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Il ruolo della scialoendoscopia nel trattamento delle litiasi salivari: principi
di base, aspetti tecnici ed esperienza clinica
#MMPMID28516972
Carta F
; Farneti P
; Cantore S
; Macrì G
; Chuchueva N
; Cuffaro L
; Pasquini E
; Puxeddu R
Acta Otorhinolaryngol Ital
2017[Apr]; 37
(2
): 102-112
PMID28516972
show ga
Obstructive sialadenitis is the most common non-neoplastic disease of the
salivary glands, and sialendoscopy is increasingly used in both diagnosis and
treatment, associated in selected cases with endoscopic laser lithotripsy.
Sialendoscopy is also used for combined minimally invasive external and
endoscopic approaches in patients with larger and proximal stones that would
require excessively long laser procedures. The present paper reports on the
technical experience from the Ear, Nose and Throat Unit of the
Sant'Orsola-Malpighi Hospital of Bologna, and from the Department of
Otorhinolaryngology of the University Hospital of Cagliari, Italy, including the
retrospective analysis of the endoscopic and endoscopic assisted procedures
performed on 48 patients (26 females and 22 males; median age 45.3; range 8-83
years) treated for chronic obstructive sialadenitis at the University Hospital of
Cagliari from November 2010 to April 2016. The results from the
Sant'Orsola-Malpighi Hospital of Bologna have been previously published. The
technical aspects of sialendoscopy are carefully described. The retrospective
analysis of the University Hospital of Cagliari shows that the disease was
unilateral in 40 patients and bilateral in 8; a total of 56 major salivary glands
were treated (22 submandibular glands and 34 parotids). Five patients underwent
bilateral sialendoscopy for juvenile recurrent parotitis. 10 patients were
treated for non-lithiasic obstructive disease. In 33 patients (68.75%) the
obstruction was caused by salivary stones (bilateral parotid lithiasis in 1
case). Only 8 patients needed a sialectomy (5 submandibular glands and 3
parotids). The conservative approach to obstructive sialadenitis is feasible and
can be performed either purely endoscopically or in a combined modality, with a
high percentage of success. The procedure must be performed with dedicated
instrumentation by a skilled surgeon after proper training since minor to major
complications can be encountered. Sialectomy should be the "extrema ratio" after
failure of a conservative approach.
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