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Treatment of Salivary Gland Diseases: Established Knowledge, Current Challenges and New Insights

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Otolaryngology".

Deadline for manuscript submissions: closed (10 June 2023) | Viewed by 27883

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Special Issue Editor

Prof. Dr. Konstantinos Mantsopoulos

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Department of Otorhinolaryngology, Friedrich-Alexander University, Erlangen-Nuremberg, Germany
Interests: salivary gland; thyroid surgery
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

In the last two decades, a change in paradigm has taken place in the field of management of salivary gland diseases. Hardly any kind of pathologic entity has remained unaffected by the philosophy of individualized medicine, the general need for a reduction in therapeutic “invasiveness”, or the need for a satisfactory postinterventional quality of life. For example, expanding the use of ultrasound as well as sialendoscopy has led to the development of a significant number of treatment modalities in obstructive sialopathy, aiming at the preservation of the anatomy and function of major salivary glands and a reduction in postinterventional morbidity. Furthermore, the need to lessen surgical invasiveness and secure a better quality of life for patients has given rise to minimal invasive surgical modalities in benign parotid gland lesions, focusing away from the dissection of the facial nerve and concentrating on the capsular features of the tumor itself. Last but not least, a significant amount of research is dedicated on the several nonsurgical palliative forms of treatment for malignant tumors.

Given that this area of clinical research is undoubtedly evolving continually, the present Special Issue entitled “Treatment of Salivary Gland Diseases: Established Knowledge, Current Challenges, and New Insights” is intended to provide an overview of recent advances in the field of management of salivary gland diseases in an effort to provide new evidence on several surgical and nonsurgical aspects of this topic.

Therefore, I cordially invite researchers involved in clinical research to submit their original research, systematic reviews, and short communications to this Special Issue.

Prof. Dr. Konstantinos Mantsopoulos
Guest Editor

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Keywords

salivary gland surgery
parotidectomy
extracapsular dissection
obstructive sialopathy
salivary gland oncology
postoperative quality of life
facial nerve
Frey’s syndrome

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Published Papers (9 papers)

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Editorial

Jump to: Research, Review

2 pages, 152 KiB

Open AccessEditorial

Treatment of Salivary Gland Diseases: Established Knowledge, Current Challenges and New Insights

by Konstantinos Mantsopoulos

J. Clin. Med. 2022, 11(3), 802; https://doi.org/10.3390/jcm11030802 - 2 Feb 2022

Cited by 1 | Viewed by 1450

Abstract

In the last two decades, a change in paradigm has taken place in the management of salivary gland diseases [...] Full article

(This article belongs to the Special Issue Treatment of Salivary Gland Diseases: Established Knowledge, Current Challenges and New Insights)

Research

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8 pages, 245 KiB

Open AccessArticle

Ultrasound-Guided Needle Aspiration vs. Surgical Incision of Parotid Abscesses

by Ulrich Strassen, Christophe Grimler and Benedikt Hofauer

J. Clin. Med. 2022, 11(24), 7425; https://doi.org/10.3390/jcm11247425 - 14 Dec 2022

Cited by 3 | Viewed by 3394

Abstract

Objective: Standard treatment of parotideal abscesses consists of surgical drainage. This often has to be carried out in general anesthesia and carries the risk of iatrogenic injury of the facial nerve. Ultrasound-guided needle aspiration is an alternative therapy. Up until now a lack of systematic data concerning this subject exists. The study at hand aims to answer the question whether needle aspiration is a viable alternative for surgical drainage. Methods: All patients who had been treated surgically (n = 39) or via ultrasound-guided needle aspiration (n = 18) at our clinic were included into this monocentric retrospective analysis. Results: There was no statistically significant difference (p = 0.142) regarding the mean abscess volume in both groups (5.7 vs. 10.1 mL). Therapy of the abscesses on average required 1.88 (1–5) ultrasound-guided needle aspirations or 1.10 (1–4) surgical interventions. There was a trend to a shorter inpatient treatment period (5.88 vs. 7.33 days) after ultrasound-guided needle aspiration. This trend did not reach statistical significance (p = 0.301). Facial nerve alterations did not occur in any of the patients. Postoperative bleeding did never occur after needle aspirations but in 2% of the patients after surgical abscess revision. Conclusion: Ultrasound-guided needle aspiration is safe and effective in the treatment of parotid abscesses. Full article

(This article belongs to the Special Issue Treatment of Salivary Gland Diseases: Established Knowledge, Current Challenges and New Insights)

12 pages, 2943 KiB

Open AccessArticle

Point Shear Wave Elastography in Diagnosis and Follow-Up of Salivary Gland Affection after Head and Neck Cancer Treatment

by Benedikt Hofauer, Andreas Roth, Clemens Heiser, Johannes Schukraft, Felix Johnson, Zhaojun Zhu and Andreas Knopf

J. Clin. Med. 2022, 11(21), 6285; https://doi.org/10.3390/jcm11216285 - 25 Oct 2022

Cited by 3 | Viewed by 1471

Abstract

Therapies of head and neck squamous cell carcinoma (HNSCC), particularly irradiation and chemotherapy (C/RT), can affect salivary glands to some extent. Recent studies suggest that point shear wave elastography (pSWE) is well suited for the diagnosis and rating of homogenous damage to parenchymatous organs. The purpose of this study was to assess the value of this sonographic modality as a tool for the evaluation both of salivary gland affection after HNSCC therapy and the effect of a salivary replacement therapy based on liposomes. A total of 69 HNSCC patients were included in this study. All patients had finished cancer treatment and attended regular follow-up. pSWE values of ipsi- and contralateral parotid (PG) and submandibular glands (SMG) were obtained in a standardized manner and compared to those of a healthy control (HC) group. After a two months treatment with a liposomal saliva replacement therapy pSWE quantification was performed again. Ipsi- and contralateral salivary glands suffer under standard HNSCC tumor therapy. Here, the ipsilateral parotid gland (PG) is primarily affected. Therefore, a sequence of manifestation (surgery < surgery plus adjuvant C/RT < primary C/RT) is comprehensible, evaluated by pSWE measurements. The examination of all glands and statistical analysis of the values compared to controls resulted in an pSWE cutoff value for affected glandular tissue of >2 m/s. Using a liposomal saliva replacement therapy, pSWE values of the ipsilateral PG can be improved, although the level of HC could not be restored. Full article

(This article belongs to the Special Issue Treatment of Salivary Gland Diseases: Established Knowledge, Current Challenges and New Insights)

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9 pages, 18748 KiB

Open AccessArticle

Multimodal Evaluation of Long-Term Salivary Gland Alterations in Sarcoidosis

by Benedikt Hofauer, Miriam Wiesner, Konrad Stock, Friedhelm Peltz, Felix Johnson, Zhaojun Zhu, Adam Chaker and Andreas Knopf

J. Clin. Med. 2022, 11(9), 2292; https://doi.org/10.3390/jcm11092292 - 20 Apr 2022

Cited by 1 | Viewed by 1656

Abstract

Background: Sarcoidosis is a systemic inflammatory disease characterized by non-caseating granulomas. In addition to the lungs as classical site of affection, extrapulmonary manifestations are common, for example in the cervical lymph nodes or the salivary glands. The aim of this investigation is the analysis of the long-term course of glandular symptoms and the sonographic evaluation of long-term salivary gland changes. Material and methods: All patients with a diagnosis of sarcoidosis over a period of 20 years in the departments of otorhinolaryngology, rheumatology, and pneumology were identified. In addition to clinical examinations and functional evaluation of the salivary glands, a sonographic examination of the salivary glands was carried out. The changes in the area of the salivary glands were assessed using B-mode sonography and different elastographic methods with appropriate scoring systems. Results: A total of 76 patients were included in the study (age 35.1 ± 21.6 years). Overall, 17 patients presented with salivary gland manifestation at the time of the initial diagnosis. Of these patients, 15 received steroid therapy, 6 were also treated with another drug, and 2 patients were not treated with drugs. The time span between initial diagnosis and follow-up was 88.2 months (±83.0). At the time of the initial diagnosis, 17/17 complained of swelling of the salivary glands, 9/17 of xerostomia, and 8/17 of pain in the area of the salivary glands. At the time of follow-up, 5/17 reported swelling of the salivary glands, 6/17 reported xerostomia, and 1/17 reported pain in the salivary gland area. Sonography showed sonomorphological abnormalities of the salivary glands only in individual cases, with only mild alterations on average. Conclusion: In summary, it can be observed that patients with initial symptoms in the area of the salivary glands, such as swelling or pain, also suffer more frequently from dry mouth and eyes. In all patients, however, these symptoms regressed over time. A previous diagnosis of sarcoidosis with involvement of the salivary glands only leads to permanent abnormalities in the area of the salivary glands in individual cases. Full article

(This article belongs to the Special Issue Treatment of Salivary Gland Diseases: Established Knowledge, Current Challenges and New Insights)

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10 pages, 733 KiB

Open AccessArticle

Comparative Longitudinal Analysis of Malignant Transformation in Pleomorphic Adenoma and Recurrent Pleomorphic Adenoma

by Sung Yong Choi, Jaehyuck Choi, Inwoo Hwang, Junhun Cho, Young-Hyeh Ko and Han-Sin Jeong

J. Clin. Med. 2022, 11(7), 1808; https://doi.org/10.3390/jcm11071808 - 25 Mar 2022

Cited by 11 | Viewed by 2570

Abstract

Background: Recurrence in pleomorphic adenoma (PA) has been debated as a risk factor for malignant transformation (MT). In this study, we investigated whether recurrence is a risk factor for MT, by longitudinally analyzing cases with recurrent PA (RPA), and carcinomas from PA (CXPA) or RPA (CXRPA). Methods: The study population included 24 CXPA, 24 RPA, 6 CXRPA, and 386 PA cases (study period 2010–2018). Time and event data were collected from the medical documents to identify the time–event sequences. Results: The time interval to MT in CXRPA was significant longer than that of benign recurrence (median 342.0 vs. 109.5 months). In CXRPA, the recurrence intervals were not shorter than those in RPA according to recurrence frequency. Crudely, the MT rate was 5.9% among primary cases and 20.0% among recurrent cases. However, the time-adjusted MT rates increased up to 11.4% (incubation time > 60 months) and 20.0% (>120 months) in primary cases, which were not different from recurrent cases. Conclusion: In these longitudinal analyses, we did not find any clinical evidence that recurrence facilitates MT in the background of PA. Instead, a long incubation time seems to be a key factor for MT of underlying RPA. Full article

(This article belongs to the Special Issue Treatment of Salivary Gland Diseases: Established Knowledge, Current Challenges and New Insights)

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8 pages, 568 KiB

Open AccessArticle

Inhalative Treatment of Laryngitis Sicca in Patients with Sjögren’s Syndrome—A Pilot Study

by Benedikt Hofauer, Lara Kirschstein, Simone Graf, Ulrich Strassen, Felix Johnson, Zhaojun Zhu and Andreas Knopf

J. Clin. Med. 2022, 11(4), 1081; https://doi.org/10.3390/jcm11041081 - 18 Feb 2022

Cited by 1 | Viewed by 1844

Abstract

Xerostomia and keratoconjunctivitis sicca are the main symptoms of Sjögren’s syndrome. Often patients also suffer from laryngeal complaints, but there is a lack of specific treatment options. The aim of this study was to evaluate the effect of a liposomal inhalation therapy. Patients with Sjögren’s syndrome were included and received a two-month period of liposomal inhalation therapy. The effect was evaluated by standardized questionnaires (patient-reported indices) and measurement of unstimulated whole salivary flow and glandular stiffness. Forty-five patients were included in this study. A comparison of baseline and therapeutic values demonstrated a significant improvement of the EULAR Sjögren’s syndrome patient reported index (ESSPRI) with a baseline of 5.0 ± 2.1 and a therapeutic value of 4.1 ± 2.4 (p = 0.012). This improvement was mainly based on the item on dryness within this score. Overall, the therapy was well tolerated. In conclusion, an inhalative application of liposomes had a beneficial effect on the reported dryness in patients with Sjögren’s syndrome. A first insight into the effect of inhalation therapy on laryngeal symptoms could thus be obtained and at the same time the basis was created on which case calculations can be carried out in the future. Full article

(This article belongs to the Special Issue Treatment of Salivary Gland Diseases: Established Knowledge, Current Challenges and New Insights)

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13 pages, 2485 KiB

Open AccessArticle

Correlation between Electrophysiological Change and Facial Function in Parotid Surgery Patients

by Feng-Yu Chiang, Chih-Chun Wang, Che-Wei Wu, I-Cheng Lu, Pi-Ying Chang, Yi-Chu Lin, Ching-Feng Lien, Chien-Chung Wang, Tzu-Yen Huang and Tzer-Zen Hwang

J. Clin. Med. 2021, 10(24), 5730; https://doi.org/10.3390/jcm10245730 - 7 Dec 2021

Cited by 4 | Viewed by 3003

Abstract

This observational study investigated intraoperative electrophysiological changes and their correlation with postoperative facial expressions in parotidectomy patients with visual confirmation of facial nerve (FN) continuity. Maximal electromyography(EMG) amplitudes of the facial muscles corresponding to temporal, zygomatic, buccal and mandibular branches were compared before/after FN dissection, and facial function at four facial regions were evaluated before/after parotidectomy in 112 patients. Comparisons of 448 pairs of EMG signals revealed at least one signal decrease after FN dissection in 75 (67%) patients. Regional facial weakness was only found in 13 of 16 signals with >50% amplitude decreases. All facial dysfunctions completely recovered within 6 months. EMG amplitude decreases often occur after FN dissection. An amplitude decrease >50% in an FN branch is associated with a high incidence of dysfunction in the corresponding facial region. This study tries to establish a standard facial nerve monitoring (FNM) procedure and a proper facial function grading system for parotid surgery that will be useful for the future study of FNM in parotid surgery. Full article

(This article belongs to the Special Issue Treatment of Salivary Gland Diseases: Established Knowledge, Current Challenges and New Insights)

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Review

Jump to: Editorial, Research

19 pages, 333 KiB

Open AccessReview

Targeted Therapy, Chemotherapy, Immunotherapy and Novel Treatment Options for Different Subtypes of Salivary Gland Cancer

by Sarina K. Mueller, Marlen Haderlein, Sebastian Lettmaier, Abbas Agaimy, Florian Haller, Markus Hecht, Rainer Fietkau, Heinrich Iro and Konstantinos Mantsopoulos

J. Clin. Med. 2022, 11(3), 720; https://doi.org/10.3390/jcm11030720 - 29 Jan 2022

Cited by 32 | Viewed by 5007

Abstract

Surgical resection remains the first line treatment for salivary gland cancer (SGC). In the case of locally advanced disease, surgery is followed by adjuvant radiotherapy. Surgical resection should be favored in resectable locoregional recurrent disease as well, and even the complete resection of all distant oligometastases has clinical benefit for the patients. For inoperable and disseminated metastatic disease, a multitude of systemic therapies including chemotherapy, targeted therapy, and immunotherapy are available. In this review, the current therapeutic options for inoperable recurrent or metastatic SGCs are summarized. Systemic treatment can achieve prolonged progression-free and overall survival, while the overall prognosis remains poor. Current clinical trials include only a limited number of patients and mostly combine different histologic subtypes. Additionally, no randomized controlled trial comparing different therapeutic options has been performed. In the future, further studies with a larger patient cohort and ideally only one histologic subtype are needed in order to improve the outcome for SGC patients. However, this may be difficult to accomplish due to the rarity and diversity of the disease. Additionally, molecular analyses need to be performed routinely in order to individualize treatment and to go one step further towards precision medicine. Full article

(This article belongs to the Special Issue Treatment of Salivary Gland Diseases: Established Knowledge, Current Challenges and New Insights)

14 pages, 2554 KiB

Open AccessReview

Treatment of Sialolithiasis: What Has Changed? An Update of the Treatment Algorithms and a Review of the Literature

by Michael Koch, Konstantinos Mantsopoulos, Sarina Müller, Matti Sievert and Heinrich Iro

J. Clin. Med. 2022, 11(1), 231; https://doi.org/10.3390/jcm11010231 - 31 Dec 2021

Cited by 29 | Viewed by 6516

Abstract

Treatment for sialolithiasis has undergone significant changes since the 1990s. Following the development of new minimally invasive and gland-preserving treatment modalities, a 40–50% rate of gland resection was reduced to less than 5%. Extracorporeal shock-wave lithotripsy (ESWL), refinement and extension of methods of transoral duct surgery (TDS), and in particular diagnostic and interventional sialendoscopy (intSE) are substantial parts of the new treatment regimen. It has also become evident that combining the different treatment modalities further increases the effectiveness of therapy, as has been especially evident with the combined endoscopic–transcutaneous approach. In the wake of these remarkable developments, a treatment algorithm was published in 2009 including all the known relevant therapeutic tools. However, new developments have also taken place during the last 10 years. Intraductal shock-wave lithotripsy (ISWL) has led to remarkable improvements thanks to the introduction of new devices, instruments, materials, and techniques, after earlier applications had not been sufficiently effective. Techniques involving combined approaches have been refined and modified. TDS methods have been modified through the introduction of sialendoscopy-assisted TDS in submandibular stones and a retropapillary approach for distal parotid sialolithiasis. Recent trends have revealed a potential for significant changes in therapeutic strategies for both major salivary glands. For the submandibular gland, ISWL has replaced ESWL and TDS to some extent. For parotid stones, ISWL and modifications of TDS have led to reduced use of ESWL and the combined transcutaneous–sialendoscopic approach. To illustrate these changes, we are here providing an updated treatment algorithm, including tried and tested techniques as well as promising new treatment modalities. Prognostic factors (e.g., the size or location of the stones), which are well recognized as having a strong impact on the prognosis, are taken into account and supplemented by additional factors associated with the new applications (e.g., the visibility or accessibility of the stones relative to the anatomy of the duct system). Full article

(This article belongs to the Special Issue Treatment of Salivary Gland Diseases: Established Knowledge, Current Challenges and New Insights)

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