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IAOMRPGCON2014-PA209
Sialoendoscopy – a novel minimally invasive diagnostic and therapeutic technique.
IntroductionSialoendoscopy is specialized procedure that
allows endoscopic transluminal visualization of major salivary gland ductal system.
Sialoendoscopy is both diagnostic and therapeutic modality
History In 1990 - Katz and Gundlach.
In 1994 - Nahlieli et al(Israel). In 1995 - Marshal (Switzerland). In 1997 - flexible endoscope with irrigation. In 2002 - European Sialendoscopy Training Center was
started .
Indication1. Conventional method is hazardous for calculus
removal.2. Ductal stenosis, intraductal adenoids /foreign
bodies.3. Recurrent major salivary gland swelling without
cause.4. Determination & treatment of anatomic
variations/malformations5. Diagnosing autoimmune diseases of salivary
gland.6. Follow up & control of treatment success rate.
contraindicationAcute inflammatory disease
Pre operative evaluationHistory Number of infectionsPrevious treatmentsHistory of radiation therapy & radio iodine
exposureEvaluation of anatomical limitation
Armamentarium
Types of endoscopes Erland all in one endoscope
Marchal all in one endoscope
Conical Dilator
Dilator of varying sizes
Bougies of varying sizes
Types of dormia basket
Types of balloon catheter
Foreign body forceps Biopsy forceps
Pre operative preparation
AnesthesiaPatient positioning
Technique
Wharton’s duct Stenson’s duct
Identification of papilla microscope or surgical loupes and massage
of glands to express saliva.
Next inject 2 ml of Lidocaine with epinephrine in periphery .
Dilation of salivary ductStandard dilation: Non toothed tissue forceps - straighten
the tortuous duct and fix the papilla .
Salivary duct probe in the papilla.
Salivary canula Canulated duct
Salivary dilator inserted in the papilla.
Dilated papilla
Seldinger technique:
papillotomy (Nahlieli et al) - prevents creation of mucosal seal around endoscope resulting in leakage of irrigates thereby preventing maximum dilation of duct.
Interventional Sialendoscopy
Stenosis
After dilation
Post operative follow Intra venous antibiotics and steroids to
decrease post operative infection and edema.
Normal diet.
Advantages
1. Minimal invasive procedure done on outpatient basis.
2. Ensure complete removal of any obstructions.
3. The status of glandular tissues from appearance of ductal lining is appreciated.
4. Identify radiolucent stone, polyps, stenosis, mucous plugs and foreign body.
Complication
1.Avulsion of duct and ductal wall perforation.2. Development of post operative infections.3. Ranula formation. 4. Lingual nerve parasthesia.5. Temporary swelling of gland.6. Superficial mucosal necrosis at LA site.
Conclusion
Successful application of sialoendoscopy requires a well-organized training program.
more advances it is the future solution for management of obstructive salivary gland disease.
Bibliography1) Is Sialendoscopy an effective treatment for obstructive salivary gland disease? The American
Laryngological, Rhinological and Otological society 2003.3 ) Sialendoscopy allows for endoscopic removal of saliva stones. UCLA health.4) A newly developed interventional sialendoscope for a completely non surgical
sialolithectomy using intracorporeal electro hydraulic lithotripsy. Journal of oral maxillofacial surgery 2007.
5) Therapeutic Sialendoscopy .National Institute for Health and Clinical Excellence may 2007. ) 6) Sialendoscopy minimally invasive surgery for benign salivary gland diseases.MD Singapore
March 2011.7) Sialendoscopy the Endoscopic approach to Salivary Gland Ductal Pathologies. Author Francis
Marshal MD, FACS.8) The open Access atlas of Otolaryngology, Head & Neck operative Surgery by Johan Fagan &
Robert L Witt 9) Sialoendoscopy: a new Diagnostic and Treatment Modality. The Journal of Indian Academy of
Oral medicine & Radiology.2007.10)Sialendoscopy :endoscopic approach to benign salivary gland diseases, advances in
endoscopic surgery.11) Sialoendoscopy meds cape reference drugs, diseases & procedures.
Thank you