Parotidectomy should no longer be regarded as a routine treatment for parotid duct stenosis and should be indicated only in individual cases, report researchers.
Treatment of the condition can be highly successful with minimally invasive treatment, say Michael Koch (University of Erlangen-Nuremberg, Erlangen, Germany) and team.
In a study of 93 individuals with stenoses of the parotid duct, glands were preserved in 90 (96.8%) patients using only minimally invasive treatment methods, with 86 (92.5%) patients reporting clear improvements of their complaints.
After categorizing the individuals by stenoses types as inflammatory (Type 1), web-associated fibrous (Type 2), and fibrous (Type 3), the team treated all patients using sialendoscopy-guided rinsing with cortisone. If required, this was then followed with interventional instrumental dilation either alone or in combination with transoral ductal surgery.
"In addition to allowing assessment of the tissue characteristics in the area of the stenosis, sialendoscopy at the same time allows appropriate therapy, with direct endoscopic guidance, based on the sialendoscopic findings," explain the researchers. "Sialendoscopy thus allows both diagnosis and simultaneous treatment with direct vision."
As reported in Archives of Otolaryngology - Head and Neck Surgery, symptomatic control was achieved in 21.5% of patients who received sialendoscopy-guided rinsing alone. Nine (60.0%) of 15 patients with Type 1 stenoses were successfully treated using just the rinsing technique, as well as eight (47.1%) of 17 Type 2 patients, and three (4.9%) of 61 Type 3 patients.
"Particularly in stenoses in which there is a clear inflammatory reaction, an expectant approach avoiding or minimizing surgical manipulation seems to be justified," says the team. "In addition, progression (eg, from Type 1 to Type 3 stenosis) is imaginable and can be prevented at early stage in this way."
Interventional sialendoscopy using instrumental dilation was required in five (33.3%) Type 1 patients, nine (52.9%) Type 2 patients, and 47 (77.1%) Type 3 patients. Stenoses were dilated in 88.2% of cases and treatment was successful in 59.2% of all patients.
Eleven (18%) Type 3 patients required interventional sialendoscopy that was combined with transoral ductal surgery, and 72.3% of these procedures were also successful.
The team reports that parotidectomy was ultimately necessary in only three (3.2%) of the 93 patients studied.
"The fact that gland-preserving treatment was possible in 96.8% of the patients… with 92.2% reporting no relevant symptoms afterward, argues in favor of the treatment regimen described herein, adapted to the different types of stenoses," comment Koch and team.
"These results, as well as those reported by other research groups, show that endoscopically guided therapy is the treatment of choice for parotid gland stenosis," they conclude.
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