A Prospective Observational Study of Complications in 140 Sialendoscopies.

Objectives To evaluate the incidence and nature of complications associated with diagnostic and interventional sialendoscopies and to report intervention failures in a prospective setup. Study Design Prospective observational study. Setting Academic tertiary care university hospital. Subjects and Methods Patients who underwent diagnostic or interventional sialendoscopy between October 2015 and December 2016 were prospectively enrolled. Patient data, operation-related factors, treatment failures, and complications were recorded into a database and analyzed. Results A total of 140 sialendoscopies were attempted or performed on 118 patients; 67 (48%) were for a parotid gland and 73 (52%) for a submandibular gland. The sialendoscopy was interventional in 81 cases (58%), diagnostic in 56 (40%), and not possible to perform in 3 (2.1%). A total of 21 complications were registered for 21 sialendoscopies (15%) and 21 patients (18%). The most common complication was infection, in 9 cases (6.4%). Other observed complications were salivary duct perforation (4 cases), prolonged glandular swelling (3 cases), transient lingual nerve analgesia (2 cases), basket entrapment (2 cases), and transient weakness in the marginal branch of the facial nerve (1 case). All complications were related to interventional procedures or papilla dilatation. Failure to treat occurred in 21 (15%) sialendoscopies: sialendoscopy itself was unsuccessful in 3 cases, and an intended intervention failed in 18 cases. Conclusion Complications in sialendoscopy are usually related to interventional procedures. The complications are mainly minor and temporary but lead to additional follow-up visits, further treatments, and sometimes hospitalization. Sialendoscopic procedures are safe but not free of complications.

Endoscopic Salivary Stone Fragmentation with Pneumatic Lithotripsy in a Simulation Model.

OBJECTIVE: To evaluate the endoscopic fragmentation and removal of human salivary stones by employing intracorporeal pneumatic lithotripsy in a clinical simulation model of the submandibular gland. STUDY DESIGN: Simulation model evaluating endoscopic management of human salivary stones. SETTING: Laboratory. SUBJECTS AND METHODS: A flexible nitinol contact probe adapted to a CO2-driven handheld salivary pneumatic lithotripter was deployed through a sialendoscope to disrupt parotid (n = 1) and submandibular (n = 8) stones embedded in separate 3-dimensionally printed plastic models of the mouth and submandibular glands. Simulation included endoscopic removal of small stone fragments by standard basket retrieval supplement by irrigation and suction through a salivary duct introducer system. Correlations were made between stone volume and density with the duration of the procedures and number of pneumatic pulses required to disrupt and remove stone fragments. RESULTS: Among the 8 stones fragmented sufficiently to permit either full endoscopic removal (n = 7) or removal of the central portion leaving an adherent rind to the duct (n = 1), the average procedure time (32 minutes) and the average number of pneumatic pulses (98) correlated with stone density (range, 0.4-1.5 g/mL) and stone volume (range, 0.05-0.4 mL). One stone was sufficiently resistant to fragmentation as to prevent successful removal. CONCLUSIONS: Modification to the evolving technology of intracorporeal pneumatic management of nephrolithiasis was successfully applied in an ex vivo model to simulate management of sialolithiasis.

Tratamiento quirúrgico de la parotiditis litiasica crónica. A propósito de un caso / Surgical treatment in chronic sialolithiasis. A case report

La litiasis salival se produce por la obstrucción mecánica de una glándula salival o de su conducto excretor, debido a la formación de concreciones calcáreas o sialolitos. Los sialolitos determinan una ectasia salival que puede provocar la dilatación posterior de la glándula. Secundariamente puede producirse la infección de la misma, dando lugar a un cuadro de sialoadenitis crónica. En la parótida los cálculos suelen ser de tamaño pequeño, raramente múltiples y presentan largas fases de latencia clínica. La técnica quirúrgica puede ser compleja debido a la relación con el nervio facial. El tratamiento implica la eliminación del cálculo. La manipulación por parte del profesional empujando el cálculo fuera del conducto suele ser suficiente pero en algunos casos se precisa de la extracción quirúrgica. El objetivo de este artículo es enumerar las formas de diagnóstico y tratamiento de la parotiditis litiasica, poner de manifiesto la técnica ideal adecuada y mínimamente invasiva solucionando una patología que puede diagnosticarse en el sillón odontológico y en algunos casos menores solucionarse. Se presenta el caso de un hombre de 50 años con parotiditis litiasica programada para tratamiento quirúrgico, bajo anestesia general (AU)

Salivary duct lithiasis is caused by the obstruction of a salivary gland or its excretory duct due to the formation of calcareous concretions or sialoliths. Sialoliths resulting in salivary ectasia and even provoking the subsequent dilation of the salivary gland. Secondary it can may produce a infection itself, leading to chronic sialadenitis sintoms. In the parotid the calculi are usually small, rarely have multiple size and long phases of clinical latency. The surgical procedure can be complex because of the relationship with the facial nerve. Treatment involves removal of the calculi. The manipulation by the professional pushing out the calculi of the duct is often sufficient but in some cases requires surgical removal. The aim of this article is to list the ways of diagnosis and treatment of sialolithiasis, to explain the appropriate ideal and minimally invasive technique,solving a disease that can be diagnosed in the dental clinic and solved in some cases. The case report a man of 50 years with sialolithiasis scheduled for surgery under general anesthesia (AU)

Adenoid cystic carcinoma of the parotid gland associated with salivary calculi: An unusual presentation.

Adenoid cystic carcinomas (ACC) of the head and neck are relatively rare tumors, consisting of approximately 10-15% of all salivary gland neoplasms. ACC, a slow-growing aggressive malignant tumor of salivary gland commonly seen in the submandibular, sublingual, minor salivary glands is seldom found in the parotid. Calculus, the common cause of salivary gland dysfunction is usually identified in submandibular salivary gland because of its duct anatomy and physiochemical characteristic serous secretion. We report an unusual case of co-existent presentation of ACC with salivary calculi in the parotid gland which is never been reported in the literature. Co-existence of ductal calculi and ACC is rare. Presence of parotid calculus could be due to long standing ductal obstruction by the slow-growing ACC of the parotid or other possibility is that the malignancy could have developed because of chronic irritation by parotid calculi. Confirmatory studies are required to understand its mutual pathological association.

Management of obstructive salivary disorders by sialendoscopy: a systematic review.

Our aim was to assess the effectiveness and safety of sialendoscopy as a diagnostic and therapeutic technique in the management of obstructive salivary disorders. We searched the following databases: MEDLINE, EMBASE, ISI Web of Knowledge, The Cochrane Library, and the National Health Service Centre for Reviews and Dissemination (up to April 2014). References from the studies included and from review articles were scanned. A study was eligible for inclusion if it was a fully published peer-reviewed report with original data, if participants included adult patients with obstructive disease of the major salivary glands, if the outcome variables gave information about the success rates of the procedure in terms of freedom from symptoms and absence of residual obstruction, and if the paper was published in English, French, Italian, Portuguese, or Spanish. The data were extracted and summarised in tables of evidence. We report weighted pooled proportions, 95% CI, and test results for heterogeneity. The weighted pooled proportion of success rates of the obstruction's resolution was 76% (95% CI 71 to 82) for 40 studies involving 2654 patients undergoing sialendoscopy alone, and 91% (95% CI 88 to 94) for the 23 studies and 1480 procedures made with sialendoscopy and a combined surgical approach. In general, few complications were reported and the rate of sialadenectomy was low (4.6%). This systematic review suggests that sialendoscopy is effective and safe for the diagnosis and treatment of patients with obstructive salivary gland disease.

[Surgical Simulation Models for Sialendoscopy]. / Trainingsmodelle für die Sialendoskopie.

OBJECTIVE: Different simulation models are in use to teach the technique of sialendoscopy. Only a few reports in literature deal with this topic with no comparison having been published, yet. We therefore asked sialendoscopy training course participants about our applied models by using a questionnaire. Material und Methods: A tube-, a pepper-, a porcine kidney-, and a pig head-model were developed as training models and used during 6 consecutive practical sialendoscopy courses from 2012 to 2014. Participants were asked to answer a questionnaire specifically designed to assess the value of the different training models. RESULTS: All respondents (n=61) rated all training models positively. However, porcine kidney- and pig head-models were described to be superior, especially with respect to realistic simulation. Intubation of the papilla can be practised sufficiently only in the pig head-model. The tube- and peppers-models have the advantage of being less expensive, easier to handle and cleaner. CONCLUSIONS: The models described are all useful in learning the sialendoscopy technique. However, they have distinct advantages and disadvantages making a combination of different models useful.

Submandibular ductal fistula: an obstacle to sialendoscopy.

IMPORTANCE: Submandibular fistula is a rare condition that presents diagnostic and treatment challenges. Accurate diagnosis may be achieved by means of thorough physical examination, proper imaging, and usually surgical exploration. We describe the clinical significance of aberrant submandibular ductal fistula or ostium and discuss our dilemmas during sialendoscopy in 2 patients with repeated submandibular glandular swelling. OBSERVATIONS: Two patients had submandibular ductal abnormalities. The first patient was found to have the ostium of the submandibular duct in an unusual anatomical location at the posterior floor of the mouth, which was identified during surgical exploration of the floor of the mouth. The second patient was found to have a submandibular ductal fistula into the floor of the mouth proximal to a calculus in the main duct (which was severely atrophic and could not be cannulated). CONCLUSIONS AND RELEVANCE: The precise etiology and pathogenesis of sialo-oral fistula formation are currently unknown but could be extrapolated from previously described syndromes involving ductal obstruction and inciting damage in other regions of the body. Consideration of submandibular fistula in the differential diagnosis may spare the patient morbidity of redundant invasive procedures.

Minimally invasive surgery of sialolithiasis using sialendoscopy.

OBJECTIVE: The introduction of minimally invasive surgical procedures using sialendoscopy has significantly reduced the rate of major salivary gland removal due to sialolithiasis. The present study assessed the utility of sialendoscopy and identified potential factors influencing successful sialendoscopic salivary stone retrieval. METHODS: Medical records of sialendoscopic procedures performed at the Department of Otolaryngology of the National Defense Medical College in Japan from November 2007 to January 2014 were retrospectively reviewed. We identified 78 patients diagnosed with sialolithiasis and treated with sialendoscopy (SE). Factors analyzed included stone location, size, symptom duration, surgical methods, and complications. RESULTS: The mean age at presentation was 41 years (range, 11-76 years) with a male-to-female gender ratio of 1:1.89. In total, 73 submandibular and 5 parotid endoscopies were performed. Stone size ranged from 2 to 20mm in diameter. Submandibular stones were removed either by SE alone (9.6%), by transoral stone removal (19.2%), or a combined approach (57.5%). Only 13.7% (10/73) of the cases required submandibular gland removal. Stone size and shape were significant predictors for successful endoscopic stone removal, and stone size and location were significant predictors for submandibular gland removal. CONCLUSION: Sialendoscopy is a reasonable, minimally invasive treatment option for sialolithiasis that avoids salivary gland removal. The present results indicate that sialendoscopy is the first treatment of choice for submandibular gland sialolithiasis. Complete surgical excision is becoming uncommon as a first-line treatment, but it remains indispensable in certain cases.

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.

[Combined technique in the removal of parotid gland stones]. / Yhdistelmätekniikka korvasylkirauhasen kivien poistossa.

Sialendoscopy is used in the diagnostics and treatment of salivary gland swelling. Small intraductal stones can be removed with various instruments during sialendoscopy. In cases with larger fixed stones a combined technique can be applied. The stone is approached endoscopically, skin flap is raised or a small incision is made through the illuminated area and the stone is removed via the external route with minimal morbidity. In this series five out of seven patients treated by the combined technique became symptomless. Superficial parotidectomy was performed on one patient. The combined technique is recommended in the removal of stones that are large, fixed in the duct or located in the gland's hilus.

Parotidectomy and submandibulectomy for benign diseases in Thuringia, Germany: a population-based study on epidemiology and outcome.

Although salivary gland surgery for benign diseases is an integral part of clinical routine of head and neck surgeons, there is not many population-based data published on incidence and efficiency of this surgery. Parotidectomy was performed in 180 patients and submandibulectomy in 97 patients for benign diseases in eight otorhinolaryngology and two maxillofacial surgery departments in Thuringia, Germany, in 2005. All patients were analysed regarding patients' characteristics, therapy, complications and further course of disease. Predominant indications were epithelial tumours for parotidectomy (79 %) and sialolithiasis for submandibulectomy (50 %). The most frequent tumour types were pleomorphic adenoma (46 %) and Warthin tumours (29 %). Pleomorphic adenoma was significantly more frequent in female patients and Warthin tumours in male patients and smokers. The incidence of parotidectomy, i.e. the surgical rate, was 7.8/100,000 habitants and of submandibulectomy 4.1/100,000 habitants. One hundred and seventy-eight tumours including 154 epithelial tumours resulted in an incidence of 7.6/100,000 habitants for all treated tumours and of 6.6/100,000 for epithelial tumours, respectively. The majority of parotid cases were treated by lateral parotidectomy (79 %). Relevant complications were observed in 22 % of patients. After parotidectomy and submandibulectomy a postoperative facial palsy was observed in 28 and 2 % of cases, respectively. Only 1 % was permanent. During a mean follow-up time of 9.6 months, 3 % of parotidectomy patients developed a Frey's syndrome needing treatment and 0.8 % developed a tumour recurrence. This population-based analysis shows that salivary gland surgery is performed in higher incidence than expected, effectively and with low-risk in daily routine of head and neck surgeons.

The role of adenectomy for salivary gland obstructions in the era of sialendoscopy and lithotripsy.

Salivary gland ductal obstructions are common, being the most frequent nonneoplastic salivary disorders in adults. Salivary calculi are the main cause of obstruction. Traditional and invasive transcervical sialadenectomy is still the most widely used treatment for perihilar and intraparenchymal obstructive salivary diseases worldwide despite the well-known morbidity related to its functional, neurologic, and aesthetic sequelae. However, improved radiologic imaging, better optical systems and endoscopic devices, and the introduction of minimally invasive therapeutic options have allowed the development of conservative gland-preserving techniques for managing salivary gland obstructions, including extracorporeal shock wave lithotripsy, operative sialoendoscopy, video-assisted transoral and transcervical stone removal, and ductal rehabilitation through interventional radiology and sialoendoscopy. Through adopting a minimally invasive and multimodal policy, a significant number (74%-100%, technique dependent) of salivary calculi can be safely and successfully retrieved while leaving an intact and functional salivary gland system. Only 2% to 5% of patients require gland excision. However, long-term follow-up evaluations of obstructive symptom recurrence are needed before the ultimate benefits of a gland-preserving conservative approach and the residual role of adenectomy can be assessed.

[Endoscopic management of sialolithiasis (a practical experience in 52 cases)].

OBJECTIVE: To investigate the value of endoscopy in the diagnosis and treatment of sialolithiasis. METHODS: Diagnostic and interventional sialoendoscopic procedures were performed in 52 patients with sialolithiasis (43 submandibular glands and 9 parotid glands). RESULTS: Of the 34 sialoliths in the anterior and/or posterior part of the Wharton's duct, 24 were removed with basket retrieval; 2 removed with open surgery and basket retrieval, and 8 removed with open surgery under the guidance of endoscopy. Eight sialoliths in the hilum of the Wharton's duct were treated with open surgery. Of the 9 stone cases in the Stensen's duct, 3 was removed with basket retrieval, 3 was removed after opening-up of the ostium, 1 was treated with basket capturing and open surgery. The obstructive symptoms were improved in these cases during 1-24 months' follow-up. CONCLUSIONS: Sialoendoscopy is a minimal invasive and efficacious technique for the diagnosis and treatment of sialolithiasis.

Selective management of obstructive submandibular sialadenitis.

UNLABELLED: We aimed to describe the effect of our surgical and sialoendoscopic technique for diagnosis and treatment of chronic obstructive submandibular sialadenitis. METHODS: Between January 2004 and June 2006, 68 patients presented with obstructive symptoms and were diagnosed and treated by interventional sialoendoscopy or excision. The patients all had radiographs and then, if the sialolith could not be found, diagnostic sialoendoscopy. The obstruction was treated by operation or interventional sialoendoscopy depending on the size, shape, site, and quality of the sialolith. RESULTS: Forty-nine patients had sialoliths shown radiographically, and the features of 19 were found endoscopically and were of three types: radiolucent (n=6), in the branch (n=3), mucus plug (n=3), and stenotic (n=7). Twenty-seven obstructions were successfully removed surgically, giving a success rate of 27/31 (87%). Twenty-seven patients were treated by interventional sialoendoscopy, and in 22 cases the sialoliths were removed directly by sialoendoscopy (22/27, 81%). Obstructive symptoms were relieved in 9 of 10 cases without stones. CONCLUSION: Operation or sialoendoscopy can be used to treat the obstruction in the submandibular gland.

[Salivary calculi in children]. / Litiasis salival en la infancia.

UNLABELLED: The main salivary glands are the submaxillary, sublingual and parotid glands. Infectious and tumoral conditions are prominent in the parotid gland whilst calculi are in submaxillary and sublingual glands. METHODS. Medical record review of 18 cases with a diagnosis of salivary calculi over a 13 year period. Data collected consisted in, clinical presentation, ultrasound (US), sialography (SG) and computarized tomography (CT), and treatment. RESULTS: 13 male and 5 female. Mean age was 7.2 years. All of them presented with pain and tenderness. Parotid gland was affected in 10 cases. An infectious cause for calculi was found in 7 while 3 presented calculi with no underlying infectious cause. Submaxillary gland was affected in 6 and sublingual in 2. No infectious condition was associated to submaxillary and sublingual calculi. Surgical treatment consisted in duct canalization for calculi removal and was performed in all patients after initial treatment with antibiotics. Neither complications nor relapse was found after surgical removal. CONCLUSIONS: Diagnosis of salivary calculi is made by clinical symptoms and imaging exams. Treatment is surgical and has to be performed after medical treatment for infection and inflamation.