AAO-HNSF Primary Care Otolaryngology Handbook

SALIVARY GLAND DISEASE

stasis with possible secondary bacterial infection . Treatment is removal of the stone. Sialendoscopy is a minimally invasive diagnostic and therapeutic tool that allows for endoscopic visualization of the salivary ductal system. Endoscopes ranging in size from 0.8 to 1.6 mm are introduced into the orifice of the salivary duct and gently advanced through the natural ductal system using irrigation to distend the duct. Sialendoscopy offers a gland- preserving technique that allows removal of stones, dilatation of stric- tures, and local infusion of steroids in certain inflammatory disorders. For sialolithiasis cases, depending on the size of the stone, removal may be amenable using a basket or forceps, fragmentation using a drill or a combined transoral/transcutaneous sialendoscopy-assisted approach. Extracorporeal shockwave lithotripsy has been studied and is commonly used alone or in combination with sialendoscopy in Europe, although it has not been approved for use in North America. Sialendoscopy may also be used to treat chronic inflammatory conditions, such as radioiodine-induced sialadenitis or juvenile recurrent parotitis (JRP). JRP is an inflammatory process that results in recurrent, painful swelling of the parotid gland and often presents in children between the ages of 3 and 6 years with resolution by puberty. It is the second-most common pediatric salivary gland disorder after mumps. Sialendoscopy findings are similar to other chronic inflammatory conditions, including pale ductal mucosa, focal stricture, and intraductal debris. Drooling or excessive salivation, also known as sialorrhea , is a common problem in neurologically impaired children and adults. Management includes the use of conservative measures (such as swallow therapy, positioning, and portable suction), use of oral or transdermal anticholin- ergics to decrease saliva production, or injection of botulinum toxin into the major salivary glands for targeted therapy. Effective long-term management usually requires a multidisciplinary approach and a combi- nation of treatments. Masses often present in the salivary glands and need to be evaluated by an otolaryngologist. Physicians often perform fine-needle aspiration to determine whether a malignancy is present. In general, any lump in front of or below the ear must be considered a parotid mass until proven other- wise. The majority of major salivary gland tumors are benign. The parotid gland has a large amount of lymphoid tissue, to which the lymphatics on the side of the head drain. The most common metastatic lesion to the parotid gland is squamous cell carcinoma, generally a metastasis from a skin cancer on the side of the head. Malignant mela- noma on the ear or scalp also metastasizes to the lymph nodes in the

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