Sialoendoscopy

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Sialoendoscopy is a minimally invasive technique that allows for salivary gland surgery for the safe and effective treatment of sialadenitis and other conditions of the salivary glands. During sialoendoscopy a small camera is placed into the salivary glands through the salivary ducts that empty into the mouth. Sialoendoscopy is an efficient yet simple mode of treatment for major salivary gland obstructions, strictures and sialoliths (salivary stones). Depending on the obstruction, sialoendoscopy can be conducted under local anesthesia in an outpatient office or in the operating room under general anesthesia.

Contents

Conditions indicating sialoendoscopy

Salivary gland stones are one of the major causes of salivary gland infections (sialadenitis). These types of stones can be found in 1.2 percent of the general population.[1]

The second leading cause of salivary obstruction is from strictures and adhesions, which can happen from prior salivary gland infections, including childhood infections like mumps. Most strictures could be seen in the parotid duct and mostly in the disease process of chronic recurrent sialadenitis.

Description of the technique

Generally, the salivary duct opening needs to be either dilated or incised prior to introduction of the endoscope. Once the sialoendoscope is in place, saline is utilized to dilate the salivary duct and its branching.

Once the endoscopes are introduced into gland, the internal anatomy is explored either for diagnosis or for treatment of a specific disease entity. The endoscope is introduced into the gland through its natural orifice in the mouth or by a making a small incision in the duct opening. These techniques for introduction are completely intraoral techniques.

Salivary gland stone removal[2]

  1. The grasping technique
  2. Using a small wire basket retrieval system
  3. Mechanical Fragmentation
  4. Laser fragmentation

Treatment of strictures and adhesions

In the case of strictures or adhesions, the following technique can be used as a treatment modality. First the surgeon will makes his diagnosis and find the exact location of the obstruction using a sialogram. Following this, the surgeon can use the endoscopic method. The first step in this is anesthetizing and laving the duct with 2 percent lidocaine and saline. If there is no improvement, the surgeon then can insert a dilation balloon, which can be inflated up to 3 mm. The pressure created by the inflation can be sufficient to dilate most strictures. Another technique for dilating strictures is to expand the stricture region with grasping forceps used as a dilator.

Instrumentation

The ability to perform this technique is the result of the development of miniaturized endoscopic imaging tools. The majority of sialoendoscopes that are currently in use are of the semirigid type. The semirigid endoscope allows for visualization of the diseased process, but the stiffness allows manipulation and navigation of the internal salivary anatomy.

Multiple types of micro instrumentation are available, including grasping forceps, biopsy forceps, drills, needles, laser fibers, and lithotripters (although the last is currently unavailable in the US pending U.S. Food and Drug Administration approval). Multiple companies make various types of sialoendoscopes and instrumentation. There are advantages and disadvantages to all of the systems and none are recommend over the other. Different practitioners utilize different systems due to the experience and clinical training of the surgeon.

Milestones in sialoendoscopy

References

  1. ^ Rauch S GR: Diseases of the salivary glands. (ed. 6th). St. Louis: Mosby, 1970:997
  2. ^ Nahlieli O, Nakar LH, Nazarian Y, Turner MD: Sialoendoscopy: A new approach to salivary gland obstructive pathology. J Am Dent Assoc 2006;137:1394
  3. ^ Konigsberger R, Feyh J, Goetz A et al.: [Endoscopic controlled laser lithotripsy in the treatment of sialolithiasis]. Laryngorhinootologie 1990;69:322
  4. ^ Gundlach P, Scherer H, Hopf J et al.: [Endoscopic-controlled laser lithotripsy of salivary calculi. In vitro studies and initial clinical use]. Hno 1990;38:247
  5. ^ Katz P: [Endoscopy of the salivary glands]. Ann Radiol (Paris) 1991;34:110
  6. ^ Nahlieli O, Neder A, Baruchin AM: Salivary gland endoscopy: A new technique for diagnosis and treatment of sialolithiasis. Journal of Oral and Maxillofacial Surgery 1994;52:1240

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