Sialendoscopy for the management of obstructive salivary gland disease: A systematic review and meta-analysis

Objective: To conduct a systematic review with metaanalysis to determine the efficacy and safety of sialendoscopy in the treatment of obstructive diseases of the salivary glands in adults. Data Sources: MEDLINE, EMBASE, and the Cochrane Library (no lower limit to October 2010). Reference lists were searched for identification of relevant studies. Study Selection: Prospective or retrospective studies of adult patients treated with interventional sialendoscopy for the management of salivary gland obstruction were selected. Outcome measures included rates of success (symptom-free and absence of residual obstruction), sialadenectomy, and complications. Non-English publications were excluded. Data Extraction: Two independent review authors screened eligible studies, extracted relevant data, and resolved discrepancies by consensus when applicable. Weighted pooled proportion, 95% confidence intervals, and test results for heterogeneity are reported. Data Synthesis: Twenty-nine studies were included in the analysis. The weighted pooled proportion of success rates were 0.86 (95% CI, 0.83-0.89) for studies involving 1213 patients undergoing sialendoscopy alone and 0.93 (95% CI, 0.89-0.96) for the 374 patients undergoing sialendoscopy with a combined surgical approach. Outcomes following interventional sialendoscopy for radioiodine-induced sialadenitis were reported in 3 studies, and success rates were variable. Rates of sialadenectomy were low, and few major complications were reported. Conclusion: Findings from the present systematic review and meta-analysis suggest that sialendoscopy is efficacious, safe, and gland preserving for the treatment of obstructive major salivary gland disease

Outcome of minimally invasive management of salivary calculi in 4,691 patients

Objective: To evaluate the application of minimally invasive techniques in the management of salivary stones. Background: The incidence of salivary calculi is 60 cases/million/year, with most stones situated in the mid or proximal duct. The current treatment of these stones is adenectomy. This paper reports the results of minimally invasive methods of stone removal that avoid gland excision. Methods: Observational study of 5,528 consecutive patients treated by lithotripsy, endoscopy, basket retrieval, and/or surgery in five centers from 1990 to 2004 inclusive. A total of 567cases were excluded, leaving 4,691 patients (parotid n=1,165, submandibular n=3,526) for analysis. Results: Salivary calculi were eliminated in 3,775/4,691 (80.5%) of cases and partly cleared in 782/4,691 (16.7%). Salivary glands were removed in 134/4,691 (2.9%) of patients with symptoms in whom treatment failed. Conclusions: Minimally invasive techniques move treatment of salivary calculi to an outpatient or a day case setting. They are reliable ways of both retrieving stones and eliminating symptoms, and mean that the gland rarely has to be removed

Oynophagia in patients after dental extraction: surface electromyography study

OBJECTIVES: Surface electromyographic (sEMG) studies were performed on 40 adult patients following extraction of lower third and second molars to research the approach and limitations of sEMG evaluation of their odynophagia complaints. METHODS: Parameters evaluated during swallowing and drinking include the timing, number of swallows per 100 cc of water, and range (amplitude) of EMG activity of m. masseter, infrahyoid and submental-submandibular group. The above mentioned variables (mean + standard deviation) were measured for the group of dental patients (n = 40) and control group of healthy adults (n = 40). RESULTS: The duration of swallows and drinking in all tests showed increase in dental patients' group, in which this tendency is statistically significant. There was no statistically significant difference between male and female adults' duration and amplitude of muscle activity during continuous drinking in both groups (p = 0.05). The mean of electric activity (in μV) of m. masseter was significantly lower in the dental patients' group in comparison with control group. The electric activity of submental-submandimular and infrahyoid muscle groups was the same in both groups. CONCLUSION: Surface EMG of swallowing is a simple and reliable noninvasive method for evaluation of odynophagia/dysphagia complaints following dental extraction with low level of discomfort of the examination. The surface EMG studies prove that dysphagia following dental extraction and molar surgery has oral origin, does not affect pharingeal segment and submental-submandibular muscle group. This type of dysphagia has clear EMG signs: increased duration of single swallow, longer drinking time, low range of electric activity of m. masseter, normal range of activity of submental-submandibular muscle group, and the "dry swalow" aftereffect. The data can be used for evaluation of complaints and symptoms, as well as for comparison purposes in pre- and postoperative stages and in EMG monitoring during treatment of post-surgical oral cavity discomfort and dysphagia

Oral vs. pharyngeal dysphagia: surface electromyography randomized study

<p>Abstract</p> <p>Background</p> <p>A clear differential diagnosis between oral and pharyngeal dysphagia remains an unsolved problem. Disorders of the oral cavity are frequently overlooked when dysphagia/odybophagia complaints are assessed. Surface electromyographic (sEMG) studies were performed on randomly assigned patients with oral and pharyngeal pathology to evaluate their dysphagia complaints for the sake of differential diagnosis.</p> <p>Methods</p> <p>Parameters evaluated during swallowing for patients after dental surgery (1: n = 62), oral infections (2: n = 49), acute tonsillitis (3: n = 66) and healthy controls (4: n = 50) included timing and amplitude of sEMG activity of masseter, infrahyoid and submental muscles.</p> <p>Results</p> <p>The duration of swallows and drinking periods was significantly increased in dental patients and was normal in patients with tonsillitis. The electric activity of masseter was significantly lower in Groups 1 and 2 in comparison with the patients with tonsillitis and controls. The submental and infrahyoid activity was normal in dental patients but infrahyoid activity in patients with tonsillitis was high.</p> <p>Conclusion</p> <p>Dysphagia following dental surgery or oral infections does not affect pharynx and submental muscles and has clear sEMG signs: increased duration of a single swallow, longer drinking time, low activity of the masseter, and normal range of submental activity. Patients with tonsillitis present hyperactivity of infrahyoid muscles. These data could be used for evaluation of symptoms when differential dental/ENT diagnosis is needed.</p

Voltage-Dependent Anion Channel 1 Expression in Oral Malignant and Premalignant Lesions

Background: The voltage-dependent anion channel 1 protein (VDAC1) plays a role in cellular metabolism and survival. It was found to be down or upregulated (overexpressed) in different malignancies but it was never studied in application to oral lesions. The purpose of this study was to retrospectively evaluate the expression of VDAC1 in biopsies of oral premalignant, malignant, and malignancy-neutral lesions and to examine the possible correlations to their clinicopathological parameters. Materials and methods: 103 biopsies including 49 oral squamous cell carcinoma, 33 epithelial dysplasia, and 21 fibrous hyperplasia samples were immunohistochemically stained with anti-VDAC1 antibodies for semi-quantitative evaluation. The antibody detection was performed with 3,3′-diaminobenzidine (DAB). The clinicopathological information was examined for possible correlations with VDAC1. Results: VDAC1 expression was lower in oral squamous cell carcinoma 0.63 ± 0.40 and in oral epithelial dysplasia 0.61 ± 0.36 biopsies compared to fibrous hyperplasia biopsies 1.45 ± 0.28 (p < 0.01 for both; Kruskal–Wallis test). Conclusion: Oral squamous cell carcinoma and epithelial dysplasia tissues demonstrated decreased VDAC1 protein expression if compared to fibrous hyperplasia samples, but were not different from each other, suggesting that the involvement of VDAC1 in oral carcinogenesis is an early stage event, regulating cells to live or die