Sialendoscopy as a treatment and
diagnostic procedure, has become the choice in all ages of patients with
salivary duct pathologies especially in the elderly patients with recurrent diseases,
as it has low morbidity and less invasive. Interventional sialendoscopy allows
the treatment of sialolithasis and stenosis, and help therefore to prevent
salivary gland excisions and to minimise postoperative complications. Finally,
it should be noted that in the early phases of sequential learning
complications rates are significant. However, major complications are
infrequent and in general can be rectified by standard salivary gland surgery.
Patient may experience
weakness on the face, around the mouth or of the eyelids for a few days
following surgery. Incision line swelling is also expected. Numbness of the skin
around the incision, possibly around the earlobe, is also expected. Post-operative
hydration has to be accounted for. Antibiotics are used in the initial post-op
period to prevent infection while the incision is healing. Watch out for Signs
of a post-operative infection, like fever, swelling or redness at the surgical site,
and foul-smelling discharge from the line of incision. Post-operative visit patients
are called for review within 7-10 days after surgery to decide on the further
course of action is any.
Just before starting
diagnostic sialendoscopy, patients are given sialogogues like lemon or Vitamin
C tablet to augment the salivary secretion. This facilitates in easy
identification of duct opening and manoeuvring of scope through the ductal
anatomy during the procedure.
The introduction of the
endoscopes into the gland through the orifice in the mouth or by making a small
incision in the duct opening allows transluminal visualization of the ductal anatomy with the aim of diagnosis or for
treatment of a specific disease identified.
Sialoendoscopy is a procedure where a small
endoscope is placed into the salivary glands via the salivary duct that empty
into the mouth. Based on the analysis of the type of obstruction,
sialoendoscopy can be conducted under local
anaesthesia at an outpatient facility or in the operation
theatre under general anaesthesia.
If the patient presents with acute inflammation
of the salivary glands, then Sialendoscopy should not be attempted as it may
increase the swelling and pain in an already inflamed gland. Due to inflammation cannulation rate decreases,
and also leads to poor visibility of the internal ductal
anatomy, leading to complication like perforation of the duct resulting in stenosis
of the duct, thereby increasing the overall complication.
Sialendoscopy can be
both diagnostic and therapeutic. It compliments diagnostic procedures such as plain
radiography, ultrasonography, computed tomography (CT), magnetic resonance
sialography, and conventional sialography. Since it is diagnostic and therapeutic
it can get over in a single session and mostly at an outpatient facility. And
though it is an invasive procedure the morbidity associated with sialendoscopy
is minimal and often temporary.
Management of the salivary gland pathologies has
seen a paradigm shift after the introduction of sialendoscope. This technique
was first described by Katz and Fritsch in 1990s who used flexible endoscope
for evaluation of salivary gland ducts. Since then, enhanced optical resolution
and miniaturisation of instruments through various advances in technology has
resulted in advanced techniques in sialendoscopy. Oral surgeons and
Otolaryngologists and some other clinicians at certain health care facilities
have pioneered this technique and have been involved in its propagation through
structured training programmes. Introduction of Sialendoscopy as a diagnostic
and therapeutic tool for management of salivary gland pathologies has helped
significantly reduce the morbidity rates, loss of work hours and significantly
reduced hospital stay duration. Though still under research this technique has
evolved with a set of indications and techniques.
Earlier, for surgical gland
disorders mentioned above patients received treatments like antibiotics,
steroids, sialogogues, anticholinergics or would undergo surgeries like
intraoral incision and excision of the sialolith or even gland.
Also, there were no treatment protocols for the pathologies like ductal
stenosis secondary to chronic inflammation.
Sialoendoscopy or Sialendoscopy as it is referred
to commonly is a safe and effective surgical treatment of obstructive salivary
gland disorders and other conditions of salivary gland like sialolithasis, ductal
polyps, and juvenile recurrent parotitis,
using minimally invasive
Introduction, Indications and Technique