Sialendoscopy proves its worth in children

By Sarah Guy, medwireNews Reporter

Sialendoscopy is a safe and effective technique for use in pediatric patients with salivary gland disorders including juvenile recurrent parotitis (JRP), which is the most common disorder in this population, say US researchers.

The procedure has already been shown to be effective in an adult population, and the current findings highlight both its diagnostic and therapeutic abilities, remarks the team in the Archives of Otolaryngology - Head and Neck Surgery.

"The therapeutic portion of the procedure is the mechanical washout of debris, the hydrostatic pressure dilation of the duct, and the instillation of steroids and/or antibiotics," explain Deepak Mehta, from the Children's Hospital of Pittsburgh-UPMC in Pennsylvania, and colleagues.

Their study included 18 patients aged 6-16 years who were treated between September 2009 and June 2011 for obstructive symptoms or at least two episodes of parotitis. JRP was present in 12 participants, with sialolithiasis the second most common indication.

All participants underwent sialendoscopy under general anesthetic, with a laser available for treatment of salivary stones, report the researchers. Children with JRP also had steroids injected into their parotid gland.

Of the 12 patients with JRP, eight only needed one procedure to address their symptoms, while two patients needed two procedures and one required a parotidectomy.

The authors suggest that, in view of this, "informed consent should include a discussion of the natural history of JRP, and in patients with obstructive symptoms suggesting a stone, the preoperative discussion should include the possibility of gland excision."

A total of four patients had salivary stones, with two experiencing complications during sialendoscopy. One patient had a 7-mm stone that could not be removed, and one had a 3-mm stone that broke during an attempt to remove it with the laser. The single patient with parotid stones had normal findings at follow up after sialendoscopy, and remained asymptomatic for 24 months, note Mehta and co-workers.

Despite the availability of gland removal as an option, Mehta et al conclude that "sialendoscopy should be the first approach because it preserves the gland and avoids the small but present complications that can occur with gland excision."

They add: "Research is needed to determine whether instilling antibiotics and steroids into the gland has an impact on the course of JRP and to improve the endoscopic management of sialoliths in children."

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