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Etiology of Salivary Duct Stenosis (Parotid Duct Stricture - Submandibular Duct Stricture)

Return to: Salivary Duct Stenosis (or click for more detail: Diagnosis / Classification / Management

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. Amond 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'

 

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

  A. Trauma

      1.  Surgical manipulation of oral cavity

      2. Intra-oral dental xrays - (Kieliszak 2015)

  B. Sialolith

  C. Autoimmune disorders

  D. Viral and bacterial infection

  E. Radiation (I131, External beam)

  F. Pneumoparotitis (Goates AJ, Lee, Dan et al 2018)

  G. 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.