Radioiodine therapy induced sialadenitis versus chronic idiopathic sialadenitis-Presentation and outcomes.

BACKGROUND: This study explores the unique characters of high dose radioactive iodine (RAI) induced chronic sialadenitis. METHODS: A retrospective study of patients having received salivary endoscopy and followed in our outpatient clinic. RESULTS: A total of 100 patients met the inclusion criteria, 75 were diagnosed with chronic idiopathic sialoadenitis and 25 with radio-iodine induced sialoadenitis (RIS). The main complaint in both groups was swelling of the parotid gland. Pain, dysphagia, and xerostomia were observed considerably more in the RIS group. During sialo-endoscopy, fibrosis of the Stensen's duct was more common in the RIS group (p = 0.003). RIS patients group generally managed better with interventional endoscopic treatment alone (80% vs. 46%). CONCLUSION: RIS patients have distinct clinical characteristics. There may be a collateral muscular damage to the masticatory muscles. Fibrosis and parenchymal damage are major findings during sialendoscopy. Sialendoscopy is a safe and efficient treatment for RAI induced sialadenitis.

Salivary gland function after sialendoscopy for treatment of chronic radioiodine-induced sialadenitis.

BACKGROUND: The purpose of this study was to determine whether sialendoscopy could ameliorate radioactive iodine-induced obstructive sialadenitis and restore the salivary gland dysfunction in recalcitrant radioactive iodine sialadenitis. METHODS: Ten patients with 15 parotid glands of chronic radioactive iodine sialadenitis who did not respond to medical treatment were enrolled in this prospective study. We assessed subjective symptom scores and evaluated the objective salivary gland functions before and 3 months after sialendoscopy. RESULTS: The post-sialendoscopic obstructive symptoms were significantly improved relative to pre-sialendoscopy (p = .009). Xerostomia-related symptom scores post-sialendoscopy did not differ significantly from the pre-sialendoscopy scores. Stimulated salivary flow rate post-sialendoscopy tended to increase relative to pre-sialendoscopy. No pre-sialendoscopic parameters associated with salivary uptake and secretion by salivary gland scintigraphy were significantly improved post-sialendoscopy. CONCLUSION: These results show that sialendoscopy can improve obstructive symptoms; however, it seems to have some limitations for relief of xerostomia and improvement of salivary gland dysfunctions in recalcitrant chronic radioactive iodine sialadenitis.

Endoscopic-assisted gland-preserving therapy for chronic sialadenitis: a German and US comparison.

OBJECTIVE: To determine whether unique patterns of care are evolving in the United States compared with Germany in endoscopic management of chronic sialadenitis. DESIGN: Comparison of consecutive series of patients. SETTING: Academic tertiary salivary referral centers in Germany and the United States. PATIENTS: A total of 446 patients having chronic sialadenitis treated with salivary endoscopy. MAIN OUTCOME MEASURES: To compare practice patterns and outcomes at each location, databases tracking patients having chronic sialadenitis treated with salivary endoscopy were searched for the following variables: age, sex, involved gland, radiographic studies, endoscopic findings, endoscopic-related complications, gland preservation rate, patient symptom control, and techniques for managing salivary stones and intraductal scar tissue. RESULTS: Significantly more patients in the US cohort had chronic sialadenitis of the parotid gland (P = .03) and multiple gland involvement (P < .001). Salivary endoscopy was regularly performed using local anesthesia in Germany and using general anesthesia in the United States (P < .001). Endoscopic-related complication rates were higher (10.9% vs 1.6%) and gland preservation rates lower (85.9% vs 98.4%) among US patients; however, patients with intact glands demonstrated similar rates of symptom control at both centers (92.7% in the United States vs 85.3% in Germany) at the last follow-up visit. The lower rate of gland preservation in the United States is largely because of lack of access to lithotripsy for larger salivary stones. CONCLUSIONS: Different patterns of care are emerging in the endoscopic management of chronic sialadenitis in the United States compared with Germany, where these techniques were largely developed. Nevertheless, patients with chronic sialadenitis at both locations who undergo endoscopic gland-preserving therapy have high rates of gland preservation and symptom control.

Pediatric sialendoscopy under local anesthesia: limitations and potentials.

OBJECTIVE: Sialendoscopy in children is a recently described procedure. The small amount of existed literature presents the procedure under general anesthesia. We report our experience on pediatric sialendoscopy under local anesthesia at an outpatient setting. METHODS: In a period of 1.5 years 9 children with age >8 years suffering from recurrent parotid swellings were assessed with sialendoscopy. In 8 out of 9 cases the parents accepted a procedure under local anesthesia. In 7 cases the procedure was completed uneventfully however in one case was discontinued and repeated under general anesthesia. The endoscope used was a 1.1mm Marchal type. Prior to endoscopy xylocaine solution 4% was applied on the papilla area for 15min. Intraductal injection of xylocaine 2% (5ml) was performed prior the insertion of the endoscope. During the procedure parents evaluated pain by means of a 6-point smiley scale. Social life and school activity were also evaluated by means of an 11-point scale pre- and 1 year post-sialendoscopy. RESULTS: Seven out of eight children (8 sialendoscopies) tolerated and completed the sialendoscopy assessment. The mean duration of the procedure was 39.2min. No major complications were reported at the early post-endoscopy period. Four children presented no further swellings, two experienced one recurrence and one needed a repeat sialendoscopy (3 recurrent episodes). Sialendoscopy findings showed fibrinous debris in 4 children, mucous plugs in 2, evidence of sialodochitis with purulent debris in one child and stenosis in 3 children. The diagnosis in our cases was Juvenile Recurrent Parotitis in 6 children and chronic microbial parotitis in one case. Social life and school activity were improved in 6 children 1-year post-sialendoscopy according to parent's ratings. CONCLUSIONS: Sialendoscopy under local anesthesia can be an alternative option in children of age >8 years and satisfactory cooperative skills, avoiding unnecessary general anesthesias and hospital stay.

[Diagnostic and therapy of salivary gland diseases: relevant aspects for the pathologist from the clinical perspective]. / Diagnostik und Therapie von Speicheldrüsenerkrankungen: Relevantes für den Pathologen aus Sicht der Klinik.

Significant progress in the diagnosis and therapy of salivary gland diseases has been made in recent years. The new technique of diagnostic and interventional sialendoscopy has made an important contribution and is indicated in every case of obstructive sialadenitis. The number of open resections of salivary glands due to stones will clearly decrease in the future in favor of endoscopic removal. Due to recent publications on the appropriate extent of salivary gland resection in benign tumors, more and more specimens with reduced cuffs of healthy salivary gland tissue will be sent to the pathologists. Ultrasound will stay the procedure of first choice for imaging of salivary gland diseases in Germany. In combination with fine-needle aspiration cytology high sensitivity and specificity for the assessment of salivary gland tumors can be achieved. Diffusion-weighted magnetic resonance imaging (MRI) is a new imaging tool and the power of distinction of pleomorphic adenoma from malignant tumors is promising. The use of botulinum toxin for salivary glands diseases is increasing. Intraglandular injections have been shown to induce salivary gland atrophy in animal experiments. The availability of biologicals is currently yielding new aspects for the treatment of Sjögren's disease.

[Salivary gland damage after 131I therapy in patients with differentiated thyroid cancer. Preliminary report]. / Uszkodzenie slinianek po terapii 131I u pacjentów ze zróznicowanym rakiem tarczycy. Doniesienie wstepne.

INTRODUCTION: The purpose of the study was to evaluate salivary gland dysfunction after a high-dose radioiodine therapy administered to patients with differentiated thyroid carcinoma. MATERIAL AND METHODS: The study group consisted of 60 patients (age range 20-78 years). Detailed history about complaints from the oral cavity were taken, followed by the ultrasonography and dynamic scintigraphy. The procedure was performed on 40 patients before and one year after radioiodine administration, and a single-time on 20 patients treated with multiple doses in the past. RESULTS: Data analysis shows no statistically significant increase of subjective sufferings after first radioiodine dose (60-150 mCi), small decrease of uptake ratio UR (< 10%) and diminished parotid glands transverse diameter (approximately 10%). The patients after multiple therapies (i.e. average dose of 250 mCi) informed more often about problems connected with decreased salivation (approximately 20% patients), in scintigraphy there was a reduction of parotid UR 21-23% and parotid maximal secretion MS 7-13%. Ultrasonography did not show changes in salivary glands echogenicity after 12 months from the first dose of 131I. There was no close relationship between scintigraphically revealed dysfunctions and the occurrence of complaints; no correlation between appearance of acute sialadenitis symptoms after radioiodine therapy and subsequent dysfunctions. CONCLUSIONS: The main conclusion is that a single dose of 131I has no significant influence on salivary gland function; a repeated high-doses therapy is connected with an essential risk of side-effect occurrence. Scintigraphy can evaluate salivary gland function with high sensitivity. Parotid glands are more radiosensitive than submandibular.

[Kuttner's inflammatory tumor (sialadenosis of submandibular salivary glands). Case report].

A clinical case of a observation over the patient with Kuttner's inflammatory tumor is described. Quick and complete curative effect was achieved after the use of one course of hyperbaric oxygenotherapy.

Hypokalaemic alkalosis, acquired Gitelman's and Bartter's syndrome in chronic sialoadenitis.

Two patients with chronic sialoadenitis had features of Bartter's and Gitelman's syndrome, respectively. The main complaints were leg paraesthesiae and acute arthritis. A good response to oral K+ supplementation, allopurinol and low-dose prednisone was obtained. The features of Sjögren's-related renal diseases are reviewed.

[Biopsy of the accessory salivary glands. 5 years' experience]. / Biopsie des glandes salivaires accessoires. Bilan de 5 ans.

Biopsy of the minor salivary glands has become a routine examination ordered by physicians working in a wide range of disciplines in order to search for or eliminate the diagnosis of Gougerot Sjögren's disease or another systemic disease. We emphasize the need to use this examinations as a part of a complete work-up of the buccal cavity and the salivary glands. We reviewed our experience with 1,500 biopsies. The glands biopsied were normal in 56% of the cases and led to the diagnosis of Gougerot Sjögren's disease in 24%, chronic sialadenitis in 10% and diverse trophic problems in 5%. The clinical stage of Gougerot Sjögren's disease is usually proposed according to the Chisholm classification which we propose to compare with the Chomette classification. Finally, we described the technique of minor salivary gland biopsy.