La sialoendoscopia en el manejo de la sialoadenitis. Nuestra experiencia

Abstract

Introduction and objective: The salivary glands can be affected by different non-tumoral pathologies such as lithiasis or the presence of mucus in the ducts, which prevent the correct elimination of saliva, causing glandular inflammation. Until the appearance of sialoendoscopy, an expectant attitude was taken or the affected gland was removed. This new minimally invasive technique allows both the diagnosis and treatment of salivary gland pathology, without their exeresis. Through a small caliber endoscope, direct visualization of the salivary duct is achieved, being able to obtain both objectives in the same procedure. The purpose of this communication is to present our experience with this technique since its implementation at the University Hospital of Burgos (2019), until the present time (2022). Method: A descriptive study was carried out, in which the patients who underwent simple sialendoscopy or in the context of a combined approach between March 2019 and May 2022 were analyzed retrospectively. The most notable epidemiological data are collected, as well as other variables of interest such as the affected gland, the etiology or the complications of the procedure, among others. Results: During these 3 years, 34 procedures have been performed on a total of 32 patients, of whom 14 are women (44%) and 18 men (56%). The mean age at the time of the intervention was 56.25 years. In 70.6% of the cases the affectation was unilateral and the most frequently affected gland was the submandibular gland in 52.9%. The most frequent etiology was lithiasis (18 cases in total). In 22 cases the approach was exclusively endoscopic while in 12 cases the intraoral approach was combined. No combined parotid approach was performed. Only 2 patients required surgical reintervention due to persistent symptoms, and another female patient is awaiting parotidectomy. 20.6% of the cases presented perioperative complications, but none of the complications were serious or permanent. Discussion: The introduction of sialendoscopy has brought about a change in the therapeutic attitude and in the management of salivary pathology. The minimally invasive approach allows this technique to be performed through outpatient surgery, with earlier postoperative recovery. Like other interventional techniques, it has a long learning curve. Previous knowledge and handling of sinonasal endoscopic surgery, as well as specific surgical training in this technique, will facilitate adaptation to this procedure. The use of general anesthesia in the first interventions will allow this technique to be carried out more comfortably and minimize the learning curve. As we gain experience, we will be able to minimize the surgical time, and even a greater number of sialoendoscopies could be performed under local anesthesia Conclusions: Sialendoscopy can be considered a safe and effective technique that allows us to simultaneously diagnose and treat inflammatory pathology of the salivary glands, whether due to lithiasis or other causes. In addition, it reduces the number of sialoadenectomies performed, which means less postoperative hospitalization time, with fewer adverse effects, of little severity.