title: Endoscope-assisted submandibular sialadenectomy: a review of outcomes, complications, and ethical concerns.
abstract: OBJECTIVE
  To review outcomes and complications of endoscope-assisted submandibular sialadenectomy (EASS) and to analyze this innovative technique with regard to ethical issues.
  
  
  METHODS
  We used a systematic review study design to identify clinical studies on EASS, published in English, French, German, and Thai. The last electronic search was conducted in September 2009. We checked the bibliographies of the identified articles, relevant local journals, and congress abstracts. Publications were further assessed and assigned their respective levels of evidence. We also investigated reporting on human subject protection, conflicts of interest, funding support, and commercial relationships.
  
  
  RESULTS
  Five case series reporting a total of 28 patients met the inclusion criteria. There was no need of recourse to open surgery. All of the authors claimed satisfactory cosmetic results. Complications were uncommon. However, no controlled trial was available, and outcome measures varied between studies. Human subject protection and funding sources were mentioned in only 2 articles. Commercial relationships and conflicts of interest could not be identified.
  
  
  CONCLUSIONS
  All of the reports favor outcomes of EASS. However, their level of evidence is low, and the superiority of this procedure over the conventional surgery remains unknown. The success of this procedure should not be overemphasized in information for consent and mislead surgeons to begin it without adequate training and elaborate environment. The lack of ethical documentation creates a high degree of suspicion of the studies.
authors.forename: Poramate
authors.initials: P
authors.lastname: Pitak-Arnnop
authors.forename: Niels Christian
authors.initials: NC
authors.lastname: Pausch
authors.forename: Kittipong
authors.initials: K
authors.lastname: Dhanuthai
authors.forename: Kraison
authors.initials: K
authors.lastname: Sappayatosok
authors.forename: Pichit
authors.initials: P
authors.lastname: Ngamwannagul
authors.forename: Ute
authors.initials: U
authors.lastname: Bauer
authors.forename: Robert
authors.initials: R
authors.lastname: Sader
authors.forename: Alexander D
authors.initials: AD
authors.lastname: Rapidis
authors.forename: Christian
authors.initials: C
authors.lastname: Hervé
authors.forename: Alexander
authors.initials: A
authors.lastname: Hemprich