Sialendoscopy in the old patients: A new tool or a revolution?

Pathologies of the salivary glands can be divided into neoplastic, which affect mostly parenchyma, and non neoplastic, which are mainly ductal, cited in Myers and Ferris (2007) [1]. Ductal diseases consist in Sialadenitis that can be acute, due to a stone, or chronic, due to a stricture. One of the factors that contribute to sialadenitis is hyposalivation and altered composition of saliva, given in Triantafyllou (1992) [2]. Xerostomia affects the elderly in 20 to 39% of cases, according to various studies (Astor et al. (1999) [3], Locker (1993) [4], Gilbert et al. (1993) [5]). Main causes in the old patient are medications side effects, cited in Navazesh et al. (1996) [6], irradiation cited in Dreizen et al. (1976) [7], Sjögren's syndrome cited in Kaarela et Mutru (1982) [8], probable atrophy of the gland and ducts due to aging, and salivary stones. Obstructive inflammatory pathologies of salivary glands, caused mainly by sialolithiasis and strictures affect the general population as well as the elderly. However, no specific study has described yet its prevalence in the elderly population. But as xerostomia is probably associated with chronic sialadenitis, and as it is quite frequent in the old population, we can assume that ductal pathologies must be far underestimated in the geriatric population. The classical treatment for obstructive sialadenitis is the removal of the gland which is often difficult to consider in old patients because of the general anesthesia, and morbidity of the surgery (longer hospital stay, risk for facial nerve, complications related to external surgery). Sialendoscopy is one of the new innovations introduced in the last few years in the field of Otolaryngology, head and neck surgery for the diagnosis and treatment of acute and chronic sialadenitis, cited in Marchal et al. (1999) [9]. Its main advantage in the elderly population is that it can be performed in most cases as an ambulatory, outpatient procedure under local anesthesia.