Balloon Dilatation of Salivary Duct Strictures: Report on 36 Treated Glands Nicholas A. Drage, 1 Jackie E. Brown, 1 Michael P. Escudier, 2 Ron F. Wilson, 3 Mark McGurk 4 1 Department of Dental Radiology, Guy’s Dental Hospital, Guy’s and St. Thomas’ Hospital Trust, London, UK 2 Department of Oral Medicine and Pathology, Guy’s, King’s & St. Thomas’ Dental Institute, King’s College, London, UK 3 Dental Clinical Research, Guy’s, King’s & St. Thomas’ Dental Institute, King’s College, London, UK 4 Department of Oral and Maxillofacial Surgery, Guy’s, King’s & St. Thomas’ Dental Institute, King’s College, London, UK Abstract Purpose: This paper describes the technique for balloon dilatation of salivary duct strictures and evaluates the clinical and radiographic findings in a consecutive series of 36 af- fected glands. Methods: Thirty-four patients (36 glands) had balloon dila- tation of their salivary duct strictures performed under fluo- roscopic control. They were evaluated immediately afterwards and at review by sialography. Results: In 36 cases attempted, 33 (92%) strictures were dilated. The immediate post-treatment sialogram was avail- able in 28 cases, of which 23 (82%) demonstrated complete and four (14%) partial elimination of stricture. In one case the appearance was unchanged (4%). Review data (mean 6.8 months) were available on 25 glands: 12 were asymptomatic (48%), 12 (48%) had reduced symptoms and one (4%) failed to improve. Sialographic data were available on 21 glands: in 10 (48%) the duct remained patent, in one (5%) the stricture was partially eliminated, in seven (33%) the strictures had returned and in the remaining three (14%) cases there was complete obstruction. Conclusions: Balloon dilatation is an effective treatment of salivary duct stenosis. In half the cases the stricture recurred but symptomatic improvement was achieved and maintained in the majority of cases. Key words: Salivary glands, interventional procedure/Sali- vary glands, radiography/Salivary glands, diseases/Surgery Obstruction of the salivary duct can cause recurrent salivary gland swelling. The majority of cases are due salivary cal- culi; however a small but important cause of obstruction is stricture(s) of the duct, which accounts for up to 25% of recurrent parotid gland swellings [1, 2]. Until recently the only treatment for symptomatic stric- tures was adenectomy. This carried with it the attendant risks of neurologic damage and cosmetic deformity [3]. These are important considerations in the management of benign dis- ease. Minimally invasive techniques may eliminate the need for surgery, as well as moving the treatment to an outpatient setting. This paper describes the technique for balloon dila- tation of salivary duct strictures and the results achieved in consecutive series of 36 affected glands. Materials and Methods Thirty-four patients (16 male, 18 female) with main salivary duct stricture(s) were recruited from the Salivary Gland Clinic and treated between May 1997 and January 2001. The main presenting complaint was recurrent pain and swelling at mealtimes (100%), with a mean duration of symptoms of 29 months (range 1–120 months, SD 31.8 months). The diagnosis of stricture(s) of the main duct was made by conventional sialography. Thirty patients had parotid gland obstruction (of whom two had bilateral obstruction) and four patients had submandibular duct obstruction, giving a total of 36 symptomatic glands. The strictures were subjectively catego- rized as “point” (if the stricture was a localized constriction) or diffuse. The only selection criteria for patient suitability were that the stricture(s) was in the main duct and that the duct was patent beyond the stricture(s). Technique Imaging was obtained on a Siemens Angiostar C-arm fluoroscopic unit (Siemens, Erlangen, Germany). Immediately prior to dilatation a sialogram was performed to visualize the stricture(s). A digitally subtracted modified occipito-mental view and an unsubtracted lat- eral view were used to image to stricture. Ionic contrast medium (Ultravist 370) was mixed with local anesthetic (2% lignocaine) in Correspondence to: N. Drage, Department of Dental Radiology, Floor 23, Guy’s Tower, Guy’s Hospital, London SE1 9RT, UK; email: nicholas.drage@kcl.ac.uk Cardio V ascular and Interventional Radiology © Springer-Verlag New York, Inc. 2002 Cardiovasc Intervent Radiol (2002) 25:356 –359 Published Online: 18 September 2002 DOI: 10.1007/s00270-002-1951-8