Sialendoscopy-based diagnosis and classification of parotid duct stenoses

To assess stenoses of Stensen's duct considering findings provided by sialendoscopy-based direct visualization. A practical classification scheme based on different parameters is presented.

Ultrasonography and sialendoscopy were used to diagnose and analyze symptomatic stenoses of the parotid gland excretory duct in 93 patients. Sialendoscopy was performed with semirigid endoscopes that enabled direct evaluation and classification of those stenoses in terms of tissue quality, luminal narrowing, extend, number, location, and in consideration of possible etiologic diseases or conditions.

A total of 111 stenoses were diagnosed in 93 patients. Three types could be distinguished. Stenoses were inflammation-dominated with various narrowing of the lumen (type I) in 16.1% of patients, fibrous and web-associated, predominant incomplete (luminal narrowing <50%, type II) in 18.3%, and fibrous, predominant high-grade (luminal narrowing >50%, type III) in 66.6%. A length of more than 1 cm or diffuse involvement of the duct system was observed in 12.9% of cases. Together 70.1% of all stenoses were found in middle and distal regions of the duct. Multiple stenoses were found in 12.9% of patients, bilateral in 6.5%. Of all patients, 45.2% had diseases possibly implicated in the etiogenesis. Type III stenoses were associated with these comorbidities in up to 100%.

Minimally invasive techniques play a central role in the diagnosis and treatment of Stensen's duct stenoses. Sialendoscopy is the diagnostic method of first choice. It enables an exact and direct classification of stenoses and provides additional information for planning effective treatment.