During the last few decades, the treatment of sialolithiasis and chronic recurrent sialadenitis has shifted more toward a minimally invasive approach. The development of salivary endoscopy (sialendoscopy) has allowed visual access into the salivary duct system to diagnose and treat various duct conditions. Favorable results have been achieved in the treatment of sialolithiasis and duct strictures, and the symptoms of chronic sialadenitis seem to respond to this novel intervention as well. The aim of the present study was to assess the results of sialendoscopy in the treatment of obstructive and chronic sialadenitis, the complications of sialendoscopy, and tolerability of sialendoscopy under local anesthesia (LA). In addition, the health-related quality of life (HRQoL) of sialadenitis patients and the costs of treatment were investigated. We evaluated the medical records of all (n=228) patients who underwent sialendoscopy at the Department of Otorhinolaryngology – Head and Neck Surgery at Helsinki University Hospital (HUS) between January 2011 and December 2013. Using these data, we analyzed the main endoscopic findings and treatment results. To assess the patient experience and compliance in sialendoscopy, 89 LA patients completed a questionnaire designed by the authors; on it, the patients rated their sensations (pain, discomfort, and nervousness) before, during, and after the operation using a scale from “none” to “major”. In the prospective study, 49 patients with chronic recurrent parotitis without sialoliths were collected. They underwent sialendoscopy and were randomized to receive either a concurrent intraductal injection of isotonic saline solution or 125 mg of hydrocortisone (1:1). To evaluate the incidence and nature of complications associated with sialendoscopy, we prospectively recruited 118 patients with 140 sialendoscopies between October 2015 and December 2016. Patient data, treatment failures, and complications were recorded in a database and analyzed. In the fifth study, all patients (n=260) who had a sialendoscopy at our institution between January 2014 and May 2016 were identified from a surgical database, and the direct hospital costs were retrospectively evaluated from one year before to one year after the sialendoscopy. In addition, the 15D health-related quality of life (15D HRQoL) questionnaire and a survey exploring the use of health care services during the preceding three months were mailed to the patients preoperatively and at 3 and 12 months postoperatively. The sialoliths were successfully removed in a majority of patients, but removal was possible with the endoscopic technique only in a minority. The symptoms resolved or improved in most patients after successful sialolith removal or stricture dilatation. Improvement was also seen in patients with inflammatory changes, but the symptoms relapsed quite often in this group. A single-dose steroid injection concomitant to sialendoscopy provided no additional benefit for the symptoms of chronic recurrent parotitis in this study. In most cases, both diagnostic and interventional sialendoscopy were well tolerated under LA or under local anesthesia with sedation (LAS), with reasonably low patient-reported discomfort and pain. The complications of sialendoscopy were usually related to interventional procedures, and infection was the most common complication. Treatment costs were higher in sialolithiasis patients than in patients with other diagnoses. In sialolithiasis patients, the improvement of HRQoL was noticed at three months postoperatively. In conclusion, according to this study, sialolithiasis patients benefit from the sialendoscopic intervention but combined techniques are often needed. Symptoms of chronic recurrent parotitis seem to improve after sialendoscopy, but total resolution of symptoms remains rare. Sialendoscopy is a safe and well-tolerated procedure, but not free of complications. It improves HRQoL, at least in patients with sialolithiasis in a short-term fashion.
|Status||Publicerad - 2019|
|MoE-publikationstyp||G5 Doktorsavhandling (artikel)|
Bibliografisk informationM1 - 104 s. + liitteet
- 3125 Öron-, näs- och halssjukdomar, ögonsjukdomar