Role of Sialendoscopy in Non-neoplastic Parotid Diseases: A Prospective Study of 241 Patients in Indian Population

Abstract

Objectives To assess the role of sialendoscopy as a diagnostic modality and in managing cases of non-neoplastic parotid gland diseases. Secondly, to provide descriptive analysis of intraoperative findings. Methods The patients of chronic parotid sialadenitis who presented with complaints of recurrent unilateral or bilateral parotid swelling and pain were included in the study. All patients underwent sialendoscopy, and the findings were noted. Intervention was carried out in the same sitting like dilatation of stenosis, stone removal by basket, combined approach, flushing of mucoid flakes, etc. Failed cases were worked up with radiological investigation and managed accordingly. Results Two hundred and forty-one cases of parotid sialadenitis who underwent sialendoscopy between 2012 and 2018 were included. Diagnostic sialendoscopy was achieved in 100% cases, while intervention was successful in 96.7% (233/241) cases after the first procedure. On diagnostic sialendoscopy, ductal stenosis was the most common pathology present in 177 (73.4%) patients followed by stones (12%) and debris (11.6%). All cases of stenosis were serially dilated with increasing sizes of sialendoscopes followed by stenting in 75% of the cases. The diagnosis of juvenile recurrent parotitis was confirmed in 17 children (mean age 5.6 years) with consistent clinical history and sialendoscopic findings of stenosis along with pale ductal mucosa. There were 18 cases where ductal perforation was seen. One case showed multiple hyperdense foci in bilateral parotid gland along with multiple strictures that underwent repeat sialendoscopy, but the symptoms did not resolve, and finally the patient underwent bilateral superficial parotidectomy. Conclusion Sialendoscopy is a safe and highly effective modality in managing non-neoplastic parotid gland disorders with low complication rates and resulted in gland preservation in the vast majority of patients. Therefore, it can be concluded that sialendoscopy is the diagnostic and therapeutic modality of choice for parotid obstructive sialadenitis.

Sialendoscopy Findings Associated with Positive Minor Salivary Gland Biopsy

“…Of those studies, many utilized different classifications systems to identify location of ductal pathologies. 19,[33][34][35] [36][37][38] Although useful for descriptive purposes, no single classification scheme has been validated as a means to predict disease etiology or patient outcome from treatment. We followed the Kopec et al classification to include the gland's ostium, main duct, hilum, and the segment of the duct proximal to the hilum (including secondand third-order intraglandular ducts).…”

“…Few studies have mentioned the different locations of pathology along the salivary duct. Of those studies, many utilized different classifications systems to identify location of ductal pathologies 19,33–35 . These different classifications include the LSD classification (Lithiasis, Stenosis, Dilation) created by Marchal et al in 2008 and the ductal stenosis classification which is a modified version of the Koch et al classification created by Kopec et al in 2013 36–38 .…”

A retrospective study of magnetic resonance sialography imaging applied in the prognostic evaluation of chronic obstructive parotitis

“…Recurrent infections may lead to the destruction of alveoli and progressive loss of glandular function ( 1 ). Its inciting factors include stones, strictures, mucus plugs and debris ( 2 ).…”