Endoscopic approach to Salivary Gland Pathology

By, Dr Rajeev Nerurkar

Sialendoscopy

Sialendoscopy is a new procedure , aiming to visualize the lumen of the salivary ducts and their pathologies. The technique can be performed in most cases as an ambulatory, outpatient procedure.

The most frequent ductal pathology is Sialolithiasis or Salivary Calculus which can be diagnosed and removed by Sialendoscopy

Standard diagnostic approaches

Xrays, Ultrasound, CTscan , Sialography and MRI upto now were considered standard diagnostic modalities. Salivary gland diseases have remained underdiagnosed and poorly diagnosed due to inability of radiological investigations to accurately diagnose varied pathologies.

Sialendoscopy allows almost complete exploration of the ductal system of both the Submandibular and Parotid glands. This provides for direct, reliable information about most pathologies and reduces the need for radiological investigations.

Pathological findings

Mucus plugs,Duct Stenosis, Ductal Kinking, Duct Granulomas are also some of the other pathologies that can be managed my Sialendoscopy.

Sialolithiasis or Salivary Calculi

Sialolithiasis is supposed to affect 1% of salivary glands . However its frequency is most probably underestimated due to poor sensitivity of outdated detection methods and an absence of treatment options for interglandular stones.

Salivary stones can be either solitary or multiple. They are localized in Submandibular gland in 80% and in Parotid about 15 to 18 %.

Clinical Consequances of Pathology

These pathologies result in a mechanical obstruction of the salivary duct causing recurrent painful glandular swelling during meals which can remain transitory or be complicated by bacterial infections causing Parotitis/Submandibular Sialoadenitis.

Classical treatment methods to manage salivary gland diseases are either inadequate to alleviate the symptoms or overly radical procedures such as gland resections. Interventional Sialendoscopy is a minimally invasive technique developed to address these pathologies.

Indications

All salivary gland swellings of clear and unclear origins can undergo Interventional Sialendoscopy. There are no specific contraindications ..even elderly , unstable and paediatric patients can benefit from this technique.

Despite its apparent simplicity Interventional Sialendoscopy is a technically challenging procedure. Operating the rigid sialendoscope is delicate and requires experience and expertise.

At Mumbai Sial-Endoscopy Clinic we have state of the art Sialoendoscopes from Carl Storz, Germany and are able to offer the a comprehensive solution for Salivary Gland Diseases.

Currently, our centre is one of the very few ENT clinics in India to offer this advanced technique.

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