A Retrospective Analysis of Multiple Affected Salivary Gland Diseases: Diagnostic and Therapeutic Benefits of Interventional Sialendoscopy.

OBJECTIVES: Multiple affected salivary gland diseases are rare compared to single gland diseases and represent a major diagnostic challenge. These cases are commonly neglected in the scientific literature, despite the considerable suffering of these patients. The aim of this retrospective study was to report disease characteristics, diagnostic pathways, and therapeutic options, including sialendoscopic treatment of multiple affected salivary gland disorders. METHODS: Patients experiencing multiple affected salivary gland diseases treated between 2013 and 2020 were consecutively identified. Data regarding demographics, clinical presentation, disease characteristics, treatment, complications, and follow-up were analyzed retrospectively. RESULTS: In total, 71 patients were identified with these diseases and included obstructive disease without sialolithiasis (n = 22), inflammation (n = 15), immune disease (n = 19), radioiodine-induced sialadenitis (RAI) (n = 5), sialadenosis (n = 2), and juvenile recurrent parotitis (JRP) (n = 8). Diagnostic and therapeutic sialendoscopy was performed on 113 salivary glands in 42 patients, leading to completely (n = 27, 64.3%) or partially (n = 11, 26.2%) improved symptoms in most cases. In total, 4 patients did not improve after interventional therapy. CONCLUSIONS: Multiple affected salivary gland diseases are rare and diagnostically challenging. Interventional sialendoscopy offers an effective and safe therapeutic option and should be considered in this specific cohort.

Correction to: Laser-assisted surgery of the upper aero-digestive tract: a clarification of nomenclature. A consensus statement of the European Laryngological Society.

The article 'Laser-assisted surgery of the upper aero-digestive tract: a clarification of nomenclature. A consensus statement of the European Laryngological Society,' written by Marc Remacle, Christoph Arens, Mostafa Badr Eldin, Guillermo Campos, Carlos Chiesa Estomba, Pavel Dulguerov, Ivana Fiz, Anastasios Hantzakos, Jerôme Keghian, Francesco Mora, Nayla Matar, Giorgio Peretti, Cesare Piazza, Gregory N. Postma, Vyas Prasad, Elisabeth Sjogren, Frederik G. Dikkers, was originally published Online First without open access. After publication in volume 274 issue 10, page 3723-3727 the authors decided to opt for Open Choice and to make the article an open access publication. Therefore, the copyright of the article has been changed to

Laser-assisted surgery of the upper aero-digestive tract: a clarification of nomenclature. A consensus statement of the European Laryngological Society.

Acronyms and abbreviations are frequently used in otorhinolaryngology and other medical specialties. CO2 laser-assisted transoral surgery of the pharynx, the larynx and the upper airway is a family of commonly performed surgical procedures termed transoral laser microsurgery (TLM). The abbreviation TLM can be confusing because of alternative modes of delivery. Classification and definition of the different types of procedures, performed transorally or transnasally, are proposed by the Working Committee for Nomenclature of the European Laryngological Society, emphasizing the type of laser used and the way this laser is transmitted. What is usually called TLM, would more clearly be defined as CO2 laser transoral microsurgery or CO2 TOLMS or CO2 laser transoral surgery only (with a handpiece) would be defined as CO2 TOLS. KTP transnasal flexible laser surgery would be KTP TNFLS. Transoral use of the flexible CO2 wave-guide with a handpiece would be a CO2 TOFLS. One can argue that these clarifications are not necessary and that the abbreviation TLM for transoral laser microsurgery is more than sufficient. But this is not the case. Laser surgery, office-based laser surgery and microsurgery are frequently and erroneously interchanged for one another. These classifications allow for a clear understanding of what was performed and what the results meant.

Progressive experience in tracheal stenting with self-expandable stents.

We experienced an unacceptably high 21% complication rate with the stainless steel Gianturco stent: a 68-month mean follow-up (range: 37-96 months) of 23 patients revealed three stent fractures and two migrations. Consequently, we began using nitinol mesh stents (Ultraflex) for fibrous stenoses and silicone-covered prostheses (Rush) for proliferative tracheal tumors. The extractable nitinol stent, made from alloy with thermal memory, was palliatively used in 15 patients with fibrous tracheal stenosis; the mean follow-up currently covers 21 months (range: 1-60 months). The silicone-covered prosthesis was used for two patients with inoperable tracheal tumor; follow-up covers 4 months and 2 months, respectively. The prostheses were positioned under visual guidance via the endoscopic approach. The median forced inspiratory volume in 1 s (FIV1) improved from 2.1 l/s (IQR: 0.7-2.4) to 3.2 l/s (IQR: 0.9-3.4) (P=0.018, Wilcoxon signed rank test). The median ratio of peak inspiratory flow (PIF 50%) to peak expiratory flow (PEF 50%) was 1.0 preoperatively (IQR: 0.8-1.5) and 1.8 postoperatively (IQR: 0.6-6.3). Between months 1 and 12, six granulomas developed. Five were treated with antibiotics and steroid aerosol inhalation therapy and one required CO2 laser vaporization. On day 10, one stent migration was observed. The migrated stent was substituted. To date, no stent fracture has been observed. Nitinol and silicone-covered prostheses can be proposed for the palliative treatment of fibrous tracheal stenoses and tracheal tumors, respectively.

Endoscopic CO2 laser-assisted surgery for cricopharyngeal dysfunction.

Endoscopic cricopharyngeal myotomy was performed on 29 patients with dysphagia from failed relaxation of the cricopharyngeal muscle. The patient outcome was retrospectively evaluated. The average age at the time of treatment was 62 years (range: 38-81 years), and the mean follow-up was 18 months (range:1-36 months). The procedure was the first to be performed in all except four of the patients. Preoperative and postoperative assessments included videofluoroscopic and flexible endoscopic evaluations of the swallow as well as patients' subjective ratings for dysphagia and aspiration. These investigations and self-assessments were rated from 0 (poor or abnormal) to 4 (good or normal). Surgical procedures were performed under general anesthesia. Using the diverticuloscope, the posterior portion of the cricopharyngeal muscle was exposed and CO2 laser sectioned. The wound was then covered with fibrin glue. Patients were parenterally fed for 72 h. Postoperative videofluoroscopy showed the absence of leakage, and all patients resumed oral intake on day 2. The median self-rating score improved from 1 to 4 for dysphagia and from 3 to 4 for aspiration. The outcome of the flexible endoscopic evaluation of swallow improved from 2 to 4 and videofluoroscopy improved from 2 to 4. No surgical complication occurred. Endoscopic CO2 laser-assisted surgery is an effective and safe alternative for the treatment of cricopharyngeal dysmotility.

Carbon-dioxide laser-assisted tonsil ablation for adults with chronic tonsillitis: a 6-month follow-up study.

Sixty-six adult patients with a mean age of 44 years (range: 16-78) with chronic tonsillitis underwent laser-assisted tonsil ablation between January 1998 and January 2002. Instead of vaporization of the tonsil surface, extended serial tonsillectomy was performed, namely, vaporizing 80-90% of the palatine lymphoid tissue. Of the 66 patients, 49 (74%) underwent local anesthesia (LA group) and 17 (26%) general anesthesia (GA group). In the LA group, one surgical session sufficed for 40 patients (82%); two sessions were required for seven patients (14%) and three sessions for two patients (4%). Monopolar electrocautery was necessary to ensure hemostasis in two patients (3%). Median value results revealed a pain-intensity score of 4.5 (range: 0-10) for the GA group and 5 (range: 0-10) for the LA group. Pain lasted for 3 days (range: 0-15) in both groups (nonsignificant difference). A satisfaction score of 10 (range: 1-10) was recorded for the GA group and 8 (range: 1-10) for the LA group (P=0.029). The minimum follow-up was 6 months. Forty of the 49 LA group patients (82%) and 16 of the 17 GA group patients (94%) would recommend the surgical procedure and would accept undergoing the same operation again (nonsignificant difference).