PurposeTo analyse costs related to the diagnosis and treatment of patients with sialolithiasis and sialadenitis managed with sialendoscopy, and to prospectively evaluate the impact of sialendoscopy on health-related quality of life (HRQoL) in a longitudinal follow-up study.MethodsAll patients undergoing sialendoscopy or sialendoscopy-assisted surgery at a tertiary care university hospital between January 2014 and May 2016 were identified from a surgical database, and the direct hospital costs were retrospectively evaluated from 1 year before to 1 year after the sialendoscopy. The 15D HRQoL questionnaire and a questionnaire exploring the use of health care services during the preceding 3 months were mailed to the patients before sialendoscopy as well as at 3 and 12 months after the operation.ResultsA total of 260 patients were identified. Mean total hospital costs, costs related to the sialendoscopy, and complications were significantly higher in sialolithiasis patients than in patients with other diagnoses. 74 patients returned the baseline 15D questionnaire, and 51 patients all three 15D questionnaires. At baseline, the dimensions “discomfort and symptoms” and “distress” were lower in patients than in age- and gender-standardised general population, but the total 15D score did not differ significantly. The dimension “discomfort and symptoms” improved significantly at 3 and 12 months postoperatively, and the mean total HRQoL score improved in patients with sialolithiasis at 3 months postoperatively.ConclusionsThe costs related to sialendoscopy are substantial and the cost-effectiveness of sialendoscopy warrants further studies. However, sialendoscopy seems to reduce patients’ discomfort and ailments and to improve HRQoL at least in patients with sialolithiasis.

Dear Editor, Benign inflammatory and obstructive salivary gland diseases are relatively common. Sialoliths, duct strictures or stenosis, sialodochitis, polyps, and anatomic variations can lead to mechanical obstruction and stasis. 1 The main cause of obstruction is sialolithiasis, which occurs in up to 70% of cases, and the second most common cause is stricture, which accounts for almost 25% of all obstructive symptoms. 2 Traditionally, submandibular gland resection has been used to manage hilar or intraparenchymal stones. Management of obstructive symptoms of the parotid gland has been challenging. The development of sialendoscopy allows intraluminal visualisation and evaluation of the ductal system permitting minimally invasive treatment.Studies showing functional recovery of the gland after management of the obstruction support the use of minimally invasive techniques. 3 The role of sialendoscopy in the management of inflammatory conditions, however, remains controversial.We investigated the clinical findings, treatment and outcome of patients with major salivary gland symptoms managed with sialendoscopy at our institution. Ethical considerationsAccording to Finnish legislation, because the data were collected retrospectively and the study had no impact on the present patients' treatment, it required no Research Ethics Board approval. An institutional research permission was granted. ResultsA total of 228 patients (mean age 46 years, range 4-81; 61% women, 17 under age 18) underwent 266 sialendoscopies: 50.4% (134) for the parotid and 49.6% (132) for the Correspondence: J. Jokela,

The level of discomfort and pain experienced during the operation was assessed as 'mild' or 'none' by 85% and 89% of the patients, respectively. The level of pain experienced after the operation was 'major' in 4% of patients and 'mild' or 'none' in the majority (87%) of patients. The patients' estimations showed no significant difference between the diagnostic and interventional procedures, although it seems that patients who underwent stone removal by transoral incision experienced the operation as a bit more uncomfortable and painful than other patients. Afterwards 97% of patients stated that they would agree to a new LA/LAS sialendoscopy in the future if needed.