Improvement of dry mouth following intraductal irrigation of salivary glands

Abstract

Objectives To assess the effect of major salivary gland intraductal irrigations (IGs) to relieve mouth dryness. Methods We retrospectively analyzed the records of patients with mouth dryness who underwent major salivary gland IG during 2013–2015. Records included demographics, medical background, dry mouth etiologies and symptomatology, and results of sialometry and sialo‐cone‐beam computerized tomography. Subjective improvement following the IG procedure (yes/no) and sustained subjective improvement (mouth dryness relief for ≥1 month) were recorded. Objective improvement was assessed by comparing the mean unstimulated (USF) and stimulated (SSF) whole salivary flow (WSF) rate before and after the IG. Results Seventy‐four patients were included [mean age: 59.08 ± 12.46 years]. Improvement was detected in the USF (p = .027), but not in the SSF (p = .878). Fifty‐five (84.6%) noted subjective improvement, while 10 (15.4%) did not. Subjective improvement was positively associated with the USF following IG (p = .037), with salivary gland swelling episodes (p = .033), and with difficulties in swallowing dry foods (p = .014). Of those with subjective improvement, 45 (81.8%) reported sustained improvement, which was positively associated with lack of a gritty eye sensation (p = .042) and abnormal sialo‐CBCT findings (p = .001). Conclusions Major salivary gland IG is a simple and safe procedure that may relieve dry mouth for a relatively extended duration. Further studies are needed to confirm these preliminary findings and assess their underlying mechanisms.

Efficacy of Office-Based Salivary Ductal Steroid Irrigation for Managing Post-Irradiation Xerostomia in Head and Neck Cancer Patients: A Retrospective Study

“…Furthermore, the analysis of between-subject effects on UWSF measurements in their study showed statistically significant results for the use of a salivary gland manipulator as a negative prognostic factor, which corresponded to our previously published study [18] which identified anti-xerostomic medicine as a significant indicator for irresponsiveness to the irrigation treatment. Another study from the same institute [17] also demonstrated similar findings, and identified that different diagnosis/etiologies for dry mouth had no significant associations with subjective or objective improvements after irrigation therapies, which was similar to our results. Douglas et al [26] reported 88.1% of symptomatic resolution in a total of 59 patients with a history of either Sjogren's syndrome or post radioactive iodine therapy status after a corticosteroid injection and a ductal dilation in sialendoscopic surgery, and again disclosed no significant predictors of the ultimate success rates of sialendoscopy in these patient populations.…”

“…Salivary gland ductal irrigation is a therapeutic procedure involving the flushing of the salivary ducts with a variety of solutions to address conditions such as obstructive sialadenitis, chronic recurrent parotitis, and xerostomia. Saline solution, frequently utilized for its safety and non-irritating nature, mechanically removes debris [10,11,17]. Antibiotics like gentamicin [23] are directed towards bacterial pathogens, particularly in cases of sialadenitis or post-operative infections, although their inappropriate use can result in resistance and allergic responses.…”

“…It has been reported that sialendoscopy increased saliva secretion and reduced xerostomia for up to 60 weeks in Sjögren's syndrome patients [16]. Up to 84% of subjective improvement in dry mouth following intraductal irrigation of salivary glands was reported by using only saline [17]. The effect of salivary ductal steroid irrigation on head and neck cancer patients with post-irradiation xerostomia remains largely unknown.…”

Intraoperative Visualization and Treatment of Salivary Gland Dysfunction in Sjögren’s Syndrome Patients Using Contrast-Enhanced Ultrasound Sialendoscopy (CEUSS)

“…It is suggested that exposure of salivary glands to stress results in the propagation of salivary gland stem cell capabilities due to cellular plasticity in the glands’ parenchyma. This could promote salivary gland repair [ 16 , 17 ]. Future (animal) studies should explore the effect of sialendoscopy on the ductal and acinar compartments to reveal the mechanism that accounts for this finding.…”

Sialographic Analysis of Radioiodine‐Associated Chronic Sialadenitis

“…This improved technology rekindled an interest in salivary imaging, including use of sialography, to assist in decision‐making regarding the role for sialendoscopy 4,5 . In addition, the intraductal irrigation done with bactericidal iodinated contrast in the course of performing a sialogram has helped with symptom control in selected cases 6–9 …”