Chronic Obstructive Parotitis Due to Strictures of Stenson's Duct—Our Treatment Experience With Sialoendoscopy

doi:10.1016/j.joms.2009.08.019

Journal of Oral and Maxillofacial Surgery

Volume 68, Issue 1, January 2010, Pages 83-87

https://doi.org/10.1016/j.joms.2009.08.019 Get rights and content

Purpose

The present retrospective analysis was performed to assess the effectiveness of sialoendoscopic treatment of chronic obstructive parotitis.

Materials and Methods

The study group included 87 parotid glands with stricture as the only cause of gland obstruction. After sialographic and sialoendoscopic evaluation, sialoendoscopic 4-step surgical treatments were performed. The treatment protocol was designed.

Results

Sialoendoscopy proved to be a successful procedure in 94.7% of the affected parotid glands we treated.

Conclusion

The minimally invasive technique of sialoendoscopy for treatment of strictures of the salivary glands could be a welcome innovation, helping to avoid radical surgical treatment of salivary gland disease.

Section snippets

Materials and Methods

We performed a sialoadenoscopic evaluation of 335 glands in patients with suspected ductal system disease treated at our department since 2004. In 149 of the 335 glands, an obstruction of the ductal system due to siaolithiasis was found.

In 87 parotid glands, a stricture was diagnosed and was the only cause of gland obstruction. This phenomenon represented 25.9% of all checked salivary glands, and these patients were included in our study group.

The inclusion criteria were cases of recurrent

Results

The strictures were classified according to their location, extent, and dilation. Only in 3 cases did ultrasonography show dilation of the ductal system and symptoms of infection. The typical finding then obtained using sialographic imaging was filling of the ductal system by sialectasia and stenosis (sausage-like appearance of the duct; Fig 1).

The strictures were of partial thickness, occupying less than 50% of the ductal lumen, or full thickness, occupying more than 50% of the ductal lumen.

Discussion

The etiology of stricture formation in Stenson's ducts is still unclear. However, stricture formation most probably results from ductal epithelial lining injury after recurrent infections or trauma caused by a sialolith or surgical intervention in Stenson's duct. Also, some investigators have reported on congenital strictures as a possible cause.¹³

The traditional diagnostic approach to ductal stenosis includes sialography, which is still considered the diagnostic reference standard and also

Acknowledgment

The senior author would like to show his gratitude toward Prof Francis Marchal, Department of Otolaryngology, Head and Neck Surgery, University Hospital, Geneva, Switzerland, for his contribution and support.

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Sialendoscopic Management of Obstructive Salivary Gland Pathology: A Retrospective Analysis of 236 Cases
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Citation Excerpt :
The incidence of sialolithiasis in a study by Koch et al12 was 60 to 70% and in a study by Nahlieli et al13 was 79%. Accordingly, the reported incidence of strictures was 12% in a large study by Nahlieli et al,13 19.7% in a study by – et al,14 and 25.9% in a study by Ardekian et al.15 The other most common causes of obstruction were mucoid debris, foreign bodies, and anatomical variations of the duct.16 In contrast to this, the incidence of sialolithiasis in our study was 51%, with the submandibular gland accounting for 84.2% of the cases, and incidence of strictures was 35% (parotid gland accounting for 80.7% of them), which is important.
To analyze and assess the results of treating obstructive salivary gland pathology by sialendoscopy or sialendoscopic-assisted surgery and analyze the difference in submandibular and parotid gland pathology.
Between December 2012 and March 2020, 211 patients (236 procedures) underwent sialendoscopy/sialendoscopic-assisted surgery for treatment of obstructive salivary gland pathology. The cases were retrospectively analyzed for type of pathology, symptomatic relief, type of intervention (endoscopy alone or combined with open surgery), recurrence of symptoms, number of gland excisions, and complications encountered. Sialolith cases (n = 117) were treated by sialendoscopic/sialendoscopy-assisted surgical sialolithotomy using basket or graspers. Strictures (n = 69) were treated by serial dilatation or balloon dilatation with or without intraductal steroid. Mucous plugs (n = 26) were managed by sialendoscopic lavage and occasional retrieval using wire baskets.
There were 123 submandibular sialendoscopies in 118 patients and 113 parotid sialendoscopies in 95 patients. Of the 123 submandibular sialendoscopies, 99 were treated for sialolithiasis, 14 for strictures, 3 for mucous plugs, and 2 for foreign bodies. Of the 95 parotid sialendoscopies, 18 were treated for sialolithiasis, 55 for strictures, 23 for mucous plugs, and 1 for foreign body. The success rate was 85.3% for submandibular gland treatment and 92% for parotid gland treatment. About 62.7% of cases were treated by combined method (sialendoscopy with open approach) in submandibular gland and 50% in parotid gland. The number of gland excisions performed was 5 (2.1%).
Sialendoscopy although associated with a gradual learning curve can be used for all cases of obstructive salivary gland pathology with excellent success rate and minimum morbidity. Parotid gland obstructive pathology is distinct from that seen in the submandibular gland, with strictures and mucous plugs contributing to most cases. Diagnosing and treatment planning for strictures and mucous plugs should therefore be as seamless as that for sialoliths.
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Parotid Gland Intraoral/External Combined Approaches for Strictures
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Management of sialolithiasis with sialendoscopy alone: Evaluation of the size and location of removed calculi
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Citation Excerpt :
In the submandibular gland, 68.2 % of cases of ductal stenosis occurred in the posterior third and hilar regions [25]. Additionally, kinks often occurred in the region that intersects the lingual nerve and the mylohyoid muscle [26]. In the parotid gland, 80 % of the cases of stenosis occur in the region of the buccinator muscle and along the anterior edge of the masseter muscle [25,27].
The aim of this study was to evaluate the effect of size and location on removal rate using sialendoscopy alone for the management of sialolithiasis in the submandibular and parotid glands.
The Wharton’s duct and the Stensen’s duct were divided into 2 and 3 parts, respectively. All calculi were also examined preoperatively for their size and location in computed tomography images. Patients at our hospital with sialolithiasis who were treated with sialendoscopy alone were analyzed retrospectively to investigate whether the size and location of calculi correlated with removal rate.
The removal rate of ductal calculi was significantly higher than of hilar calculi in the submandibular gland. A correlation between size and removal rate was observed in Wharton’s ductal calculi. In parotid sialolithiasis, no correlation was seen between removal rate and the size or location of calculi.
We concluded that sialendoscopy treatment alone is safe and resulted in favorable outcomes. However, the removal rate varies depending on the location.
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Following dilation, a salivary duct stent can be placed for 4 to 6 weeks. Ardekian and colleagues12 followed 87 patients with parotid stenoses who were treated with steroid irrigation and ductal dilation. Their group reported an 81.7% success rate.

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Basic and patient-oriented researchChronic Obstructive Parotitis Due to Strictures of Stenson's Duct—Our Treatment Experience With Sialoendoscopy

Purpose

Materials and Methods

Results

Conclusion

Section snippets

Materials and Methods

Results

Discussion

Acknowledgment

J Oral Maxillofac Surg

J Oral Maxillofac Surg

Clin Radiol

J Oral Maxillofac Surg

Oral Surg Oral Med Oral Pathol

Oral Surg Oral Med Oral Pathol

Minimally invasive techniques for the treatment of benign salivary gland obstruction

Cardiovasc Interv Radiol

Long term experience with endoscopic diagnosis and treatment of salivary gland inflammatory diseases

Laryngoscope

Development and application of microsalivary gland endoscopy

Salivary Glands in Health and Disease

Basic and patient-oriented research
Chronic Obstructive Parotitis Due to Strictures of Stenson's Duct—Our Treatment Experience With Sialoendoscopy