Sialendoscopy is an emerging minimallyinvasive procedure that is used as a diagnostic and therapeutic aid in a numberof non-neoplastic salivary gland pathologies like sialolithiasis, sailadenitisand other obstructive disorders. Sialendoscopy serves as an superior diagnostictool in comparison to other imaging modalities used for obstructivepathologies. The technique employs a small probe which is attached to a camera andplaced into the salivary glands through the salivary ducts. The latest innovationof miniaturized endoscopic imaging tools has brought a revolutionary change inthe field of sialendoscopy.
Preservation offunctionality of the gland while relieving the obstruction forms the majoradvantage of sialendoscopy. Currently, sialendoscopy is being used for treatmentof sialolithiasis, stricture dilation, and as a therapeutic aid for recurrentjuvenile sialadenitis, radioiodine induced sialadenitis, and patients who have recurrent sialedenitis fromautoimmune processes such as sjogren’s syndrome and systemic lupuserythematosus. This paper presents review ofliterature about sialendoscopy history, instrumenttechniques and its significance as diagnostic and therapeutic aid in salivarygland disorders.KEYWORDS:Imaging modalities, Salivary gland diseases, Sialolithiasis, Sialendoscopy.INTRODUCTIONObstructive sialadenitis is themost common non-neoplastic salivary gland disorder and represents approximatelyone-half of benign salivary gland disease.
1 Obstructive sialadenitisfrequently 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, or variations inanatomical ductal systems forms the major etiological factors. (STRYCHOWSKYAMERICAN MED ASSOC 2012) Initial treatment of obstructive sialadenitis isusually conservative with hydration, salivary flow stimulation,anti-inflammatory medication and antibiotics when bacterial infection issuspected. (CAARTA ACTA OTORHINOLOGY 2017) Surgical protocol (including papillotomyand gland removal) may be indicated for recalcitrant lesions.
3 (STRYCHOWSKYAMERICAN MED ASSOC 2012) While conservative therapy doesn’t provide permanent cure,surgical management may be associated with potential nerve injury (marginalmandibular nerve, hypoglossal nerve, lingual nerve and facial nerve), 1 poorcosmetic outcome, gustatory sweating (auriculotemporal syndrome), andparaesthesias. (DEENDAYAL OTOLARYNGOLOGY 2016) With the introduction ofsialendoscopy, the management of salivary gland obstruction has undergone arevolutionary change. 5 (CAARTA ACTA OTORHINOLOGY 2017) 3 Sialendoscopy has evolvedas an ideal investigative as well as therapeutic tool for of salivary glandpathologies over the last two decades. (PP SINGH IND J OTOLARYNG HEAD AND NECK2015) Sialendoscopy is a minimally invasive procedure that incorporates a small-calibre endoscope and facilitates direct examination of the salivary ductalsystem. (ATINEZA 2015 BRITISH ASSOC OF ORAL SURG) HISTORYThe anatomicaldescription of the major salivary gland ductal system was first accounted asearly as late 17th century. In 1990, Konigsberger et al.
were the pioneer in salivaryendoscopy and used a 0.8-mm flexible endoscope.1,2 This was followed by Katz,who performed sialendoscopy using aflexible scope and a basket, and a wide array of sialendoscopy instruments andmethods were further delineated by Nahlieli et al. and Marchal.3,4 The semirigidsialendoscopes were introduced by Zenket al. and Nahlieli et al. incorporated pediatricsialendoscopy for treatment of recurrent juvenile parotitis and radioiodinesialadenitis patients in 2004 and 2006 respectively.
6 7 In 2007, the combined technique ofendoscopy and external method for sialolith extirpation was put forward byMarshall. 8 (ERKUL 2016 LARYNGOSCOPE INVESTIGATIVE OTOLARYNGOLOGY)INSTRUMENTATIONSialendoscopes may beclassified as rigid, semi-rigid and flexible sialendoscopes. Flexible endoscopesare beneficial as their manoeuvering is easier through the tortuous duct system and aregenerally atraumatic.
The disadvantages include- fragility, shorter lifespan, difficulthandling and they cannot be are not autoclaved 14. Rigid endoscopes employ high-qualityoptical lens system and results in improved exploration of the duct system, aresturdier and autoclaving is possible. These endoscopes show difficulty inhandling because of larger diameters and the camera being directly fixed ontothe ocular attached to the endoscope 14. (CAARTA ACTA OTORHINOLOGY 2017)These days, semi rigid endoscopes are preferred and considered as thesialendoscope of choice.
They exhibit properties intermediate to rigid andflexible sialendoscopes. They are easy to manoeuvre through the ductal system asthey possess certain degree of flexibility (45 degrees) and zero degree viewingangle. (PP SINGH IND J OTOLARYNG HEAD AND NECK 2015) INDICATIONSSialendoscopyserves as an ideal investigative as well as therapeutic protocol for obstructivesalivary gland pathologies. 3. With the advancements in instrumentation andacceptance of minimally invasive surgeries, sialendoscopy has emerged as theprincipal therapeutic modality for obstructive salivary gland disorders 9. Sialendoscopyis now widely accepted therapeutic tool for sialolithiasis, stricture dilation,recurrent juvenile sialadenitis 3. radioiodine induced sialadenitis, 10intraductal masses 2 (Indian J Otolaryngol Head Neck Surg. 2013 Apr;65(2): 111–115.
InterventionalSialendoscopy with Endoscopic Sialolith Removal Without Fragmentation Payman Dabirmoghaddam and Rima Hosseinzadehnik) and patients with recurrent sialedenitis due toautoimmune disorders such as systemic lupus erythematosus and sjogren’ssyndrome ( Wilson-advances in endoscopic surgery intechopen.com) Sialolithiasis is the major etiological factor for sialadenitis andpresents as a diffuse unilateral swelling of the major salivary glands. (MarchalF, Dulguerov P. 2003; Nahlieli O. 2006). Generally, sialendoscopy is successfulin surgical extirpation of salivary stones less than 4 mm in the submandibulargland and less than 3 mm in the parotid gland respectively. Further disintegrationof sialoliths (with holmium laser or lithotripsy) may be required beforeendoscopic procedure for salivary stones sized between 5-7 mm.
Sialoliths ofdiameter greater than 8 mm necessitate a combined approach technique for stoneremoval (Karavidas K, Nahlieli O, Fritsch N, et al. 2010). The combinedapproach technique incorporates a sialendoscope for localization of stone andeither an intra-oral or an external approach for extirpation of a large submandibularor parotid stones, respectively (Bodner L. 2002; Lustmann J, Regev E, MelamedY. 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). (WILSON-ADVANCESIN ENDOSCOPIC SURGERY INTECHOPEN.COM)