Response to "Interventional sialendoscopy for treatment of juvenile recurrent parotitis".

Sir,

The article by Gary et al.[1] aroused our interest and simultaneously raised some areas of discussion on which we would like to expand.

First, the authors understated that “Sialendoscopy is a relatively new procedure introduced by Marchal et al[1]” and a book of Dr. Marchal (2003) was cited.[2] Indeed, sialendoscopy is not new and is not invented by Dr. Marchal. The first reports on sialendoscopy were published by Dr. Katz from Paris, France,[3] and Dr. Königsberger and his colleagues from Munich, Germany.[4] Both teams reported this innovation in the same year; that is in 1990 (or 13 years before Dr. Marchal's book), and these two publications have been indexed by PubMed.[34] Since then, over 8000 patients undergoing sialendoscopy have been reported by Dr. Katz and his colleagues from the Institute of Functional Exploration and Endoscopy of Salivary Glands in Paris, France.[5-7]

Up until now, sialendoscopy has become one of the routine procedures in several European oral-maxillofacial surgery (OMS)/otolaryngology departments and private practices [unpublished data]. The use of sialendoscopy as a tool in diagnosis and management of salivary gland infections, including juvenile recurrent parotitis, was recently reviewed by Carlson[8] and Patel and Karlis.[9] In many European university hospitals/training centers, an endoscopic craniomaxillofacial surgery course has been integrated into residency and/or fellowship programs in OMS, otolaryngology and plastic surgery, such as at Henri Mondor University Hospital, Créteil, France, by Prof. Meningaud.[10] Based on the primary author (P.P.)'s experiences, endoscopy is applicable very well to various maxillofacial/head and neck procedures, such as repair of the orbital wall fractures,[1112] excision of the submandibular or parotid salivary gland,[13-15] and lipoma on the forehead.[16]

Second, the authors described that “An informed consent was obtained from the parents of the patients for management with interventional sialendoscopy.” It is important to note that clinical consent differs largely from research consent. Clinical consent reviews something that has been known, whereas research consent must point to uncertain or unpredictable study results. Once a surgeon introduces an innovative surgery to patients, he or she should take 2 situations into account: “selective hearing” (patients take all information about potential benefits and filter out all information about potential risks) and “innovative alliance” (the surgeon encourages patients to try any new things to improve the quality of life or prospects for survival. Meanwhile, the surgeon is also eager to apply that innovation for the same reasons). Moreover, research involving humans must not be mixed with routine practice and then later reported as a retrospective study. For details on ethical aspects of endoscopic surgery of salivary glands, we refer interested readers to our recent publication.[13]

Third, the authors mentioned in their surgical technique that “The oral cavity can be kept open using splints.”[1] This seems to be a misnomer because the term “splint” means material or a device used to protect or immobilize a body part, usually for fracture treatment, rehabilitation, or physiotherapy.[17] Commonly used intraoral splints include a wire-composite splint for traumatized teeth and/or alveolar bone [Figure 1], an occlusal splint for temporomandibular disorders, and a surgical splint for orthognathic surgery [Figure 2]. The devices frequently used to keep the mouth open during intraoral procedures, are called “mouth gag” [Figure 3] and “mouth prop” [Figure 4]—both are not a type of intraoral splints.

Figure 1

A wire-composite splint for dentoalveolar injuries

Figure 2

A surgical splint for orthognathic surgery: (a) wearing surgical splint and (b) the surgical splint is placed in its position to allow the accurate position of the jaws and good surgical fixation

Figure 3

Mouth gag

Figure 4

Mouth prop

Lastly, there is an inaccurate citation in the Discussion of the article: “Quenin et al. reported a series of 10 patients in 2008.”[4] In fact, the paper by Quenin et al. is Reference No. 11, and Reference No. 4 is from Motamed et al.