Sialendoscopy: Introduction, Indications and Technique

Abstract

Recent decades have been marked by clinical research in otolaryngology and head & neck surgery directed towards the concept of organ and function preservation. Morbidity in head and neck diseases has been greatly reduced with acceptance of conservation procedures and open surgical approaches are getting largely replaced with endoscopic ones, wherever possible. Though there are more or less set treatment protocols for tumors of salivary glands, other pathologies like sialolithiasis and juvenile recurrent parotitis have been treated on arbitrary basis. Sialadenitis secondary to obstructive pathologies including sialoliths, strictures and ductal polyps, remains the most common disorder of the salivary gland [1–3]. Patients would receive sorts of treatment like antibiotics, steroids, sialogogues, anticholinergics or would undergo surgeries like intraoral incision and removal of the sialolith or even gland removal. Also, there were no answers to pathologies like ductal stenosis secondary to chronic inflammation. Introduction of sialendoscope has brought in a paradigm shift in the management of these pathologies. This minimally invasive technique was first described by Katz and Fritsch [4] in 1990s who used flexible endoscope for evaluation of salivary gland ducts. Since then, enhanced optical resolution and miniaturisation of instruments through various advances in technology has resulted in advanced techniques in sialendoscopy. Otolaryngologists and some other clinicians including oral surgeons at certain centres pioneered this speciality and have propagated the philosophy through structured training programmes. Sialendoscopy has emerged as a preferred diagnostic as well as therapeutic tool for management of salivary gland pathologies and has helped significantly reduce the morbidity, loss of work hours and hospital stay. Though a lot of research is still going on in this field, but a set of indications and techniques have evolved over a period of time.