Sialendoscopy scope and a basket, and a wide

Sialendoscopy is an emerging minimally
invasive procedure that is used as a diagnostic and therapeutic aid in various non-neoplastic
salivary gland disorders like sialolithiasis, sailadenitis and other
obstructive disorders. Sialendoscopy provide superior diagnostic details as compared
to other imaging modalities used for obstructive pathologies. The technique
employs a small probe which is attached to a camera and placed into the
salivary glands through the salivary ducts. The latest innovation of
miniaturized endoscopic imaging tools has brought a revolutionary change in the
field of sialendoscopy. Preservation of
functionality of the gland while relieving the obstruction forms the major
advantage of sialendoscopy. Currently, sialendoscopy is being used for treatment
of sialolithiasis, stricture dilation, and as a therapeutic aid for recurrent
juvenile sialadenitis, radioiodine induced sialadenitis, and patients who have recurrent sialedenitis from
autoimmune processes such as sjogren’s syndrome and systemic lupus
erythematosus. This paper presents review of
literature about sialendoscopy history, instrument
techniques and its significance as diagnostic and therapeutic aid in salivary
gland disorders.

KEYWORDS:
Imaging modalities, Salivary gland diseases, Sialolithiasis, Sialendoscopy.

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INTRODUCTION

Obstructive sialadenitis is the
most common benign salivary gland disease and accounts to almost 50% of non-neoplastic
salivary gland pathologies. 1 Obstructive sialadenitis frequently affects the
saubmandibular gland (80% to 90%) followed by parotid (5% to 10%) and
sublingual (less than 1%) glands. 2 Sialolithiasis, stenosis, mucus plugs,
polyps, foreign bodies, external compression, and variations in anatomical ductal
system forms the major etiological factors. (STRYCHOWSKY AMERICAN MED ASSOC
2012) Initial treatment of obstructive sialadenitis is usually conservative
with hydration, salivary flow stimulation, anti-inflammatory medication and
antibiotics when bacterial infection is suspected. (CAARTA ACTA OTORHINOLOGY
2017) Surgical protocol (including papillotomy and gland removal) may be
indicated for recalcitrant lesions. 3 (STRYCHOWSKY AMERICAN MED ASSOC 2012) While
conservative therapy doesn’t provide permanent cure, surgical management may be
associated with potential nerve injury (marginal mandibular nerve, hypoglossal
nerve, lingual nerve and facial nerve), 1 poor cosmetic outcome, gustatory
sweating (auriculotemporal syndrome), and paraesthesias. (DEENDAYAL
OTOLARYNGOLOGY 2016) With the introduction of sialendoscopy, the management of
salivary gland obstruction has undergone a revolutionary change. 5 (CAARTA ACTA
OTORHINOLOGY 2017) 3 Sialendoscopy has evolved as an ideal investigative as
well as therapeutic tool for of salivary gland pathologies over the last two
decades. (PP SINGH IND J OTOLARYNG HEAD AND NECK 2015) Sialendoscopy is a
minimally invasive procedure that incorporates a small -calibre endoscope and
facilitates direct examination of the salivary ductal system. (ATINEZA 2015
BRITISH ASSOC OF ORAL SURG)

HISTORY

The anatomical
description of the major salivary gland ductal system was first accounted as
early as late 17th century. In 1990, Konigsberger et al. were the pioneer in salivary
endoscopy and used a 0.8-mm flexible endoscope.1,2 Katz performed sialendoscopy
using a flexible scope and a basket, and a wide array of sialendoscopy
instruments and methods were further delineated by Nahlieli et al. and
Marchal.3,4 The semirigid sialendoscopes were introduced by  Zenk et al. and Nahlieli et al.  incorporated pediatric sialendoscopy for treatment
of recurrent juvenile parotitis and radioiodine sialadenitis patients in 2004
and 2006 respectively.  6 7 In 2007, the combined
technique of endoscopy and external method for sialolith extirpation was put
forward by Marshall. 8 (ERKUL 2016 LARYNGOSCOPE INVESTIGATIVE OTOLARYNGOLOGY)

INSTRUMENTATION

Sialendoscopes may be
classified as rigid, semi-rigid and flexible sialendoscopes. Flexible endoscopes
are beneficial as their manoeuvering is easier through the tortuous duct system and are
generally atraumatic. The disadvantages include- fragility, shorter lifespan, difficult
handling and they cannot be are not autoclaved 14. Rigid endoscopes employ high-quality
optical lens system and results in improved exploration of the duct system, are
sturdier and autoclaving is possible. These endoscopes show difficulty in
handling because of larger diameters and the camera being directly fixed onto
the ocular attached to the endoscope 14. (CAARTA ACTA OTORHINOLOGY 2017)
These days, semi rigid endoscopes are preferred and considered as the
sialendoscope of choice. They exhibit properties intermediate to rigid and
flexible sialendoscopes. They are easy to manoeuvre through the ductal system as
they possess certain degree of flexibility (45 degrees) and zero degree viewing
angle. (PP SINGH IND J OTOLARYNG HEAD AND NECK 2015)

INDICATIONS

Sialendoscopy
serves as an ideal investigative as well as therapeutic protocol for obstructive
salivary gland pathologies. 3. With the advancements in instrumentation and
acceptance of minimally invasive surgeries, sialendoscopy has emerged as the
principal therapeutic modality for obstructive salivary gland disorders 9. Sialendoscopy
is now widely accepted therapeutic tool for sialolithiasis, stricture dilation,
recurrent juvenile sialadenitis 3. radioiodine induced sialadenitis, 10
intraductal masses 2 (Indian J Otolaryngol Head Neck Surg. 2013  Apr;
65(2): 111–115. Interventional
Sialendoscopy with Endoscopic Sialolith Removal Without Fragmentation Payman Dabirmoghaddam and Rima Hosseinzadehnik) and patients with recurrent sialedenitis due to
autoimmune disorders such as systemic lupus erythematosus and sjogren’s
syndrome ( Wilson-advances in endoscopic surgery intechopen.com)

Sialolithiasis is the major
causative factor for sialadenitis and manifest as diffuse unilateral major
salivary glands swelling. (Marchal F, Dulguerov P. 2003; Nahlieli O. 2006). Generally,
sialendoscopy is successful in surgical extirpation of salivary stones less
than 4 mm in the submandibular gland and less than 3 mm in the parotid gland
respectively. Further disintegration of sialoliths (with holmium laser or lithotripsy)
may be required before endoscopic procedure for salivary stones sized between
5-7 mm. Sialoliths of diameter greater than 8 mm necessitate a combined
approach technique for stone removal (Karavidas K, Nahlieli O, Fritsch N, et
al. 2010). The combined approach technique incorporates a sialendoscope for stone
localization and either an intra-oral or an external approach for extirpation
of 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). 

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