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Instruments used for salivary duct and gland irrigation. From the right, a dental mirror, a periodontal probe, a scalp vein set connected to a 5-mL syringe, and a lacrimal probe (size: #0000 to #0).
Source publication
Purpose
Obstructive and inflammatory disease often occurs in the major salivary glands, and no predictive treatment has yet been developed for this condition. The aim of this report was to introduce an intraductal irrigation procedure and to illustrate its application to practical patient cases.
Materials and Methods
Two patients complaining of pa...
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The clinical features of xerostomia induced by immune checkpoint inhibitors (ICI) are similar to those of Sjögren's syndrome (SS), whereas the immunohistological and serological features are known to differ from those of SS. However, the radiologic imaging features of salivary glands are not yet well known. We report a case of a 56-year-old male pa...
Citations
... Quy trình bơm rửa tuyến sẽ được tiến hành tương tự như trong nghiên cứu của Lee C và cộng sự (2017) 10 : ...
Mục tiêu: Đánh giá kết quả điều trị của liệu pháp bơm rửa tuyến nước bọt bằng nước muối sinh lý trên bệnh nhân viêm tuyến nước bọt mạn tính. Phương pháp: 11 bệnh nhân được chẩn đoán viêm tuyến nước bọt mạn tính được điều trị bằng liệu pháp bơm rửa tuyến nước bọt với nước muối sinh lý, đánh giá sự thay đổi mức độ đau của bệnh nhân trước và sau can thiệp bằng thang đánh giá số (Numeric Rating Scale- NRS). Kết quả: Sự thay đổi NRS sau can thiệp lần đầu giảm có ý nghĩa thống kê (p=0,001). Số lần bơm rửa trung bình cho đến khi bệnh nhân cảm thấy hết đau (NRS =0-1) khoảng 5,38 ± 1,61 lần. Kết luận: Bơm rửa tuyến nước bọt bằng nước muối sinh lý là một liệu pháp điều trị đơn giản, hiệu quả, giảm đau tốt, an toàn cho bệnh nhân viêm tuyến nước bọt mạn tính.
... [4][5][6] Sialography has also been reported to provide therapeutic effects in addition to its diagnostic capabilities through mechanical dilations and irrigation with contrast agent. 7,8 Additionally, sialography may identify parenchymal disease in the absence of significant ductal strictures to permit in-office steroid insufflation. This approach permits drug delivery to a gland not already permeated by the saline infused during sialography. ...
Objectives
To assess the adequacy of gadolinium in sialography as an alternative contrast agent for patients with iodine allergies. To directly compare images taken with gadolinium versus iodine‐based contrast agents using the Iowa Sialography Classification System.
Methods
Retrospective chart review was performed on patients undergoing sialography between February 2008 and July 2022. Patients with sialograms obtained with gadolinium were identified and matched to similar sialograms obtained with iodine‐based contrast agent. Patients were matched based on duct location, duct side, and initial radiology findings. Blinded reevaluation of sialograms was performed first independently and then by consensus by two head and neck radiologists to evaluate overall image adequacy and grade using the Iowa Sialography Classification System.
Results
Four patients with six sialograms (one bilateral parotid and one parotid + submandibular) obtained with gadolinium were identified and reevaluated. Five patients with six sialograms (one bilateral parotid) obtained with iodine‐based were matched to the gadolinium sialograms. The overall adequacy of images for gadolinium sialograms was graded at an average of 4.25 (4 = good and 5 = excellent); whereas, the overall adequacy of iodine‐based sialograms was graded at an average of 5. Inter‐observer variability was observed in three sialograms obtained with gadolinium (50%), while no interobserver variability was observed in sialograms obtained with iodine‐based contrast agent.
Conclusion
Gadolinium is an adequate alternative to use in sialography for patients with iodine allergies undergoing contemporary digital infusion sialography. Adverse reactions to iodine contrast agents are rare in sialography; however, the precautionary use of gadolinium is acceptable for the diagnostic and therapeutic benefits in sialography.
Level of Evidence: IV
... The increase in salivary secretion can be explained by dilatation prior to, and during, the endoscopic procedure, as this may open ductal strictures and remove debris such as microsialoliths and mucus plugs [45]. Additionally, other mechanisms that may explain any beneficial effect of ductal irrigation that can also apply to sialendoscopic treatments were suggested by Aframian et al. ...
In sialendoscopy, ducts are dilated and the salivary glands are irrigated with saline. Contrast-enhanced ultrasound sialendoscopy (CEUSS), using microbubbles, may facilitate the monitoring of irrigation solution penetration in the ductal system and parenchyma. It is imperative to test CEUSS for its safety and feasibility in Sjögren’s syndrome (SS) patients. CEUSS was performed on 10 SS patients. The primary outcomes were safety, determined by the occurrence of (serious) adverse events ((S)AEs), and feasibility. The secondary outcomes were unstimulated and stimulated whole saliva (UWS and SWS) flow rates, xerostomia inventory (XI), clinical oral dryness score, pain, EULAR Sjögren’s syndrome patient reported index (ESSPRI), and gland topographical alterations. CEUSS was technically feasible in all patients. Neither SAEs nor systemic reactions related to the procedure were observed. The main AEs were postoperative pain (two patients) and swelling (two patients). Eight weeks after CEUSS, the median UWS and SWS flow had increased significantly from 0.10 to 0.22 mL/min (p = 0.028) and 0.41 to 0.61 mL/min (p = 0.047), respectively. Sixteen weeks after CEUSS, the mean XI was reduced from 45.2 to 34.2 (p = 0.02). We conclude that CEUSS is a safe and feasible treatment for SS patients. It has the potential to increase salivary secretion and reduce xerostomia, but this needs further investigation.
... Sialendoscopy can remove the stricture of the main duct to facilitate saliva outflow (14,15). However, many salivary gland imaging studies have confirmed stenoses in each branch of the ductal system in patients with SS. ...
Objective
To verify the effect of triamcinolone acetonide (TA) and major salivary glands saline irrigation on relieving xerostomia in Sjögren’s syndrome (SS) patients.
Methods
The enrolled 49 SS patients were randomly assigned to the control group (no irrigation, n=16), saline group (irrigation with saline, n=17) and TA group (irrigation with TA, n=16). Fourteen cases of each group were treated differently but received the same examinations. The examinations include unstimulated whole saliva flow (UWS), chewing-stimulated whole saliva flow (SWS), citric acid-stimulated parotid flow (SPF), Clinical Oral Dryness Score (CODS), Xerostomia Inventory (XI) and EULAR SS Patient Reported Index (ESSPRI) of 1 week before irrigation (T0) and 1 week(T1), 8 weeks (T8), 16 weeks (T16) and 24 weeks (T24) after major salivary irrigation.
Results
Each group had 14 cases with completed follow-ups. Both TA and saline irrigation of major salivary glands resulted in higher SWS and SPF of T8, T16 and than those at T0. ESSPRI (oral dryness domain) of T8, T16 and T24 were significantly lower than that at T0, respectively (P < 0.05). SWS and SPF of T8, T16 and T24 in the saline group were significantly higher than in the control group (P< 0.05). XI and ESSPRI (oral dress domain) of T8, T16 and T24 in the saline group were significantly lower than those in the control group, respectively (P< 0.05). SWS and SPF of T16 and T24 in the TA group were significantly higher than in the control group (P< 0.05). All cases with completed follow-up in TA and saline groups were divided into responders and non-responders. Compared with responders, the UWS, SWS, SPF and CODS of T0 in non-responders were significantly increased (P<0.05). Compared with responders, the XI and ESSPRI of T0 in non-responders were significantly decreased (P<0.05).
Conclusion
The irrigation of major salivary glands by TA and saline relieve xerostomia in SS patients. Patients with non-severe xerostomia (responders) have better relief after irrigation than patients with severe xerostomia (non-responders).
Clinical Trial Registration
www.chictr.org.cn, identifier (ChiCTR210052314).
... The irrigation procedure was performed as previously reported. 1,6 Orifice exploration and duct enlargement were performed using a #15 endodontic finger spreader, and an endodontic 27-gauge irrigation needle with a vent was placed into the enlarged duct, gradually pushing 270-300 μL of the solution into the duct. 6 Filling of the duct with solution was maintained for 1 minute and the needle tip was removed to allow the solution to evacuate. ...
Purpose:
This study aimed to compare the therapeutic effects of corticosteroid irrigations and normal saline irrigations in the early inflammatory state of the salivary gland.
Materials and methods:
Adult male Wistar rats were divided into experimental (n=6) and control (n=3) groups. Inflammation was induced in the experimental subjects on both sides of the submandibular gland with ligation. After 14 days, both sides of the glands were de-ligated and retroductal irrigation using saline (n=3) and a corticosteroid (n=3) was performed on the left sides only. The controls (n=3) were used to normalize the gland state for the effects of diet and aging. Magnetic resonance imaging was performed to confirm inflammation and post-irrigation gland recovery by measuring relative signal intensity (SI). The glands were excised for histological examination.
Results:
All experimental animals showed inflamed glands with increased SI and subsequent recovery of the gland with decreased SI to varying degrees. The SI of the controls showed no significant changes during the overall period. The mean SI change of the irrigated gland was higher than that of the non-irrigated side, without a significant difference. The corticosteroid-irrigated glands showed a greater change in SI than that of the saline-irrigated glands. Histology revealed that inflammation was not observed in most of the irrigated glands, while mild to moderate quantities inflammatory cells were found in non-irrigated glands.
Conclusion:
Corticosteroid irrigation mitigated the early stages of salivary gland inflammation more effectively than normal saline.
... 21 A case report recently disclosed the effectiveness of simple ductal irrigation to treat two patients with chronic sialodochitis and sialadenitis. 22 Nevertheless, the therapeutic efficacy of this officebased treatment on patients with postradiotherapy or post-RAI sialoadenitis remains largely unknown. Capaccio et al. reported that the episodes of glandular swelling decreased by 87% in the subgroup of patients with Sjogren's syndrome (N Z 12) treated by sialendoscopic surgery followed by an outpatient cycle of six ductal irrigation sessions every three weeks. ...
Background/purpose:
To evaluate the therapeutic responsiveness of office-based salivary gland ductal irrigation in patients with chronic sialoadenitis.
Methods:
Between August 2017 and April 2019, 55 patients comprising the following three disease groups were enrolled: Sjogren's syndrome: 39 patients; postradiotherapy sialoadenitis: ten patients; and post-RAI sialoadenitis: six patients. Quantitative salivary scintigraphy was recorded, and a formulated questionnaire including the Summated Xerostomia Inventory was utilized to assess acute/chronic symptoms. All patients received at least three serial salivary gland ductal irrigations with a one-month interval in our outpatient department.
Results:
The general response rates for each disease groups are as follows: Sjogren's syndrome: 61.5% (24/39); postradiotherapy: 60% (6/10); and post-RAI: 83.3% (5/6). Among the patients with Sjogren's syndrome, the parotid scintigraphic Tmin showed a significant positive correlation with the responsiveness of salivary irrigation (P = 0.046), whereas the treatment tended to be irresponsive in patients who previously took medicine for their related discomfort (P = 0.009). In the postradiotherapy and post-RAI groups, no significant factors were found to be associated with the responsiveness of irrigation.
Conclusion:
Simple salivary ductal irrigation without complex equipment can be performed as an outpatient procedure to alleviate glandular swelling or xerostomia in patients with Sjogren's syndrome, postradiotherapy sialoadenitis or post-RAI sialoadenitis, and it can be considered an alternative management approach for patients refractory to conventional strategies.
... The increase in salivary secretion can be explained by dilatation prior to and during the endoscopic procedure as this may open ductal strictures and remove debris such as microsialoliths and mucus plugs [25]. In patients with SS and other autoimmune diseases, stricture formation is a frequent cause of salivary duct obstruction and recurrent sialadenitis [7,26]. ...
Objective:
To assess the effect of sialendoscopy of the major salivary glands on salivary flow and xerostomia in patients with Sjögren's syndrome (SS).
Methods:
Forty-five patients with SS were randomly assigned to a control group (no irrigation, control, n = 15), to irrigation of the major salivary glands with saline (saline, n = 15) or to irrigation with saline followed by corticosteroid application (triamcinolone acetonide in saline, saline/TA, n = 15). Unstimulated whole saliva flow (UWSF), chewing-stimulated whole saliva flow (SWSF), citric acid-stimulated parotid flow, Clinical Oral Dryness Score (CODS), Xerostomia Inventory (XI) and EULAR SS Patient Reported Index (ESSPRI) scores were obtained 1 week before (T0), and 1, 8, 16, 24, 36, 48 and 60 weeks after sialendoscopy. Data were analysed using linear mixed models.
Results:
Irrespective of the irrigation protocol used, sialendoscopy resulted in an increased salivary flow during follow-up up to 60 weeks. Significant between-group differences in the longitudinal course of outcomes were found for UWSF, SWSF, XI and ESSPRI scores (P = 0.028, P = 0.001, P = 0.03, P = 0.021, respectively). UWSF at 60 weeks was higher compared with T0 in the saline group (median: 0.14 vs median: 0.10, P = 0.02) and in the saline/TA group (median: 0.20, vs 0.13, P = 0.035). In the saline/TA group SWSF at 48 weeks was higher compared with T0 (median: 0.74 vs 0.38, P = 0.004). Increase in unstimulated salivary flow was also reflected in improved CODS, XI and ESSPRI scores compared with baseline.
Conclusion:
Irrigation of the major salivary glands in patients with SS increases salivary flow and reduces xerostomia.
... Sialography may be considered not only diagnostic but also therapeutic in some cases. The process of distal duct dilation with catheter insertion as well as hydro-dilation of the entire system with "flushing out the gland" employs a radiocontrast watersoluble iodinated compound that has bactericidal activity [17]. Tucci et al. in 2019 reported successful treatment of juvenile recurrent parotitis in 89% of 110 patients (all younger than 16 years of age) employing sialography without local anesthesia or sedation [18]. ...
Purpose of Review
Imaging modalities useful in the contemporary evaluation of salivary gland disorders are discussed.
Recent Findings
Salivary gland ultrasound—due to its wide applicability, versatility, availability, and low cost—is supported as a frontline evaluation and is frequently done as an in-office procedure by the treating surgeon. Contrast-enhanced CT may be as accurate as non-contrast CT in detecting sialolithiasis. Although conventional sialography (fluoroscopic salivary gland evaluation with ductal dilation and radiocontrast insufflation) was initially designed as a diagnostic procedure, more recently, reported experience has demonstrated it to result in improved salivary function for several disorders—including its use as treatment of juvenile recurrent parotitis. Conventional sialography remains the most accurate method to assess the full ductal anatomy and is superior to MRI sialography which fails to adequately image the more proximal ducts. For benign salivary tumors, US may obviate the need for further imaging and provide reliable estimation of tumor location.
Summary
Salivary gland disorders are most efficiently imaged with in-office ultrasound. In settings where US cannot be performed, CT (with or without contrast) remains a reliable initial method to detect salivary gland abnormalities including sialolithiasis. MR sialography has become a useful modality for evaluating stenosis and may be considered when conventional sialography is not available.
... The Institutional Review Board of Seoul National University Dental Hospital have approved the present study (IRB142/ [10][11][12][13][14][15][16][17][18]. Patients with at least one of the following subjective symptoms were recruited: pain, swelling, stiffness (particularly when chewing), and dry mouth. ...
... The specific method used for intraductal irrigation was as described in the previous technical report [14]. ...
Background:
The aim of the present study was to evaluate the effectiveness of intraductal irrigation using normal saline in chronic obstructive sialadenitis.
Methods:
Patients who had one of the following symptoms were recruited: pain, swelling, stiffness, and dry mouth. A total of 58 salivary glands in 33 patients were diagnosed as having sialadenitis using sialography and ultrasonography. The patients were divided into two groups (swelling group and dry mouth group), according to the major complaint. Repeated intraductal irrigation was performed on each gland. Difference of symptom severity evaluated using numerical rating scale (NRS), and ductal width measured using ultrasonography were compared between the two groups.
Results:
The average NRS score was significantly decreased from 6.0 to 3.3 after 3-5 visits of intraductal irrigation (P < 0.05). The reduction in NRS was greater in the swelling group than in the dry mouth group, although the difference between the groups was not statistically significant. There was no change of ductal width before and after the irrigation.
Conclusions:
Intraductal irrigation according to this study method using normal saline is a simple treatment for the patients with chronic obstructive sialadenitis. It provides a conservative treatment option reducing the subjective symptoms.
... The remaining material and mucous plaque within the duct were removed by this procedure, further enhancing the effectiveness of the treatment. If the discharged saline contained whitish or yellowish plaque, the entire process was repeated [8]. ...
Ultrasound (US)-guided salivary gland irrigation is a popular conservative treatment method that improves the success rate and reduces complications of the sialo-irrigation procedure. US is routinely used for evaluation of various salivary gland diseases because of its easy accessibility and absence of ionizing radiation. US also allows dynamic studies with real-time imaging during diagnostic or surgical procedures. However, conventional US images have limitations in salivary duct visualization. Although US images acquired with saline irrigation have improved visualization because of ductal system dilation by the pulling effect, the resultant image quality remains insufficient for diagnosis. Therefore, contrast agents are required during US-guided sialo-irrigation procedures to produce diagnostic image quality. Air bubbles in saline solution have high echogenicity and enhance image quality by acting as a US contrast agent. The aim of this study was to assess the clinical significance of US-guided sialo-irrigation with a saline–air contrast medium, to estimate its diagnostic and treatment efficacy, and to examine the procedure in two patients. In the study, two patients underwent US-guided salivary gland irrigation with air-bubble mixed saline solution. During the procedure, we were able to visualize the salivary gland duct and subsequently irrigate and clean the inside of the duct. As a result, the patients’ symptoms were relieved and saline solution mixed with air bubbles was confirmed to be an effective contrast agent.
