IAOMRPGCON2014-PA209

Sialoendoscopy – a novel minimally invasive diagnostic and therapeutic technique.

IntroductionSialoendoscopy is specialized procedure that

allows endoscopic transluminal visualization of major salivary gland ductal system.

Sialoendoscopy is both diagnostic and therapeutic modality

History In 1990 - Katz and Gundlach.

In 1994 - Nahlieli et al(Israel). In 1995 - Marshal (Switzerland). In 1997 - flexible endoscope with irrigation. In 2002 - European Sialendoscopy Training Center was

started .

Indication1. Conventional method is hazardous for calculus

removal.2. Ductal stenosis, intraductal adenoids /foreign

bodies.3. Recurrent major salivary gland swelling without

cause.4. Determination & treatment of anatomic

variations/malformations5. Diagnosing autoimmune diseases of salivary

gland.6. Follow up & control of treatment success rate.

contraindicationAcute inflammatory disease

Pre operative evaluationHistory Number of infectionsPrevious treatmentsHistory of radiation therapy & radio iodine

exposureEvaluation of anatomical limitation

Armamentarium

Types of endoscopes Erland all in one endoscope

Marchal all in one endoscope

Conical Dilator

Dilator of varying sizes

Bougies of varying sizes

Types of dormia basket

Types of balloon catheter

Foreign body forceps Biopsy forceps

Pre operative preparation

AnesthesiaPatient positioning

Technique

Wharton’s duct Stenson’s duct

Identification of papilla microscope or surgical loupes and massage

of glands to express saliva.

Next inject 2 ml of Lidocaine with epinephrine in periphery .

Dilation of salivary ductStandard dilation: Non toothed tissue forceps - straighten

the tortuous duct and fix the papilla .

Salivary duct probe in the papilla.

Salivary canula Canulated duct

Salivary dilator inserted in the papilla.

Dilated papilla

Seldinger technique:

papillotomy (Nahlieli et al) - prevents creation of mucosal seal around endoscope resulting in leakage of irrigates thereby preventing maximum dilation of duct.

 

Interventional Sialendoscopy

Stenosis

After dilation

Post operative follow Intra venous antibiotics and steroids to

decrease post operative infection and edema.

Normal diet.

Advantages

1. Minimal invasive procedure done on outpatient basis.

2. Ensure complete removal of any obstructions.

3. The status of glandular tissues from appearance of ductal lining is appreciated.

4. Identify radiolucent stone, polyps, stenosis, mucous plugs and foreign body.

 

Complication

1.Avulsion of duct and ductal wall perforation.2. Development of post operative infections.3. Ranula formation. 4. Lingual nerve parasthesia.5. Temporary swelling of gland.6. Superficial mucosal necrosis at LA site.

Conclusion

Successful application of sialoendoscopy requires a well-organized training program.

more advances it is the future solution for management of obstructive salivary gland disease.

Bibliography1) Is Sialendoscopy an effective treatment for obstructive salivary gland disease? The American

Laryngological, Rhinological and Otological society 2003.3 ) Sialendoscopy allows for endoscopic removal of saliva stones. UCLA health.4) A newly developed interventional sialendoscope for a completely non surgical

sialolithectomy using intracorporeal electro hydraulic lithotripsy. Journal of oral maxillofacial surgery 2007.

5) Therapeutic Sialendoscopy .National Institute for Health and Clinical Excellence may 2007. ) 6) Sialendoscopy minimally invasive surgery for benign salivary gland diseases.MD Singapore

March 2011.7) Sialendoscopy the Endoscopic approach to Salivary Gland Ductal Pathologies. Author Francis

Marshal MD, FACS.8) The open Access atlas of Otolaryngology, Head & Neck operative Surgery by Johan Fagan &

Robert L Witt 9) Sialoendoscopy: a new Diagnostic and Treatment Modality. The Journal of Indian Academy of

Oral medicine & Radiology.2007.10)Sialendoscopy :endoscopic approach to benign salivary gland diseases, advances in

endoscopic surgery.11) Sialoendoscopy meds cape reference drugs, diseases & procedures. 

Thank you