Endoluminal Intervention in the Salivary Duct: Clinical Outcomes at a District General Hospital

Abstract

Our aim was to assess the preliminary clinical outcomes of interventional radiology for salivary duct obstruction in relation to salivary duct strictures or calculi. A retrospective analysis of consecutive patients referred for endoluminal procedures by ENT surgeons during a 4-year period were identified. The procedure was performed by a single interventional radiologist under fluoroscopic guidance using wire baskets and angioplasty balloons. Between June 2004 and October 2008, 50 sialoplasties were performed in 43 patients (30 female and 13 male). Twenty-six patients were prepared for 32 procedures for extraction of calculi (13 submandibular and 13 parotid), and 17 patients had 18 procedures for strictures (16 parotid and 1 submandibular). One patient in the group with calculi was judged unsuitable for intervention because the stone had migrated outside the salivary duct. Information was collected regarding the clinical indication; duration and type of symptoms; technical factors; follow-up; and success or failure of reintervention. Complete stone removal was achieved in 18 of the 26 patients (69%), with success on the first attempt in 14 patients (54%). Redo procedures were required in 4 patients (15%), with subsequent complete clearance of calculi. In this cohort, 20 patients were symptomatically improved (77%). Of the 6 patients (26%) with continuing symptoms, 2 patients had mild symptoms; two had moderate symptoms; and two patients opted to have surgery for unremitting symptoms. In the stricture group, 18 procedures were performed in 17 patients, with a successful outcome in 16 patients after the initial sialoplasty. Only 1 patient required repeat intervention (6%) and later opted to have surgery for continuing symptoms. In this group, 14 patients (82%) were symptomatically improved, and 3 remained symptomatic despite a good immediate result due to restenosis. Two patients experienced early complications: One had a transient facial nerve palsy, and the other had sialadenitis treated with antibiotics. Preliminary results suggest that symptom resolution at first intervention is higher in patients with acalculous strictures. Patients with calculi are more likely to require a repeat procedure for complete clearance.

Stensen's Duct Stenosis Balloon Dilatation: Long‐term Evaluation of Clinical Outcomes and Quality of Life Impacts

“…In articles detailing the medium‐ and long‐term effects of SSBD, symptoms improved in 77% to 100% of patients, 6,7,10,14 in line with our results. Apart from isolated case reports, 3 other articles cited 30 additional cases, 24 of which were asymptomatic after at least 3‐month follow‐up (66%‐100% of patients) 9,12,16 …”

“…Apart from isolated case reports, 3 other articles cited 30 additional cases, 24 of which were asymptomatic after at least 3-month follow-up (66%-100% of patients). 9,12,16 Impacts of SSBD on QoL have yet to be assessed. Our general and specific QoL assessment results add an objective patient-focused dimension to this study.…”

“…Surprisingly, it is currently used very little in SDS reference centers. According to the literature, just 248 patients have been treated by this technique, 4–16 which is very low when compared with the SDS incidence in the population (close to 1/2500) 1,2 . There is a serious lack of data on the technique, its use, and long‐term clinical outcomes.…”

Lactoferrin and the development of salivary stones: a pilot study

“…The exact cause appears to be multifaceted and various hypotheses have been put forward. The formation seems to be related with factors such as hyposalivation, dehydration, and impaired crystalloid solubility (Avishai et al 2021a , b ; Capaccio et al 2007 ), agglomeration of sialomicroliths (Harrison 2009 ) and anatomical variation of the excretory salivary ducts (Nagra et al 2010 ). A decreased secretion rate and/or altered biochemical composition of saliva may also be a possible explanation for the formation of salivary stones (Kraaij et al 2014 ).…”

Computational fluid dynamics analysis of salivary flow and its effect on sialolithogenesis

“…Calculi development in the salivary extraglandular system frequently causes salivary gland obstruction, which manifests as pain and swelling (Jardim et al , 2011). Generally, the etiologies of sialolith retention can be divided into morpho-anatomic (Nagra et al , 2010) and saliva composition factors (Grases et al , 2003). These, in combination with other physiologic and physical factors, shape salivary calculi into fairly round micronuclei surrounded by concentric circled layers consisting of mucin and various other protein and mineral constituents, especially apatites (Sabot et al , 2012).…”