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- Salivary Duct Stenosis
- Click for more detail: Etiology/Diagnosis/Classification
Management Options
- Duct dilation
- Mechanical (ballon, sialendoscope, bougie) Parotid duct stricture sialoballon dilation with fluoroscopy and ultrasound
- Hydrostatic (instillation of saline / kenalog / radiocontrast (Diggelmann 2015) Submandibular sialogram ductal stricture; Normal Submandibular Sialogram Sequence
- Observation with intermittent medical therapy (steroids/antibiotics/botox)
- Parotidectomy (Marcus KS, Zhu VL et al 2020) Sialogram showing distal ductal stricture treated with parotidectomy; Sjogren's Syndrome ( Sjögrens ) with Sialolithiasis Treated with Bilateral Parotidectomy
- Ductoplasty with or without stenting Salivary Ultrasound Sonopalpation for Stone Favorable for Transoral Removal
- Duct reconstruction (vein graft)
- Tympanic neurectomy
- Botulinum neurotoxin
- Ductal infusion (Schwalje 2019) Botulinum neurotoxin infusion to the parotid via Stensen's duct Research protocol (IRB approved)
- Ultrasound guided needle injection Botox injection to salivary glands for hypersalivation
- Conservative Treatment
- Hydration / Avoid Drying Agents / Intermittent oral antibiotics/steroids
- Gland massage:
- Other (see: Ultrasound aided parotid ductoplasty - sialodochoplasty)
Outcomes Analysis
Plonoswska, Ochaoa, Ryan and Chang (Plonaowska 2020) - compared conservative treatment with sialendoscpy-assisted salivary duct surgery (SASDS) to manage chronic sialadenitis without sialolithiasis
- SADS included various combinations of sialodochotomy with sialodochoplasty; balloon dilation; application of diluted triamcinolone; stent placement; botulinum injection for refractory sialadenitis symptoms
- Conservative management included counseling about gland massage; oral hydration; avoidance of drying medications
- COSS (Chronic Obstructive Sialadenitis Symptoms) questionnaire administered at initial consultation and 3,6,9,12 and >12 months after (exclude irradiation/previous duct surgery/evidence of sialolithiasis)
- The intermittent and cyclical pattern of obstructive symptoms warrant assessments at multple time points after treatment
- Patients treated with SASDS improved symptom scores and reduced symptom severity at 6 month followup compared to those treated conservatively
References
Koch M, Zenk J, Iro H. Stenosis and stenosis-like lesions in the submandibular duct: Detailed clinical and sialendoscopy-based analysis and proposal for a classification. Oral Surg Oral Med Oral Pathol Oral Radiol. 2020 Nov;130(5):486-495. doi: 10.1016/j.oooo.2020.05.015. Epub 2020 Jun 5. PMID: 32665204.
de Paiva Leite SH, Morton RP, Ahmad Z, Marchal F. Do Postoperative Oral Corticosteroids Improve Results After Sialendoscopy for Ductal Stenosis? Laryngoscope. 2020 Sep 29. doi: 10.1002/lary.29111. Epub ahead of print. PMID: 32990331.
Makdissi J, Feinberg L, Roy A. Is there a role for ultrasound-guided balloon sialoplasty technique in salivary gland structures. Dentomaxillofac Radiol. 2017 Dec;46(8):20170088. doi: 10.1259/dmfr.20170088. Epub 2017 Oct 6. PMID: 28707525; PMCID: PMC5965945.
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.
Drage NA, Brown JE, Escudier MP, et al. Balloon dilatation of salivary duct strictures: report on 36 treated glands. Cardiovasc Intervent Radiol 2002;25:356–9.
Kruegel J, Winterhoff J, Koehler S, et al. Botulinum toxin: A noninvasive option for the symptomatic treatment of salivary gland stenosis - a case report. Head Neck. 2010;32:959–963.
Ellies M, Gottstein U, Rohrbach-Volland S, et al. Reduction of salivary flow with botulinum toxin: extended report on 33 patients with drooling, salivary fistulas, and sialadenitis. Laryngoscope. 2004;114:1856–1860.
Schwalje AT, Hoffman HT. Intraductal Salivary Gland Infusion With Botulinum Toxin. Laryngoscope Investig Otolaryngol. 2019 Sep 3;4(5):520-525. doi: 10.1002/lio2.306. PMID: 31637296; PMCID: PMC6793609.
Marcus KS, Zhu VL, Eigsti RL, Hoffman HT. Fibrous Salivary Ductal Stricture: A Novel Histopathologic Correlate. Ear Nose Throat J. 2020 May 26:145561320927553. doi: 10.1177/0145561320927553. Epub ahead of print. PMID: 32453645.
Marcus KS, Hoffman HT, Rajan Kd A. Not All Küttner Tumors Are IgG4-Related Disease (IgG4-RD). Head Neck Pathol. 2021 Jan 4. doi: 10.1007/s12105-020-01268-3. Epub ahead of print. PMID: 33398685.
Thorpe RK, Foggia MJ, Marcus KS, Policeni B, Maley JE, Hoffman HT. Sialographic Analysis of Radioiodine-Associated Chronic Sialadenitis. Laryngoscope. 2020 Nov 17. doi: 10.1002/lary.29279. Epub ahead of print. PMID: 33200832.
Marcus KS, Zhu VL, Eigsti RL, Hoffman HT. Fibrous Salivary Ductal Stricture: A Novel Histopathologic Correlate. Ear Nose Throat J. 2020 May 26:145561320927553. doi: 10.1177/0145561320927553. Epub ahead of print. PMID: 32453645.
Foggia MJ, Peterson J, Maley J, Policeni B, Hoffman HT. Sialographic analysis of parotid ductal abnormalities associated with Sjogren's syndrome. Oral Dis. 2020 Jul;26(5):912-919. doi: 10.1111/odi.13298. Epub 2020 Mar 3. PMID: 32031309.
Abukhiran I, Jasser J, Hoffman HT, Syrbu S. Mantle Cell Lymphoma Involving Major and Minor Salivary Glands With Parotid Sparing. JAMA Otolaryngol Head Neck Surg. 2020 Mar 1;146(3):309-311. doi: 10.1001/jamaoto.2019.4116. PMID: 31895458.
Schwalje AT, Hoffman HT. Intraductal Salivary Gland Infusion With Botulinum Toxin. Laryngoscope Investig Otolaryngol. 2019 Sep 3;4(5):520-525. doi: 10.1002/lio2.306. PMID: 31637296; PMCID: PMC6793609.
Hoffman HT, Pagedar NA. Ultrasound-Guided Salivary Gland Techniques and Interpretations. Atlas Oral Maxillofac Surg Clin North Am. 2018 Sep;26(2):119-132. doi: 10.1016/j.cxom.2018.04.001. PMID: 30077320.
Blake Sullivan C, Hoffman H. Dynamic imaging with sialography combined with sialendoscopy to manage a foreign body in Stensen's duct. Am J Otolaryngol. 2018 May-Jun;39(3):349-351. doi: 10.1016/j.amjoto.2018.03.001. Epub 2018 Mar 3. PMID: 29525141.
Truong K, Hoffman HT, Policeni B, Maley J. Radiocontrast Dye Extravasation During Sialography. Ann Otol Rhinol Laryngol. 2018 Mar;127(3):192-199. doi: 10.1177/0003489417752711. Epub 2018 Jan 7. PMID: 29308655.
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.
Goates AJ, Kung RW, Tracy CR, Hoffman HT. Intraductal Laser Fiber Tip Fracture and Retrieval During Sialendoscopic Laser-Assisted Lithotripsy. Ann Otol Rhinol Laryngol. 2017 Nov;126(11):774-777. doi: 10.1177/0003489417728736. Epub 2017 Sep 12. PMID: 28895432.
Ferreira da Silva RC, Lieberman SM, Hoffman HT, Policeni B, Bashir A, Smith RJ, Sato TS. IgG4-related disease in an adolescent with radiologic-pathologic correlation. Radiol Case Rep. 2016 Dec 7;12(1):196-199. doi: 10.1016/j.radcr.2016.10.008. PMID: 28228909; PMCID: PMC5310240.
Walvekar RR, Hoffman HT, Kolenda J, Hernandez S. Salivary Stone Pneumatic Lithotripsy in a Live Porcine Model. Otolaryngol Head Neck Surg. 2016 Jun;154(6):1023-6. doi: 10.1177/0194599816638313. Epub 2016 Apr 5. PMID: 27048662.
Hoffman HT, Walvekar RR, Tracy CR, Kolenda J, Pagedar N. Endoscopic Salivary Stone Fragmentation with Pneumatic Lithotripsy in a Simulation Model. Otolaryngol Head Neck Surg. 2016 Mar;154(3):454-9. doi: 10.1177/0194599815626138. Epub 2016 Jan 19. PMID: 26786265.
Diggelmann HR, Hoffman HT. Intraductal infusion of steroids in patients with Sjögren syndrome to treat painful salivary swelling: Report of 2 cases. Ear Nose Throat J. 2015 Jun;94(6):238-9. doi: 10.1177/014556131509400611. PMID: 26053983.
Truong K, Guerin LA, Hoffman H. Value of sialendoscopy-assisted transoral sublingual gland resection for a plunging ranula: case report and review. J Laryngol Otol. 2015 May;129(5):509-12. doi: 10.1017/S0022215115000948. Epub 2015 Apr 16. PMID: 25877148.
Savage MW, Sobel RK, Hoffman HT, Carter KD, Finkelstein MW, Shriver EM. Salivary gland dysfunction and nasolacrimal duct obstruction: stenotic changes following I-131 therapy. Ophthalmic Plast Reconstr Surg. 2015 May-Jun;31(3):e50-2. doi: 10.1097/IOP.0000000000000066. PMID: 24836449.
Hoover AC, Milhem MM, Anderson CM, Sun W, Smith BJ, Hoffman HT, Buatti JM. Efficacy of nelfinavir as monotherapy in refractory adenoid cystic carcinoma: Results of a phase II clinical trial. Head Neck. 2015 May;37(5):722-6. doi: 10.1002/hed.23664. Epub 2014 Jun 18. PMID: 24596143; PMCID: PMC4285572.
Tryggvason G, Hulstein SL, Karnell LH, Hoffman HT, Funk GF, Van Daele DJ, Jensen CS, Gailey MP. In response to Accuracy of fine-needle aspiration and imaging in the preoperative workup of salivary gland mass lesions treated surgically. Laryngoscope. 2013 Sep;123(9):2330. doi: 10.1002/lary.23991. Epub 2013 Jun 28. PMID: 23813297.
Tryggvason G, Gailey MP, Hulstein SL, Karnell LH, Hoffman HT, Funk GF, Jensen CS, Van Daele DJ. Accuracy of fine-needle aspiration and imaging in the preoperative workup of salivary gland mass lesions treated surgically. Laryngoscope. 2013 Jan;123(1):158-63. doi: 10.1002/lary.23613. Epub 2012 Sep 18. PMID: 22991236.
Potash A, Hoffman HT. Retrograde sialendoscopy: a new technique for avoiding retained ductal stones. Ann Otol Rhinol Laryngol. 2012 Jan;121(1):38-43. doi: 10.1177/000348941212100107. PMID: 22312926.
Plonowska KA, Ochoa E, Ryan WR, Chang JL. Sialendoscopy in Chronic Obstructive Sialadenitis Without Sialolithiasis: A Prospective Cohort Study. Otolaryngol Head Neck Surg. 2020 Sep 29:194599820957256. doi: 10.1177/0194599820957256. Epub ahead of print. PMID: 32988282.
Trapeau C, Foletti JM, Collet C, Guyot L, Chossegros C. Clinical efficacy of botulinum toxin in salivary duct stenosis: A preliminary study of six cases. J Stomatol Oral Maxillofac Surg. 2017 Dec;118(6):349-352. doi: 10.1016/j.jormas.2017.09.002. Epub 2017 Sep 9. PMID: 28899693.