Sialolithiasis: retrospective analysis of the effect of an escalating treatment algorithm on patient-perceived health-related quality of life

Abstract

Background Gland preserving techniques in the treatment of sialolithiasis have continuously replaced radical surgery. The aim of this study was to evaluate a multimodal treatment algorithm in the therapy of sialolithiasis and assess improvement of HRQoL perceived by patients. Methods Patients with sialolithiasis were treated by a multimodal treatment algorithm based on multiplicity of stones, stone size, affected gland, and stone position. The therapeutic spectrum ranged from conservative measures, extracorporeal shockwave lithotripsy, interventional sialendoscopy, combined endoscopic-surgical procedures to surgical gland removal as ultima ratio. Outcomes were evaluated by surgeons by means of the electronic patient record and by patients themselves using a standardized questionnaire. Results 87 patients treated for sialolithiasis were comprised in this study. The submandibular gland (SMG) was affected in 58.6% and the parotid gland (PG) in 41.4% of cases. Mean patient age was 41.67 years for SMG and 48.91 years for PG. In over 80% of cases sialolithiasis was associated with classic meal-related pain and swelling. Type and intensity of symptomatic sialolithiasis were not dependent on patient age or gender, nor could a relation between the affected gland and the occurrence of symptoms be demonstrated. Overall, 86.2% of cases were reported as cured using the multimodal step-by-step treatment algorithm. Resection of the affected gland could be dispensed in 98.9% of cases. According to patients pain could be reduced in 94.3% of cases. Conclusions The analyzed treatment algorithm of increasing invasiveness is a favorable and effective tool to successfully treat sialolithiasis in > 86% of cases. For the first time, the present study shows that patient-perceived improvement of HRQoL due to ease of symptoms has an even higher success rate of > 94%.

Treatment of Sialolithiasis: What Has Changed? An Update of the Treatment Algorithms and a Review of the Literature

“…On the basis of these developments, treatment algorithms for sialolithiasis were published for centers that did not have regular access to ESWL [ 27 ] and those that did [ 26 , 28 ]. Although some differences were noted, all of the studies confirmed that the role of gland resection was becoming more and more limited [ 15 , 27 , 29 ].…”

“…Although some differences were noted, all of the studies confirmed that the role of gland resection was becoming more and more limited [ 15 , 27 , 29 ]. The treatment algorithm published by our research group in 2009 included all of the known techniques and combinations of them [ 26 ], and a modification based on this was published by another group [ 28 ].…”

“…For nearly all of these combined approaches, sialendoscopy-guided intraductal shock-wave lithotripsy (ISWL) emerged as an alternative treatment modality during the last 5–10 years. ISWL is not included in any of the published algorithms [ 26 ], meta-analyses, reviews, or comprehensive studies [ 5 , 16 , 21 , 22 , 28 , 56 , 70 , 71 , 72 ].…”

“…Several treatment algorithms have been proposed, highlighting the decline in the importance of ESWL and the increase in the importance of combined techniques. However, the growing impact of ISWL and new options for combining it with familiar treatment modalities have not been considered, or at least not adequately [ 28 , 56 , 72 ], with the exception of one recent review [ 1 ]. Although it is clear that ESWL is declining in importance, it may perhaps be underrepresented.…”

Substantiation of Targeted Research on the Development of Diagnostic and Differential-Diagnostic Tests Used in Chronic Sialoadenitis. Literature review

“…Хронические сиалоадениты и сиалозы составляют 42,0-54,4% от всей патологии СЖ [10]. Они занимают значимую долю в структуре патологии челюстно-лицевой области, плохо поддаются лечению, в значительной мере снижают качество жизни пациентов [1,12,13,14]. Частота обращения пациентов данной категории к специалистам -челюстно-лицевым хирургам и стоматологам-хирургам составляет 4-7% от общего числа профильных обращений.…”