Chronic Obstructive Chronic Obstructive

SialadenitisSialadenitis

&&

SialendoscopySialendoscopy

Chronic Obstructive Chronic Obstructive

SialadenitisSialadenitis

&&

SialendoscopySialendoscopy

Parotid Ductal System

Nicolaus Stenonius

1660

Anatomy--Salivary gland Anatomy--Salivary gland

Stensen’s duct

• Submandibular Ductal System

Thomas Wharton, 1659

• Sublingual Ductal System

Casparus Bartholinus, 1690

Anatomy--Salivary glandAnatomy--Salivary gland

Wharton’s duct

Bartholin’s duct

Chronic Obstructive Chronic Obstructive SialadenitisSialadenitis

Chronic Obstructive ParotitisChronic Obstructive Parotitis

Submandibular sialadenitisSubmandibular sialadenitis

Chronic Obstructive Chronic Obstructive ParotitisParotitis

EtiologyEtiology

Clinical manifestationsClinical manifestations

DiagnosisDiagnosis

TreatmentTreatment

Etiology ofEtiology of

Chronic Obstructive Chronic Obstructive

ParotitisParotitis ScarScar

SialolithiasisSialolithiasis

AnatomyAnatomy

Clinical Clinical manifestationsmanifestations

Recurrent swelling and pain Recurrent swelling and pain

of the gland of the gland

Purulent dischargePurulent discharge

Diagnostic methodsDiagnostic methods Plain radiographsPlain radiographs

SialographySialography

UltrasoundUltrasound

Scintigraphy(Scintigraphy( 闪烁扫描法闪烁扫描法 ) )

CT CT

MRIMRI

SialographySialography

“Sausage like” appearance of enlarged duct“Sausage like” appearance of enlarged duct

MRIMRI

Appearance of enlarged duct

Sialography EndoscopySialography Endoscopy Sialography EndoscopySialography Endoscopy

DilationDilation StenosisStenosis

SialendoscopySialendoscopy

Differentiating Differentiating diagnosisdiagnosis

Chronic recurrent parotitis

SjÖgren syndrome

Chronic recurrent parotitis

SjÖgren syndrome

TreatmentTreatment systemic antibiotic administration

Sialogogues(促唾剂 )

Gland massage

Drug lavage(灌洗 ) and perfusion

systemic antibiotic administration

Sialogogues(促唾剂 )

Gland massage

Drug lavage(灌洗 ) and perfusion

Duct ligation

Parotidectomy

Tympanic(鼓室 ) neurectomy

Duct ligation

Parotidectomy

Tympanic(鼓室 ) neurectomy

Submandibular Submandibular

sialadenitis sialadenitis

and and

SialolithiasisSialolithiasis

Submandibular Submandibular

sialadenitis sialadenitis

and and

SialolithiasisSialolithiasis

Etiology of Etiology of

Submandibular Submandibular

sialadenitis sialadenitis SialolithiasisSialolithiasis

TraumaTrauma

InfectionInfection

Foreign bodyForeign body

SialolithiasisSialolithiasis Reasons of Reasons of arisingarising

1. Anatomy1. Anatomy

Upwarding routeUpwarding route Longer ductLonger duct Curve duct Curve duct

2.Components of saliva2.Components of saliva

Mucus proteinMucus protein Calcium contentCalcium content

ManifestationsManifestationsManifestationsManifestations

Intermittent swelling of the Intermittent swelling of the

glandgland

Aggravating with taking foodAggravating with taking food

Acute infectionAcute infection

Diagnostic methodsDiagnostic methods

plain radiographsplain radiographs sialographysialography ultrasoundultrasound CT scan CT scan SialoendoscopySialoendoscopy

Plain radiographsPlain radiographs

One Two Three

Sialography Sialography && CT CT

Sialolith

SialoendoscopySialoendoscopy

Stone in main ductStone in second branch duct

Stone embedded

Differentiating diagnosisDifferentiating diagnosis

Tumor in sublingual glandTumor in sublingual gland

Tumor in submandibular glandTumor in submandibular gland

KKÜÜtter tumortter tumor

Space infection in submandibular regionSpace infection in submandibular region

LymphadenopathyLymphadenopathy

Traditional treatmentTraditional treatment

Intraoral routeIntraoral route

Sialadenectomy via external Sialadenectomy via external

approachapproach

New technique New technique

SialendoscopySialendoscopy

Diagnostic SialendoscopyDiagnostic Sialendoscopy

Interventional SialendoscopyInterventional Sialendoscopy

History of the History of the

SialendoscopySialendoscopy 19911991 KatzKatz Flexible mini-endoscopeFlexible mini-endoscope

19931993 KonigsbergerKonigsberger Endoscopic intracorporeal lithotripsyEndoscopic intracorporeal lithotripsy

19941994 Arzoz Arzoz Endoscopic intracorporeal lithotripsyEndoscopic intracorporeal lithotripsy

Nahlieli Nahlieli SialendoscopySialendoscopy

1995 1995 Marchal Marchal SialendoscopySialendoscopy

1999 1999 Our Dept.Our Dept. YuYu

Diagnostic Diagnostic SialendoscopySialendoscopy

First generation branches Second generation branches

Types of obstructionsTypes of obstructions

SialolithSialolith

Polyps Polyps

StrictureStricture

KinkKink

Foreign bodyForeign body

Anatomic malformationAnatomic malformation

SialolithSialolith

Polyps Polyps

StrictureStricture

KinkKink

Foreign bodyForeign body

Anatomic malformationAnatomic malformation

SialolithSialolith

Main ductFirst branch of duct

80%~90% in Submandibular gland

Polyps and Mucous Polyps and Mucous PlugPlug

Sialolith

10%~30% in Parotid gland

Mucous Plug Sialolith?

Interventional SialendoscopyInterventional Sialendoscopy

Grasping wire basketGrasping wire basket

Biopsy forcepsBiopsy forceps

Balloon-tipped catheterBalloon-tipped catheter

Custom papilla dilatorCustom papilla dilator

Electrohydraulic lithotripterElectrohydraulic lithotripter

Holmium laser probeHolmium laser probe

Grasping wire basketGrasping wire basket

diameter<4mmdiameter<4mm

Balloon-tipped catheterBalloon-tipped catheter

Stenosis in the second branchStenosis in the second branch

Ductal StenosisDuctal Stenosis

Close-up view of the same site

Close-up view of the same site

diameter>4mmdiameter>4mm • Stone was fragmentized by Lithotripter

• Debris extracted by wire basket

• Stone was fragmentized by Lithotripter

• Debris extracted by wire basket

Electrohydraulic Shockwave Electrohydraulic Shockwave LithotripsyLithotripsy

Holmium laser probeHolmium laser probe

Laser fragmentationLaser fragmentation

Stone debris extracted by wire basketStone debris extracted by wire basket

Sialendoscopy in our Sialendoscopy in our departmentdepartment

1999 2002 2003

Sialolith removal by Sialolith removal by graspergrasper

Radiolucent sialolithRadiolucent sialolith

Mucus plug---Lavage and Mucus plug---Lavage and dilationdilation

Thank youThank youThank youThank you