Evaluation der Wirksamkeit und therapeutischen Sicherheit neuer Behandlungsmethoden der Sialolithiasis und chronisch rezidivierenden juvenilen Parotitis
Abstract
Saliva serves not only to moisten food pulp, initiate digestion and increase gustatory perception. It is also an important part of the immune system, remineralizes dental enamel, protects against
caries and parodontosis, as well as accelerates wound healing. Malfunction within this complex system can cause major reduction in the quality of life. This cumulative dissertation presents two studies that evaluate new minimally invasive treatment options for frequent salivary gland diseases in adults and children, the obstructive sialolithiasis and juvenile recurrent parotitis.
The first publication Intracorporeal lithotripsy of salivary stones: in vitro comparison of different
methods investigates the efficacy and therapeutical safety of the electrokinetic lithotripsy compared to the already established treatment methods of sialolithiasis, laser and pneumatic
lithotripsy.
A fragmentation experiment on a sieve showed, that efficacy of the electrokinetic lithotripsy is higher than laser lithotripsy and lower than pneumatic lithotripsy. New in vitro setups were developed to comprehensively assess the damage that intracorporeal lithotripters induce to surrounding tissue. Aside from measurements of the propulsion, stone models were fragmented
within gelatin blocks to measure duct widening and lengthening, tear number and length that were then summarized in a damage index. In a third experiment, impulses were applied to a duct model consisting of cattle ureter and counted until the duct model perforated. Our study showed that therapeutic safety of the electrokinetic lithotripsy lay withing the range of laser and
pneumatic lithotripsy. Overall, electrokinetic lithotripsy seems to be a suitable alternative to
laser and pneumatic lithotripsy. Based on these promising preclinical results, electrokinetic lithotripsy was tested clinically on three patients with sialoliths in the parotid duct. The treatment caused no relevant side effects and treatment duration was similar to laser and
pneumatic lithotripsy.
The second publication Treatment of juvenile recurrent parotitis with irrigation therapy without
anesthesia investigated whether the sole irrigation therapy in children with juvenile recurrent
parotitis is a suitable alternative treatment option to sialendoscopy under general anesthesia. The therapeutic effect of diagnostic sialendoscopy, has been attributed to irrigation. We investigated whether the therapeutic irrigation effect alone can be used without patients having to undergo general anesthesia, and therefore minimizing risks and use of resources by simply irrigating with saline solution. Our study showed an improvement of symptoms in 6/6 of the
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subjective parent reports after treatments, a complete removal of symptoms in 3/6 cases and
the recurrence of episodes in 4/6 cases with a mean follow-up time of 27.7 months. Our
observations indicated that the irrigation therapy without anesthesia is a suitable and less invasive option in the treatment of the juvenile recurrent parotitis.
The exact preclinical and clinical evaluation of efficacy and therapeutic safety of new treatment
options for inflammatory salivary gland diseases lays the foundation to improve patient care. A reduction of treatment time and side effect can ultimately lead to an improved quality of life in
our patients.
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