Sialendoscopy in Management of Juvenile Recurrent Parotitis—A Single Centre Experience

Abstract

Juvenile recurrent parotitis is a rare inflammatory disease of the parotid gland that shares diverse therapeutic management between institutions. Sialendoscopy has been demonstrated as an efficient diagnostics and therapeutic method with minimal complications; however, due to the rarity of the disease and limited data, there is a lack of universal guidelines on its optimal management. Herein, we retrospectively analysed patients with juvenile recurrent parotitis who had the sialendoscopy performed at our tertiary centre. Descriptive data were retrieved along with the number of swelling episodes one year before and after the sialendoscopy intervention. In the last decade, twenty-nine sialendoscopic procedures were performed at our clinics on twenty-one patients diagnosed with juvenile recurrent parotitis. Most of them underwent the procedure under general anaesthesia (86%). In the year before and after the sialendoscopic procedure, the patients had 3.9 ± 2.7 and 0.2 ± 0.4 episodes of swelling per year, respectively. The difference proved to be statistically significant (p < 0.0001). The complete resolution was noted in sixteen patients (76%); however, the procedure was not repeated on the same side of any patient. Solely one patient had a relapse of the disease reported more than twelve months after the sialendoscopy, nonetheless, one of his exacerbation episodes was already reported in the first year after the sialendoscopy. The mean follow-up period of patients was 48.6 months (range, 13–116 months). All things considered, this study emphasises sialendoscopy as an effective minimally invasive diagnostic and therapeutic tool for the management of juvenile recurrent parotitis.

Key Findings and Experience in the Management of Juvenile Recurrent Parotitis with Sialoendoscopies—A Retrospective Study

“…It should be noted that the need for repeated sialoendoscopy treatments to completely resolve symptoms is commonly described in the literature [1,20,[49][50][51][52], even up to five times. It is reported that the recurrence of swellings after treatment, if it does occur, tends to be less intense and less painful and the treatment can be performed again in cases of several recurrences of swellings [8,24,27]. In this study, two children (12%) needed a second intervention, and one child (6%) needed up to four interventions in order to reach a successful treatment result.…”

“…On the other hand, another study showed that 90% of participants were free of symptoms after only one endoscopy procedure [46]. A recent study [27] described 76% of patients as symptom-free, but only for the first year after the procedure. A meta-analysis that included seven studies showed a success rate with no further sialoendoscopy needed at 87% [26].…”

“…Episodes tend to stop in early adulthood, for unknown reasons [1,23]. As mentioned above, the first episode commonly occurs between the ages of 3-6 years old and is more common in males [1,8,[24][25][26][27]. Equal distribution between genders was also reported [28].…”

“…Sialoendoscopy is simultaneously diagnostic and therapeutic and enables irrigation and dilation of the parotid duct with a direct view of any ductal pathologies [24]. Typical findings during the sialoendoscopy that are consistent with a diagnosis of JRP are mucus plugs, debris and ductal stenosis, scarce vascularity in the ductal lamina, dilations, strictures, and a whitish ductal mucosa which is evidence of inflammation [8,21,26,27,[42][43][44][45]. In this study, common endoscopic findings were decreased vascularization (5 glands, 4 patients), no vascularization (19 glands, 12 patients), strictures (14 glands, 10 patients), and few or vast mucous plugs (19 glands, 13 patients).…”

“…Performing the sialoendoscopy under local rather than general anesthesia is agedependent, and among children, it is mostly performed under general anesthesia [4,8,24,56,57]. A recent study [27], which performed sialoendoscopy on patients with JRP, performed it under local anesthesia only with patients older than 16 years, and two additional studies [43,50] suggested that sialoendoscopy under local anesthesia may be useful for patients older than 8 years of age. Sialoendoscopy under sedation was also reported [49].…”