Parotid duct dilation and steroid insufflation in clinic
see detail of catheter insertion in video: Salivary Cannulation and Infusion Techniques and Sialogram Technique
return to:Salivary Swelling, Sialograms and Sialography ; Sialogram Technique, Sjogren's Syndrome, Sialogram Left Parotid Sjogrens Syndrome
- GENERAL CONSIDERATIONS
- Clinic based intraductal infusion of corticosteroids is one option for the treatment of painful salivary swelling associated with Sjögren’s syndrome or other inflammatory processes of the parotid gland.
- Also, clinical based dilation of distal strictures of the salivary duct is possible under local anesthesia.
- Both represent simple procedures, performed in the microscope room in clinic, lasting less than 10 minutes, and provides excellent relief for the patient.
- CONSENT FOR PROCEDURE
- Identify the indications/technique/alternatives and risks:
- Bleeding, infection, reaction to the steroid
- Need for further treatment/procedures
- Damage to adjacent structures
- Possible scarring or perforation of duct
- Possible persistence/exacerbation of pain/swelling
- Identify the indications/technique/alternatives and risks:
- NURSING CONSIDERATIONS
- See pictures above for set up. Requires 0.015 inch guidewire, 22 gauge angiocath, possible dilators, KY jelly, viscous lidocaine (2%)
- Set up in microscope room
- Kenalog 10 is used for infusions
- ANESTHESIA CONSIDERATIONS
- A 4x4 piece of gauze is soaked in Topical 2% viscous lidocaine and applied to the duct region for several minutes
- OPERATIVE PROCEDURE
- Visualize duct with microscope
- Pre-load 22 gauge angiocath onto 0.018 inch guidewire
- Pick up 0.015 inch guidewire with DeBakey forceps and dip tip of guidewire in KY jelly (may also use 0.015 inch Cook guide wire with 24 gauge angiocath on it)
- Place guidewire into duct and slide angiocatheter over guide wire into duct. As an alternative, it may be necessary to dilate with the hollow Marchal dilators before placing the angiocatheter
- Remove guidewire and attach syringe with steroids
- Infuse 2.0-3.0 cc of Kenalog 10.
- It is useful to leave the catheter in place with syringe attached for 2 minutes to prevent the steroids from flowing out of the duct, and to allow the triamcinolone to work into gland
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Note that we currently use the 0.015 guidewire in the picture rather than 0.018 teflon coated guidewire used previously
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- REFERENCES
- Izumi M, Eguchi K, Nakamura H, Takagi Y, Kawabe Y, Nakamura T. Corticosteroid irrigation of parotid gland for treatment of xerostomia in patients with Sjögren’s syndrome. Ann Rheum Dis 1998 ;57:464-469
- Diggelmann HR, Hoffman HT: Intraductal infusion of steroids in patients with Sjogren syndrome to treat painful salivary swelling: Report of 2 cases. Ear Nose Throat J. 2015 Jun;94(6):238-9