Complications of traditional and modern therapeutic salivary approaches

Abstract

Le complicanze dopo chirurgia tradizionale delle ghiandole salivari sono notoriamente documentate in letteratura e comprendono: la sindrome di Frey, la paralisi parziale o completa del nervo facciale, le lesioni del nervo grande auricolare, lo scialocele, la fistola salivare e gli esiti cicatriziali a livello della cute del volto. Per contro, le principali complicanze secondarie ai trattamenti endoscopici risultano essere l’avulsione del dotto salivare, le stenosi secondarie, la tumefazione ghiandolare, le fistole salivari, le perforazioni da falsa strada, le ranule post- traumatiche e le parestesie del nervo linguale. In generale, le moderne tecniche di chirurgia minimamente invasiva mostrano un tasso di complicanze post-operatorie significativamente inferiore rispetto alla chirurgia tradizionale delle ghiandole salivari. Tuttavia, un confronto tra le due strategie chirurgiche non può svolgersi correttamente perché esse sono applicate a diversi ambiti patologici. La combinazione di più tecniche di chirurgia minimamente invasiva rende sfumata la linea di confine tra chirurgia “tradizionale” e “moderna”, risultando utile e necessaria una più dettagliata descrizione del progressivo abbandono delle tecniche tradizionali a favore delle nuove.

Transoral Robotic Surgery in the Management of Submandibular Gland Sialoliths: A Systematic Review

“…Notably, the possible traumatic mechanical effect of robotic instruments during RAS might contribute to the high rate of postsurgical transient lingual nerve injury (28.3%) in our review. Although our results are higher than those reported in the literature regarding the CA technique [7,9,33,35,36], patients from the included studies were considered to suffer from transient lingual nerve injury, even if the lingual paresthesia remained very subtle. Additionally, all patients in our review were treated with the Da Vinci Si and SP robot (Intuitive Surgical Inc., Sunnyvale, CA, USA), or Flex Robotic system (Medrobotics Inc., Raynham, MA, USA).…”

An Overview on the Histogenesis and Morphogenesis of Salivary Gland Neoplasms and Evolving Diagnostic Approaches

“…There are risks of morbidity in all therapeutic interventions of SGNs. First of all, the complications after surgical therapy may include total or partial nerve damage, facial numbness, loss of lingual sensation, sialoceles, and salivary fistula [99]. In some cases, patients experience Frey's syndrome or gustatory sweating, which is sweating in the facial area while chewing.…”

“…In some cases, patients experience Frey's syndrome or gustatory sweating, which is sweating in the facial area while chewing. These complications usually take months to heal; however, in rare cases, they can be permanent [99]. Regarding the application of radiotherapy in treating SGNs, this method would also leave multiple complications to the patients.…”

Outcomes of Submandibular Stone Removal With and Without Salivary Endoscopes

“…Although rare (2%-3%), complications include duct avulsion, stricture, fistula, perforation, ranula, and lingual nerve paresthesia. 23,24 Furthermore, training a surgeon to operate the equipment requires at least 30 cases to reach satisfactory operation times and performance ratings. 25 The increase in cost to the patient may also be significant in comparison to incisional sialolithomy, depending on the location of the procedure (outpatient or operating room) and variable costs for different institutions.…”