A Retrospective Review of the Types of Chronic Sialadenitis Encountered and Outcomes of Sialoendoscopic Treatment at New York University/Bellevue Hospital

Statement: There are many potential factors that can initiate and propagate recurrent sialadenitis. The primary initiating factor of sialadenitis is either a decrease, or a complete cessation, of salivary flow. Salivary stagnation allows a retrograde bacterial migration of the oral flora into the sterile gland, initiating an immune and inflammatory response, termed bacterial sialadenitis. The inflammation causes damage to the epithelium and fibrotic tissue formation causing adhesions and strictures. Partial obstruction of the gland is gradually followed by salivary retention and duct dilatation, leading to recurrent infections and propagation of adhesion formation. This ultimately leads to a continuous sialostasis. The continual inflammation causes a necrosis of the acinar cells in addition to the proliferated fibrotic process. The avascular environment leads to a transformation of the bacterial flora from predominant aerobic gram positive cocci to a combination of anaerobic bacilli and peptostreptococcus (Brook, 2002). Materials and Methods: Sialoendoscopy has been used in the management of obstructive sialadenitis since 1990. Depending on the etiology of the sialadenitis, it has had a significant high success rate with a very low morbidity and recurrence rate. Although the treatment of chronic sialadenitis still remains a difficult disease to manage, the treatment modality of sialoendoscopy allows for a combination of treatment, including removal of sialolith, lysis of adhesions and other ductal obstructions, irrigation of infected regions, removal of necrotic tissue, creation of a patent ductal system, under direct visualization (Nahlieli et al, 2006). Method of Data Analysis: A retrospective case analysis was performed, dividing the data by eitiology, short term success, long term success, and type of anesthesia. Each area was evaluated individually. Results: In the thirty patients we have treated over the past 36 months at our facilities, can be divided into three distinct diagnoses based upon etiological cause: Chronic Sialadenitis Secondary to Sialolithiasis (CSL) (N 16), Chronic Sialadenitis Secondary to Stricture Formation (CSS) (N 12), and Juvenile Recurrent Parotitis (JRP) (N 2). The criterion of success used was divided into two categories, short term and long term. Short term success was defined as a resolution of symptoms 30 days following endoscopy. Long term is defined by resolution 1 year and longer following surgery. Our overall short term success rate for CSS was (15/16) 94%, with a long term success rate of 81% (13/16). Short term success rate for CSL was (10/12) 83%. Percentages for long term follow up are not relevant because either the stone was removed or it was not. One case that was performed as an open surgical procedure as sialoendoscopic assist case was not performed by the author and is classified as a failure. Of the JRP cases (N 2), one was symptom free at one year and one relapsed four months later and is scheduled for surgery. Conclusion: Of interest, in comparing cases performed under local anesthesia/sedation, in an office setting versus general anesthesia in the operating room, the local/sedation cases were successful (short and long term) 60% (6/10) and the general anesthetic cases were successful (short and long term) 90% (18/20). Although no statistically significant conclusions can be drawn from this data, it does appear that an association between the type of anesthesia and the success rate can be inferred in our experience. As case numbers increase, this variable needs to be monitored for significance.