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Minimally Invasive Endoscopic Salivary Gland Surgery (Sialendoscopy)

by , last modified on 4/13/21

Sialendoscopy is a minimally invasive way to endoscopically address structural problems with the large salivary glands of the mouth (in green in the picture). When spit is produced in these glands, they travel thru ducts (purple) before escaping into the mouth. When these ducts become blocked for one reason or other, saliva can't come out causing it to backup into the gland itself. When this happens, painful swelling of the salivary gland occurs (sialadenitis). Traditionally, if the problem did not resolve with conservative measures including hydration, massage, warm compresses, sialogogues, etc, invasive surgical options would have been pursued. Such invasive options include removing the gland completely through a large incision in the neck or if a stone is present near the duct opening, an incision in the mouth into the duct to extract the stone could be performed (sialolithotomy).

The parotid duct is called Stenson's Duct and exits on the cheek mucosa near the first and second maxillary molar (first pic below) whereas the submandibular duct is called Wharton's Duct and exits under the tongue in the midline (2nd pic below).

Compared to the invasive options, sialendoscopy attempts to correct the obstruction using tiny cameras through the duct opening itself in the mouth. No new incisions are made. The tiny cameras (ie, endoscopes) are passed through the opening and threaded into the duct tunnel. However, because the duct opening (papilla) is only 0.5mm in diameter whereas the duct tunnel itself is about 4 mm in size, the duct opening has to be stretched open in order to be able to insert the camera endoscope into the duct tunnel. The stretching of the papilla is accomplished by serially inserting progressively larger diameter bougies until the endoscope or other instruments are able to be inserted easily. The salivary duct system is than visually examined for any source of obstruction whether it be thick sludge, stone, or abnormal narrowing. Once the obstruction is identified, tiny instruments can be passed to correct the problem as well as to flush the duct system with steroids and/or other medications.

Image of main duct

Image of hlium where main duct divides into two branches

Image of stone found in a duct

What are the benefits of sialendoscopy?

  • No incision, No scar
  • No risk of nerve damage
  • No risk of bleeding
  • Fast recovery time
  • Preservation of normal salivary gland and duct
  • Same day procedure in a safe outpatient setting
  • Early return to normal diet

However, not all salivary stones are amenable to pure endoscopic retrieval. Limitations include:

  • Stone is >4mm in size
  • Parotid stone is past the masseter muscle
  • Submandibular stone is at or past the hilum

As such, the biggest risk of sialendoscopy is not being able to retrieve the stone. In such situations, a combined approach may be required whereby sialendoscopy is used to precisely locate the stone followed by retrieval through an incision in the mouth or on the face.

During sialendoscopy, the salivary duct system is copiously flushed with saline, antibiotics, and/or steroids which allow for dilation of the duct which may enable the stone to be passed even if not retrieved. The antibiotics and steroids can address any infection or inflammation that may be present for symptom relief as well.

Tests required prior to sialendoscopy include Ultrasound and/or CT scan of the neck. Even if a stone is not seen on these imaging modalities, sialendoscopy may still be of benefit because there are other things that may cause symptoms similar to salivary stones that can also be treated with sialendoscopy including:

  • Stenosis / Strictures
  • Sludge / Debris
  • Mucus Plugging
  • Foreign Body

As such, other patient populations that may benefit from sialendoscopy include those suffering from Sjogren's Disease or radioactive iodine (I131) sialadenitis.

Please note that at this time, our office does not treat stenosis / strictures beyond diagnostic purposes.

Be aware that sialendoscopy is not recommended when the gland is actively infected and typically needs to be treated prior to any endoscopic intervention.

Read the consent form as well as post-operative instructions.

Please note, at this time Dr. Chang does not perform this procedure.

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