Sialoendoscopy in the management of the salivary gland disorders

Abstract

BACKGROUND: The aim of this study was to determine the long-term (> 6 month) outcome of patients suffering from obstructive sialadenitis treated by sialoendoscopy. METHODS: Between 2009 and 2013 seventy-six subjects underwent sialoendoscopy under local anesthesia at the University Hospital P. Giaccone of Palermo. RESULTS: The mean age of presentation was 50.5 years for male (56.6%) and 44.7 years for female (43.4%). The presenting symptoms were frequent pain in 72% of cases, frequent purulent secretions in 65% of cases, frequent swelling in 62% of cases and frequent bitter taste in 44% of cases. Affected glands were in 54 cases the submandibular unilaterally, in 21 cases the parotid unilaterally and in 1 case the submandibular bilaterally. Preoperative ultrasound showed in 30 cases a sialolitiasis and in 19 cases a ductal stenosis, in 3 cases were both associated. In 46 cases showed a ductal dilatation, variably combined with the previous two and in 13 cases ultrasound gave no indication. Average operating time was 60.7 minutes (range 35-125 min). In 35 cases it was necessary to perform a papillotomy. Presence of stones was shown in 36 patients, in 3 cases these stones were multiple. Endoscopic removal of stones was achieved in 72.2%, with a mean size of 3.6 mm (range 0.7-5.5 mm), only two were larger than 5 mm. In five of this cases was performed a trans-oral combined approach. In 15 cases was highlighted a ductal stenosis, in 6 cases associated with mucus plugs, that were treated with daily irrigations with Thiamphenicol glycinate acetylcysteinate. A percentage of 64.8% of patients had complete resolution of symptoms after sialendoscopy, with 25% having partial resolution of symptoms and 6.6% required the removal of the gland. CONCLUSIONS: Sialendoscopy is the procedure of choice for the diagnosis and treatment of chronic non-lithiasic sialoadenitis, but unlike its apparent simplicity has a significant learning curve, and need appropriate selection of patients.