Sialendoscopy is an emerging minimallyinvasive procedure that is used as a diagnostic and therapeutic aid in various non-neoplasticsalivary gland disorders like sialolithiasis, sailadenitis and otherobstructive disorders.
Sialendoscopy provide superior diagnostic details as comparedto other imaging modalities used for obstructive pathologies. The techniqueemploys a small probe which is attached to a camera and placed into thesalivary glands through the salivary ducts. The latest innovation ofminiaturized endoscopic imaging tools has brought a revolutionary change in thefield of sialendoscopy. Preservation offunctionality of the gland while relieving the obstruction forms the majoradvantage of sialendoscopy. Currently, sialendoscopy is being used for treatmentof sialolithiasis, stricture dilation, and as a therapeutic aid for recurrentjuvenile sialadenitis, radioiodine induced sialadenitis, and patients who have recurrent sialedenitis fromautoimmune processes such as sjogren’s syndrome and systemic lupuserythematosus.
This paper presents review ofliterature about sialendoscopy history, instrumenttechniques and its significance as diagnostic and therapeutic aid in salivarygland disorders.KEYWORDS:Imaging modalities, Salivary gland diseases, Sialolithiasis, Sialendoscopy.INTRODUCTIONObstructive sialadenitis is themost common benign salivary gland disease and accounts to almost 50% of non-neoplasticsalivary gland pathologies. 1 Obstructive sialadenitis frequently affects thesaubmandibular gland (80% to 90%) followed by parotid (5% to 10%) andsublingual (less than 1%) glands. 2 Sialolithiasis, stenosis, mucus plugs,polyps, foreign bodies, external compression, and variations in anatomical ductalsystem forms the major etiological factors. (STRYCHOWSKY AMERICAN MED ASSOC2012) Initial treatment of obstructive sialadenitis is usually conservativewith hydration, salivary flow stimulation, anti-inflammatory medication andantibiotics when bacterial infection is suspected. (CAARTA ACTA OTORHINOLOGY2017) Surgical protocol (including papillotomy and gland removal) may beindicated for recalcitrant lesions. 3 (STRYCHOWSKY AMERICAN MED ASSOC 2012) Whileconservative therapy doesn’t provide permanent cure, surgical management may beassociated with potential nerve injury (marginal mandibular nerve, hypoglossalnerve, lingual nerve and facial nerve), 1 poor cosmetic outcome, gustatorysweating (auriculotemporal syndrome), and paraesthesias.
(DEENDAYALOTOLARYNGOLOGY 2016) With the introduction of sialendoscopy, the management ofsalivary gland obstruction has undergone a revolutionary change. 5 (CAARTA ACTAOTORHINOLOGY 2017) 3 Sialendoscopy has evolved as an ideal investigative aswell as therapeutic tool for of salivary gland pathologies over the last twodecades. (PP SINGH IND J OTOLARYNG HEAD AND NECK 2015) Sialendoscopy is aminimally invasive procedure that incorporates a small -calibre endoscope andfacilitates direct examination of the salivary ductal system. (ATINEZA 2015BRITISH ASSOC OF ORAL SURG) HISTORYThe anatomicaldescription of the major salivary gland ductal system was first accounted asearly as late 17th century. In 1990, Konigsberger et al.
were the pioneer in salivaryendoscopy and used a 0.8-mm flexible endoscope.1,2 Katz performed sialendoscopyusing a flexible scope and a basket, and a wide array of sialendoscopyinstruments and methods were further delineated by Nahlieli et al. andMarchal.3,4 The semirigid sialendoscopes were introduced by Zenk et al. and Nahlieli et al.
incorporated pediatric sialendoscopy for treatmentof recurrent juvenile parotitis and radioiodine sialadenitis patients in 2004and 2006 respectively. 6 7 In 2007, the combinedtechnique of endoscopy and external method for sialolith extirpation was putforward by Marshall. 8 (ERKUL 2016 LARYNGOSCOPE INVESTIGATIVE OTOLARYNGOLOGY)INSTRUMENTATIONSialendoscopes may beclassified as rigid, semi-rigid and flexible sialendoscopes. Flexible endoscopesare beneficial as their manoeuvering is easier through the tortuous duct system and aregenerally atraumatic. The disadvantages include- fragility, shorter lifespan, difficulthandling and they cannot be are not autoclaved 14.
Rigid endoscopes employ high-qualityoptical lens system and results in improved exploration of the duct system, aresturdier and autoclaving is possible. These endoscopes show difficulty inhandling because of larger diameters and the camera being directly fixed ontothe ocular attached to the endoscope 14. (CAARTA ACTA OTORHINOLOGY 2017)These days, semi rigid endoscopes are preferred and considered as thesialendoscope of choice. They exhibit properties intermediate to rigid andflexible sialendoscopes. They are easy to manoeuvre through the ductal system asthey possess certain degree of flexibility (45 degrees) and zero degree viewingangle.
(PP SINGH IND J OTOLARYNG HEAD AND NECK 2015) INDICATIONSSialendoscopyserves as an ideal investigative as well as therapeutic protocol for obstructivesalivary gland pathologies. 3. With the advancements in instrumentation andacceptance of minimally invasive surgeries, sialendoscopy has emerged as theprincipal therapeutic modality for obstructive salivary gland disorders 9. Sialendoscopyis now widely accepted therapeutic tool for sialolithiasis, stricture dilation,recurrent juvenile sialadenitis 3. radioiodine induced sialadenitis, 10intraductal masses 2 (Indian J Otolaryngol Head Neck Surg.
2013 Apr;65(2): 111–115. InterventionalSialendoscopy with Endoscopic Sialolith Removal Without Fragmentation Payman Dabirmoghaddam and Rima Hosseinzadehnik) and patients with recurrent sialedenitis due toautoimmune disorders such as systemic lupus erythematosus and sjogren’ssyndrome ( Wilson-advances in endoscopic surgery intechopen.com) Sialolithiasis is the majorcausative factor for sialadenitis and manifest as diffuse unilateral majorsalivary glands swelling. (Marchal F, Dulguerov P. 2003; Nahlieli O. 2006).
Generally,sialendoscopy is successful in surgical extirpation of salivary stones lessthan 4 mm in the submandibular gland and less than 3 mm in the parotid glandrespectively. Further disintegration of sialoliths (with holmium laser or lithotripsy)may be required before endoscopic procedure for salivary stones sized between5-7 mm. Sialoliths of diameter greater than 8 mm necessitate a combinedapproach technique for stone removal (Karavidas K, Nahlieli O, Fritsch N, etal. 2010). The combined approach technique incorporates a sialendoscope for stonelocalization and either an intra-oral or an external approach for extirpationof a large submandibular or parotid stones, respectively (Bodner L.
2002;Lustmann J, Regev E, Melamed Y. 1990; Marchal F. 2007; Raif J, Vardi M,Nahlieli O, et al. 2006; Seldin HM, Seldin SD, Rakower W. 1953; Walvekar RR,Bomeli SR, Carrau RL, et al. 2009).