Interventional Sialendoscopy: Complications

Misdiagnosis

Glandular calcifications of any variety are often interpreted as stones by both referring practitioners and radiologists ( Fig. 26.1 ). This is due to the frequent occurrence of parenchymal soft tissue calcifications that result from chronic glandular inflammation. Factors that suggest glandular calcifications that are not stones include nonobstructive symptoms (i.e., swelling not predicated on eating); multigland involvement; multiple, small (1–2 mm) calcifications; and peripheral (intraglandular) location not within central ductal branching pattern. In most cases, patients with the above presentations have chronic inflammatory disorders (e.g., Sjögren; sarcoid; IgG4-related disorders; juvenile recurrent parotitis; idiopathic chronic sialadenitis). Although many of these patients may eventually benefit from sialendoscopy, the goal of the surgery would be to dilate the ducts, flush out inflammatory debris, infuse steroids, and potentially establish a diagnosis via open biopsy of the gland. In such cases, the procedure is expected to reduce symptoms with the recognition that the patient has an ongoing disorder, which will require additional follow-up.