Intraductal salivary gland irrigation - a critical appraisal of an alternative treatment approach for patients with...

Xerostomia and hyposalivation impair oral function and quality of life. Current therapies are largely palliative, and systemic sialogogues are often limited by side effects or contraindications. Intraductal salivary gland irrigation (IDSGI) has emerged as an alternative, being a minimally invasive outpatient technique aimed at relieving oral dryness by flushing and stimulation of the major salivary glands with saline or corticosteroid solutions. This technique has been described for various disorders of the salivary glands (e.g. Sjögren’s syndrome, sialadenitis), and substantial objective and subjective benefits following intraductal irrigation have been reported. The present article describes and critically appraises this technique by presenting three randomly chosen patient cases with documented hyposalivation and severe xerostomia. The patients were all treated by intraductal irrigation of their major salivary glands using sterile saline. Before and after therapy, unstimulated and stimulated whole-saliva flow rates, salivary pH, and subjective dryness using a visual analogue scale (VAS) were measured. The procedure was well tolerated with no complications by all three patients included. After one month, unstimulated and stimulated salivary flow rates increased in two cases and one patient previously treated with sialogogues showed no improvement in salivary flow rates. However, all three patients showed a decreased VAS for dryness by 30-50% with subjective improvement persisting also on later check-ups. The cases presented suggest that IDSGI represents a simple and safe outpatient procedure that can improve salivary flow and xerostomia as an adjunct to other conservative measures, particularly when systemically acting sialogogues are ineffective or contraindicated.