| Chronic sialadenitis or sialolithiasis is a relatively common disease that may present to the head and neck surgeon. And the incidence of sialolithiasis presents in 1 per 10,000 to 30,000 people in the general population per year. Chronic sialadenitis is often secondary to salivary gland obstruction which causes pain and swelling in the affected gland especially during meals. The traditional methods to treat sialolithiasis include medical treatment with antibiotics and anti-inflammatory drugs and surgical excision of the involved salivary gland. Medical treatment only can control the symptom, but not cure. While surgical excision of the involved salivary gland can cause many complications such as facial nerve injury, lingual nerve injury, scar on face. Both methods are not good for patients. Salivaryendoscopy which was first described in 1991 is a technique that has been developed and successfully applied to offer a minimally invasive and gland-preserving approach to chronic obstructive sialadenitis. Also sialendoscopy is considered to be a safe technique with few complications. So it had been widely used to treat patients of obstructive sialoadenitis by the head and neck surgeon. But still there are some controversies. For example: whether stent should be placed in the duct or not and how long should stent be kept? In some reports, stent was used after operation, and kept for 1-2weeks; while in other studies, stent seems to be unnecessary, and it made patient uncomfortable after surgery.The aim of this retrospective review was to validate the necessity of stent placement after operation and the residence time of stent in our patient. The influencing factors of the residence time are also investigated.Part One:Epidural tube making endoscopic access easier in the Sialendoscopy operationAbstract:Salivary endoscopy which was first described in 1991 is a safe technique with few complications that has been developed and successfully applied to offer a minimally invasive and gland-preserving approach to chronic obstructive sialadenitis. To many surgeons the entrance to the duct lumen of salivary gland is the most difficult and time consuming step in the procedure. Here we introduce a timesaving and simple method to enter duct lumen by epidural tube, a plastic tube with a blunt tip.Objective:To evaluate the value of epidural tube in modified endoscopic approach.Method:Two groups were divided including traditional group and modified group. The time consuming and success rate for endoscopic approach were reviewed.Results:Traditional methods:6 cases by papilla dilation,4 cases needed papillotomy, the average time consuming were about 22.6 minutes, with 60%success rate. While modified methods all the sialendoscopy approach by papilla dilation, the average time consuming were about 13.7 minutes.Conclusion:Epidural tube made the sialendoscopy approach by papilla dilation method easier. The method can be time saving, practicality, low cost, and was worth for application in clinical practice.Part Two:Stent is recommended to be placed in the duct after sialendoscopyAbstract:Introduction:Chronic sialadenitis or sialolithiasis is a relatively common disease which was hard to treat. Salivaryendoscopy which was first described in 1990 is a technique that has been developed and successfully applied to offer a minimally invasive and gland-preserving approach to chronic obstructive sialadenitis. But still there remain some controversies. The placement of Stent and stenting time is one of the controversies.Objective:to validate the necessity of stent placed after operation and the residence time of stent in our patient. The influencing factors of the residence time are also investigated.Method:Sialendoscopy was used to treat patients of sialolithiasis and sialadenitis. During the operation, epidural tube used to find the papilla hole, and worked as a guide wire to help sialendoscopy getting into the duct was used as a stent. The effect of stent residence and stenting time were documented.Material:During the study period, from 2013 to 2014, we performed interventional sialendoscopy on 17 patients (M 8:F 9), mean age of 43.2 years (range,28-64 yrs). 10 of our patients had sialolithiasis, and 7 had sialadenitis. Preoperational investigations included scintigraphic examination and ultrasonography.Results:17 cases were performed endoscopically whereas in 1 (1/17) patient a combined approach was used to remove the stones,1(1/17) patient had submandibular gland excision.10(10/17) cases had stones. In sialolithiasis cases:8 (8/10) cases had stone anterior of the duct,1(1/10) case stone was in the middle of duct,1(1/10) case stone was posterior of the duct.9(9/10) cases of stone were removed by sialendoscopy, 1(1/10) case of stone had gland excision.4 cases stent kept in 1 week,6 cases stent kept in 2 weeks,4 cases stent kept in 3 weeks,2 cases stent kept in 4 weeks. Cases of papilla dilation approach (7/8) and sialadenitis without stone (6/7) had a shorter time, from 1 week to 2 weeks, while cases of papillotomy approach (4/7) and sialolithiasis (5/9) had a longer time, from 3 weeks to 4 weeks; Gland with a better function had a shorter time (6/12), from 1 week to 2 weeks, while gland with a worse function need a longer time (5/12), from 3 weeks to 4 weeks. One case with papillotomy of the Wharton's duct developed a ranula. No other major complications were observed in the follow-up period except several cases have little discomfort in eating and speaking caused by stent.Conclusion:Early results suggest that stent is necessary to be placed in the duct after sialendoscopy. The time stent kept in the duct was determined by the gland function, surgical approach and operation wound.Part Three:The initial study for Sialoendoscopy therapy combined with catheterization to treat recurrent salivary gland inflammation in childrenABSRACT:Background:The definitive cause of most cases of recurrent salivary gland inflammation in children remains unknown. Relatively little has been written about the use of sialendoscopy as a diagnostic and therapeutic tool in children. Objective:To evaluate the safety and efficacy of sialendoscopy as a diagnostic and therapeutic tool for recurrent salivary gland inflammation in children.Methods:Medical records of all patients who underwent sialendoscopy for recurrent salivary gland inflammation from the Second Department of Oral and Maxillofacial Surgery, School &Hospital of Stomatology, Wuhan University were reviewed. Comparison of pre-procedure vs. post-procedure frequency and severity of disease was reviewed. Sialendoscopy findings were also reviewed.Results:Nine patients (aged 3.5-14 years old) underwent sialendoscopy (6/9 parotid, 3/9 submandibular). There were no complications except swelling. No post-operative recurrence was noted in 6/9 patients; decreased frequency of recurrence was noted in 3/9 patients. Operative findings from sialendoscopy from 9 cases showed stones (2/9), purulent debris (2/9), duct stenosis (4/9), fibrinous debris (5/9),mucoid debris (2/9), sialodochitis (2/9).Conclusions:Sialendoscopy is a safe, minimally invasive procedure that may decrease the frequency of recurrences for salivary gland inflammation in children. In contrast to previously published work, the most common cause of salivary gland obstruction in this series was debris, rather than stones. For the safety, the indications should grasp in clinic. The initial results need to be confirmed in a larger series with a more long-term follow-up. |
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