Salivary gland disorders have been treated traditionally with such tools as radiography, ultrasonography, computed tomography (CT), magnetic resonance sialography and conventional sialography. Though these approaches are time-tested, sialoendoscopy is complementary to their techniques. It is presently being applied to examine the major salivary glands to assist in diagnosis and treatment of inflammatory and obstructive disorders. It is used in conjunction with other diagnostic techniques to evaluate the ductal system.
Sialoendoscopy is minimally invasive, and though it is commonly performed in the operating room, there are no incisions to the skin required. The procedure requires a small camera to be introduced into the salivary gland by way of the mouth. The duct is illuminated by the device for enhanced visualization during the examination.
When It’s Used
Salivary gland stones and narrowing of ducts are the most common indications for use. It can be applied along with the laser to break up and remove stones and also to dilate a narrow duct. Prior to availability of sialoendoscopy, ultrasonography has been the favored diagnostic tool. Ultrasonography proved to be limited in its ability to evaluate the deeper portions of the submandibular gland and competency of the operator has demonstrated to be a factor in the result.
Computed tomography (CT) and ultrasonography are both plagued with the inability to distinguish stones that cannot be detected on imaging. Magnetic resonance sialography is then introduced. Saliva is used as the contrast medium to improve visualization of gland anatomy.
Sialoendoscopy is commonly used as a diagnostic tool to evaluate unexplained swelling of major salivary glands. It is also used in the treatment of sialolithiasis, which is one of the most common nonneoplastic disorders of the salivary glands. Several studies have suggested benefits in treating recurrent sialadenitis from autoimmune processes and recurrent parotitis in children. Acute sialadenitis is the only condition that has proven to be problematic due to inflammation in the ductal system making dilation more difficult. Use of the rigid dilator increases the chance of trauma to the duct and may cause soft tissue infection to spread in the head and neck.
Early intervention with sialoendoscopy produces a more desirable outcome due to stones becoming larger and more established over time. Patients remain eligible for the procedure regardless of disease duration. Removal of stones by endoscopy is not recommended for submandibular stones greater than 4 millimeters and parotid stones greater than 3 millimeters. Larger stones may also be excised using this method but may require an incision or other additional measures.
The result of this treatment is reliant on proper training in the application of this method as well as selection of the appropriate patient. Sialoendoscopy is the preferred treatment method due to low occurrences of facial nerve injury and other adverse effects. Success rates in both diagnostics and treatment have shown to be larger than 90 percent in the long-term. Preservation of the gland is one of the major advantages of sialoendoscopy with the success rate reported at 86 percent.