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OBJECTIVES: First, establishment and validation of a novel questionnaire documenting the burden of xerostomia and sialadenitis symptoms, including quality of life. Second, to compare two versions regarding the answering scale (proposed developed answers Q3 vs. 0-10 visual analogue scale Q10) of our newly developed questionnaire, in order to evaluate their comprehension by patients and their reproducibility in time. STUDY DESIGN: The study is a systematic review regarding the evaluation of the existing questionnaire and a cohort study regarding the validation of our new MSGS questionnaire. MATERIALS AND METHODS: A Multidisciplinary Salivary Gland Society (MSGS) questionnaire consisting of 20 questions and two scoring systems was developed to quantify symptoms of dry mouth and sialadenitis. Validation of the questionnaire was carried out on 199 patients with salivary pathologies (digestive, nasal, or age-related xerostomia, post radiation therapy, post radioiodine therapy, Sjögren's syndrome, IgG4 disease, recurrent juvenile parotitis, stones, and strictures) and a control group of 66 healthy volunteers. The coherence of the questionnaire's items, its reliability to distinguish patients from healthy volunteers, its comparison with unstimulated sialometry, and the time to fill both versions were assessed. RESULTS: The novel MSGS questionnaire showed good internal coherence of the items, indicating its pertinence: the scale reliability coefficients amounted to a Cronbach's alpha of 0.92 for Q10 and 0.90 for Q3. The time to complete Q3 and Q10 amounted, respectively, to 5.23 min (±2.3 min) and 5.65 min (±2.64 min) for patients and to 3.94 min (±3.94 min) and 3.75 min (±2.11 min) for healthy volunteers. The difference between Q3 and Q10 was not significant. CONCLUSION: We present a novel self-administered questionnaire quantifying xerostomia and non-tumoral salivary gland pathologies. We recommend the use of the Q10 version, as its scale type is well known in the literature and it translation for international use will be more accurate. Laryngoscope, 132:322-331, 2022. ispartof: LARYNGOSCOPE vol:132 issue:2 pages:322-331 ispartof: location:United States status: published

Sjögren's syndrome (SS) is a systemic autoimmune disease affecting the lacrimal and salivary glands. In up to one third of patients, SS may be complicated by potentially severe extra-glandular visceral involvement, which can be life-threatening. Diagnosis is often difficult based on a combination of clinical and biological evidence. The development of new imaging techniques can now help the clinician in his diagnostic approach. Long considered incurable, new medical and surgical treatments are being studied and are potentially promising. Paramedical management and regular physical activity are also essential and contribute to the improvement of patients' fatigue. The objective of this article is to review the main clinical manifestations as well as the diagnostic and therapeutic novelties developed in recent years.Le syndrome de Sjögren (SS) est une maladie autoimmune systémique touchant les glandes lacrymales et salivaires. Chez près d’un tiers des patients, il peut se compliquer d’atteintes extraglandulaires potentiellement sévères. Le diagnostic, reposant sur un faisceau d’arguments clinicobiologiques, est souvent difficile. Le développement des nouvelles techniques d’imagerie peut aujourd’hui aider le clinicien dans sa démarche diagnostique. Longtemps considéré comme incurable, de nouveaux traitements médicochirurgicaux sont en cours d’étude et potentiellement prometteurs. Une prise en charge paramédicale avec une activité physique régulière est également essentielle. L’objectif de cet article est de revoir les manifestations cliniques ainsi que les nouveautés diagnostiques et thérapeutiques développées ces dernières années.

Objective: The aim of this study is to develop a simple and efficient screening questionnaire to be able to routinely monitor potential radioiodine therapy-induced complications.Materials and Methods: A new radioiodine 6 (RAI-6) questionnaire containing six questions adressing salivary, ocular, and nasal symptoms as well as quality of life was developed. Validation of the RAI-6 questionnaire was assessed with a group of fifty-four patients diagnosed with differentiated thyroid carcinoma treated post-operatively with radioiodine therapy, and in a group of fifty healthy volunteers. The patient's group was subdivided into subgroups according to the radioiodine dose received: 23 patients received less or 30 mCi, 28 patients received 100 mCi, and three patients received between 200 and 300 mCi. We asked the patients to complete the RAI-6 questionnaire in a retrospective manner, regarding their situation before radioiodine therapy and regarding their actual symptoms after radioiodine therapy. The time needed to complete the RAI-6 was also assessed both in patients and in healthy volunteers.Results: The mean post radioiodine treatment RAI-6 score were significantly higher than the mean pre radioiodine RAI-6 scores (p < 0.001) and the scores of healthy participants (p < 0.001). The mean total RAI-6 scores increased significantly with increasing radioiodine dose. A total mean RAI-6 score of each question was also analysed and revealed that ocular and nasal discomfort as well as quality of life were the items which affected the patients most after radioiodine treatment. The mean time to fill the RAI-6 questionnaire was 2 min for patients and 49 s for healthy volunteers.Conclusion: The RAI-6 represents a new questionnaire which is easy and quick to complete. This simple screening tool can be recommended for general clinical practise and further epidemiological research.

Objectives This study aims to review the effects of short- and long-term oral administration of postoperative corticosteroids in patients undergoing sialendoscopy for the treatment of obstructive sialadenitis due to ductal stenosis. Study design Prospective comparative study. Methods A prospective observational study was conducted at Manukau Surgical Center in Auckland, New Zealand, where patients undergoing sialendoscopic surgery for recurrent obstructive sialadenitis due to ductal stenoses were reviewed. Univariable and multivariable analysis, and also logistic regression were performed to identify variables correlated with the likelihood of the need for revision surgery for persistent or recurrent symptoms. Results In this study, sialendoscopy was performed in 142 patients: 162 parotid glands (86.6%) and 25 submandibular glands (13.4%). Postoperative oral steroids were prescribed for 48 patients (34%); 19 (13%) were prescribed for less than 7 days and 29 (20%) for more than 7 days. In total, 33 patients (23.2%) required a revision sialendoscopy during follow-up due to recurrence of symptoms. Oral steroids prescribed for more than 7 days after a sialendoscopy reduced the likelihood of a revision procedure by 93% when compared with patients who did not receive this medication, and by 96% when compared with patients who received steroids for less than 7 days. Conclusion The results showed that in our population oral administration of corticosteroids for more than 7 days after sialendoscopy for the treatment of recurrent obstructive sialadenitis due to ductal stenosis markedly reduced the need for later revision surgery. Routine use of corticosteroids for more than 7 days is recommended after sialendoscopy in patients with ductal stenosis. Level of evidence II Laryngoscope, 131:E1503-E1509, 2021.

BACKGROUND Postoperative radioactive iodine (RAI) administration is widely utilized in patients with differentiated thyroid cancer. While beneficial in select patients, it is critical to recognize the potential negative sequelae of this treatment. The prevention, diagnosis, and management of the salivary and lacrimal complications of RAI exposure are addressed in this consensus statement. METHODS A multidisciplinary panel of experts was convened under the auspices of the American Head and Neck Society Endocrine Surgery and Salivary Gland Sections. Following a comprehensive literature review to assess the current best evidence, this group developed six relevant consensus recommendations. RESULTS Consensus recommendations on RAI were made in the areas of patient assessment, optimal utilization, complication prevention, and complication management. CONCLUSION Salivary and lacrimal complications secondary to RAI exposure are common and need to be weighed when considering its use. The recommendations included in this statement provide direction for approaches to minimize and manage these complications.

Objectives/hypothesis To compare the results of magnetic resonance imaging with magnetic resonance sialography (MRSIAL) and the clinical and laboratory characteristics in a well-characterized cohort of patients with primary or secondary Sjogren's syndrome (SS) meeting the American-European Consensus Group criteria. Study design Retrospective, observational, monocentric study. Methods Thirty-six patients (81% female, mean age = 48 ± 35 years) with primary or secondary SS who underwent MRSIAL were included in the study. Results MRSIAL revealed characteristic radiological signs in the parotid, sublingual, and submandibular salivary glands in 35/36 patients (97%). Patients presenting with anti-Sjogren's syndrome-related antigen A (SSA) autoantibodies showed more often fatty infiltration, a "pepper-and-salt" appearance, ductal stenosis, and/or ductal dilation of the parotid gland (88%, 88%, and 72% respectively) than patients negative for anti-SSA (12%, 4%, and 28% respectively). MRSIAL demonstrated signs characteristic of SS in all 11 patients with negative minor salivary gland biopsy. For 15 patients undergoing ultrasound examination only, 11 (73%) had SS findings, but all 15 had SS findings on MRSIAL. Two cases of parotid lymphoma were detected by MRSIAL (6%). Conclusions MRSIAL is a reliable technique to detect glandular anomalies in patients with SS, and seems to provide a valuable aid in the diagnosis of SS. Level of evidence 4 Laryngoscope, 131:E83-E89, 2021.

The articles have been again selected among more than 15 000 abstracts and the review aims to be generalist. Interest of honey in head and neck pathologies, apnea syndrome, tonsillectomy and immunotherapy. In otology, middle ear infections and mastoiditis, cochlear implant in the elderly, deafness in children, auto-evaluation of audition and new perspectives regarding ciliar cell cultures. In rhinology the interest of different treatments including Xylitol, new technologies and nasal bleeding. In laryngology and thyroid surgery, guidelines for dysphonia, the interest of ultrasound in vocal cord evaluation and relation between thyroid surgery outcomes and training. HPV will be largely discussed as well as immunotherapy, interest of cannabis in cancer patients. Regarding salivary glands sialendoscopy, rerouting of salivary ducts and multiple detection of diseases in saliva.Les actualités thérapeutiques en ORL 2018, établies à partir de plus de 15 000 abstracts, se veulent une fois de plus généralistes. En ORL générale, les sujets seront le miel, les apnées du sommeil, l’adénotonsillectomie et l’immunothérapie. En otologie, l’otite moyenne aiguë et la mastoïdite, les nouvelles technologies, l’implant cochléaire chez le patient âgé, la surdité et l’intérêt des cultures de cellules ciliées. En rhinologie, la rhinosinusite et ses traitements dont le xylitol, l’apport de nouvelles technologies et l’épistaxis. En laryngologie et chirurgie thyroïdienne, les guidelines pour la dysphonie, l’intérêt de l’ultrason en préopératoire et les résultats en chirurgie thyroïdienne selon la formation. En chirurgie cervico-faciale, le VPH, l’immunothérapie, l’intérêt du cannabis et la possibilité de diagnostics tumoraux précoces dans la salive. En glandes salivaires, la sialendoscopie, la transposition de canaux salivaires et la détection de maladies à l’aide de biomarqueurs dans la salive.

In expanding the scope of sialendoscopy across the globe and assessing the impact of training activities at the European Sialendoscopy Training Centre, this study was conducted to find out the knowledge and attitude among respondents as well as identify potential obstacles to the initiation of the procedure. Delegates attending the 2011 International Federation of Otorhinolaryngological Societies meeting received a set of five questions. There were a total of 257 responses from 57 countries. Nearly all (238/257) were practising in the academic setting. A significant number of respondents had heard about sialendoscopy (231/257). An equal number found it interesting and were keen to learn more about the procedure (233/257). More than 85 % (219/257) respondents expressed their desire to start sialendoscopy. Hurdles to overcome included financial limitations (110) and “not enough knowledge” (100). Awareness about the existence of the procedure was rather high although the knowledge was limited. Several of the responders seemed keen on starting it, but had not done so due to financial limitations. However, there was a high rate of bias owing to the limited number of responders per country precluding a country-wise inference of awareness. Moreover, meetings of this nature tend to be attended by academics who in general seem to be more aware of new developments than their non-academic peers. Future surveys can address these issues as part of ensuring the universal adoption of sialendoscopy.

These novelties in ENT were selected among more than 15'000 abstracts in the 2016 literature, and dedicated to the practioner Guidelines of the American Academy of ORL will resume the attitude towards chronic otitis media, and reviews of hearing impairment and tinnitus are presented, as well as impact of the pneumoccal vaccine on otitis media. In rhinology, the flora of chronic rhinosinusitis and its non surgical treatments will be discussed, as well as epistaxis and malignant tumor series. 17 Diseases dignanosed only with exhaled air will be also reported. The importance of HPV in head and neck cancer will be again discussed, with the increasing incidence of oropharyngeal cancer. Peritonsillar abcesses, and indications for tonsillectomy, as well as progresses in salivary glands, including sialendoscopy will be finaly presented.Les actualités thérapeutiques ORL 2016 sont, comme à l’accoutumée, établies à partir de la revue de plus de 15 000 abstracts parus pendant l’année, à l’attention du pratitien. En otologie, la prise en charge de l’otite moyenne chronique, l’impact du vaccin antipneumococcique sur l’otite, la malentendance et le tinnitus seront abordés. En rhinologie, la rhinosinusite chronique, allergique ou aiguë et leurs traitements, l’épistaxis et l’importance diagnostique des tumeurs malignes du nez et des sinus seront abordés. Une étude remarquable évoquant de nouvelles perspectives diagnostiques à partir de l’air exhalé a également été retenue. En chirurgie cervico-faciale, une revue des indications à tonsillectomies, les abcès péri-amygdaliens, les tumeurs ORL liées au HPV, et les glandes salivaires complèteront cette sélection non exhaustive.

The aim of the current study was to analyze the use of sialendoscopy for the diagnosis and treatment of juvenile recurrent parotitis (JRP), note possible complications, and the rate of disease recurrence. We believe that this cutting edge procedure may be very effective both for the diagnosis and treatment of JRP, with few complications and low rates of recurrence.A retrospective descriptive case study was conducted on a sample of patients presenting with JRP. Data was collected from the patient's medical records. Diagnostic sialendoscopy was performed to identify and classify the ductal pathology, treated by interventional therapeutic sialendoscopy. We carefully noted all complications and the disease recurrence rates.The patient sample included 50 children presenting with JRP (33 M, 17 F; age range: 2 to 16 years). Seven children presented with bilateral parotitis, the remaining 43 with unilateral parotitis. The study was conducted from 2003 to 2012. There was a statistically significant association between sialendoscopic data and the actual outcome. Seven children underwent additional sialendoscopy because of recurrence. They were all in the group of children presenting with unilateral parotitis.Our results validate the expected outcome. Sialendoscopy is an accurate technique for the diagnosis of JPR, and an effective tool for the treatment of JRP, with a low rate of complications and recurrence.

Objective The purpose of this study is to document our experience with sialendoscopy for the treatment of multiple calculi of the salivary ducts, as well as to discuss the technique and indications for the procedure. Patients and Methods In this retrospective non-interventional study, 530 consecutive cases of sialolithiasis were investigated, and the cases with multiple calculi were selected for further analysis. These selected cases were analyzed from clinical and surgical aspects. Results Multiple calculi were detected in 37 of 530 consecutive investigated sialolithiasis cases. The gender distribution was 15 men and 22 women, with a mean age of 40.4 years. Among these patients, the submandibular gland was affected in 33 cases (right in 13 and left in 20) and the parotid gland was affected in 4 cases (right in 3 and left in 1). As for complications, 1 patient had a postoperative infection and 2 other patients had postoperative ranulas that were considered minor complications. Among all 37 cases, we had 3 cases in which preoperative imaging (sonography in 1 and radiography in 2) showed a single sialolith in the duct, but failed to show further sialoliths that were discovered later by sialendoscopy. Conclusions The use of sialendoscopy allows a better diagnosis and minimally invasive treatment for multiple calculi. Interventional sialendoscopy allows the extraction of sialoliths in most patients, preventing open gland excision or surgical removal of the gland even in cases with multiple calculi. Sialendoscopy allows exploration of the ductal system in detail. This technique helps to discover additional stones in the ductal system that could not have been identified with the conventional imaging modalities available.

Introduction Sialendoscopy has changed the management of obstructive sialadenitis. Nowadays, minimally invasive techniques evolve to preserve salivary gland function. Intraductal lithotripsy allows stones fragmentation and retrieval without opening the salivary duct. We report our experience with the StoneBreaker (SB), a new lithotripter with improvement using a sterile bag that permits reuse of the SB without passing to sterilization. Technical note The non-sterilized SB was used into a sterile camera sleeve in 5 patients, 3 submandibular lithiases and 2 parotid lithiases. Technique and outcomes were described with a review of the literature. An explanatory video of the procedure was performed. Discussion Complete fragmentation was achieved and all fragments were extracted without any ductal damage. Utilization of the sterile sleeve did not change the SB efficiency and the procedure duration. The use of a sterile bag allowed several consecutive procedures with a single non-sterilized handpiece. However, the gas cartridge change may be more delicate when more than 80 impacts are needed. Patients remained symptoms and stones free one month after surgery.

The objective of this study is to provide a comprehensive classification system for parotidectomy operations. Data sources include Medline publications, author's experience, and consensus round table at the Third European Salivary Gland Society (ESGS) Meeting. The Medline database was searched with the term "parotidectomy" and "definition". The various definitions of parotidectomy procedures and parotid gland subdivisions extracted. Previous classification systems re-examined and a new classification proposed by a consensus. The ESGS proposes to subdivide the parotid parenchyma in five levels: I (lateral superior), II (lateral inferior), III (deep inferior), IV (deep superior), V (accessory). A new classification is proposed where the type of resection is divided into formal parotidectomy with facial nerve dissection and extracapsular dissection. Parotidectomies are further classified according to the levels removed, as well as the extra-parotid structures ablated. A new classification of parotidectomy procedures is proposed.

Objective To evaluate the efficacy and safety of thulium-YAG laser in sialendoscopic fragmentation of salivary lithiasis. Design Retrospective, interventional case series. Material Sixty-three patients treated by interventional sialendoscopy with thulium-Yag laser fragmentation between 2003 and 2010 at Edouard Herriot Hospital were included in the study. The laser was used for non-floating or large lithiasis (>4 mm). Methods The sialendoscopic thulium fiber laser was used in a pulsed mode with an average power output of 2–8 W to fragment and facilitate extraction of salivary stones. Several variables were studied: success rate, total number of procedures, total energy per procedure, size and number of salivary stones removed, and complications. Results Our series of 63 cases includes 40 cases of parotid lithiasis and 23 cases of submandibular lithiasis. In nine cases, two sessions of laser were performed. Stone size was evaluated pre-operatively by ultrasound and varied between 2 and 18 mm. Laser fragmentation was possible in every case. Complete extraction of the lithiasis was possible in 51 cases (73.9%) and partial extraction in eight cases (12.6%). Extraction failed in four cases (6.3%). Mean stone size was 5.4 mm (5.7 mm for parotid glands and 5.0 mm for sub-mandibular glands) and mean energy per procedure was 1,450 J (range: 1,400–1,800 J). Ductal perforations were observed in 12.7% of the cases. 65.1% of patients were free of symptoms with a mean follow-up of 18 months. Conclusion Thulium-YAG laser appears to be an effective and safe technique in the treatment of salivary lithiasis. Lasers Surg. Med. 44: 783–786, 2012. © 2012 Wiley Periodicals, Inc.

In this review we present recent progress in diagnostic workup, prognostic evaluation, treatment options and resulting outcomes. Whenever possible, complete resection remains the mainstay of treatment. Sacrifice of facial nerve branches is reserved for the clinically or electromyographically dysfunctioning facial nerve. Clinical or radiological neck disease demands combined surgery and radiotherapy. Treatment of the N0 neck is indicated for advanced stage-high grade tumors but the question remains unanswered whether this should be surgical or radiotherapeutic elective treatment. Surgery alone will cure low stage, low grade tumors, that show no additional negative prognostic factors following adequate resection. In all other tumors postoperative radiotherapy will improve locoregional control. This approach results in good locoregional control, in a way that distant metastasis remains the typical presentation of treatment failure. In this setting, the results of systemic treatment today remain limited, but a huge effort in the molecular biology field has been done to introduce targeted therapy into this domain of head and neck cancer. Disease control remains variable within the patient population. This variation can increasingly be predicted by systems that incorporate the combined information of multivariately identified and quantified prognostic factors into an individualized prognosis for the parotid carcinoma patient.

To assess the efficacy of sialendoscopy as a diagnostic and interventional procedure for salivary ductal pathologies of children.Prospective case series study.Tertiary care teaching hospitals.Eight children were investigated under general anesthesia by sialendoscopy for recurring salivary gland swellings between 2003 to 2004 in two university centers.Diagnostic sialendoscopy was used for classifying ductal lesions as sialolithiasis or stenosis. Interventional sialendoscopy was used to treat these disorders. Different variables were analyzed: type of endoscope used, intraoperative findings, type of device used for sialoliths fragmentation or extraction, total number of procedures, and size and number of sialoliths removed.Five cases of parotid and three cases of submandibular gland recurring swellings were included in the present study. Diagnostic sialendoscopy was possible in all cases. Salivary stones were found in six patients and parotid ductal stenosis in the remaining two. Multiple stones were seen in two cases. Interventional sialendoscopy was also possible in all cases, allowing an intraductal retrieval of the stones in three cases, and a marsupialization of the duct in two cases. Two cases required laser fragmentation of the stone. No major complications occurred intraoperatively or during follow-up (mean 18 months).Diagnostic sialendoscopy is a new technique allowing a reliable evaluation of salivary ductal disorders in children, with low morbidity. Interventional sialendoscopy allows early treatment of pediatric sialoliths and stenosis in most cases, avoiding classical open surgery.

Background. Mucoepidermoid carcinoma of Stensen's duct is a rare neoplasm, with only five cases reported in the literature. Methods. We report another case of mucoepidermoid carcinoma of Stensen's duct and review the literature. Results. Stensen's duct neoplasms tend to be symptomatic at an early stage by causing an obstruction of the parotid duct. New imaging techniques such as MR sialography and sialoen- doscopy are very helpful in diagnosis and patient management. Conclusions. Although the rarity of this condition prevents definitive conclusions about the optimal treatment, we propose that Stensen's duct neoplasms should be treated like similar neoplasms occurring in the parotid gland tissue, taking into consideration clinical stage, tumor grade, and surgical margins. A 2005 Wiley Periodicals, Inc. Head Neck 27: 829-833, 2005

To evaluate the accuracy of magnetic resonance (MR) sialography in detecting salivary glandular calculi and ductal stenoses.In a prospective study, 64 salivary glands in 61 consecutive patients with acute or recurrent parotid or submandibular glandular swelling were examined by using three-dimensional (3D) extended-phase conjugate-symmetry rapid spin-echo (EXPRESS) MR imaging. Transverse and sagittal-oblique source images and maximum intensity projection images were obtained. All MR images were analyzed independently by two radiologists, without knowledge of the final diagnosis. The reference standard was conventional sialography, ultrasonography (US), and sialendoscopy with or without surgery in 31 glands and was conventional sialography and US in 33 glands.Final diagnoses included sialolithiasis (n = 23), sialolithiasis and stenosis (n = 9), stenosis without lithiasis (n = 11), early Sjögren syndrome without ductal stenosis (n = 2), ductal displacement (n = 3), and normal salivary glands (n = 16). The sensitivity, specificity, and positive and negative predictive values of MR sialography to detect calculi were 91%, 94%-97%, 93%-97%, and 91%, respectively. False-negative readings occurred due to calculi with a diameter of 2-3 mm in nondilated salivary ducts. Ductal stenosis was assessed, with a sensitivity of 100%, specificity of 93%-98%, positive predictive value of 87%-95%, and negative predictive value of 100%. Interobserver agreement was very good (kappa = 0.85-0.97).MR sialography with 3D EXPRESS imaging enables reliable prediction of salivary gland calculi and stenoses.

Objective: Analyze the incidence and factors responsible for postparotidectomy facial nerve paralysis when the surgery is performed with the routine use of facial nerve monitoring. Study Design: A prospective, nonrandomized study. Methods: Seventy consecutive patients underwent parotidectomy with intraoperative facial nerve monitoring. Two devices were used: a custom mechanical transducer and a commercial electromyograph-based apparatus. All patients were analyzed, including those with cancer and those with deliberate or accidental sectioning of facial nerve branches. The outcome variables were the motor facial nerve function according to the House-Brackmann grading scale (HB) at 1 week (temporary paralysis) and 6 to 12 months (definitive paralysis). Facial nerve grading was performed blindly from reviewing videotapes. Results: The overall incidence of facial paralysis (HB > 1) was 27% for temporary and 4% for permanent deficits. Most of the deficits were partial, most often concerning the marginal mandibular branch. Temporary deficits with HB scores of greater than 2 were only present in patients with parotid cancer or infection. Permanent deficits were present in three patients, including one patient with facial nerve sacrifice. Factors significantly associated with an increased incidence of temporary facial paralysis include the extent of parotidectomy, the intraoperative sectioning of facial nerve branches, the histopathology and the size of the lesion, and the duration of the operation. Conclusions: Despite a stringent accounting of postoperative facial nerve deficits, these data compare favorably to the literature with or without the use of monitoring. An overall incidence of 27% for temporary facial paralysis and 4% for permanent facial paralysis was found. Although the lack of a control group precludes definitive conclusions on the role of electromyograph-based facial nerve monitoring in routine parotidectomy, the authors found its use very helpful.

A variety of benign and malignant non-squamous cell neoplasms may affect the larynx. Most of these uncommon laryngeal neoplasms are located beneath an intact mucosa, making diagnosis difficult with endoscopy alone, and sampling errors may occur if only traditional superficial biopsies are performed. In some laryngeal neoplasms, radiologic evaluation allows the correct diagnosis. Hemangiomas have very high signal intensity at T2-weighted magnetic resonance (MR) imaging and strong enhancement at both computed tomography (CT) and MR imaging after administration of contrast material. Phleboliths, which are pathognomonic for hemangiomas, are easily identified at CT. Chondrogenic tumors typically manifest with coarse or stippled calcifications at CT. Because of their high water content, chondrogenic tumors have very high signal intensity on T2-weighted MR images, whereas only moderate enhancement is observed after administration of contrast material. Lipomas typically manifest at both CT and MR imaging as homogeneous nonenhancing lesions. They are isoattenuating to subcutaneous fat at CT and isointense relative to subcutaneous fat with all MR pulse sequences. Metastases from renal adenocarcinoma typically demonstrate strong contrast enhancement and flow voids at MR imaging, and metastases from melanotic melanoma usually have high signal intensity on T1-weighted MR images and low signal intensity on T2-weighted images owing to the paramagnetic properties of melanin. Although radiologic findings are nonspecific in most other non-squamous cell neoplasms of the larynx (eg, Kaposi sarcoma, hematopoietic tumors, tumors of the minor salivary glands, metastases from amelanotic melanoma), cross-sectional imaging can play an important role in the diagnostic work-up of these unusual tumors by delineating the extent of submucosal tumor spread and directing the endoscopist to the appropriate site for the deep, transmucosal biopsies needed to establish the diagnosis. In addition, CT and MR imaging are crucial for posttherapeutic monitoring and early detection of local recurrence.

Fragestellung: Evaluation der Wirksamkeit der Neurektomie des Nervus singularis nach Gacek bei Patienten, die an chronisch persistierendem paroxysmalem Lagerungsschwindel leiden. Patienten und Methodik: Zwischen 1980 und 1998 wurde bei 14 Patienten, die an chronisch persistierendem paroxysmalem Lagerungsschwindel (Symptomdauer 1–15 Jahre, mittlere Dauer 5 Jahre) litten, eine selektive Singularisneurektomie unter Lokalanästhesie durch transkanalären Zugang durchgeführt. Zusätzlich wurden die Variationen des anatomischen Verlaufs des N. singularis und seine Beziehung zum runden Fenster anhand von Bohrungen in Felsenbeinpräparaten studiert. Ergebnisse: 13 (93%) von den 14 operierten Patienten waren nach dem Eingriff von ihrem Lagerungsschwindel befreit. Während des Eingriffs konnte der N. singularis allerdings nur bei 3 Patienten eindeutig identifiziert und durchtrennt werden. Bei 9 weiteren Patienten provozierte die Bohrung unter dem runden Fenster plötzlich ein Schwindelgefühl mit einem vertikalen, nach unten schlagenden Nystagmus, was ebenfalls als Zeichen einer Durchtrennung des N. singularis gedeutet wurde. Bei 1 Patientin kam es zu einer zusätzlichen Innenohreröffnung mit postoperativem Hörverlust. Dieser Hörverlust war die einzige Komplikation bei den 14 operierten Patienten. Bei 1 Patienten konnte der N. singularis nicht identifiziert werden, und der Eingriff wurde abgebrochen. Dieser Patient wurde später durch eine Okklusion des hinteren Bogengangs vom Lagerungsschwindel befreit. Schlussfolgerung: Die Ergebnisse unserer Studien bestätigen die Resultate von Gacek und anderen Autoren, wonach die selektive Neurektomie des N. singularis ein wirksamer und wenig invasiver Eingriff ist, um chronisch persistierenden und rezidivierenden Lagerungsschwindel definitiv zu heilen.

Program Description:This miniseminar intends to open a discussion with the audience on the exponential growth of sialendoscopy throughout the United States (about 150 centers by end 2011) and throughout the world. During the last years, it has proven to be efficient in treating salivary gland ductal pathologies, and more importantly sparing unnecessary and high morbidity removal of salivary glands. The international panel from all continents will discuss with the audience the 2013 state of the art attitude towards sialadenitis, from the first acute episode, investigations, treatment (with all options: balloon dilatation, laser fragmentation, stenting, endoscopic-surgical combined approaches) and complications.Educational Objectives:1) Recognize the role of sialendoscopy, replacing gradually parotidectomy and submandibulectomy, in case of symptomatic sialadenitis due to stones or strictures. 2) Evaluate the importance this technique has gained over the years and its cost-effective implementation on all con...

OBJECTIVE. The purpose of this study was to determine the value of sonography for the diagnosis of salivary gland calculi. SUBJECTS AND METHODS. In this study, 82 salivary glands in 79 consecutively registered patients with acute or recurrent parotid or submandibular gland swelling were examined with 7.5-12 MHz linear probes. All sonographic examinations were performed by two experienced radiologists without knowledge of the final diagnosis. The reference standard was digital sialography and sialendoscopy with or without surgery for 54 salivary glands and digital sialography alone for 28 glands. RESULTS. Sialolithiasis was present in 44 glands and was absent in 38 glands as confirmed by the final diagnosis. The overall sensitivity, specificity, accuracy, and positive and negative predictive values of sonography in the detection of calculi were 77%, 95%, 85%, 94%, and 78%, respectively. False-negative sonographic findings were associated with calculi with a diameter less than 3 mm in nondilated or dilated ...

This review is again focussing on novelties in ENT in 2010 for our non ENT colleagues, as we removed on purpose technical and hyperspecialised topics. Interesting subjects include the increasing role of Helicobacter pylori, the epidemiology of otitis media and the efficiency of topical treatment, an MRSA review in US children, the impaired nasal permeability in smokers, the contamination of the "nose bottle" in case of sinusitis, new technologies in adjuvant cancer treatment, and the prevalence of HPV positive tumors, having a better prognosis, and the importance of follow-up, ENT tumor patients being at risk for recurrences. Other subjects will also be covered.

Sjogren’s syndrome (SjS) is an autoimmune disease that primarily affects the secretory function of lacrimal and salivary glands [1]. Dry mouth (xerostomia) is the most common presenting complaint [2], but SjS can affect multiple organs including the kidneys, lungs, liver, blood vessels, and lymph nodes, resulting in a myriad of clinical manifestations [3]. This chapter provides an overview of the key manifestations of SjS associated with the ear, nose, and throat region. We review the otologic, sinus and nasal, laryngopharyngeal, and tracheal manifestations of this disease.

radically changed clinical and surgical practice. This miniseminar will review developing technologies in PET, ultrasound, MRI, and optical imaging and their potential to improve diagnostic and interventional otolaryngology. A brief review of novel imaging modalities that are in early clinical development will be discussed. These include optical coherence tomography, fluorescence imaging and molecular imaging. PET Imaging: This seminar will review indications and limitations of conventional FDG PET/CT for use in head and neck cancer and salivary gland disease and then discuss new developments in hardware and PET imaging agents. New PET imaging agents have been developed using more sensitive radioactive compounds such as copper and gold radioisotopes. The speaker will introduce novel targeting agents designed to improve sensitivity and specificity of cancer imaging. Ultrasound Imaging: A brief review of standard ultrasound imaging strategies for thyroid disease will be discussed followed by a review of microbubble contrast agents to improve differentiation of lesions. Microbubbles for ultrasound imaging are FDAapproved for use in humans and have significantly improved soft-tissue resolution while providing measurements of vascular density. This strategy has been applied to imaging the thyroid and other cancer types with considerable success. Optical imaging: The use of tissue autoflouresence is FDA-approved for mucosal screening. Commercial handheld devices are currently available for use in the clinic and have been rapidly adopted by the dental community. Basic principles of this technology and the key studies that led to its adoption in the clinic will be reviewed. The seminar will review use of optical imaging for lymphangiograms and sentinel node detection. The use of narrow band imaging and blue light imaging strategies for detection of early malignancies will also be reviewed. Diffusion weighted MRI: Although MRI is well established for anatomic imaging of head and neck malignancies, diffusion weighted MRI uses novel pulse sequences to measure cell death. Images obtained before and after initiation of treatment have been used in multiple cancer types to measure treatment response. There is considerable interest in diffusion weighted MRI to non-invasively measure tumor response in clinical trials and predict tumor response to targeted therapy. EDUCATIONAL OBJECTIVES: 1) Use of diffusion weighted MRI to predict apoptosis during chemotherapy. 2) Role of PET/CT and the development of novel PET radioisotopes to improve cancer imaging. 3) Use of microbubble contrast agents and elasticity for differentiation of thyroid

In the past, the classic division of salivary gland diseases relied on differential diagnosis. A different concept proposed is to classify these diseases according to their clinical presentation, considering the frequency of episodes and combinations of the associated symptoms. This understanding necessitates separating glands into submandibular and parotid categories because of their different aetiologies and frequencies of these disorders (Figs. 4.5.1, 4.5.2).

Importance of biofims, detected on adenoids. Incidence of post-tonsillectomy hemorage increased in summer and winter, interst of a systematic hearing screening in newborns, proven interst of nasal irrigation in cases of rhino-sinusitis, correlation between obesity and nasal obstruction, interst of nasal evaluation in cases of Wegener, importance of reffe-red otalgia with normal eardrum as an indicator for ENT tumors, observation of neurinomas inpatients over 65 years, higher and earlier recurrence of T3T4 tumors, while T1T2 tumors of the upper aerodigestive tract reccur mostly in the 4th year. Therapeutic impact of 18FDG-PET/CT in the management of iodine-negative recurrence of differentiated thyroid carcinoma, interest of parotid gland biopsy in the diagnosis of patients with primary Sjogren's syndrome.

Sialendoscopy is finding increasing application in the management of salivary-gland swellings as it provides a diagnostic method for the main salivary ducts coupled with a therapeutic tool. Many recent studies have emphasized the diagnostic and therapeutic advantages of this noninvasive technique. This review discusses both of these aspects of sialendoscopy and their development in the management of salivary-gland diseases.Management of paediatric obstructive swelling has improved during the last 10 years. New semi-rigid sialendoscopes and complete miniaturized instrumentation allow diagnosis and treatment of obstructive paediatric salivary-gland swelling. Paediatric sialendoscopy has allowed us to recognize salivary stones and stenoses misdiagnosed by conventional radiography or ultrasound.Pediatric sialendoscopy is now an improved diagnostic technique for obstructive salivary-gland swelling. It has a greater sensitivity than conventional radiology ultrasound and MRI. With further improvement in devices and technique, early sialendoscopy is possible in very young children, using a conservative approach. Sialendoscopic dilatation of Stensen's duct is possible and could be used for the treatment of juvenile recurrent parotitis. The initial results need to be confirmed in a larger series with a more long-term follow-up.

Infections of the salivary gland most commonly affect the major glands. Infections may present as an acute, chronic, or acute and chronic problem. The most common pathogens identified are viral and bacterial. Children are affected with the same diseases as adults. Adults most commonly present with total gland obstruction associated with sialolithiasis, ductal stenosis, or sialectasis. Patients with recurrent symptoms should be investigated electively. Total gland swelling is more likely ductal disease, as distinct to partial gland swelling which may be neoplastic or inflammatory disease.

Patients with large calculi require specialists who have special expertise to evaluate and treat their symptoms. The treatment of each patient must be individualized. Combined surgical expertise using interventional sialendoscopy and conventional salivary gland surgery may avoid removal of the gland.

Our present choice of papers will cover various generalist aspects of our speciality. We will report on the importance of biofilms, the role of helicobacter in otitis media, de role of fungi in sinusal disease, or on the increase of MRSA in neck abscesses. Treatments of mycotic otitis and middle ear infection, sudden hearing loss, or acute ethmoiditis in children will be described. The interest of tonsillectomy, dacryocystorhinostomy or preservation radiotherapy will be also discussed.