Procedural Uses
The majority of sialendoscopy procedures are performed in context with non-neoplastic salivary gland disease; consequently, the factors that drive the need for surgical intervention include symptom severity, recurrent nature of the problem, non-responsiveness to the medical line of treatment, and disturbance of the patient’s quality of life, Dr. Walvekar said.
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October 2021
It’s an elegant solution to obstructive salivary disease, and in the right circumstances it can be nothing short of miraculous. —Kenneth Hsu, MD
Sialendoscopy is a tool that’s used to evaluate patients with obstructive salivary symptoms, also called chronic sialadenitis. The causes of chronic sialadenitis mainly involve salivary duct stones or salivary duct stenosis, said Jolie Chang, MD, associate professor and chief of the divisions of general otolaryngology and sleep surgery in the department of otolaryngology–head and neck surgery at the University of California in San Francisco. Typical symptoms of obstructive salivary disease include recurrent swelling and pain of the major salivary glands, including the submandibular and parotid glands.
The advent and use of sialendoscopy help physicians to gain access to the lumen of the submandibular and parotid ducts for diagnostic visualization and therapeutic intervention, such as stone extraction and stenosis dilation or bypass (sialodochoplasty), said William R. Ryan, MD, associate professor of head and neck oncologic and endocrine surgery in the department of otolaryngology–head and neck surgery at the University of California in San Francisco. Such techniques help bring patients relief and preserve the salivary glands. Transoral and transfacial techniques aided by sialendoscopes can significantly reduce and nearly eliminate the need for salivary gland excision.
Sialendoscopy can also help alleviate ductal stenosis/narrowing and chronic inflammation in patients with recurrent sialadenitis (i.e., post-radioactive iodine patients, Sjögren’s syndrome patients, and other autoimmune disorder patients) by allowing for saline and steroid flushes of the ductal system, said Nadia G. Mohyuddin, MD, associate professor of clinical otolaryngology in the department of otolaryngology–head and neck surgery at Houston Methodist Hospital in Texas. It also allows for stone localization and extraction from the salivary ducts in patients with sialolithiasis.
Additionally, sialendoscopy is used less commonly as an intervention to dilate strictures in the ducts, Dr. Hsu said. Dilation of these narrowed segments can resolve symptoms and restore normal drainage and glandular function.
Evaluating Candidates
Sialendoscopy can be applied to a wide variety of patients with non-neoplastic salivary gland disease, from sialolithiasis to radioactive iodine sialadenitis ductal strictures to complex salivary duct reconstruction, said M. Allison Ogden, MD, professor and vice chair for clinical operations in the department of otolaryngology at Washington University School of Medicine in St. Louis, Mo. Patients with acute suppurative sialadenitis aren’t good candidates for sialendoscopy at the time of acute infection, but sialendoscopy may be used to treat a potential underlying cause after an active illness has been resolved.