201 Intraglandular sclerotherapy The safety of ethanol in the head- and neck region has long been established. There is broad experience with the use of ethanol in the head and neck region, which includes treatment of Arterio-Venous Malformation, thyroglossal cyst ablation, and ranula ablation.34, 69-72 Ethanol initially damages cells via dehydration, denaturalizes proteins, coagulates vessels, and results in tissue necrosis.70 Subsequently, there is fibrosis which replaces damaged cells and prevents regrowth of functional tissue.73 Recent rat studies revealed extensive parenchymal damage, inflammation, fibrosis, and increased connective tissue after unilateral percutaneous 98% ethanol submandibular gland injection.74 Moreover, treated glands were 43% lighter than the contralateral gland, which was not treated. Gland size and general appearance seemed good indicators of salivary gland function.75 Rat studies were also previously used to study management for drooling,76-78 and animal studies are reputable to correlate well to clinical outcomes.74, 77, 79, 80 A very recent study revealed 63% treatment success after percutaneous ranula ablation with ethanol under ultrasound guidance. Although there were no skin or nerve injury cases in the cohort, their broad experience taught them that ethanol injection in the sublingual and submandibular gland could result in skin injury, temporary paresis of the lingual and marginal mandibular nerve when ethanol reaches surrounding tissues.34 Even though the percutaneous injections were under radiologic guidance, the procedure has related risks, which ensue when the sclerosant agent reaches surrounding tissue.69 74Animal studies revealed skin ulcers after percutaneous submandibular gland injection.74 Percutaneous ethanol injections of head- and neck AVM revealed 3,8% major adverse events, including watershed infarction due to procedural difficulties, severe swelling, and skin necrosis requiring surgical intervention. Minor adverse events (26%) included skin necrosis, skin bullae, mucosal ulcer, and transient nerve palsy.69 This led several research groups to evaluate the efficacy of intraductal salivary gland infusion with promising results, which will be reflected on below.
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