Do Postoperative Oral Corticosteroids Improve Results After Sialendoscopy for Ductal Stenosis?

Abstract

Objectives This study aims to review the effects of short‐ and long‐term oral administration of postoperative corticosteroids in patients undergoing sialendoscopy for the treatment of obstructive sialadenitis due to ductal stenosis. Study Design Prospective comparative study. Methods A prospective observational study was conducted at Manukau Surgical Center in Auckland, New Zealand, where patients undergoing sialendoscopic surgery for recurrent obstructive sialadenitis due to ductal stenoses were reviewed. Univariable and multivariable analysis, and also logistic regression were performed to identify variables correlated with the likelihood of the need for revision surgery for persistent or recurrent symptoms. Results In this study, sialendoscopy was performed in 142 patients: 162 parotid glands (86.6%) and 25 submandibular glands (13.4%). Postoperative oral steroids were prescribed for 48 patients (34%); 19 (13%) were prescribed for less than 7 days and 29 (20%) for more than 7 days. In total, 33 patients (23.2%) required a revision sialendoscopy during follow‐up due to recurrence of symptoms. Oral steroids prescribed for more than 7 days after a sialendoscopy reduced the likelihood of a revision procedure by 93% when compared with patients who did not receive this medication, and by 96% when compared with patients who received steroids for less than 7 days. Conclusion The results showed that in our population oral administration of corticosteroids for more than 7 days after sialendoscopy for the treatment of recurrent obstructive sialadenitis due to ductal stenosis markedly reduced the need for later revision surgery. Routine use of corticosteroids for more than 7 days is recommended after sialendoscopy in patients with ductal stenosis. Level of Evidence II Laryngoscope, 131:E1503–E1509, 2021

The Need for Studies on Oral Corticosteroids After Sialendoscopy for Obstructive Salivary Gland Disease: Systematic Review

“…More high-quality evidence is required in the form of a comparative study or randomized controlled trial, with appropriate long-term follow up. To date, the benefits of oral steroids after sialendoscopy for ductal stenoses have been clearly described in only 1 paper, 24 but the risk versus benefit of oral steroid administration remains as yet undefined, and requires further study.…”

“…Only 1 study was prospective comparing patients with ductal stenoses that had no steroids after sialendoscopies and those who had postoperative oral steroids for more than 7 days and less than 7 days. 24…”

“…This systematic review was inspired by the results found in a study carried out by our research group on salivary glands in Auckland. 24 Such research has revealed a remarkable benefit in the prescription of systemic (oral) corticosteroids after sialendoscopy for the treatment of ductal stenoses, which led us research whether other studies with the same objective had already been performed.…”

“…Only 1 study was prospective comparing patients with ductal stenoses that had no steroids after sialendoscopies and those who had postoperative oral steroids for more than 7 days and less than 7 days. 24 It is likely that several variables other than oral steroids influenced the results, such as surgical experience, operative technique, ductal irrigation, combined surgical approach, use of stents, and administration of post-operative antibiotics or non-steroidal anti-inflammatory medication.…”

Pediatric Sialendoscopy

“…While prednisolone, triamcinolone, and hydrocortisone have all been used topically, there are no studies to date analyzing outcomes of steroid irrigation [2]. One study of 140 adults found that patients with ductal stenoses who were treated with a 1-week course of oral steroids followed by a slow taper were significantly less likely to require repeated sialendoscopy for recurrent symptoms as compared to those who received less than 1 week of postoperative oral steroids [29].…”