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Objective: The purpose of this study was to assess how well ChatGPT, an AI-powered chatbot, performed in helping to manage pediatric sialadenitis and identify when sialendoscopy was necessary., Methods: 49 clinical cases of pediatric sialadenitis were retrospectively reviewed. ChatGPT was given patient data, and it offered differential diagnoses, proposed further tests, and suggested treatments. The decisions made by the treating otolaryngologists were contrasted with the answers provided by ChatGPT. Analysis was done on ChatGPT response consistency and interrater reliability., Results: ChatGPT showed 78.57% accuracy in primary diagnosis, and 17.35% of cases were considered likely. On the other hand, otolaryngologists recommended fewer further examinations than ChatGPT (111 vs. 60, p < 0.001). For additional exams, poor agreement was found between ChatGPT and otolaryngologists. Only 28.57% of cases received a pertinent and essential treatment plan via ChatGPT, indicating that the platform's treatment recommendations were frequently lacking. For treatment ratings, judges' interrater reliability was greatest (Kendall's tau = 0.824, p < 0.001). For the most part, ChatGPT's response constancy was high., Conclusions: Although ChatGPT has the potential to correctly diagnose pediatric sialadenitis, there are a number of noteworthy limitations with regard to its ability to suggest further testing and treatment regimens. Before widespread clinical use, more research and confirmation are required. To guarantee that chatbots are utilized properly and effectively to supplement human expertise rather than to replace it, a critical viewpoint is required., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: Antibiotics have been prescribed routinely in sialendoscopy procedures to reduce the risk of postoperative infection, despite the limited evidence supporting this practice. Being necessary to assess the need for antibiotics in Sialendoscopy, aiming to provide evidence-based guidance to clinicians regarding antibiotic administration in this procedure., Materials & Method: A prospective, randomized, double-blind, controlled clinical trial to evaluate the of prophylactic antibiotics in Sialendoscopy was designed., Results: A total of 80 patients were included in this study, including 57 females (71.8%) and 23 males (28.8%). In terms of prophylaxis, 36 patients (45%) received prophylactic treatment, and 44 patients (55%) did not. The occurrence of infectious events was observed in 2 patients (5.6%) with prophylaxis and 4 patients (9.1%) without prophylaxis. However, this difference was not statistically significant (p = 0.556)., Conclusion: In conclusion, our prospective, randomized clinical trial aimed to address the debate regarding the use of prophylactic antibiotics in sialendoscopy. Our study's findings suggest that the routine use antibiotics may not be necessary to prevent postoperative infections in sialendoscopy procedures. These results have important implications for clinical practice, potentially reducing the unnecessary use of antibiotics and addressing concerns related to antibiotic resistance and adverse drug reactions., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: The aim of this communication was to introduce a novel combined image (magnetic resonance and computed tomography-guided and sialendoscopy-assisted transoral approach for the treatment of a parotid duct stenosis with megaduct., Methods: A 46-year-old woman was referred to our department for recurrent infections of the right parotid gland following unsuccessful multiple transoral surgical approaches for a Stensen's duct stricture with megaduct. An image (magnetic resonance and computed tomography)-guided and sialendoscopy-assisted transoral sialodochoplasty was planned and performed., Results: No complications occurred. The patient was discharged 2 days after surgery. No more swelling or infections occurred. The patient is currently symptom-free after a follow up of 11 months., Conclusion: Although imaging navigation means more technical effort and costs, this novel approach can be considered a viable surgical opportunity for distal and mid-third parotid duct stenosis with concomitant megaduct, particularly in cases of persistent inflammation or iatrogenic scars due to previous surgery.

Background: Nasopharyngeal fiberendoscopy (NFE) is the gold standard diagnostic procedure for adenoidal disease, but there is no consensus concerning the optimal technical approach. The aim of this study was to investigate the attitudes of Italian otolaryngologists towards diagnostic NFE in children, and the most widely used methods., Methods: Nine hundred randomly selected members of the two largest Italian otolaryngological scientific societies were e-mailed an anonymous web-based questionnaire containing 29 multiple-choice items regarding their opinions about, and use of NFE in children., Results: Questionnaires were returned by 764 clinicians (84.9 %). About 75 % declared they used NFE, but 35 % said they preferred alternative diagnostic methods. Most of the respondents considered NFE safe, but more than 80 % judged it to be poorly or only fairly well tolerated. Almost all declared that they generally use flexible, small-diameter instruments, with the patient seated on a chair or a parent's lap; 65 % use gentle restraining methods. Fewer than 50 % reported using a standardised hypertrophy grading system., Conclusion: Italian otolaryngologists have a generally positive attitude towards using NFE in children. However, some have reservations, and there was no unanimous agreement concerning how it should be done. Given the medical advantages of NFE, it is essential to clarify the many still controversial aspects of the procedure by means of comparative studies and educational programmes.

Minimally invasive surgical approaches to parotid stones (such as extra-corporeal shockwave lithotripsy and sialendoscopy) have proved to be effective in a high percentage of cases, although success depends on factors such as the localisation of the stone, its size and its mobility. The failure rate of 10% is largely due to large and impacted stones and, in such cases, a combined external and sialendoscopic approach can be used to avoid morbidity and the risks of more invasive superficial parotidectomy. We treated eight patients with large parotid stones (>7 mm) using a sialendoscopy-assisted transfacial surgical approach that was effective in all but one case, which was successfully solved by combining this procedure with extra-corporeal lithotripsy and operative sialendoscopy. Our results confirm that the combined approach is a valid alternative to parotidectomy for large parotid stones and should be added to other minimally invasive techniques aimed at restoring the function of the affected parotid gland., (Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Objectives/hypothesis: To evaluate the long-term outcome of intraoral removal of large submandibular gland calculi., Study Design: Retrospective cohort study., Methods: A retrospective review (1995-2008) of 118 patients with submandibular calculi > or = 10 mm treated by intraoral surgical removal with preservation of the salivary gland., Results: Calculi were completely removed in 103/118 (87.3%) cases, partially removed in 14/118 (11.9%), with failure to remove any fragments in only 1/118 (0.8%). After a mean follow-up of 42 months, 101/118 (85.6%) cases remained asymptomatic, 17/118 (14.4%) cases had modest obstructive or infective symptoms, 4/118 (3.4%) cases suffered recurrent stones, and in 1/118 (0.8%) case persistent symptoms dictated salivary gland removal., Conclusions: The data suggest that the majority of large submandibular gland calculi can be removed by gland-preserving procedures retaining an asymptomatic salivary gland. This casts doubt on the commonly held premise that salivary stones normally lead to chronic sialoadenitis, which is the basis for the current policy of sialoadenectomy.

Salivary gland ductal obstructions are common, being the most frequent nonneoplastic salivary disorders in adults. Salivary calculi are the main cause of obstruction. Traditional and invasive transcervical sialadenectomy is still the most widely used treatment for perihilar and intraparenchymal obstructive salivary diseases worldwide despite the well-known morbidity related to its functional, neurologic, and aesthetic sequelae. However, improved radiologic imaging, better optical systems and endoscopic devices, and the introduction of minimally invasive therapeutic options have allowed the development of conservative gland-preserving techniques for managing salivary gland obstructions, including extracorporeal shock wave lithotripsy, operative sialoendoscopy, video-assisted transoral and transcervical stone removal, and ductal rehabilitation through interventional radiology and sialoendoscopy. Through adopting a minimally invasive and multimodal policy, a significant number (74%-100%, technique dependent) of salivary calculi can be safely and successfully retrieved while leaving an intact and functional salivary gland system. Only 2% to 5% of patients require gland excision. However, long-term follow-up evaluations of obstructive symptom recurrence are needed before the ultimate benefits of a gland-preserving conservative approach and the residual role of adenectomy can be assessed.

Drooling generally arises as a result of neurologic or muscular impairments, especially in subjects affected by cerebral palsies. It has never previously been described in patients with ring chromosome 21 syndrome. We describe the video-assisted surgical rehabilitation of the left parotid duct in a child with ring chromosome 21 syndrome and a persistent and painful swelling of the left parotid region after the surgical ligation of the Stensen ducts because of drooling. The diagnosis of Stensen duct dilatation as a result of iatrogenous complete distal acquired atresia was made by means of clinical and magnetic resonance evaluations. Video-assisted sialoendoscopical surgical rehabilitation of the left parotid duct was successfully performed; based on this experience, this minimally invasive procedure is preferred before traditional invasive parotid surgery in these cases. Other therapeutical options such as botulinum toxin therapy might be considered for the management of drooling in such young patients.

Atresia of the submandibular ducts (particularly the duct orifice) is a rare occurrence that is mainly observed in newborns or infants; moreover, its differential diagnosis with other anomalies of the oral floor is sometimes difficult. Given the lack of data concerning the differences between atresia of the orifice of Wharton's duct and other anomalies of the submandibular duct system, we describe here the findings of videosialoendoscopic assessment of the salivary duct system in an infant who underwent traditional surgery for bilateral atresia of the orifice of Wharton's duct. During sialoendoscopy, a trifurcation of the main duct, a normal variant of the more common bifurcation of the secondary branches of the salivary duct system, was observed bilaterally. No other ductal anomalies were encountered. Complete resolution of the symptoms and complete patency of both ducts at 19-month follow-up evaluation were observed. In conclusion, although spontaneous resolution of the disease during feeding is possible, minimal incision of the orifice of the imperforated submandibular duct together with diagnostic videosialoendoscopy of the main salivary duct system may be considered as part of the modern approach to salivary obstructive disorders in pediatric age as is currently the case for sialolithiasis and recurrent juvenile parotitis.

Testing for coronavirus disease 2019 is critical in controlling the pandemic all over the world. Diagnosis of severe acute respiratory syndrome coronavirus-2 infection is based on real-time polymerase chain reaction performed on nasopharyngeal swab. If not adequately performed, the viral specimen collection can be painful and lead to complications. We present a complication occurred during a nasopharyngeal swab collection performed in a noncooperative patient where the plastic shaft of the swab fractured during the procedure, resulting in swab tip retention deep into the nasal cavity. The foreign body was found endoscopically, stuck between the nasal septum and the superior turbinate tail at the upper level of the left choana and removed under general anesthesia in a negative pressure operating room with the health care personnel wearing personal protective equipment. Unpleasant complications like the one described can happen when the swab is collected without the necessary knowledge of nasal anatomy or conducted inappropriately, especially in noncooperative patients. Moreover, the design of currently used viral swabs may expose to accidental rupture, with risk of foreign body retention in the nasal cavities. In such cases, diagnosis and treatment are endoscopy-guided procedures performed in an adequate setting to minimize the risk of spreading of the pandemic. [ABSTRACT FROM AUTHOR]

Submandibular gland excision is generally performed through a transcervical approach, a safe procedure that, however, carries few neurological, functional and aesthetic drawbacks. Intraoral approach to the submandibular gland has been described many years ago but it has been newly proposed in recent years thanks to endoscope‐assisted and robot‐assisted surgical procedures. The main purpose of intraoral approaches is to avoid cosmetic sequelae and to reduce the risk of marginal nerve injury although the recent introduction of retroauricular, postauricular, facelift and transhairline neck incisions has overcome the need for an alternative to traditional transcervical approach. Different surgical approaches (transoral versus transcervical) to the submandibular gland as well as different type of cutaneous incisions will be illustrated and discussed in the light of advancement of endoscope‐assisted and robot‐assisted procedures. [ABSTRACT FROM AUTHOR]

Horizontal glottectomy (HG) is an efficient surgical procedure for the treatment of selected laryngeal carcinoma. The aim of this study was to verify the long-term voice results in a group of HG subjects. The study involved 16 subjects who had undergone HG at least 1 year before. Each subject underwent laryngoscopy and his/her voice was perceptually rated using the GRBAS (grade, roughness, breathiness, asthenicity, strain) scale; the other objective examinations included maximum phonation time (MPT), spectrography, and perturbation analysis. Finally, all of the subjects assessed their own voice using the voice handicap index (VHI). The endoscopic examinations showed good arytenoid mobility and antero-posterior valving of the arytenoid-epiglottal-ventricular band complex, whereas vibration of the neoglottis was more severely impaired. The mean GRBAS values were, respectively, 2.7, 1.9, 1.9, 0.9 and 0.7; the mean MPT was 8.2 s. The Yanagihara score of the voice spectrograms was 4 in all cases; perturbation analysis revealed the following mean values: fundamental frequency = 147; Jitter% = 6.5; Shimmer% = 13.9; and noise-to-harmonic ratio = 0.76. The mean VHI value was 35.8. Objective and subjective data showed a dysphonic voice after HG, whereas the self-assessment results revealed a low degree of perceived disability, suggesting that oral communication was well preserved. [ABSTRACT FROM AUTHOR]

Sialendoscopy is a minimally invasive diagnostic and therapeutic tool for juvenile recurrent parotitis (JRP); the procedure is under general anesthesia, but local anesthesia has been used for sialendoscopy in children >8 years. Based on the experience in children with sedation for gastrointestinal endoscopy, we investigated the reliability and safety of deep sedation for sialendoscopy in JRP. Six children (3 females, 6–13 years) with episodes of parotid swelling underwent interventional (duct dilation and steroid irrigation) sialendoscopy with intravenous bolus of 1 mg/kg propofol and 1 mcg/kg fentanyl, and continuous infusion of 2 mg/kg/h propofol. Sialendoscopy under deep sedation was successfully performed in all the patients; the procedure was well tolerated, without any adverse effects. One event of full awakening was registered and promptly solved without needing to interrupt the procedure. Effectiveness of sialendoscopy under deep sedation was subjectively attested by high positive scores obtained at post-operative standardized questionnaires administered to the patients and their parents, and objectively by the lack of clinical recurrences during the follow-up. The combination of propofol and fentanyl seems to be a reliable and safe means of sedating children with JRP undergoing sialendoscopy. [ABSTRACT FROM AUTHOR]