202 FUTURE RESEARCH Intraductal infusion to the salivary gland Animal studies revealed that intraductal liquids are evenly distributed throughout the salivary gland.81 The authors conclude that intraductal infusion could serve as a potential route for therapeutic salivary gland procedures.81 Now, there is already broad experience with intraductal infusion to the salivary gland, including successful intraductal treatment for chronic sialadenitis, chronic obstructive parotitis and m. Sjögren, sialography, and treatment of drooling.82-86 Previous literature that studied sialography showed 5% extravasation of radiocontrast in 255 sialograms. Extravasation was only seen in patients with ductal stenosis or stricture.85 Other authors found 42% remainder radiocontrast after intra-ductal infusion in 66 patients who underwent sialography. The main reason for radiocontrast (lipiodol) retention in the latter study were fausse route and sialectasis.87 There were no complications due to retention of radiocontrast.87 The authors conclude that the fausse route might be due to inexperience with sialography or rigid instruments.88 Inability to cannulate the salivary duct was reported in 10 - 14% of patients. However, cannulation failure seemed highly related to anatomical deformities like strictures or stones near the orifice.49, 85 Main indications of sialography are ductal anomalies like ductal stenosis or strictures, sialolithiasis or sialectasis, so the inability to cannulate and secondary extravasation is highly susceptible to selection bias.85, 87, 89, 90 Salivary ductal stenosis or strictures are due to pathological processes in the salivary gland.85 In drooling patients, there is generally no salivary gland abnormality like ductal stenosis, strictures, or sialectasis, so extravasation or problems with cannulation are not probable. A recent study that evaluated percutaneous and intraductal salivary gland ethanol revealed that it is a safe and effective procedure for treating drooling. The drooling frequency and severity scale reduced from 9 to 7 after a median of 5,4 years. There were no permanent sequala, and adverse events occurred in 11% of patients, including respiratory difficulty, temporary nerve palsy, and infection. Injections to
RkJQdWJsaXNoZXIy MjY0ODMw