Sialendoscopy: Endoscopic Approach to Benign Salivary Gland Diseases

Abstract

Sialadenitis, or recurrent salivary gland infection associated with pain and swelling of the major salivary glands, is a common presentation to emergency rooms and outpatient clinics. One of the most frequent causes of sialadenitis is obstruction in the salivary ductal system. Salivary calculi affect 1.2% of the population and account for 60-70% of salivary duct obstruction (Nahlieli 2004; Kim 2007; Bomeli 2009; Nahlieli 2006). Additional causes of obstruction to salivary flow include strictures in 25-25%, inflammation (5-10%) and other rare pathologies such as foreign bodies (1%) Conservative treatment is the first line of therapy that includes treatment with antibiotics, salivary stimulants or sialogogues, and anti-inflammatory agents. However, conservative therapy fails in up to 40% of people with sialadenitis; in which case the recommended treatment is excision of the involved salivary gland. There as several important nerves that are in close proximity to the major salivary glands. The facial nerve, motor to facial muscles, runs through the parotid glandular system. Similarly, the submandibular gland is associated with the lingual nerve that is 1sensory to the anterior two thirds of the oral tongue; marginal mandibular nerve that allows movement of the angle of the mouth; and the hypoglossal nerve, motor to the tongue. Surgical excision of the gland carries numerous risks include but are not limited to paresis or palsy of the facial nerve, lingual nerve, and hypoglossal nerve. Other complications include Frey syndrome (gustatory sweating), sialoceles, salivary fistula, xerostomia, numbness in the distribution of the greater auricular nerve, infection, and hemorrhage. Consequently, although surgical resection in experienced hands is safe, it’s often not desired due to the associated surgical risk and external scar in the neck associated with it. In 1988, salivary duct endoscopes were introduced. Since their introduction, sialendoscopes have undergone technical refinements that have been instrumental in permitting clear and high definition visualization and manipulation of the salivary ductal system. Today, salivary duct endoscopy or “Sialendoscopy” allows the minimally invasive endoscopic visualization of major salivary gland ductal system and endoscopic interventions to treat chronic sialadenitis with or without sialolithiasis.