Return to: Salivary Duct Stenosis (or click for more detail: Etiology / Diagnosis / Classification)
A. 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
B. Observation with intermittent medical therapy (steroids/antibiotics/botox)
C. 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
D. Ductoplasty with or without stenting Salivary Ultrasound Sonopalpation for Stone Favorable for Transoral Removal
E. Duct reconstruction (vein graft)
F. Tympanic neurectomy
G. Botulinum neurotoxin
a. Ductal infusion (Schwalje 2019) Botulinum neurotoxin infusion to the parotid via Stensen's duct Research protocol (IRB approved)
b. Ultrasound guided needle injection Botox injection to salivary glands for hypersalivation
H. Conservative Treatment
a. Hydration / Avoid Drying Agents / Intermittent oral antibiotics/steroids
b. Gland massage:
i. Parotid - Salivary gland massage (parotid massage technique demonstrated)
ii. Submandibular - Submandibular Gland Massage (Clinical Exam) Impact of BotulinumToxin (Botox) Ductal Insufflation
I. Other (see: Ultrasound aided parotid ductoplasty - sialodochoplasty)
Outcome 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
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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.
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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.
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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.
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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.
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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.