Pediatric Sialendoscopy for Recurrent Salivary Gland Swelling: Workup, Findings, and Outcomes

Abstract

Introduction: Recurrent salivary gland swelling of the parotid and submandibular glands results in painful swelling in the pediatric population. There is no defined algorithm for workup and treatment of these disorders, resulting in wide heterogeneity and in some cases overuse of computed tomography (CT) imaging. Sialendoscopy (SE) is an interventional option for recurrent swelling of both glands; however, its effectiveness in the pediatric population is still being determined. Objectives: To assess preoperative imaging utilization and benefit in the workup of recurrent pediatric sialadenitis, intraoperative SE findings, and postoperative outcomes after intervention with SE. Methods: Case-series with a 5-year retrospective chart review on children undergoing SE for recurrent sialadenitis. Results: Forty-nine SE procedures were performed on 38 parotid glands (PG) and 11 submandibular glands (SMGs) in 29 children. CT imaging findings were useful for identifying a stone or stricture and guiding surgical management in 45.5% of SMGs versus 2.6% of PGs ( P < .001). A stone was found in 45.5% of SMGs and none in PG ( P < .001). SE intervention such as balloon dilation or stone removal was performed in 54.6% of SMGs and 5.3% of PGs ( P < .001). 74% of parotid patients undergoing SE responded to 1 intervention with a cessation of recurrent gland swelling, while 26% required additional interventions. One hundred percent of SMG patients responded to first intervention. There was no improvement in the beneficial effect of SE with steroid injection ( P = .897) regardless of steroid used ( P = .082). Conclusion: CT findings were found to be low yield for recurrent parotid swelling, and ultrasound is a recommended first-line step for PG pathology. SE is a recommended first-line intervention for SMG and parotid sialadenitis as demonstrated by 100% and 74% response rate to initial SE, respectively.

Unilateral Sialendoscopy for Juvenile Recurrent Parotitis: What Happens to the Other Side?

“…Some authors raise questions whether to attribute positive outcomes in JRP to sialendoscopy or to the natural history of the disease based on the higher age of children with better clinical response. 22 However this was not the case in our study as such correlation was not found.…”

Sialendoscopy approach in treating juvenile recurrent parotitis: A systematic review

“…Amoxicillin-clavulanic. Cephalosporin N/A Borner et al [ 14 ] Fibrous, stenosis Methylprednisolone LA /GA N/A N/A Velasquez et al [ 27 ] Fibrinous debris, duct stenosis Triancinolona GA N/A N/A Capaccio et al [ 35 ] Mucous plugs, stenosis, debris, pale duct SS + dexamethasone Sedation Amoxicillin Swelling (1 case) and pain (N/A) Iordanis et al [ 21 ] N/A SS + prednisone GA Amoxi-clavulanate (1 day preOP) N/A Kanerva et al [ 15 ] N/A SS ± hydrocortisone GA/LA None Swelling (1 case) Gellrich et al [ 16 ] N/A SS + prednisone N/A N/A N/A Nation et al [ 17 ] Sludg, stenosis SS ± steroids (solumedrol, hydrocortisone, triamcinolone, decadron) GA N/A None Berlucchi et al [ 28 ] Mucous plugs, stenosis, debris, pale duct SS + hydrocortisone GA Yes (postOP) None Faizal et al [ …”

“…The same number of episodes but in a 12-month period was the criterion for sialoendoscopy, which was applied in 213 patients [ 7 , 9 , 11 , 18 , 27 – 30 ]. In 11 studies in our review, the presence of two or more episodes of parotid swelling was reported as a criterion, but without specifying the time of presentation [ 1 , 14 , 15 , 17 , 19 , 20 , 31 – 35 ]. Two authors, Gellrich et al [ 16 ] and Singh et al [ 36 ] describe, in their series, the indication for the technique included patients who presented a minimum of five or six episodes of swelling in 12 months.…”

Treatment of juvenile recurrent parotitis with irrigation therapy without anesthesia

“…Furthermore, sialendoscopy may be a useful diagnostic tool for the assessment of a specific obstructive etiology for sialadenitis and thus allows for the correct diagnosis of JRP. However, intraoperative findings of a specific obstructive etiology, as stones or ductal stenosis are rare [ 18 ]. Furthermore, the effect of the mechanical manipulation by introducing and advancing the endoscope remains unknown.…”