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Research in Sialendoscopy

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Sialendoscopy is an emerging minimally invasive procedure that is used as a diagnostic and therapeutic aid in a number of non-neoplastic salivary gland pathologies like sialolithiasis, and other obstructive disorders. Sialendoscopy serves as a superior diagnostic tool in comparison to other imaging modalities used for obstructive pathologies. The technique employs a small probe which is attached to a camera and placed into the salivary glands through the salivary ducts. The latest innovation of miniaturized endoscopic imaging tools has brought a revolutionary change in the field of sialendoscopy. Preservation of functionality of the gland while relieving the obstruction forms the major advantage of sialendoscopy. Currently, sialendoscopy is being used for the treatment of sialolithiasis, stricture dilation, and as a therapeutic aid for recurrent juvenile sialadenitis, radioiodine-induced sialadenitis, and patients who have recurrent sialadenitis from autoimmune processes such as Sjogren’s syndrome and systemic lupus erythematosus. This paper presents a review of literature about sialendoscopy history, instrument techniques and its significance as a diagnostic and therapeutic aid in salivary gland disorders.

Obstructive sialadenitis is the most common non-neoplastic salivary gland disorder and represents approximately one-half of benign salivary gland disease. 1 Obstructive sialadenitis frequently affects the submandibular 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 in anatomical ductal systems forms the major etiological factors. (STRYCHOWSKY AMERICAN MED ASSOC 2012) Initial treatment of obstructive sialadenitis is usually conservative with hydration, salivary flow stimulation, anti-inflammatory medication and antibiotics when a bacterial infection is suspected. (CAARTA ACTA OTORHINOLOGY 2017) Surgical protocol (including papillotomy and gland removal) may be indicated for recalcitrant lesions. 3 (STRYCHOWSKY AMERICAN MED ASSOC 2012) While conservative therapy doesn’t provide a permanent cure, surgical management may be associated with potential nerve injury (marginal mandibular nerve, hypoglossal nerve, lingual nerve and facial nerve), [1] poor cosmetic outcome, gustatory sweating (auriculotemporal syndrome), and paraesthesias. (DEENDAYAL OTOLARYNGOLOGY 2016) With the introduction of sialendoscopy, the management of salivary gland obstruction has undergone a revolutionary change. 5 (CAARTA ACTA OTORHINOLOGY 2017) 3 Sialendoscopy has evolved as an ideal investigative as well as therapeutic tool for of salivary gland pathologies over the last two decades. (PP SINGH IND J OTOLARYNG HEAD AND NECK 2015) Sialendoscopy is a minimally invasive procedure that incorporates a small – caliber endoscope and facilitates direct examination of the salivary ductal system. (ATINEZA 2015 BRITISH ASSOC OF ORAL SURG)

The anatomical description of the major salivary gland ductal system was first accounted as early as a late 17th century. In 1990, Konigsberger et al. were the pioneer in salivary endoscopy and used a 0.8-mm flexible endoscope.1,2 This was followed by Katz, who performed sialendoscopy using a flexible scope and a basket, and a wide array of sialendoscopy instruments and methods were further delineated by Nahlieli et al. and Marchal.3,4 The semirigid sialendoscopes were introduced by Zenk et al. and Nahlieli et al. incorporated pediatric sialendoscopy for the treatment of recurrent juvenile parotitis and radioiodine sialadenitis patients in 2004 and 2006 respectively. 6 7 In 2007, the combined technique of endoscopy and external method for sialolith extirpation was put forward by Marshall. 8 (ERKUL 2016 LARYNGOSCOPE INVESTIGATIVE OTOLARYNGOLOGY)

Sialendoscopes may be classified as rigid, semi-rigid and flexible sialendoscopes. Flexible endoscopes are beneficial as their manoeuvering is easier through the tortuous duct system and are generally atraumatic. The disadvantages include- fragility, shorter lifespan, difficult handling and they cannot be are not autoclaved 14. Rigid endoscopes employ high-quality optical lens system and result in the improved exploration of the duct system, are sturdier and autoclaving is possible. These endoscopes show difficulty in handling because of larger diameters and the camera is directly fixed onto the ocular attached to the endoscope 14. (CAARTA ACTA OTORHINOLOGY 2017) These days, semi-rigid endoscopes are preferred and considered as the sialendoscope of choice. They exhibit properties intermediate to rigid and flexible sialendoscopes. They are easy to maneuver through the ductal system as they possess a certain degree of flexibility (45 degrees) and zero degrees viewing angle. (PP SINGH IND J OTOLARYNG HEAD AND NECK 2015)

Sialendoscopy serves as an ideal investigative as well as therapeutic protocol for obstructive salivary gland pathologies. [3]. With the advancements in instrumentation and acceptance of minimally invasive surgeries, sialendoscopy has emerged as the principal therapeutic modality for obstructive salivary gland disorders [9]. Sialendoscopy is now a widely accepted therapeutic tool for sialolithiasis, stricture dilation, recurrent juvenile sialadenitis [3]. radioiodine-induced sialadenitis, [10] intraductal masses.

Interventional sialendoscopy with Endoscopic Sialolith Removal Without Fragmentation Payman Dabirmoghaddam and Rima Hosseinzadehnik) and patients with recurrent sialadenitis due to autoimmune disorders such as systemic lupus erythematosus and Sjogren’s syndrome ( Wilson-advances in endoscopic surgery intechopen.com)

Sialolithiasis is the major etiological factor for sialadenitis and presents as a diffuse unilateral swelling of the major salivary glands. (Marchal F, Dulguerov P. 2003; Nahlieli O. 2006). Generally, sialendoscopy is successful in the surgical extirpation of salivary stones less than 4 mm in the submandibular gland and less than 3 mm in the parotid gland respectively. Further disintegration of sialoliths (with holmium laser or lithotripsy) may be required before the endoscopic procedure for salivary stones sized between 5-7 mm. Sialoliths of diameter greater than 8 mm necessitate a combined approach technique for stone removal (Karavidas K, Nahlieli O, Fritsch N, et al. 2010). The combined approach technique incorporates a sialendoscope for localization of stone and either an intra-oral or an external approach for the extirpation of a large submandibular or parotid stones, respectively.

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