Sialendoscopy, a minimally invasive diagnostic and interventional tool in the management of salivary gland diseases

Abstract

Abstract

Introduction. Sialendoscopy is a novel branch of minimally invasive surgery, which allows diagnostic and interventional procedures deep in the ductal systems of salivary glands. Clinical Department of Otorhinolaryngology and Cervicofacial Surgery Ljubljana is a joint otorhinolaryngological sialendoscopy center, representing in that field both Slovenian University Medical Centers.

Patients and methods. Since 2011, from among more than 200 patients with unexplained swelling of the salivary glands, we have submitted 118 patients to sialendoscopy and sialendoscopy-assisted interventions and performed 131 operations (78.6% under local anesthesia), with an attempted examination of a total of 137 salivary glands. The patients had mainly submandibular problems (66%).

Results. Our rate of failed sialendoscope introductions is 2.9% so far, which is comparable to the best results abroad. The most common interventional procedure was sialendoscopy-assisted combined approach salivary stone removal (36 cases). Adding 16 cases of wire basket stone retrievals, we reached a total of 52 successful stone extraction procedures. We found ductal strictures without sialolithiasis in 40 patients, mostly of parotid systems (24 patients), and in 19 of them, dilatation was performed, followed by a temporary stent insertion in 11 cases. In three patients with submandibular papillary stricture, we performed microsurgical ductostomy; our experience supports its recognition as a specific clinical entity. With no serious complications, the practice of sialendoscopy at our department reduced salivary gland resections because of obstructive disease by 90 %.

Conclusions. We believe that sialendoscopy is a new minimally invasive approach paradigm that fundamentally changes the treatment of obstructive salivary gland diseases.