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Gland-Preserving Approach to Chronic Sialadienitis Has Successful Outcomes

by Amy Hamaker •

Clinical Question

What are the medium-term clinical and quality-of-life (QOL) outcomes following a gland-preserving approach for chronic sialadenitis (CS)?

Background: CS is a relatively common benign disorder of the major salivary glands. Salivary endoscopy provides a minimally invasive gland-preserving approach for sialolithiasis treatment with clearly demonstrated therapeutic benefit, but the symptom relief and gland preservation rates further out from treatment, and the potential effect of the procedure on salivary-related QOL are not as clear.

Study design: Cross-sectional survey with retrospective chart review of 206 eligible patients who underwent attempted gland-preserving surgery with salivary endoscopy for CS between October 2008 and April 2013.

Setting: Department of Otolaryngology, Medical University of South Carolina, Charleston.

Synopsis: Median time from surgery to survey completion was 17 months. Etiology included several broad categories: patients with stones, patients with scar blockage, thyroid cancer patients who developed CS after radioiodine treatment, recurrent juvenile parotitis patients, and a Sjögren’s/non-Sjögren’s inflammatory group. Patients with inflammatory CS causes were more likely to be younger, to be female, to have multigland involvement, and to be treated with salivary endoscopy alone. Heavy caffeine consumption, active smoking, and the use of drying medications were not associated with poorer outcomes in gland-preserving surgery. With regard to treatment, the majority of patients (95%) were managed with a gland-preserving approach; 10 patients (5%) required gland excision after a failed gland-preserving strategy. The affected gland was intact in 92% of treated patients at last follow-up. Patients with stones were significantly less likely to be managed by endoscopy alone. In QOL issues, the majority of patients (89%) reported symptom improvement and would recommend the treatment to others (90%); nearly half (46%) noted ongoing symptoms.

Bottom line: The majority of patients treated with gland-preserving surgery for CS experience symptomatic improvement, although a significant number continue to have some level of persistent symptoms.

Citation: Gillespie MB, O’Connell BP, Rawl JW, McLaughlin CW, Carroll WW, Nguyen SA. Clinical and quality-of-life outcomes following gland-preserving surgery for chronic sialadenitis. Laryngoscope. 2015;125:1340-1344.