Algorithms for Treatment of Salivary Gland Obstructions

Salivary gland dysfunction worsens the quality of life, but treatment for restoration of salivary gland function is limited. Although previous reports have demonstrated the therapeutic potentials of extracellular vesicles (EVs) in different preclinical models, the role of EVs in salivary glands remains elusive. Furthermore, little is known about the roles of salivary gland-derived EVs in tissue repair or regeneration compared to other EVs. In this study, EVs secreted from salivary gland-derived mesenchymal stem cells (sgMSCs) were comparatively analyzed with those from Wharton's jelly-derived MSC (wjMSCs). sgMSCs secreted more significant amounts of EVs than wjMSCs, and salivary gland epithelial cells showed a more efficient uptake of sgMSC-EVs than wjMSC-EVs. The possibility of immune regulation was tested via macrophage polarization and LPS-induced epithelial inflammation, resulting in an M1-to-M2 shift and reversal of acinar-to-ductal metaplasia by sgMSC-EV. Furthermore, the roles of sgMSC-EV-mediated immune regulation and tissue repair were clarified in vivo via retroductal delivery of sgMSC-EVs in a mouse model of obstructive sialadenitis. Collectively, our data demonstrate the superior role of sgMSC-EVs in the recovery from salivary gland inflammation and injury and suggest EVs as therapeutic tools for salivary gland dysfunction.

The aim of this study was to evaluate the gland function of patients following endoscopy-assisted removal of impacted hilo-parenchymal stones in the Wharton’s duct. The study cohort comprised 115 patients who had undergone successful endoscopy-assisted lithotomy for hilo-parenchymal stones (mean diameter 7.7 mm). Gland function was evaluated at a mean 12 months after surgery using ultrasonography, sialography, and/or sialometry. Postoperative ultrasonography of 51 affected glands revealed a regular gland size in 58.8%, normal parenchyma density in 51.0%, and ductal ectasia in 80.4%. Postoperative sialograms of 109 affected glands were scored as type I (approximately normal) in 13 cases, type II (saccular ectasia of the hilo-parenchymal duct with/without stenosis, and no contrast retention) in 64, type III (saccular ectasia of the hilo-parenchymal duct with/without stenosis, and mild contrast retention) in 23, and type IV (poor shape of the main duct with evident contrast retention) in nine cases. The existence of ductal ectasia corresponded well to larger stone cases (P = 0.002). In the postoperative sialometry of 35 patients with unilateral stones, differences between the two sides were insignificant (P > 0.05). For patients with hilo-parenchymal submandibular gland stones, endoscopy-assisted surgery and extended postoperative follow-up help preserve the gland with good function.

The objectives of this systematic review are to assess the efficacy of sialendoscopy alone, without combined surgical approach, in treatment of obstructive salivary gland disease and overall gland preservation.

PubMed, Cochrane library and Google Scholar were searched up to 30th October 2023. Two reviewers independently screened the articles and included them if they met the inclusion criteria. Any uncertainty and discrepancy regarding any study was discussed among the two review authors and if no harmony was met, then it was resolved by the third author. Studies that used sialendoscopy alone for the management of salivary gland obstruction were selected. Outcome measures included rates of success and overall gland preservation.

22 articles were included in the systematic review. From these 21 articles for success rate and 12 articles for gland preservation were included in meta-analysis. Pooled proportion for success rate and gland preservation was 0.75 (95% CI 68–82) and 0.98% (98% CI 97–99) respectively.

Sialendoscopy is a reliable therapeutic modality in management of non-neoplastic salivary gland diseases. It is effective, non-invasive, safe, and gland preserving.

The aim of this study was to propose a treatment strategy for intraglandular submandibular calculi based on calculus site. Seventy-three consecutive patients with impalpable intraglandular submandibular calculi were enrolled retrospectively. The calculi were classified as either post-hilar type, central type, or superficial type. Treatment approaches included transoral duct slitting (TDS), interventional basket retrieval (IBR), intraductal laser lithotripsy (ILL), and transcervical lithotomy (TCL). Complete calculus removal with gland preservation was achieved in 64 patients (87.7%). The success rate for post-hilar, central, and superficial calculi was 86.4% (51/59), 90.9% (10/11), and 100% (3/3), respectively. The treatment approach applied in patients with treatment success was TDS in 32 cases, IBR in 20, ILL in nine, and TCL in three. During follow-up (median 17.3 months), one patient experienced gland atrophy and three had ductal stenosis; the remaining 60 patients (93.8%, 60/64) had good clinical outcomes. In the eight failure cases operated by TDS, the deeply situated calculi could not be detached despite the parenchymal incision in five cases, while the procedure was ceased due to the patient’s inability to cooperate in the other three cases. In the remaining failure case, the submandibular gland was sacrificed after calculus extraction via TCL. Application of the proposed treatment algorithm might help preserve gland function in patients with intraglandular submandibular calculi.

Les lithiases parotidiennes postérieures peuvent dans certains cas nécessiter une chirurgie d’exérèse par voie combinée associant la sialendoscopie à une voie d’abord externe, soit intra-orale, soit transfaciale. Cette étude rétrospective monocentrique a pour but de décrire la technique opératoire d’une exérèse de lithiase parotidienne par voie combinée (externe et sialendoscopique) avec l’aide de la navigation. Cinq patients ont été inclus entre novembre 2014 et juillet 2020. La lithiase était extraite dans 100 % des cas. Les repérages par navigation et par transillumination correspondaient systématiquement. Aucun patient n’avait de trouble de la motricité faciale en postopératoire. Après un suivi de 2 à 21 mois, il n’y a eu aucune récidive de sialolithiase. La navigation peut-être un complément de la transillumination, susceptible d’améliorer le confort et la sécurité opératoire, mais elle ne se substitue pas à la sialendoscopie en première intention. Le contrôle visuel est en effet nécessaire lorsqu’il est possible, après ablation du calcul. Au cours des voies combinées, elle semble permettre un repérage précis des lithiases salivaires parotidiennes. En cas de sténose infranchissable, elle pourrait être une alternative thérapeutique avant la parotidectomie.

Sialendoscopy is a minimally invasive procedure considered a paradigm shift in the treatment of obstructive sialadenitis. However, it shows an average need for revision procedure in up to 24% of operated cases. This study analyzed whether patient-related variables could predict the need for a revision during postoperative follow-up.

From 2012 to 2020, this prospective comparative study analyzed demographic data as well as preoperative responses to the “Manukau Salivary Symptoms Score” (MSSS) questionnaire as predictors of the need for a revision procedure due to symptoms recurrence.

188 sialendoscopies (39.4% for stones/60.6% for stenoses) in 112 parotid (59.6%) and 76 submandibular glands (40.4%) were included in this study. Forty patients (21.3%) required a revision procedure. The variable “Impact on quality of life” in the preoperative period of patients with sialoliths showed that the likelihood of a revision procedure increases by 33.6% with each increase in the 10-point Likert scale presented in the MSSS (p = 0.010, OR = 1336, CI = 1.071 to 1.667). This finding was not influenced by the location of the sialolith in the duct (p = 0.415), size (p = 0.058) or number of stones (P = 0.476). Other demographic variables related to the patient showed no association with the need of a revision procedure.

Further studies should be performed to exclude the influence of other variables on the results; however, special attention should be given to patients who report a greater pre-operative impact on quality of life due to sialolithiasis.

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