Modern management of paediatric obstructive salivary disorders: long-term clinical experience

Abstract

I disordini ostruttivi salivari sono infrequenti nell’età pediatrica. I recenti progressi tecnologici nel distretto della testa e del collo hanno modificato la strategia diagnostica e terapeutica dei disordini salivari. La diagnosi è oggi basata sull’eco color Doppler, sulla scialo-RMN, sulla cone beam 3D TC, mentre la litotrissia extracorporea ed intracorporea, la scialoendoscopia interventistica, la chirurgia scialoendoscopico- assistita, sono attualmente utilizzati come procedure conservative e mininvasive per la preservazione funzionale della ghiandola affetta. Abbiamo analizzato i risultati dell’esperienza clinica a lungo termine nel trattamento dei disordini ostruttivi dell’età pediatrica. Un gruppo consecutivo di 66 pazienti pediatrici (38 femmine) con sintomi salivari ostruttivi causati da parotite ricorrente pediatrica (32 pazienti), calcoli (20), stenosi duttali (5), e ranule (9) è stato incluso nello studio. 45 pazienti sono stati sottoposti a scialoendoscopia interventistica per parotite ricorrente, calcoli e stenosi, 12 pazienti sono stati sottoposti ad un ciclo di litotrissia extracorporea (ESWL), tre pazienti a chirurgia transorale scialoendoscopico-assistita, un paziente a drenaggio, sei a marsupializzazione e due a sutura della ranula. Nel 90,9% è stato raggiunto un risultato favorevole. L’approccio combinato di litotrissia salivare extracorporea e di scialoendoscopia interventistica è stato utilizzato in tre pazienti ed una procedura secondaria è stata eseguita in sette pazienti. Nessun paziente è stato sottoposto a scialoadenectomia nonostante la persistenza di modesti sintomi ostruttivi in sei pazienti. Non è stata osservata alcuna complicanza maggiore. Adottando un adeguato iter diagnostico mediante eco color Doppler delle ghiandole salivari, scialo-RMN e cone beam 3D TC, i pazienti pediatrici con disordini ostruttivi salivari possono essere efficacemente trattati con un approccio moderno mini-invasivo mediante tecniche di litotrissia extracorporea ed intracorporea, scialoendoscopia interventistica, e chirurgia transorale scialoendoscopico-assistita; questo approccio garantisce un risultato favorevole nella maggior parte dei pazienti evitando così il ricorso alla scialoadenectomia invasiva e mantenendo così la preservazione funzionale della ghiandola coinvolta.

The role of magnetic resonance imaging and magnetic resonance sialography in the evaluation of salivary sialolithiasis: radiologic-endoscopic correlation

“…Three paediatric patients were included in our study. Childhood sialolithiasis is quite rare, accounting for about 3-5% of all salivary calculi [14,15].…”

Recurrent obstructive salivary disease after sialendoscopy. A narrative literature review

“…Typical endoscopic features of JRP are whitish appearance of the duct wall, mucous plugs, duct kinking and fibrotic strictures; interventional sialendoscopy is essentially performed by hydraulic dilation of the duct system up to the tertiary ductal branches thanks to continuous irrigation with saline solution and final irrigation with steroids (usually dexamethasone) 39 . Recent published case series report complete therapeutic success after one sialendoscopy in about 75% of cases, and a higher success rate after multiple procedures 5 , 41 , 42 : in a series of 32 consecutive patients, Capaccio et al 41 reported complete therapeutic success in 25 patients, while in three cases a second endoscopic procedure was useful for relief of symptoms; one of the four remaining patients was treated with medical therapy (steroid and non-steroid anti-inflammatory drugs, sialogogues); Ezer et al 42 reported that over 75% of patients treated with interventional sialendoscopy had no JRP recurrences after multiple procedures (usually three sialendoscopies). The main reason for recurrence of the disease could be intrinsic in the nature of this condition: some studies have suggested that the pathophysiology of JRP is immune-mediated, as shown by colour Doppler US findings of reactive lymphatic tissue in the affected glands 41 , and by the histopathologic evidence of lymphocyte infiltrates near the salivary ducts 41 , 42 in children undergoing parotidectomy.…”

“…Recent published case series report complete therapeutic success after one sialendoscopy in about 75% of cases, and a higher success rate after multiple procedures 5 , 41 , 42 : in a series of 32 consecutive patients, Capaccio et al 41 reported complete therapeutic success in 25 patients, while in three cases a second endoscopic procedure was useful for relief of symptoms; one of the four remaining patients was treated with medical therapy (steroid and non-steroid anti-inflammatory drugs, sialogogues); Ezer et al 42 reported that over 75% of patients treated with interventional sialendoscopy had no JRP recurrences after multiple procedures (usually three sialendoscopies). The main reason for recurrence of the disease could be intrinsic in the nature of this condition: some studies have suggested that the pathophysiology of JRP is immune-mediated, as shown by colour Doppler US findings of reactive lymphatic tissue in the affected glands 41 , and by the histopathologic evidence of lymphocyte infiltrates near the salivary ducts 41 , 42 in children undergoing parotidectomy. Indeed, most of our patients with JRP show high grade of adeno-tonsillar hypertrophy or had previously undergone tonsillectomy and/or adenoidectomy 5 thus confirming the exuberant lymphatic reactivity of these patients for whom irrigation with saline solution and steroids may be not sufficient to completely extinguish the immunological burning state; moreover, it has been previously reported that controlling general concomitant comorbidities such as atopy, associated with JRP in severe cases, may help in controlling symptoms and the pathology 42 .…”

Lactoferrin and the development of salivary stones: a pilot study

“…The exact cause appears to be multifaceted and various hypotheses have been put forward. The formation seems to be related with factors such as hyposalivation, dehydration, and impaired crystalloid solubility (Avishai et al 2021a , b ; Capaccio et al 2007 ), agglomeration of sialomicroliths (Harrison 2009 ) and anatomical variation of the excretory salivary ducts (Nagra et al 2010 ). A decreased secretion rate and/or altered biochemical composition of saliva may also be a possible explanation for the formation of salivary stones (Kraaij et al 2014 ).…”