Algorithms for Treatment of Salivary Gland Obstructions
Section snippets
Pretherapeutic diagnostic examinations
Ultrasound and sialendoscopy are the authors' methods of choice for diagnosing sialadenitis. In the absence of ultrasound, sialography is still regarded as a standard technique. Ultrasound allows a presumptive diagnosis to be made quickly, safely, cost effectively, and with great precision. Sialendoscopy serves to provide a direct demonstration of the obstruction and thus allows confirmation of the diagnosis. Furthermore, it can also lead to endoscopy-controlled treatment (interventional
Algorithm for the treatment of sialolithiasis
With an incidence of approximately 60% to 70%, stones are the most common cause of all salivary-duct obstructions; their prevalence in the general population is approximately 1%.3, 37, 38 Conservative measures of treatment like massage of the gland, sialgogues, antiinflammatories, and where indicated, antibiotic medication should precede more invasive measures.
Decisive parameters for the further management are size, location (distal duct, hilar region, intraparenchymal ductal system), number
Algorithm for the management of stenoses
An impression of the characteristics of the stenosis may be gained using ultrasound or sialography, but especially with the aid of sialendoscopy.2, 51 The decisive factors for therapy, however, are location, the number of stenoses, their length, the degree of obstruction, and the character of the tissue in the region of the stenosis.
Sialendoscopy has the advantage of direct assessment, allowing an inflammatory stenosis to be differentiated from a fibrous stenosis. The majority of the former may
Summary
The treatment of obstructive diseases of the major salivary glands has undergone a fundamental transformation over the past 10 to 15 years. The rate of gland removal has been significantly reduced to below 5%. The disadvantage of the more recent therapeutic procedures is that the use of these techniques in a daily clinical routine is linked to the availability of the instruments and equipment. Temporal, staffing, and organizational requirements for the hospital are sometimes increased. The
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2022, American Journal of Otolaryngology - Head and Neck Medicine and SurgeryCitation Excerpt :Obstructive salivary gland disease (OSGD) is associated with salivary calculi (in 50–60% of cases), ductal strictures (idiopathic, congenital, inflammatory, post-traumatic, or post-irradiation [2], mucoprotein plugs, ductal membranes, foreign bodies or even anatomical variations in the salivary ducts [3,4]. Sialolithiasis and stenosis account for approximately 90% of all obstructive salivary gland diseases [5,6]. An anatomical dissection study published by Rauch et al. showed that sialolithiasis affects 1% of the salivary glands [7], whereas the prevalence of symptomatic patients is less frequent (1/5000 to 1/30,000) [8].