Konstantinidis I, Chatziavramidis A, Tsakiropoulou E, Malliari H, Constantinidis J
Sialendoscopy Clinic, 2nd ORL Department, Aristotle University, Papageorgiou Hospital, Ring Road, Efkarpia, Thessaloniki 56403, Greece.
Int J Pediatr Otorhinolaryngol. 2011 Feb;75(2):245-9. doi: 10.1016/j.ijporl.2010.11.009. Epub 2010 Dec 4.
Sialendoscopy in children is a recently described procedure. The small amount of existed literature presents the procedure under general anesthesia. We report our experience on pediatric sialendoscopy under local anesthesia at an outpatient setting.
In a period of 1.5 years 9 children with age >8 years suffering from recurrent parotid swellings were assessed with sialendoscopy. In 8 out of 9 cases the parents accepted a procedure under local anesthesia. In 7 cases the procedure was completed uneventfully however in one case was discontinued and repeated under general anesthesia. The endoscope used was a 1.1mm Marchal type. Prior to endoscopy xylocaine solution 4% was applied on the papilla area for 15min. Intraductal injection of xylocaine 2% (5ml) was performed prior the insertion of the endoscope. During the procedure parents evaluated pain by means of a 6-point smiley scale. Social life and school activity were also evaluated by means of an 11-point scale pre- and 1 year post-sialendoscopy.
Seven out of eight children (8 sialendoscopies) tolerated and completed the sialendoscopy assessment. The mean duration of the procedure was 39.2min. No major complications were reported at the early post-endoscopy period. Four children presented no further swellings, two experienced one recurrence and one needed a repeat sialendoscopy (3 recurrent episodes). Sialendoscopy findings showed fibrinous debris in 4 children, mucous plugs in 2, evidence of sialodochitis with purulent debris in one child and stenosis in 3 children. The diagnosis in our cases was Juvenile Recurrent Parotitis in 6 children and chronic microbial parotitis in one case. Social life and school activity were improved in 6 children 1-year post-sialendoscopy according to parent's ratings.
Sialendoscopy under local anesthesia can be an alternative option in children of age >8 years and satisfactory cooperative skills, avoiding unnecessary general anesthesias and hospital stay.
儿童唾液腺内镜检查是最近才描述的一种手术。现有的少量文献介绍了在全身麻醉下进行该手术的情况。我们报告在门诊局部麻醉下进行儿童唾液腺内镜检查的经验。
在1.5年的时间里，对9名年龄大于8岁、患有复发性腮腺肿胀的儿童进行了唾液腺内镜检查评估。9例中有8例家长接受了局部麻醉下的手术。7例手术顺利完成，但1例中断并在全身麻醉下重复进行。使用的内镜是1.1毫米的马尔沙尔型。在内镜检查前，将4%的利多卡因溶液涂抹在乳头区域15分钟。在内镜插入前，进行2%利多卡因（5毫升）的导管内注射。在手术过程中，家长通过6分笑脸量表评估疼痛程度。还通过11分量表在唾液腺内镜检查前和检查后1年对社交生活和学校活动进行评估。
8名儿童中的7名（8次唾液腺内镜检查）耐受并完成了唾液腺内镜检查评估。手术平均持续时间为39.2分钟。内镜检查后早期未报告重大并发症。4名儿童未再出现肿胀，2名儿童经历了1次复发，1名儿童需要重复进行唾液腺内镜检查（3次复发）。唾液腺内镜检查结果显示，4名儿童有纤维蛋白碎片，2名儿童有黏液栓，1名儿童有化脓性碎片的涎管炎证据，3名儿童有狭窄。我们病例中的诊断为6名儿童患有青少年复发性腮腺炎，1例为慢性微生物性腮腺炎。根据家长的评分，6名儿童在唾液腺内镜检查后1年社交生活和学校活动得到改善。
局部麻醉下的唾液腺内镜检查对于年龄大于8岁且具备良好合作能力的儿童可以是一种替代选择，避免了不必要的全身麻醉和住院。
