Читать книгу Salivary Gland Pathology - Группа авторов - Страница 124

Treatment recommendations range from conservative measures including antibiotics, massage, and sialagogues and surgical procedures with sialendoscopy. Gland preservation should be the goal of treatment since cases typically resolve (Erkul and Gillespie 2016). Shacham et al. (2009) reported on 70 children with chronic recurrent juvenile parotitis who were treated with sialendoscopy and lavage of the gland with 60 ml of normal saline bilaterally. Dilatation of Stensen ducts was performed in four patients and 100 mg of hydrocortisone was injected into each gland. In 93% of patients treated in this fashion, a single treatment was sufficient to resolve the parotitis and prevent its recurrence. Although encouraging studies demonstrate the benefit of sialendoscopy for chronic recurrent juvenile parotitis, there is a lack of prospective, randomized controlled studies comparing this modality to conservative measures alone. It has been recommended to adopt a watchful waiting approach with conservative measures followed by the performance of sialendoscopy if three episodes occur within a six‐month period or four episodes within one year (Erkul and Gillespie 2016). This approach seems valid since spontaneous regeneration of salivary function has been reported (Galili and Marmary 1985).

Tucci et al. (2019) performed a retrospective study of 110 patients with a diagnosis of chronic recurrent juvenile parotitis who underwent sialography without local anesthesia or sedation. The outcome of the sialography was measured by comparing the number and magnitude of episodes of parotid swelling before and after the procedure. Marked improvement was defined by an outcome that saw no episode of parotid swelling or a reduction of more than 80% of episodes in the first year after the procedure. A nonresponder was defined by no improvement in swelling events or by a reduction of less than 30% events. Partial improvement was defined as decreased but not complete resolution of swelling or with a reduction of episodes from 30 to 80% of episodes in the year after sialography. After performing the sialography, a statistically significant overall recovery of pathology was noted in 98 (89%) of patients with a mean 67.4% reduction in the number of acute episodes of parotid swelling in the year after the procedure. Seventy‐five patients demonstrated a marked improvement in symptoms with a mean reduction of 80.6% of acute attacks. Partial improvement was noted in 23 patients with a mean reduction of the number of episodes of 36.5% in the year after sialography. No remission of swelling was noted in 12 patients. The authors concluded that sialography is an effective therapeutic method for chronic recurrent juvenile parotitis and is associated with low cost and with a low rate of complications.