealed mucous spillage with a wall formed by fibrous connective and granulation tissue with no epithelium lining the cavity. Superficial mucocele and sclerosing sialoadenitis were the more frequent pathological variants (21 cases - 8,8%). All lesions were treated with excision and enucleation of the servicing gland. The healing was uneventful in all cases, but there were four recurrences and two cases of sensory paraesthesia of the border of the tongue, all in males, except one case of paraesthesia in a female.

CONCLUSIONS

Tongue mucoceles must be differentiated from many benign and malignant lesions. For this reason, surgical removal of the lesion and of the associated gland with a pathological exam is mandatory. In fact, the anatomical location of the glands and the possible pathological variants must be considered to reach a correct diagnosis and diminish possible relapses.

TRIAL REGISTRATION

CE-Muc_Ton_3/2023.

Radiologically-guided balloon sialoplasty for benign salivary duct obstruction: a 7-year UK service evaluation

Obstructive sialadenitis is the most common cause of non-malignant salivary gland disorders, with salivary gland strictures being responsible for approximately 23% of all benign obstructive disease. Significant advances in minimally invasive techniques, including radiologically-guided balloon sialoplasty, offer the potential for successful treatment with reduced complications. At present there is a paucity of follow-up data regarding patient outcomes and repeat interventions in those undergoing the procedure. Patients with parotid or submandibular gland sialadenitis secondary to gland stricture were identified and underwent radiologically-guided balloon sialoplasty at Queen Alexandra Hospital, Portsmouth, UK between 2015 and 2022. Patient outcomes, complications and reintervention rates were recorded prospectively over the seven-year period and analysed retrospectively. A total of 44 patients underwent radiologically-guided balloon sialoplasty. Forty (89%) underwent sialoplasty for parotid gland disease, with a minority (n = 5) receiving an intervention for submandibular gland strictures. A total of 37 (84%) had their obstruction successfully treated (82% of parotid gland obstructions and 100% of submandibular gland obstructions). Five patients (11%) required a repeat intervention. Seventeen successfully treated patients (85%) who attended follow-up clinic appointments described complete resolution of their symptoms, with the remaining three (15%) describing a partial response. Radiologically-guided balloon sialoplasty for the treatment of benign obstructive sialadenitis secondary to a gland stricture is a safe and effective method of eliminating the obstruction and relieving patients' symptoms. Most patients were symptom free at short-term follow up, with a minority requiring a second sialoplastic intervention.

Sialendoscopy for treatment of major salivary glands diseases: a comprehensive analysis of published systematic reviews and meta-analyses

OBJECTIVES

Sialendoscopy is a minimally invasive procedure used to diagnose and treat obstructive salivary gland diseases. Previous studies in the topic have shown mixed results. The present study aimed to evaluate the efficacy and safety of sialendoscopy through previous systematic reviews for different outcomes of several diseases. We also aimed to assess studies' methodological quality and heterogeneity.

METHODS

We conducted a comprehensive systematic literature search of Pubmed, Embase, Lilacs and Cochrane Library. We included systematic reviews and meta-analyses that used sialendoscopy to treat both lithiasic and alithiasic salivary glands diseases. Data extraction included studies' characteristics and results. We assessed studies' methodological quality using the AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews 2) tool.

RESULTS

13 studies were included in the review, being 9 in adult populations and 4 in pediatric populations. Sialendoscopy proved to be effective at the treatment of different lithiasic and other obstructive diseases, but with important heterogeneity. The technique was also considered highly safe in most studies. However, studies had a critically low quality of evidence.

CONCLUSIONS

Most studies demonstrated high efficacy and safety of sialendoscopy, but with critically low quality of evidence. We still lack randomized studies in this field, and future systematic reviews on the topic should follow current guidelines to improve conduction and reporting.

New Conservative Approach for the Management of Recurrent Sublingual Ranula-A Case Report

Ranula is a rare and benign extravasation mucocele that is clinically characterized by asymptomatic sublingual or submandibular masses. Surgical excision is considered the most effective treatment approach, but it has been associated with high invasiveness and several complications (hemorrhage, damage to Wharton's duct, and lingual nerve injury). Over the past decade, more conservative therapies have been rapidly disseminated into clinical practice to seek a more effective and less traumatic approach for young patients. In this report, an 8-year-old female with an asymptomatic, recurrent sublingual ranula was treated using a conservative approach with marsupialization and an intracystic injection of a plaque remover (Hybenx^® gel). After incision of the cystic dome, Hybenx^® gel was applied into the cystic lumen for 20 seconds and then aspirated; next, the area was rinsed thoroughly with sterile saline solution before suturing. Ultrasound re-evaluation at 10 months and intraoral clinical examination at 24 months confirmed the absence of relapse. Our results support the hypothesis that marsupialization combined with intracystic injection of Hybenx^® gel could be an encouraging conservative treatment alternative for recurrent sublingual ranula in children. Further randomized controlled trials are needed to test this hypothesis.

Oral mucoceles: A Brazillian Multicenter Study of 1,901 Cases

Oral mucocele (OM) is the most common lesion of minor salivary glands. The present study aimed to report the clinical and demographic features of a large series of OMs and identify possible predictive variables associated with the recurrence rate of these lesions. A retrospective descriptive cross-sectional study was performed. A total of 43,754 biopsy records from four pathology services in Brazil were analyzed. All cases of OMs were reviewed, and clinical and demographic data were collected. The study comprised 1,002 females (56.2%) and 782 males (43.8%), with a mean age of 19.8±16.4 years (range: 01-87 years) and a 1.3:1 female-to-male ratio. The lower lip (n=1,160; 67.4%), and floor of the mouth (n=172; 10.0%), were the most common affected sites, presenting clinically as nodules (n=978; 79.4%) of smooth surface (n=428; 77.5%) and normal color (n=768, 46.7%). Excisional biopsy was the treatment in most cases (n=1,392; 78.0%). Recurrent OMs represented 6.2% of all diagnosed cases (n=117). OMs recurred more commonly in younger patients (aged<20 years) (p<0.0001), in lesions larger than 2 cm in diameter (p<0.0001), and in those located in the ventral tongue (p=0.0351). Also, recurrence rates were higher significantly in cases treated with laser surgery than in those with conventional surgery (p=0.0005). Patients with OMs should be carefully informed of its possible recurrence, especially when found on the ventral tongue of young patients.

Transoral approach for mandibular and sublingual sialoadenectomy in a cat

Sialocele is an uncommon condition in cats. The treatment of choice for sublingual sialocele is excision of the ipsilateral mandibular and sublingual salivary gland/duct complex. Lateral and ventral cervical approaches have been described for mandibular-sublingual sialoadenectomy; however, the transoral approach, described here, has never been reported in cats. Ranula in the present case was likely caused by an inadvertent trauma of the sublingual duct during resection of a sublingual lesion performed by the referring veterinarian. The definitive surgery consisted of mass removal and sialoadenectomy through a unique oral approach. The surgery was effective without complications encountered after 6 months of follow-up. Key clinical message: This article reports a novel, transoral approach, for mandibular and sublingual sialoadenectomy in the cat. This approach decreases the surgical time and prevents recurrence of the mucocele.

A case of parapharyngeal space salivary duct cyst with fine needle biopsy suspicious for squamous cell carcinoma

OBJECTIVES

To report a unique case of salivary duct cyst presenting as parapharyngeal space mass and review relevant literature regarding salivary duct cyst and fine needle aspiration biopsy of salivary gland lesions.

METHODS

After a case description, a review of the literature regarding salivary duct cyst etiology, pathophysiology, presentation, histologic features, and the accuracy of FNA in the context of salivary gland lesions was conducted.

RESULTS

Salivary duct cysts are rare, often acquired, cystic dilatations of salivary ducts thought to arise secondary to ductal obstruction, commonly occurring in the major salivary glands. Fine needle aspiration is the biopsy method of choice for most head and neck lesions. There is controversy surrounding this method in salivary lesions, but recent data indicates it can be just as reliable as in other locations.

CONCLUSIONS

Here, we highlight a patient with a salivary duct cyst presenting as a parapharyngeal mass, which has not been described in the literature. Overall, FNA in salivary lesions is highly pathologist dependent, which likely contributes to varying accuracy in the literature.

Excision of Sublingual Gland

There are 2 types of ranulas: oral ranulas and plunging (cervical) ranulas. The management of the cervical ranula involves surgical excision of the oral portion of the ranula along with the associated sublingual salivary gland. The sublingual gland is easily removed from an intraoral approach. Significant anatomic structures associated with the removal of the sublingual gland are the submandibular duct, lingual nerve, and sublingual artery. Knowledge of the anatomy makes the surgery easier and without complications.

Sialendoscopy under conscious sedation versus general anesthesia. A comparative study

OBJECTIVE

Sialendoscopy is a minimally invasive emerging approach, the general surgical technique has been published but many essential questions still need to be addressed with the aim of improving outcomes. For instance, should we systematically perform sialendoscopy under conscious sedation (CS) or general anesthesia (GA)? What are the limitations of CS? The objective of this study is to compare these two modalities.

METHODOLOGY

A retrospective study of 70 patients who had undergone a sialendoscopy between 2014 and 2016 (34 under GA and 36 under CS). Comparisons were made between these two groups in term of operative time, stone size and location, tolerability, operative success and post-operative pain.

RESULT

The patients' mean age was 45.33 years. The operative success rate among the GA group was 79.4% vs. 88.9% in the CS group (P = 0.276), while complications for both groups were comparable. All patients considered the intervention under CS to be tolerable.

CONCLUSION

Sialendoscopy under CS or GA demonstrated the ability to access large and distal stones among the different salivary glands with an excellent tolerability. Anesthesia type should be based on surgeon and patient preference Nevertheless, patient reassurance and surgeon experience are important to producing a good result with CS.

The added value of pretreatment DW MRI in characterization of salivary glands pathologies

OBJECTIVE

To evaluate the added value of diffusion weighted magnetic resonance imaging (DW-MRI) in characterization of salivary gland lesions.

STUDY DESIGN

A prospective study was carried out between January 2013, and March 2015.

METHODS

The study included 46 patients. The consultant radiologist, who reviewed the scans to comment on the apparent diffusion coefficient (ADC) value and ADC histogram was blind to the suspected pathology. Radiological findings were then compared to clinical and histological findings.

RESULTS

The diagnostic performance of DW-MRI for identification of malignant lesions showed that the sensitivity, specificity, and positive and negative prediction value were 100%, 92%, 91.3%, and 100%, respectively.

CONCLUSION

The specific ability of DW-MRI to probe tissue microstructures is an interesting complement to the currently used imaging procedures in the characterization, and even grading of malignancies. ADC mapping is an easy, cost effective promising tool that has neither radiation exposure, nor amalgam artifacts and can be used in helping characterization of salivary glands lesions.

LEVEL OF EVIDENCE

1B.

Sclerosing Polycystic Adenosis of the Parotid Gland: A Systematic Review and Report of 2 New Cases

PURPOSE

We sought to evaluate clinical-epidemiologic aspects, pathologic characteristics, and treatment of sclerosing polycystic adenosis (SPA) of the parotid gland and to report 2 new cases.

MATERIALS AND METHODS

We conducted a systematic review following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for studies published in or before June 2016. The inclusion criteria were as follows: final diagnosis of SPA affecting the parotid gland and articles published in Spanish or English. The exclusion criteria were as follows: unclear diagnosis after pathologic analysis and patients affected by other conditions in the major salivary glands. We added 2 new cases.

RESULTS

Our review ultimately included 21 articles and 45 cases. The mean patient age was 41 years (range, 7-84 years). The female-to-male ratio was 2:1. In all patients the tumor showed progressive growth. The evolution range was 7 days to 11 years. In 17.7% of cases, the tumor was associated with pain. The average tumor size was 30.3 mm (range, 12-60 mm). Fine needle aspiration biopsy (FNAB) was unable to diagnose 30 cases. Benign tumors comprised 58% of tumors (18), whereas malignancy was present in 25.8% (8). Thirty-five tumors were well circumscribed. There were 8 multinodular or lobed cases. The tumor was described as encapsulated in 1 case, partially encapsulated or pseudo-encapsulated in 16, and not encapsulated in 12. Five cases showed different degrees of degenerative changes, ranging from dysplasia to invasive carcinoma. All cases underwent surgical treatment. Superficial parotidectomy with preservation of the facial nerve was performed in 22 cases (61.1%), total parotidectomy in 8 (22.2%), and tumor enucleation in 6 (16.6%). The mean follow-up period was 51.5 months (range, 5-276 months). Of documented cases, 74.2% had 2 or more years of follow-up. Recurrences occurred in 6 cases (16.6%).

CONCLUSIONS

We consider SPA a benign tumor with progressive growth, which is occasionally painful. It occurs around age 40 years and occurs more often in female patients. Fine needle aspiration biopsy does not provide an adequate preoperative diagnosis. Recurrences are infrequent. Follow-up should be customized according to the pathologic findings. Malignant transformation may occur. Superficial parotidectomy with facial nerve preservation is the treatment of choice.

Microwave Ablation: A Novel Treatment for the Mucoceles of Anterior Lingual Salivary Glands

PURPOSE

The objective of this study was to evaluate the efficacy of microwave ablation as a substitute for surgery in patients with a mucocele of the anterior lingual salivary glands.

MATERIALS AND METHODS

In the Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Sichuan University (Chengdu, China), 78 patients with a clinical diagnosis of a mucocele of the anterior lingual salivary glands underwent microwave ablation from November 2012 to May 2015. Outcome and data on age, gender, size of lesion, history of trauma, and duration of lesion development for each patient were collected.

RESULTS

In this series, all patients fully recovered and only 5 patients received a second ablation. Wound healing was uneventful in all cases and a small scar was observed in only 6 patients. No serious complications were observed except for local discomfort in 2 cases and tongue tip numbness in 3 cases, but the problems resolved within several days without management.

CONCLUSION

Microwave ablation is a safe, straightforward, less invasive, economic, and effective therapeutic method for a mucocele of the anterior lingual salivary glands and can be used as a primary treatment modality before considering surgery.

Sialoendoscopy as a treatment for an obstructed mandibular salivary duct in a horse

A 14-year-old Quarter Horse was examined for a draining tract of 8 months' duration on the right mandible that was non-responsive to antibiotic therapy and surgical therapy. Further investigation and subsequent treatment with sialoendoscopy and ultrasonography were performed to relieve an obstruction of plant awns in the mandibular salivary duct.

Sialoscopy in Cases of Unclear Swelling of the Major Salivary Glands

OBJECTIVE: Sialoscopy has developed into an important diagnostic and therapeutic tool for diseases of the major salivary glands.

STUDY DESIGN AND SETTING: We evaluated 103 patients with chronic swelling of the major salivary glands. Routine diagnostic measures revealed no clear diagnosis. The findings of 109 sialoscopies are described. A semi-rigid endoscope (with a diameter of 1.1 mm and 2 integrated working channels) was used for sialoscopy, 51.5% of the cases in Warthon's duct and 48.5% in Stensen's duct.

RESULTS: Pathologic findings resulted in 83.0% of the submandibular and in 96% of the parotid ducts. Obstruction neither due to sialolithiasis nor stenosis was observed in 56.3%, whereas sialolithiasis was observed in 20.3% of the patients. In 36 (35%) patients, an interventional sialoscopy was performed.

CONCLUSIONS: In cases of invisible salivary duct obstruction, especially in those with low mineralized calculi, strictures, stenoses, or postinflammatory changes, sialoscopy gives immediate and direct information about causal pathologies. Moreover, further therapy can be planned within the same procedure.

EBM RATING: C

Sialendoscopy of Salivary Glands Affected by Sjögren Syndrome: A Randomized Controlled Pilot Study

PURPOSE

Sialendoscopy of the major salivary glands could alleviate the oral symptoms of Sjögren syndrome (SS) and restore salivary function. The aim of this pilot study was to evaluate the effect of sialendoscopy of the major salivary glands on salivary flow, saliva composition, and mouthfeel in patients with SS and to collect data for sample size analysis for a larger clinical trial.

MATERIALS AND METHODS

Twenty patients diagnosed with SS were randomly assigned to a nonintervention control group or a sialendoscopy group. Unstimulated whole saliva flow, stimulated whole saliva flow, Clinical Oral Dryness Score, Xerostomia Inventory score, and EULAR Sjögren's Syndrome Patient Reported Index score were obtained 1 week before (T0), 1 week after (T2), and 8 weeks after (T3) sialendoscopy. Unstimulated whole saliva was analyzed for amylase concentration, activity, and mucin 5B concentration. Amylase and mucin 5B output were calculated.

RESULTS

In the sialendoscopy group, unstimulated and stimulated whole saliva flows were numerically higher at T2 and T3 compared with T0. Xerostomia Inventory score was significantly lower in the sialendoscopy group at T2 compared with T0 (P = .03). Unstimulated and stimulated whole saliva flows were higher in the sialendoscopy group compared with the control group at T2 and T3 (not meaningful). Significant differences were found between groups for the EULAR Sjögren's Syndrome Patient Reported Index score at T2 (P = .03) and T3 (P = .001). Xerostomia Inventory score and Clinical Oral Dryness Score in the sialendoscopy group were lower compared with the control group at T2 (P = .02) and at T3 (P = .04), indicating less oral dryness.

CONCLUSION

This pilot study indicates a positive effect of sialendoscopy on some parameters, but it cannot yet be concluded that it has a positive effect on salivary flow in patients with SS. These preliminary results need to be verified in a randomized controlled trial with a larger sample and longer follow-up period.

Sialendoscopy learning curve: comparing our first and last 100 procedures

OBJECTIVES

Sialendoscopy is a relatively new minimally invasive technique that permits direct salivary tree visualization and is important in obstructive sialadenitis management and treatment. The present study aimed to examine the sialendoscopy learning curve between March 2009 and March 2013.

METHODOLOGY

We compared the first and last 100 sialendoscopies performed in our department with regard to anaesthesia type, operating time, success rate, technical difficulty, major complications, and clinical improvement.

RESULTS

General anaesthesia rates were 63% and 38% (P = 0.0004) among the first and last 100 sialendoscopies, respectively. Among the first and last 100 procedures, respectively, average operating times were 39 and 25 minutes (P = 0.00055) for diagnostic sialendoscopies and 68 and 65 minutes (P = 0.35) for interventional sialendoscopies. Successful stone extraction rates were 65% and 90.2% (P = 0.0058) among the first and last 100 procedures, respectively, while the corresponding rates of successful stenosis dilation were 92.5% and 97.1% (P = 0.27). Technical difficulty was encountered in 25% and 17% (P = 0.164) of the first and last 100 sialendoscopies, respectively. Neither group experienced major complications. All patients tolerated the procedures well and had excellent outcomes.

CONCLUSION

Progressive learning regarding sialendoscopy enabled more frequent operation under local anaesthesia, thus better meeting the requirements of a minimally invasive technique. We were able to decrease the operative time in diagnostic sialendoscopy. These two factors support the inclusion of diagnostic sialendoscopy into the diagnostic panel in obstructive glandular diseases.

Atypical presentation of salivary mucocele: diagnosis and management

A mucocele is a common pathological lesion involving the minor salivary glands. It usually presents as an asymptomatic small superficial swelling over the lower labial mucosa. However, uncommon variants of oral mucoceles sometimes occur. Such lesions may be difficult to diagnose due to their unusual size and atypical clinical presentation. This article describes the case of a deeply embedded large mucocele over the buccal mucosa. Ultrasonography was used to visualize the size and position of the lesion, and aspiration was used to help in the eventual diagnosis. An intraoral approach was used in the complete removal of the lesion.

Sialoendoscopy in the management of salivary gland disorders--4 years experience

Sialoendoscopy is a minimally invasive technique used in the diagnosis and management of salivary gland disorders with promising success rates. Our objective is to describe our experience in sialoendoscopy, outlining our technique, success rates and complications, and to compare our data to those reported in the literature. A retrospective review and data analysis of all sialoendoscopic procedures performed by our service between 2006 and 2010 was performed. 41 patients were identified. 4 (9.7%) patients had normal findings, 2 (4.8%) had anatomical variants, 4 (9.7%) had benign strictures, 11 (26.8%) had mucinous debris and 20 (48%) had obstructing stones. Stone removal was successful in 19 (95%) of the 20 cases and symptomatic relief was achieved in 34 (83%) cases. In our experience a single interventional modality was used, despite that our success rates are similar to those reported in the literature where multiple therapeutic modalities were used.

Idiopathic sialectasis of the Stensen's duct treated with marsupialisation

Sialectasis is an uncommon medical condition of the salivary glands. Conservative treatments of sialectasis include repeated aspiration, compression, dilation of the papilla and stent placement. This is the first reported case that we know of, using marsupialisation for distal sialectasis. Our case highlights the diagnostic and therapeutic challenges posed by sialectasis and demonstrates the efficacy of marsupialisation for distally based sialectasis when conservative treatments fail.

Ultrasound-guided core needle biopsy of salivary gland lesions: a systematic review and meta-analysis

OBJECTIVES/HYPOTHESIS

To obtain summary estimates of the sensitivity and specificity of core needle biopsy for assessment of salivary gland lesions and to investigate sources of variation in accuracy between study locations.

STUDY DESIGN

Data sources were PubMed, Embase, CAB Abstracts, CINAHL, BIOSIS, LILACS, PakMediNet, Trip Database, and the National Guideline Clearinghouse. Scopus was used to perform forward (citation) and backward (reference) searches of all potentially relevant studies.

METHODS

Screening, data extraction, and quality assessment were independently performed by two different assessors. Meta-analysis was performed using bivariate mixed-effects binary regression as implemented in Stata 12. Quality assessment was performed using the QUADAS-2.

RESULTS

The summary estimates of sensitivity and specificity of core needle biopsy for diagnosis of malignancy were 96% (95% confidence interval [CI] = 87-99) and 100% (95% CI = 84-100), respectively. There was no significant heterogeneity in accuracy between studies. The quality of included studies was high, with low risk of verification bias. The risk of hematoma was 1.6% per procedure.

CONCLUSIONS

Core needle biopsy has high sensitivity and specificity, and has low risk of complications. There is no significant variation in accuracy between study locations.

[Sublingual gland amyloidosis causing obstructive sleep apnea hypopnea syndrome: a case report and review of the literatures]

OBJECTIVE

To improve the understanding of sublingual gland amyloidosis causing obstructive sleep apnea hypopnea syndrome(OSAHS).

METHODS

A case of sublingual gland amyloidosis causing OSAHS diagnosed in april 2012 was reported and the related literatures were reviewed. The literature review was carried out respectively with "amyloidosis, sublingual gland, obstructive sleep apnea hypopnea syndrome", as the search terms in Wanfang Data and PubMed by November 2012.

RESULTS

A case of 74 year-old male patient was admitted to the hospital because of snoring for 5 years, sleep apnea for 1 year and arousal for 1 month. After admission, polysomnography showed severe OSAHS, physical examination showed redundant the sublingual gland. Enhanced CT scanning showed soft tissue masses at the sublingual gland. Abdominal B ultrasonic and CT also showed a spaces-occupying lesion in the left retroperitoneal. B-guided core needle biopsy was performed in the left retroperitoneal. Pathology report showed amyloidosis. Subsequently, sublingual gland mass resection was performed. Pathology report after operation showed amyloid deposits staining with Congo red, which gives it a characteristic green birefringence in polarised light. Accordingly, it was diagnosed as sublingual gland amyloidosis. The symptoms of snore and sleep apnea were disappeared after operation.So far, there was no local recurrence with 10 months follow-up. A total of 3 literatures were received in Wanfang Data, including 2 of macroglossia amyloidosis causeing OSAHS case report and one of retrospective study. There were no reports about sublingual gland amyloidosis in Wanfang Data. A total of 5 literatures were received in Pubmed, including 2 of sublingual gland amyloidosis case report, 2 of macroglossia amyloidosis causeing OSAHS case report and one of retrospective study. However, there were no reports about sublingual gland amyloidosis causing OSAHS.

CONCLUSIONS

Amyloidosis rarely occurred in the sublingual gland and is easy to be misdiagnosed and missed diagnosed, which can causing severe OSAHS. To make a definite diagnosis, histopathology and staining with Congo red are needed and a characteristic green birefringence in polarised light is a reliable marker for diagnosis. After sublingual gland mass resection, the patient had good prognosis.

Successful management of oral ranula: a rare case in an infant

An oral ranula is a retention cyst that arises from the sublingual gland as a result of ductal obstruction and fluid retention. This report describes the successful management of a rare case of oral ranula in an infant. A 4-month-old male infant was referred for emergency treatment due to a 2-month history of a swelling in the right sublingual region. The examination revealed a lesion of approximately 3.5 cm in diameter, which was jeopardizing the infant's breastfeeding. The lesion's dimensions suggested a ranula. Surgical specimens were sent for histopathological analysis to confirm the diagnosis. Although there are many different ways to treat an oral ranula, the marsupialization method was followed in this case due to the serious consequences of the infant's restricted access to nourishment. The treatment proved to be successful and after 18 months of follow-up, there was no sign of recurrence.

[Sialendoscopy for obstructive disorders of the salivary glands]

Obstructive disorders of the salivary glands usually manifest as a swelling which is associated with meals ('mealtime syndrome') as well as inflammation of the gland. Obstruction of the salivary ducts of the parotid and submandibular glands is usually caused by a salivary stone, mucous plug or by a stenosis. Until recently, the options for diagnosis and treating these conditions were limited. Ultimately, the decision to remove the salivary gland was often made. Sialendoscopy is a recently developed semi-rigid optical technique that can be used to detect and usually treat obstructions in the salivary ductal system. This new, minimally invasive technique has resulted in the reduction of morbidity related to salivary gland obstruction. In many patients, surgical removal of the salivary gland can be avoided by using this technique.

Steady progress seen in endoscopic surgery on major salivary glands

INTRODUCTION

The objective of this study was to investigate the development in sialendoscopy (SE) in East Denmark. Data were compared with previously published data to assess the learning curve.

MATERIAL AND METHODS

In this retrospective consecutive study, all patients who had SE performed at Hillerød Hospital from November 2009 to April 2011 were included. Data were extracted from medical records and interviews. Two surgeons performed all SEs. Z-test and Fisher's exact test were used for statistical analysis.

RESULTS

A total of 118 patients met the inclusion criteria. In all, 156 diagnostic and 139 therapeutic SEs were performed. The median age was 44 years (3-85 years) and the female-to-male-ratio was 1.81. A total of 96% of patients had pre-operative ultrasound performed (the positive predictive value for detection of stone was 0.82, 95% confidence interval 0.70-0.90. Indication for SE was recurrent or chronic swelling, pain, identified stone or recurrent infections. The only exclusion criterion was neoplasms. The success rate of diagnostic SE was 98%, and the therapeutic SE success rate was 67%. Total or partial relief from symptoms was obtained in 77% of patients which was a significant improvement (Z-test: p < 0.001). No serious persistent complications occurred.

CONCLUSION

SE is a safe and effective treatment for benign obstructive disease of the major salivary glands. The surgeon's results improve significantly over time. Updated equipment and an experienced surgeon yielded patient symptom relief in 77% of cases.

FUNDING

not relevant.

TRIAL REGISTRATION

This study was approved by the Danish Committee on Biomedical Research Ethics and the Danish Data Protection Agency.

Sialoendoscopy for diagnosis and treatment of non-neoplastic obstruction in the salivary glands

INTRODUCTION

The objective of this study was to evaluate our experience with sialoendoscopies for diagnosis and treatment of obstructive disease in the large salivary glands in Eastern Denmark and to broaden awareness of the procedure.

MATERIAL AND METHODS

A retrospective study was designed including the first 100 consecutive sialoendoscopies in 91 patients performed at Hillerød Hospital and Rigshospitalet, in the 2004-2009 period.

RESULTS

The median age of the 91 patients was 45 years (range 9-74 years) with a female-to-male ratio of 1.68. A total of 53 parotid and 47 submandibular endoscopies were performed. The indications for sialoendoscopy were sialolithiasis, stenosis, recurrent swelling and recurrent infections. We found an overall success rate of 91% in 100 diagnostic endoscopies and 62% in 65 interventional endoscopies. We observed an improvement in success rates over the course of the study period. Symptom relief was obtained in 69% of the patients with pathology following intervention. No serious complications occurred.

CONCLUSION

Sialoendoscopy is a safe, effective and minimally invasive method for diagnosis and treatment of obstructive salivary gland disease.

[Importance of submandibular salivary glands for organism]

Based upon analysis of postoperative morbidity the authors concluded that salivary glands extirpation led to considerably often development of different gastrointestinal tract diseases in comparison with other operative interventions. The most often (62%) these diseases appeared in patients with submandibular salivary gland removal in anamnesis and rarer (21%) - with parotid salivary gland removal. So it could be claimed that salivary glands were an important constituent part of digestive system. Salivary glands removal was only proper in case of impossibility of carrying organ preserving operative intervention.

[Treatment of small and sublingual salivary glands cysts by laser]

The differents variants of treatment of retention cysts of mucous membrane of oral cavity and sublingual salivary gland cysts were presented and analysed. Results of doppler examination as a method of research blood microcirculation in postoperation time were presented.

Diseases of the salivary glands in infants and adolescents

BACKGROUND

Diseases of the salivary glands are rare in infants and children (with the exception of diseases such as parotitis epidemica and cytomegaly) and the therapeutic regimen differs from that in adults. It is therefore all the more important to gain exact and extensive insight into general and special aspects of pathological changes of the salivary glands in these age groups. Etiology and pathogenesis of these entities is still not yet fully known for the age group in question so that general rules for treatment, based on clinical experience, cannot be given, particularly in view of the small number of cases of the different diseases. Swellings of the salivary glands may be caused by acute and chronic inflammatory processes, by autoimmune diseases, by duct translocation due to sialolithiasis, and by tumors of varying dignity. Clinical examination and diagnosis has also to differentiate between salivary gland cysts and inflammation or tumors.

CONCLUSION

Salivary gland diseases are rare in childhood and adolescence. Their pattern of incidence differs very much from that of adults. Acute and chronic sialadenitis not responding to conservative treatment requires an appropriate surgical approach. The rareness of salivary gland tumors is particularly true for the malignant parotid tumors which are more frequent in juvenile patients, a fact that has to be considered in diagnosis and therapy.

Sialendoscopy-based diagnosis and treatment of salivary ductal obstructions

Salivary gland ductal obstruction is traditionally treated by sialoadenectomy when conservative measures fail. During the last decade, sialendoscopy has become the preferred approach in the management of salivary ductal obstructions. Sialendoscopy can provide direct, accurate and reliable visualisation of the salivary duct lumen and ductal pathologies, and can eliminate pathologies with miniaturised instrumentation. Now, sialendoscopic surgery is a promising option for patients who can be offered a satisfactory clinical outcome while avoiding sialoadenectomy. The present article briefly outlines sialendoscopy-based diagnosis and treatment of salivary ductal obstructions.

Distal parotid duct pseudocyst as a result of blunt facial trauma

The sequelae of sharp trauma to the parotid duct, such as sialocele and salivary fistula, are well known. In contrast, complications of blunt trauma to the parotid duct are not as common. A search of the English-language literature revealed 2 cases of parotid pseudocysts caused by blunt trauma. Although no well-known management protocol exists for complications of blunt trauma to the parotid duct, the treatment modalities for sharp trauma complications potentially could be applied. We describe a case of a blunt-trauma-induced distal parotid duct pseudocyst that remained refractory to conservative management, including repeated aspiration and cannulation of the duct. After characterizing and localizing the pseudocyst with sialography and cross-sectional imaging, we performed a surgical repair. This repair involved marsupialization of the parotid duct to the level of the pseudocyst. The edges of the opening of the proximal duct and the pseudocyst were sutured to the oral mucosa, and a small intraoral drain was left in the pseudocyst to prevent collapse and abscess formation. The drain was removed after 5 days, and the patient experienced no further problems during 14 months of follow-up.

Successful conservative management of Ludwig's angina in advanced pregnancy

A 20 year-old female in her 32nd week of gestation presented to the Emergency Department with dysphonia and dysphagia associated to a recent recurrence of a periapical abscess. Her oral examination showed trismus, elevated tongue and neck swelling. A clinical diagnosis of Ludwig's angina was reached, and empirical antibiotic coverage was started. The decompression and drainage placement was performed successfully under local anesthesia without airway compromise. At the moment, no clear guidelines exist for the acute treatment of Ludwig's angina. Establishment of a secure airway has long been considered the gold standard, yet new literature suggests a more conservative management. Ascertaining an early diagnosis at the Emergency Department, and involvement of Anesthesia, Obstetrics, and, Ear, Nose and Throat specialist services is vital for materno-fetal wellbeing. Careful evaluation of the airway status in addition to prompt antimicrobial therapy with surgical decompression may represent a plausible alternative in pregnant patients.

[Surgery]

2007 was marked by a growing trend towards minimal invasive surgery and enhanced recovery, especially in visceral surgery. In comparison to the laparoscopic revolution in the eighties, Natural orifice transluminal endoscopic surgery (NOTES) must be watched on closely, and will probably have to be taken into account in a near future. Minimal invasive procedures in oesophageal cancer surgery have proved both efficient and oncologically safe. Implementation of Fast track protocols now permits a much faster patient's return to normal daily activity. In hepatobiliary and pancreatic surgery, multidisciplinary efforts have been done to better select patients, widen the indications and increase efficiency.

[Aorto-oesophageal fistula in patient with Montgomery salivary bypass tube]

Aorto-oesophageal fistula is a well-reported pathology with several known causes. The co-existence of this pathology associated with the use of a Montgomery salivary bypass tube (MSBT) is exceptional and only one case is described in the literature. We present here a case report about an 81-year-old patient with an MSBT who died because of a massive upper gastrointestinal bleeding caused by an aorto-oesophageal fistula at the site of the MSBT. The literature on this pathology will also be reviewed.

Plunging ranula in young HIV patient

The case of a 15-year-old African-American male with congenital HIV on highly active antiretroviral therapy (HAART) therapy with a plunging ranula who was treated with surgical removal of the offending sublingual gland and suffered no complications. This case may serve as an example that young HIV patients with this pathologic condition should be expected to have a similar course as a non-HIV patient.

[Diagnostic image (347). A man with a swelling underneath his tongue]

A 23-year-old man presented with a painless, growing swelling underneath his tongue due to a ranula, i.e. accumulation of saliva in the drainage canal of the sublingual salivary gland.

Speichelgangsendoskopie in der Diagnostik und Therapie von obstruktiven Speicheldrüsenerkrankungen

BACKGROUND

In 5-10% of all cases with an obstructive disease of the major salivary glands, a diagnosis cannot be established by conventional radiological imaging or ultrasound. Using sialendoscopes, intraductal pathology can made visible to the surgeon, aiding in diagnosis and adequate treatment.

MATERIAL AND METHODS

Between 2001 and 2005, 369 sialoscopies were performed on 318 patients in the ENT department of the University of Erlangen-Nuremberg. Semi-rigid sialoscopes with an external diameter of between 0.7 and 1.7 mm were used.

RESULTS

In 34.9% of cases conservative treatment was necessary. In 65.1%, based on the sialoscopic findings, further therapeutic procedures such as extracorporeal shock wave lithotripsy, interventional sialoscopy or duct slitting were required and planned. Of 133 performed interventional sialoscopies, 83.5% were successful.

CONCLUSIONS

Sialoscopy is a useful diagnostic and therapeutic tool in obstructive salivary gland disease. Interventional sialoscopy has been performed with high success rates and has proven to be an important part in our concept of a gland preserving therapeutic regime.

Modern management of obstructive salivary diseases

Over the last fifteen years, increasing public demand for minimally-invasive surgery and recent technological advances have led to the development of a number of conservative options for the therapeutic management of obstructive salivary disorders such as calculi and duct stenosis. These include extracorporeal shock-wave lithotripsy, sialoendoscopy, laser intra-corporeal lithotripsy, interventional radiology, the video-assisted conservative surgical removal of parotid and sub-mandibular calculi and botulinum toxin therapy. Each of these techniques may be used as a single therapeutic modality or in combination with one or more of the above-mentioned options, usually in day case or one-day case under local or general anaesthesia. The multi-modal approach is completely successful in about 80% of patients and reduces the need for gland removal in 3%, thus justifying the combination of, albeit, time-consuming and relatively expensive techniques as part of the modern and functional management of salivary calculi. With regard to the management of salivary duct anomalies, such as strictures and kinkings, interventional radiology with fluoroscopically controlled balloon ductoplasty seems to be the most suitable technique despite the use of radiation. Operative sialoendoscopy alone is the best therapeutic option for all mobile intra-luminal causes of obstruction, such as microliths, mucous plugs or foreign bodies, or for the local treatment of inflammatory conditions such as recurrent chronic parotitis or autoimmune salivary disorders. Finally, in the case of failure of one of the above techniques and regardless of the cause of obstruction, botulinum toxin injection into the parenchyma of the salivary glands using colour Doppler ultrasonographic monitoring should be considered before deciding on surgical gland removal.

[Transcutaneous excision of the submandibular and sublingual glands: notes on anatomy and surgical technique]

Removal of the submandibular and sublingual glands requires in-depth knowledge of the anatomy and scrupulous technique for the purposes of limiting the functional and aesthetic damage, which is unjustifiable above all in the treatment of benign lesions (sialodenitis, lithiasis). After presenting the main aspects of the surgical anatomy of the submandibular space, the operative technique for its dissection with removal of the submandibular gland and excision of the sublingual gland is described. The complexity of the anatomical structures that may be involved in submandibular and sublingual gland lesions is the cause of unsatisfactory functional and aesthetic outcomes in some cases. The most feared complications are lesions to nerve formations, due both to the resulting deficits and the possible legal implications.