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

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

                          a. SADS included various combinations of sialodochotomy with sialodochoplasty; balloon dilation; application of diluted triamcinolone; stent placement; botulinum injection for refractory sialadenitis symptoms

                          b. Conservative management included counselling about gland massage; oral hydration; avoidance of drying medications

            COSS (Chronic Obstructive Sialadenitis Symptoms) questionnaire adminaiterd 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.