J Korean Assoc Oral Maxillofac Surg.  2025 Apr;51(2):117-122. 10.5125/jkaoms.2025.51.2.117.

Role of ultrasonography in the diagnosis and management of chronic recurrent sialadenitis with sialendoscopy

• Jung HS
• Chang IS
• Kim Jy
• Song IS
• Hwang BY
• Jun SH

• KMID: 2567947
• DOI: http://doi.org/10.5125/jkaoms.2025.51.2.117

Abstract

Chronic recurrent sialadenitis is characterized by repeated inflammation of the salivary glands, leading to ductal structural abnormalities and salivary stasis, often resulting in megaducts. This study evaluates the efficacy of ultrasonography as a diagnostic and follow-up tool for the management of chronic recurrent sialadenitis. Three patients underwent sialendoscopy, which involved ductal dilation, removal of mucous plugs, and steroid administration. Ultrasonography was used postoperatively to monitor changes in ductal structure, including megaduct size, and to assess clinical outcomes. All three cases showed marked improvement in clinical symptoms after treatment. Ultrasonography demonstrated a reduction in megaduct size and provided real-time visualization of ductal and glandular changes. Compared to traditional imaging methods such as magnetic resonance imaging or sialography, ultrasonography offered a practical and safe option for follow-up assessment. This study highlights the utility of ultrasonography as an accessible, non-invasive, and effective tool for evaluating treatment outcomes in chronic recurrent sialadenitis. By offering detailed visualization of ductal changes and facilitating longitudinal follow-up, ultrasonography can optimize the management of this condition.

Keyword

Chronic sialadenitis; Salivary glands; Ultrasonography; Salivary ducts

Figure

• 

  Fig. 1 A. Ultrasound shows a dilated duct (yellow arrow). B. The image shows a reduction in the size of the dilated duct following sialendoscopy (green arrow).

• 

  Fig. 2 A. Advancement of the sialoendoscope to the megaduct. Mucous plugs and inflammatory tissue are observed. B. Mild bleeding remains after irrigation; however, the inflammatory tissue previously present in the duct has been removed. (I: inflammatory tissue, M: mucous plugs, B: bleeding)

• 

  Fig. 3 Magnetic resonance imaging reveals the formation of a megaduct in the right Stensen’s duct (yellow arrow).

• 

  Fig. 4 Sialography CT 3D reconstruction demonstrates a stricture (yellow arrow) and megaduct (green arrow) in the right Stensen’s duct.

• 

  Fig. 5 A. Ultrasound demonstrates dilation of Stensen’s duct (yellow arrow). B. Follow-up ultrasound after sialendoscopy demonstrates the resolution of ductal dilation in the same region (green arrow). (P: parotid gland)

• 

  Fig. 6 A. Sialography panoramic view demonstrates a stricture (yellow arrow) and megaduct (green arrow) in the left Stensen’s duct. B. Magnetic resonance imaging shows the formation of a megaduct (green arrow) in the left Stensen’s duct.

• 

  Fig. 7 A. Sialendoscopy shows advancement of the endoscope to the megaduct within the duct. Mucous plugs and signs of inflammation are observed. B. After ductal irrigation was performed, the ductal wall appears clear. (I: inflammatory tissue, B: bleeding)

• 

  Fig. 8 A. Sialendoscopy reveals advancement of the endoscope to the megaduct within the duct. Mucous plugs are seen attached to the ductal wall. B. Detachment of mucous plugs from the ductal wall using sialendoscopy forceps. C. After detachment of mucous plugs, the ductal wall appears clear. (M: mucous plugs, F: sialendoscopy forceps)

• 

  Fig. 9 A. Ultrasound demonstrates dilation of Stensen’s duct (yellow arrow). B. Follow-up ultrasound after sialendoscopy demonstrates the resolution of ductal dilation in the same region (green arrow). (P: parotid gland)

Reference

References

1. Karwowska NN, Turner MD. 2021; Etiology, diagnosis, and surgical management of obstructive salivary gland disease. Front Oral Maxillofac Med. 3:17. http://doi.org/10.21037/fomm-20-73. DOI: 10.21037/fomm-20-73.

2. Douglas JE, Wen CZ, Thomas WW, Elrakhawy M, Rassekh CH. 2023; Management of chronic sialadenitis due to Sjogren's syndrome and radioactive iodine therapy using sialendoscopy. ORL J Otorhinolaryngol Relat Spec. 85:7–11. https://doi.org/10.1159/000525217. DOI: 10.1159/000525217. PMID: 35817018.

3. Wilson KF, Meier JD, Ward PD. 2014; Salivary gland disorders. Am Fam Physician. 89:882–8.

4. Goomany A, Sood S. 2021; Superficial parotidectomy for chronic parotid sialadenitis: a case series and review of the literature. J Laryngol Otol. 135:883–6. https://doi.org/10.1017/s0022215121002115. DOI: 10.1017/S0022215121002115. PMID: 34353395.

5. Nouraei SA, Ismail Y, McLean NR, Thomson PJ, Milner RH, Welch AR. 2007; Surgical treatment of chronic parotid sialadenitis. J Laryngol Otol. 121:880–4. https://doi.org/10.1017/s0022215106005445. DOI: 10.1017/S0022215106005445. PMID: 17166325.

6. Hwang S, Cho JM, Yoon YJ, Seo S, Hong Y, Lim JY. 2024; Retroductal dexamethasone administration promotes the recovery from obstructive and inflammatory salivary gland dysfunction. Front Immunol. 15:1418703. https://doi.org/10.3389/fimmu.2024.1418703. DOI: 10.3389/fimmu.2024.1418703. PMID: 39044831. PMCID: PMC11263033.

7. Kim JW, Kim DH, Kim KT, Kim TY, Ko KJ, Choi JS, et al. 2005; Sialendoscopy: endoscopic diagnosis and treatment of the salivary gland disease. Korean J Otolaryngol-Head Neck Surg. 48:373–9.

8. Buchanan D, Key S, Levi E, Lyons B. 2025; Technique and efficacy of sialendoscopy in the management of recurrent sialadenitis: the Melbourne experience. Aust J Otolaryngol. 8:2. http://doi.org/10.21037/ajo-24-36. DOI: 10.21037/ajo-24-36.

9. Strychowsky JE, Sommer DD, Gupta MK, Cohen N, Nahlieli O. 2012; Sialendoscopy for the management of obstructive salivary gland disease: a systematic review and meta-analysis. Arch Otolaryngol Head Neck Surg. 138:541–7. https://doi.org/10.1001/archoto.2012.856. DOI: 10.1001/archoto.2012.856. PMID: 22710505.

10. Nahlieli O, Baruchin AM. 1999; Endoscopic technique for the diagnosis and treatment of obstructive salivary gland diseases. J Oral Maxillofac Surg. 57:1394–401. discussion 1401–2. https://doi.org/10.1016/s0278-2391(99)90716-4. DOI: 10.1016/S0278-2391(99)90716-4. PMID: 10596658.

11. Beumer LJ, Vissink A, Gareb B, Spijkervet FKL, Delli K, van der Meij EH. 2024; Success rate of sialendoscopy. A systematic review and meta-analysis. Oral Dis. 30:1843–60. https://doi.org/10.1111/odi.14662. DOI: 10.1111/odi.14662. PMID: 37486613.

12. Larson AR, Aubin-Pouliot A, Delagnes E, Zheng M, Chang JL, Ryan WR. 2017; Surgeon-performed ultrasound for chronic obstructive sialadenitis helps predict sialendoscopic findings and outcomes. Otolaryngol Head Neck Surg. 157:973–80. https://doi.org/10.1177/0194599817728867. DOI: 10.1177/0194599817728867. PMID: 28871894.

13. Koch M, Sievert M, Iro H, Mantsopoulos K, Schapher M. 2021; Ultrasound in inflammatory and obstructive salivary gland diseases: own experiences and a review of the literature. J Clin Med. 10:3547. https://doi.org/10.3390/jcm10163547. DOI: 10.3390/jcm10163547. PMID: 34441850. PMCID: PMC8397054.

14. Pniak T, Štrympl P, Staníková L, Zeleník K, Matoušek P, Komínek P. 2016; Sialoendoscopy, sialography, and ultrasound: a comparison of diagnostic methods. Open Med (Wars). 11:461–4. https://doi.org/10.1515/med-2016-0081. DOI: 10.1515/med-2016-0081. PMID: 28352836. PMCID: PMC5329868.

15. Koch M, Iro H, Zenk J. 2008; Role of sialoscopy in the treatment of Stensen's duct strictures. Ann Otol Rhinol Laryngol. 117:271–8. https://doi.org/10.1177/000348940811700406. DOI: 10.1177/000348940811700406. PMID: 18478836.

16. Koch M, Schapher M, Goncalves M, Iro H, Mantsopoulos K. 2020; Simultaneous application of ultrasound and sialendoscopy: experience in the management of stenosis and other non-sialolithiasis-related salivary gland disorders. Eur Rev Med Pharmacol Sci. 24:2196–204. https://doi.org/10.26355/eurrev_202003_20485.

17. Goncalves M, Mantsopoulos K, Schapher M, Iro H, Koch M. 2021; Ultrasound in the diagnosis of parotid duct obstruction not caused by sialolithiasis: diagnostic value in reference to direct visualization with sialendoscopy. Dentomaxillofac Radiol. 50:20200261. https://doi.org/10.1259/dmfr.20200261. DOI: 10.1259/dmfr.20200261. PMID: 33002385. PMCID: PMC7923063.

18. Karagozoglu KH, Mahraoui A, Bot JCJ, Cha S, Ho JTF, Helder MN, et al. 2023; Intraoperative visualization and treatment of salivary gland dysfunction in Sjögren's Syndrome patients using contrast-enhanced ultrasound sialendoscopy (CEUSS). J Clin Med. 12:4152. https://doi.org/10.3390/jcm12124152. DOI: 10.3390/jcm12124152. PMID: 37373845. PMCID: PMC10298935.