## 4 Discussion
A study on sialography with iodine in hundreds of JRP patients found a symptom-free period of 1 year after the procedures, without any complications [18]. In a series of 110 patients treated with sialography, an improvement in symptoms was noted in 89% of patients, with a 67% mean decrease in the number of episodes of acute parotitis in the first year after treatment [38]. Sialography is considered to be safe, yet cases of extravasation of contrast material into the gland or buccal space have been reported [39]. This research reports success rates of 88%, which is comparable to those of sialography. Another common treatment modality is that of sialoendoscopy, in which a specialized endoscope is used to assess the salivary glands and ducts minimally invasively, which was first described in 1993 [40]. It was also described for the treatment of sialolithasis [41]. The advantage of sialoendoscopy over sialography has not yet been decided, with both modalities having a therapeutic benefit due to duct dilation and debris irrigation [22]. The surgeon's and the institution's preferences should play a role in choosing a treatment modality between the two, as reports from the literature do not clearly point to a preferred modality. Sialoendoscopy is simultaneously diagnostic and therapeutic and enables irrigation and dilation of the parotid duct with a direct view of any ductal pathologies [24]. Typical findings during the sialoendoscopy that are consistent with a diagnosis of JRP are mucus plugs, debris and ductal stenosis, scarce vascularity in the ductal lamina, dilations, structures, and a whitish ductal mucosa which is evidence of inflammation [8; 21; 26; 27; 42; 43; 44]. In this study, common endoscopic findings were decreased vascularization (5 glands, 4 patients), no vascularization (19 glands, 12 patients), strictures (14 glands, 10 patients), and few or vast mucous plugs (19 glands, 13 patients). Numerous studies have shown improvement in or resolution of JRP symptoms following sialoendoscopy, although some of these have had a rather short follow-up period, which might not reveal the long-term efficacy of sialoendoscopy [8; 26; 28; 45]. A systematic review of JRP stated that the rate of recurrence of swelling after sialoendoscopy was as high as nearly 26%, but with lower severity [11]. In this study, similar results were seen, as five children (29%) had at least one recurrent swelling in the follow-up period. The reports in the literature demonstrate significant variability in percentages of symptom-free patients after sialoendoscopy. Some studies suggest that even one sialoendoscopy might be useful in healing the patient [8; 28; 31; 46; 47]. Others only saw an improvement and not a total resolution [48]. A retrospective analysis showed a complete resolution of symptoms in only 35% of the patients after one sialoendoscopy procedure, while all the remaining patients (65%) had a partial remission that was characterized by a decrease in the number and intensity of episodes [28]. On the other hand, another study showed that 90% of participants were free of symptoms after only one endoscopy procedure [46]. A recent study [27] described 76% of patients as symptom-free, but only for the first year after the procedure. A meta-analysis that included seven studies showed a success rate with no further sialoendoscopy needed at 87% [26]. The findings of this study are quite similar, as 15 children (88%) in this research had successful treatment results; 12 of them (80%) were treated with one sialoendoscopy procedure and did not need a further one. Complete resolution was seen in 10 children (65%); 8 of them (80%) were treated only once. It should be noted that the need for repeated sialoendoscopy treatments to completely resolve symptoms is commonly described in the literature [1; 20; 49; 50; 51; 52], even up to five times.