Sialendoscopy in Chronic Obstructive Sialadenitis Without Sialolithiasis: A Prospective Cohort Study

Abstract

Objectives To evaluate long-term chronic sialadenitis symptoms in patients without sialolithiasis following sialendoscopy-assisted salivary duct surgery (SASDS) compared to a control group managed conservatively. Study Design Prospective cohort study. Setting Tertiary care center. Methods Thirty-six patients (52 glands) with chronic sialadenitis without sialolithiasis completed the Chronic Obstructive Sialadenitis Symptoms (COSS) questionnaire at presentation and at 3-month time intervals thereafter for 1 year. Lower COSS scores represent lower symptom severity. We compared 27 patients who underwent SASDS to 9 control patients who elected conservative management. Results COSS gland-specific scores from 38 SASDS-treated glands (cases) and 14 control glands were similar at baseline. At 6 to 12 months (mean, 8.4 months), the surgically treated group had significantly lower scores and a greater score reduction from baseline compared to controls (mean score change [95% confidence interval] cases: 20.7 points [15.7-25.8]; controls: 11.7 points [4.9-18.4]; P = .04). There was a significant difference in scores between the 2 groups over time ( P < .001). A greater proportion (72%) of cases reported partial or complete resolution of overall sialadenitis symptoms at 6 to 12 months compared to the controls (22%, P < .05). Conclusion Compared to patients electing for conservative management, patients with sialadenitis without sialolithasis treated with SASDS had improved symptom scores and a greater reduction of symptom severity after 6 months. With SASDS, patients had higher rates of significant overall symptom improvement. In evaluating chronic sialadenitis, assessment at multiple time points is necessary to capture the intermittent and cyclical pattern of obstructive symptoms.

The Role of Sialendoscopy in Parotid Duct Stenosis in Graft‐Versus‐Host Disease

“…Obstructive sialadenitis, classically characterized by intermittent mealtime‐associated pain and swelling most commonly of the parotid gland, is most often caused by sialoliths. However, it can also result from strictures or stenoses in the setting of inflammatory or autoimmune disorders, for example, radioiodine sialadenitis or Sjogren's syndrome, or in this case, cGVHD 2 …”

“…Sialendoscopy has been established as an effective tool to diagnose and treat sialolith‐related major salivary gland obstruction and is being increasingly employed in the diagnosis and treatment of sialadenitis in the absence of sialolithiasis 2 . Outcomes data for sialendoscopy in the absence of sialolithiasis are limited, but recent studies suggest that a majority of these patients experience superior long‐term outcomes compared to those treated with medical management only 2 . The procedure can incorporate saline irrigation to clear mucus plugs; dilation of strictures with salivary dilators, balloons, or microdrills; and corticosteroid infusion to reduce inflammation 2 .…”

“…He re‐presented 1 year later with episodes now occurring more frequently (monthly) and for longer periods of time (up to 1 week). His chronic obstructive sialadenitis symptoms (COSS) questionnaire score was 12.5, exclusively related to gland swelling and xerostomia 2 . Office‐based diagnostic sialendoscopy of the left parotid gland with a 0.8 mm sialendoscope revealed a membranous appearing near‐complete stricture at 2 cm (Fig.…”

“…Chronic inflammation and ensuing ductal stenosis due to cGVHD can lead to obstructive symptoms and xerostomia. Sialendoscopy is a minimally invasive approach that utilizes miniaturized endoscopes to diagnose and treats numerous major salivary gland pathologies, with increasing application in cases of non‐sialolith‐related stenoses and strictures 2 …”

“…Sialendoscopy is a minimally invasive approach that utilizes miniaturized endoscopes to diagnose and treats numerous major salivary gland pathologies, with increasing application in cases of non-sialolithrelated stenoses and strictures. 2…”