Fatores prognósticos relacionados à necessidade de reintervenção após tratamento endoscópico da doença obstrutiva das glândulas salivares maiores

Abstract

The major salivary glands, including the parotid, submandibular and sublingual glands, are organs attached to the human digestive system which main function is to produce saliva. Obstruction to the salivary flow manifests as an acute inflammatory reaction (obstructive sialadenitis), characterized mainly by glandular edema and pain after taste stimulation, and it is caused mainly by salivary calculi or ductal stenoses. Salivary gland endoscopy (or sialendoscopy) consists of the introduction of a micro-endoscope and micro-instruments in the salivary ducts in order to improve the salivary flow, however, the literature shows an average recurrence of symptoms or need for reintervention in up to 20% of the operated cases. The research presented here aimed to analyze the prognostic factors related to recurrences and need for a reintervention after sialendoscopy. The studies were performed at the “Universidade Federal de Minas Gerais” and at the Department of Otorhinolaryngology-Head and Neck Surgery of the Minimally Invasive Therapy Center for Salivary Glands of New Zealand, the “Manukau Surgical Center” and “Middlemore Hospital”, in Auckland. All variables included in this research were prospectively collected, from 2010 to 2020, from the moment each patient attended their first medical assessment at the department. The results showed that the greater the “quality of life impact” of the patient with sialadenitis due to salivary calculi, the greater the chance of a reintervention after an endoscopic treatment. In patients with sialolithiasis, the perihilar or intraglandular location of the sialoliths was a significant variable in predicting the failure of the initial procedure, as well as the need for a further revision procedure. Almost half (46.7%) of the unsuccessful sialendoscopies to remove sialoliths did not require an additional postoperative procedure, due to symptom remission, indicating that a conservative approach may be an option in these situations. There was a 93% reduction in the likelihood for a revision procedure in patients who received oral corticosteroids for 30 days after a sialendoscopy for obstructive sialadenitis due to ductal stenosis, and its prescription is indicated to improve the results in this situation. In the studies presented here, we found that variables related to the patient, pathology, and treatment showed a significant association as prognostic factors related to reinterventions after an endoscopic procedure of the salivary glands.