title: Endoscopic-assisted gland-preserving therapy for chronic sialadenitis: a German and US comparison.
abstract: OBJECTIVE
  To determine whether unique patterns of care are evolving in the United States compared with Germany in endoscopic management of chronic sialadenitis.
  
  
  METHODS
  Comparison of consecutive series of patients.
  
  
  METHODS
  Academic tertiary salivary referral centers in Germany and the United States.
  
  
  METHODS
  A total of 446 patients having chronic sialadenitis treated with salivary endoscopy.
  
  
  METHODS
  To compare practice patterns and outcomes at each location, databases tracking patients having chronic sialadenitis treated with salivary endoscopy were searched for the following variables: age, sex, involved gland, radiographic studies, endoscopic findings, endoscopic-related complications, gland preservation rate, patient symptom control, and techniques for managing salivary stones and intraductal scar tissue.
  
  
  RESULTS
  Significantly more patients in the US cohort had chronic sialadenitis of the parotid gland (P = .03) and multiple gland involvement (P < .001). Salivary endoscopy was regularly performed using local anesthesia in Germany and using general anesthesia in the United States (P < .001). Endoscopic-related complication rates were higher (10.9% vs 1.6%) and gland preservation rates lower (85.9% vs 98.4%) among US patients; however, patients with intact glands demonstrated similar rates of symptom control at both centers (92.7% in the United States vs 85.3% in Germany) at the last follow-up visit. The lower rate of gland preservation in the United States is largely because of lack of access to lithotripsy for larger salivary stones.
  
  
  CONCLUSIONS
  Different patterns of care are emerging in the endoscopic management of chronic sialadenitis in the United States compared with Germany, where these techniques were largely developed. Nevertheless, patients with chronic sialadenitis at both locations who undergo endoscopic gland-preserving therapy have high rates of gland preservation and symptom control.
authors.affiliation: Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, 29425-5500, USA. gillesmb@musc.edu
authors.forename: M Boyd
authors.initials: MB
authors.lastname: Gillespie
authors.forename: Michael
authors.initials: M
authors.lastname: Koch
authors.forename: Heinrich
authors.initials: H
authors.lastname: Iro
authors.forename: Johannes
authors.initials: J
authors.lastname: Zenk
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General; D000772:Anesthesia, Local; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003431:Cross-Cultural Comparison; D003952:Diagnostic Imaging; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005858:Germany; D006801:Humans; D008096:Lithotripsy / Q000379:methods; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010306:Parotid Gland / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D010818:Practice Patterns, Physicians'; D015494:Salivary Gland Calculi / Q000175:diagnosis / Q000601:surgery*; D012793:Sialadenitis / Q000175:diagnosis / Q000601:surgery*; D013363:Submandibular Gland / Q000601:surgery; D014481:United States; D055815:Young Adult