Obstructive Submandibular Sialadenitis Complicated with Severe Neck Phlegmon: Transcutaneous Removal of Sialolith with a Flow of Pus: Literature Review of Extraoral Complications

Sialolithiasis, as the most common reason (60–85 percent) of obstructive salivary gland disease, in the rare cases, may be complicated by soft tissues abscess or/and fistula. The purpose of this report is to present a rare case of submandibular gland sialolithiasis complicated with severe neck phlegmon in a 47-year-old Caucasian male. Ultrasonography and transcutaneous removal of sialolith upon the purulent locus lancing are highlighted. Our literature review based on the existed ones with a total 24 complication cases is presented. Wakoh et al`s classification of submandibular gland sialolith-associated fistulas types is analyzed. The ultrasound imaging is still underestimated and not adequately popularized among head and neck and oral and maxillofacial surgeons. Presented case and published reports show the usefulness of this constantly developing diagnostic technique in a combination with knowledge of possible extraoral purulent complications’ and its management.

The Need for Studies on Oral Corticosteroids After Sialendoscopy for Obstructive Salivary Gland Disease: Systematic Review

Objectives: This qualitative systematic review evaluates the evidence in support of the use of oral corticosteroids in patients undergoing sialendoscopy for the treatment of obstructive sialadenitis. Design: Qualitative systematic review. Methods: A literature search was conducted from January 1985 and September 2020. Inclusion criteria embraced peer-reviewed articles in which adult patients undergoing interventional sialendoscopy for obstructive salivary gland disease received oral corticosteroids. The results were initially screened based on title and abstract, and the remaining articles were reviewed for eligibility. Results: About 218 papers were selected by title and abstract, 96 were selected for full-text review, and 9 met the inclusion criteria. Eight published reports were retrospective observational studies and 1 was a prospective comparative study. Overall, the heterogeneity of clinical data stood out in this systematic review. The pooled success rate in the studies was 873/979 (89%). Only 5 studies described a rationale for oral corticosteroid use as part of the post-operative management. In 4 studies, a prednisone total daily dose of 40 to 50 mg was used. One study clearly showed a lower recurrence rate in patients who received oral steroids for more than 7 days in addition to sialendoscopy for management of ductal stenoses. Conclusion: This systematic review showed that most centers that prescribe oral corticosteroids after sialendoscopy are unaware of the specific results with this treatment. For ductal stenoses, only 1 paper clearly showed the benefits of oral corticosteroids after sialendoscopy but more high-quality evidence is required in the form of a comparative study or randomized controlled trial, with appropriate long-term follow up.

HIV-Associated benign lymphoepithelial parotid cysts: a rare case report

Approximately one to 10% of patients with Human Immunodeficiency virus (HIV) infection associated with salivary gland disease. The presence of Benign lymphoepithelial cyst (BLEC) in the parotid gland is an indicator of HIV Infection. The diagnosis is usually based on a clinical course and HIV confirmatory blood testing. We have reported a case of a 35 years old Nepalese male patient with swelling of the bilateral parotid glands and HIV associated BLEC confirmed by Rapid diagnostic test kit (Determine unigold stat pack).

Sialendoscopy and CT navigation assistance in the surgery of sialolithiasis

Background A sialendoscopy-assisted combined approach is well established in the surgery of sialolithiasis. In cases of proximal salivary stones, transcutaneous sialendoscopy-assisted extractions with parotid and submandibular gland preservation is the primary intention of treatment. We recently added computer tomography (CT) navigation to improve the results of this challenging surgery equally in both localizations. Patients and methods Al l the patients who submitted to sialendoscopy and sialendoscopy-assisted procedures at the tertiary institution between January 2012 and October 2020 were included in the present study. From November 2019, CT navigation was added in cases with sialolithiasis and a presumably poor sialendoscopic visibility. We evaluated the parameters of the disease, diagnostic procedures, sialendoscopic findings and outcomes, with or without optical surgical navigation. Results We performed 178 successful salivary stone removals in 372 patients, of which 118 were combined sialendos-copy-assisted approaches, including 16 transcutaneous proximal, 10 submandibular and 6 parotid stone operations. Surgical navigation was used in six patients, four times for submandibular and twice for parotid sialolithiasis. These were all non-palpable, sialendoscopically invisible or partially visible stones, and we managed to preserve five of the six salivary glands. Conclusions The addition of CT navigation to sialendoscopy-assisted procedures for non-palpable, sialendoscopically invisible and fixed stones is a significant advantage in managing sialolithiasis. By consistently performing sialendoscopy and related preservation procedures, we significantly reduced the need for sialoadenectomies in patients with obstructive salivary gland disease.

Obstructive Salivary Gland Disease and Sialendoscopy

Obstructive salivary pathologies most commonly manifest as salivary stones (sialoliths), mucous plugs and sometimes due to narrowing of the duct (stricture/stenosis). Saliva produced by salivary glands flows into oral cavity by means of ducts. Blockage of these ducts due to the reasons mentioned above leads to sialadenitis (inflammation).Sialendoscopy is a minimally invasive technique to manage salivary duct pathologies, including sialolithiasis, sialadenitis & strictures. It is fast becoming the investigating procedure of choice for such conditions.In the last 25 years, Sialoendoscopy has gradually seen a rise in popularity for diagnostic and therapeutic means of dealing with obstructive salivary gland pathologies.