Sialadenitis without sialolithiasis: Prospective outcomes after sialendoscopy-assisted salivary duct surgery

ObjectivesTo prospectively assess symptoms before and after sialendoscopy-assisted salivary duct surgery (SASDS) in patients with symptomatic sialadenitis without sialolithiasis. Study DesignProspective cohort study. MethodsPatients with chronic obstructive sialadenitis without sialolithiasis (COSWS) completed the Chronic Obstructive Sialadenitis Symptoms (COSS) questionnaire prior to SASDS and 3 months postoperatively. ResultsOf 80 consecutive patients in a 20-month period, 20 surveyed patients underwent SASDS for COSWS in 37 symptomatic glands. Major symptom improvement (> 10 COSS score reduction) was reported in 24 of 37 (65%) of all glands, including 14 of 21 (67%) of radioactive iodine (RAI)-induced cases and 10 of 13 (77%) of idiopathic sialadenitis cases. A significant reduction in postoperative mean COSS scores was seen overall (12.6 points, standard deviation [SD] 19.3, P<0.05 to a post-SASDS mean score of 26.6). However, 19 of 37 (51%) glands demonstrated postoperative COSS scores above 25, denoting persistent disease. Mean COSS score reductions in RAI-induced sialadenitis (12.4 points, SD 22.7, P<0.05) and idiopathic sialadenitis (16.3 points, SD 13.7, P<0.005) groups were significant, with post-SASDS COSS mean scores of 30.6 (SD 19.8) and 20.8 (SD 13.8), respectively. Ducts with stenoses treated with dilation or sialodochoplasty showed significant COSS improvements of 21.1 (SD 17.9) and 12.4 points (SD 10.7), respectively (P<0.05). In a multivariate analysis, both the presence of stenosis and sialodochoplasty were independent predictors of complete or partial resolution (post-COSS score<25) and major symptom improvement (P<0.05). ConclusionSASDS provides short-term symptom reduction in patients with COSWS; particularly in RAI-induced and idiopathic sialadenitis, and in duct stenosis amenable to dilation or sialodochoplasty. However, approximately half of the glands did not achieve meaningful symptom resolution. Level of Evidence4 Laryngoscope, 127:1073-1079, 2017