Sialendoscopy for treatment of major salivary glands diseases: a comprehensive analysis of published systematic reviews and meta-analyses

Abstract Objectives: Sialendoscopy is a minimally invasive procedure used to diagnose and treat obstructive salivary gland diseases. Previous studies in the topic have shown mixed results. The present study aimed to evaluate the efficacy and safety of sialendoscopy through previous systematic reviews for different outcomes of several diseases. We also aimed to assess studies' methodological quality and heterogeneity. Methods: We conducted a comprehensive systematic literature search of Pubmed, Embase, Lilacs and Cochrane Library. We included systematic reviews and meta-analyses that used sialendoscopy to treat both lithiasic and alithiasic salivary glands diseases. Data extraction included studies' characteristics and results. We assessed studies' methodological quality using the AMSTAR-2 (A Measurement Tool to Assess systematic Reviews 2) tool. Results: 13 studies were included in the review, being 9 in adult populations and 4 in pediatric populations. Sialendoscopy proved to be effective at the treatment of different lithiasic and other obstructive diseases, but with important heterogeneity. The technique was also considered highly safe in most studies. However, studies had a critically low quality of evidence. Conclusions: Most studies demonstrated high efficacy and safety of sialendoscopy, but with critically low quality of evidence. We still lack randomized studies in this field, and future systematic reviews on the topic should follow current guidelines to improve conduction and reporting.

Sialendoscopy for Improvement of Salivary Flow in Patients with Sjögren Syndrome - Comparative Analysis of Intraglandular Washing Solutions

Abstract Introduction Among the potential diseases that present altered salivary flow and activity is Sjögren syndrome. Sialendoscopy seems to be an important therapeutic option. Objective To compare the results obtained with sialendoscopy for improving salivary flow measured by scintigraphy in patients with primary Sjögren syndrome to those obtained with other intraglandular washing solutions. Methods Patients from our institution's rheumatology clinic diagnosed with primary Sjögren syndrome underwent parotid scintigraphy prior to the sialendoscopy procedure. During the sialendoscopy procedure, one of the parotid glands was randomized to receive a wash with saline while the other was washed with a corticosteroid solution. After 1 month, a new scintigraphy examination of the parotid glands was performed to observe the salivary flow for comparison. Results A total of 13 female patients with mean age of 53.38 years (range, 27-76 years) were included in this study. After sialendoscopy, 10 patients (76.92 %) were observed to have improvement in salivary excretion with radiopharmaceutical during scintigraphy. When analyzing each gland that was treated separately (26 glands), after sialendoscopy, improvement was observed in 18 glands (69.23 %), 8 treated with dexamethasone and 10 with saline solution in the wash. There was no improvement in 8 glands (30.77 %). Conclusion This study demonstrates that sialendoscopy is as an important tool to improve salivary flow measured by scintigraphy in patients with primary Sjogren syndrome, increasing salivary excretion through dilation and consequent unblocking of the ducts. These data suggest that there is no statistically significant difference between intraductal washing solutions using saline or dexamethasone solution.

Analysis of efficiency of sialendoscopy in patients with sialolithiasis

The aim of this research was to analyze 106 clinical observations in which sialendoscopy was performed for diagnosis and treatment patients with sialolithiasis. This research showed, that endoscopy of the major salivary gland ductal system allows to obtain information not only on a sialolith, but also on a condition of ductal system. The obtained data define a method of further treatment. Sialendoscopy can be used not only as diagnostic method, but also as an independent method for sialolith removing or as an assistance. The possibility of sialolith removing depends on its mobility, the size of salivary stone, localization and a salivary duct condition.

Endoscopy-assisted transoral removal of deep hilar and intraparenchymal stones in the Wharton′s duct / 中华口腔医学杂志

Objective@#To investigate the different surgical approaches and long-term outcomes of endoscopy-assisted transoral removal of deep hilar and intraparenchymal stones in the Wharton′s duct.@*Methods@#From January 2008 to March 2018, 481 consecutive patients with deep hilar and intraparenchymal calculi in the Wharton′s duct underwent endoscopy-assisted transoral removal at Deparment of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology. There were 250 males and 231 females. Their ages ranged from 9-86 years. We operated 476 patients under local anesthesia on an outpatient basis, and the remaining 5 were operated under general anesthesia. On the basis of ultrasonography, spiral CT, sialography and endoscopy, the calculi were classified into 4 types: hilum stones (located at the hilum or proximally with a distance <5 mm from the hilum), infra-hilum stones (intra-glandular stones with a distance of 5-10 mm from the hilum), intraparenchymal stones (with a distance ≥10 mm from the hilum), and multiple stones (concomitant hilum and intra-glandular stones). The treatment approaches included: hilum duct slitting, intraparenchymal duct slitting, submandibulotomy and intraductal retrieval. The success rate, immediate safety and effectiveness of different types of stones were evaluated. After surgery, the patients were followed up, and gland function was analyzed on the basis of clinical symptoms and signs.@*Results@#The calculi sizes varied from 3 to 25 mm, with a mean of 7.8 mm. The calculi were located in the right submandibular gland in 259 patients, in the left submandibular gland in 219 patients and in bilateral glands in 3 patients. The calculi were successfully removed in 446 glands, with a success rate of 92.1% (446/484). The success rate varied according to the stone sites: 97.8% (363/371) for hilum stones, 64.4% (29/45) for infra-hilum stones, 4/16 for intraparenchymal stones and 96.2% (50/52) for multiple stones. The main treatment methods applied included hilum duct slitting in 347 glands, intraparenchymal duct slitting in 13, submandibulotomy in 4, intraductal retrieval in 73, and hilum duct slitting accompanied by intraductal retrieval in 9. Ductal breakage occurred in 2 glands. All patients complained of mild to moderate pain with a duration of 3-7 days. Nine had temporal lingual nerve injury. During 3-120 months′ follow-up (mean 36 months) of the total 484 glands, 1.6% (7/446) developed ranula, 1.3% (6/446) experienced obturation of the main duct and 2.0% (9/446) had recurrent stones. The remaining 95.1% (424/446) glands were symptom-free with good function.@*Conclusions@#Endoscopy-assisted transoral removal of deep hilar and intraparenchymal submandibular calculi is a safe and effective gland-preserving procedure. According to the depth, size and number of the calculi, variant surgical approaches should be attempted to maximize the success rate and to minimize the side effects.

A Case of Intraoral Drainage of Iatrogenic Parotid Sialocele after Sialendoscopy / 대한이비인후과학회지

A variety of treatment methods have been proposed for parotid sialocele. These include multiple aspirations and compression dressings, reconstruction of the duct, creation of a controlled internal fistula, superficial or total parotidectomy, radiation therapy and ductal ligation, etc. Most of these procedures are invasive with variables and often with poor success rates. This paper presents an unusual incidence of iatrogenic parotid sialocele after sialendoscopy and its management by a relatively simple, safe and effective technique, which is constituted of draining saliva into the intraoral.

Management of Sialolithiasis of Submandibular Gland: Sialendoscopy-Assisted Intraoral Stone Removal / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Intraoral removal is one of the most common treatments for sialolithiasis, and although newly introduced, sialendoscopy is becoming a popular tool for it. The aim of this study was to investigate the factors that influenced the removal of sialolithiais by sialendoscopy and also to compare its usefulness with intraoral removal alone. SUBJECTS AND METHOD: We retrospectively reviewed surgical results of 89 patients who underwent therapeutic sialendoscopy and compared them with the result of 43 patients who underwent intraoral removal without sialendoscopy between June 2006 and February 2012. We analyzed the success rate of sialendoscopy for sialolithiasis by age, location, stone size, stone shape and stone mobility. Then we compared sialendoscopy-assisted intraoral removal group with intraoral removal alone group by location, size and mobility. RESULTS: Among the total 89 patients with sialolithiasis of submandibular gland who underwent sialendoscopy-assisted intraoral removal, 47 were successfully treated by therapeutic sialendoscopy alone (52.8%), and 84 by sialendoscopy-assisted intraoral removal (94.3%). In cases of proximal stones and those larger than 5 mm in size, sialendoscopy-assisted intraoral removal (95.0%) was more successful than intraoral removal alone (30%). The mean operation time (min) for sialendoscopy was 39 min and that for intraoral removal after sialendoscopy was 43 min. Sialendoscopy-assisted intraoral removal took 82 min and intraoral removal alone took 56 min. CONCLUSION: Results of sialendoscopy assisted stone removal supports the less invasive therapy of proximal stones via intraoral route. We thus recommend considering sialendoscopic approach prior to considering other approaches.

Usefulness of Sialendoscopy for Sialadenitis after Radioactive Iodine Therapy / 대한갑상선학회지

BACKGROUND AND OBJECTIVES: Ablation of the thyroid remnants using radioiodine (RI) after surgical removal of differentiated thyroid cancer could induce radiation-related salivary gland dysfunction. The purpose of this study is to review our experience with therapeutic sialendoscopy for RI-induced sialadenitis. MATERIALS AND METHODS: We reviewed medical charts of all patients with RI-induced sialadenitis treated with sialendoscopy retrospectively. The study included 14 patients who underwent sialendoscopy for the treatment of RI-induced sialadenitis after failing conservative management. RESULTS: 14 patients (11 women, 3 men) with a mean age of 43.8 years (range, 26-60) underwent interventional sialendoscopy for the treatment of RI-induced sialadenitis that is unresponsive to conservative management. Symptoms arising from the parotid gland were seen in 12 (86%) of patients, whereas symptoms arising from the submandibular gland were seen in 2 (14%). 7 patients (50%) presented symptoms in bilateral parotid or submandibular glands. The mean dose of RI was 203.2 mCi (range, 150-500) received as a single dose. The mean duration from RI ablation therapy to sialendoscopy was 11.1 months (range, 0.5-29). Sialendoscopy was possible in all patients. Ductal stenosis and mucus plugs and debris were the most common types of ductal pathology. Sialendoscopy improved the symptoms in 79% (11/14) of patients, with no serious complications reported in mean follow up of 4 months (range, 1-12). CONCLUSION: Therapeutic interventional sialendoscopy appears to provide symptom improvement in most patients. Sialendoscopy is effective tool for improving symptoms due to RI-induced sialadenitis in patients who are unresponsive to conservative managements.

Usefulness of Sialendoscopy in Unusual Obstructive Salivary Ductal Diseases / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Ductal calculi and stenosis are well known causes of salivary ductal obstructive lesions. As a direct view of the ductal systems was not possible for the surgeons, sialendoscopy has been a convenient tool for finding out these obstructive lesions. This study contains some unusual endoscopic findings that we have found during diagnostic and interventional sialendoscopy. SUBJECTS AND METHOD: Retrospective chart reviews were done, and endoscopic findings were reviewed for patients who received sialendoscopy from September 2003 to January 2007. Sixtyfour patients received sialendoscopy for either diagnostic or interventional method. RESULTS: We found unusual findings in 7 cases (10.9%). Three cases of basin malformation were observed. Two cases had spontaneous ductal perforation, and we also observed 2 cases of occult stone. CONCLUSION: The sialendoscopy is an excellent method in evaluating and treating salivary ductal diseases. We found out that the sialendoscopy made it possible to explore ductal systems completely, as well as to detect unusual findings, and to help in the management of some salivary ductal diseases.