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- Salivary Duct Stenosis
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Background
Salivary duct stenosis is a common cause of obstructive sialadenitis - with a stricture defined as a narrowing in the duct sufficient to cause impairment to smooth outflow of saliva (Ngu 2007).
Ngu et al identified among 1362 sialograms done over a 10 year period for patients referred for recurrent salivary swelling and evidence for salivary obstruction. Among the 877 sialograms showing evidence of benign intraductal obstruction 198 (22.6%) identified ductal strictures in the absence of stones 642 (73.2%) or mucus plugs 37 (4.2%). the main presenting symptoms included swelling of the gland with 'meal-time syndrome'
Etiology
Causes of Ductal Stenosis | (Koch 2012, 2017 Kopec 2013) |
| Allergy | up to 26.8% / 29.6% |
| Autoimmune | up to 16.7% / 18.5% |
| Bruxism or cranio-manidbular disorder | up to 5.2% |
| Dental Prosthesis | 1.45 % |
| Irradiation | up to 3.7% - 5.1% |
| Sialolithiasis | 16.7% |
| Surgery | 13.8% / 5.2 - 12.9% |
| Other | 0.7% |
Hypothesized Causes of Stricture (Ngu 2007) |
| Epithelial ductal injury due to calculi |
| Recurrent infection |
| Minor trauma |
| Congenital |
- Trauma
- Surgical manipulation of oral cavity
- Intra-oral dental xrays - (Kieliszak 2015)
- Sialolith
- Autoimmune disorders
- Viral and bacterial infection
- Radiation (I131, External beam)
- Pneumoparotitis (Goates AJ, Lee, Dan et al 2018)
- Unknown
References
Koch M, Iro H. Salivary duct stenosis: diagnosis and treatment. Acta Otorhinolaryngol Ital. 2017 Apr;37(2):132-141. doi: 10.14639/0392-100X-1603. PMID: 28516976; PMCID: PMC5463521.
Koch M, Iro H, Kunzel J, et al. Diagnosis and gland-preserving minimally invasive therapy for wharton’s duct stenoses. Laryngoscope 2012; 122: 552-8
Kopec T, Szyfter W, Wierzbicka M, et al. Stenoses of the salivary ducts-sialendoscopy based diagnosis and treatment. Br J Oral Maxillofac Surg 2013;51:e174-7
Nahlieli O, Shacham R, Yoffe B, Eliav E. Diagnosis and treatment of strictures and kinks in salivary gland ducts. J Oral Maxillofac Surg 2001;59: 484–490; discussion, 490–492.
Plonowska KA, Gurman ZR, Humphrey A, Chang JL, Ryan WR. One-year outcomes of sialendoscopic-assisted salivary duct surgery for sialadenitis without sialolithiasis. Laryngoscope. 2019 Apr;129(4):890-896. doi: 10.1002/lary.27433. Epub 2018 Aug 27. PMID: 30152080.
Lee LI, Pawar RR, Whitley S, Makdissi J. Incidence of different causes of benign obstruction of the salivary glands: retrospective analysis of 493 cases using fluoroscopy and digital subtraction sialography. Br J Oral Maxillofac Surg. 2015 Jan;53(1):54-7. doi: 10.1016/j.bjoms.2014.09.017. Epub 2014 Nov 11. PMID: 25445390.
Ngu RK, Brown JE, Whaites EJ, Drage NA, Ng SY, Makdissi J. Salivary duct strictures: nature and incidence in benign salivary obstruction. Dentomaxillofac Radiol 2007;36:63–67
Kieliszak CR, Shokri T, Joshi AS. Acquired Wharton's duct stenosis after dental radiographs treated with sialendoscopy. BMJ Case Rep. 2015 Apr 26;2015:bcr2014209117. doi: 10.1136/bcr-2014-209117. PMID: 25917069; PMCID: PMC4422927.
Gillespie MB, Intaphan J, Nguyen SA. Endoscopic-assisted management of chronic sialadenitis. Head Neck 2011;33:1346–51.
Goates AJ, Lee DJ, Maley JE, Lee PC, Hoffman HT. Pneumoparotitis as a complication of long-term oronasal positive airway pressure for sleep apnea. Head Neck. 2018 Jan;40(1):E5-E8. doi: 10.1002/hed.25003. Epub 2017 Nov 17. PMID: 29149468.