Keypoints:
- Sialendoscopy is a minimally invasive, gland-preserving technique.
- We found low rates of complications and high success rates, hereby
confirming that sialendoscopy is a safe and efficient technique for
benign salivary diseases.
- The questionnaire showed that a vast majority of the patients reported
an improvement of their symptoms after sialendoscopy.
- The highest success rates were found for sialolithiasis.
- After conservative measures, sialendoscopy should be the first choice
of treatment.
INTRODUCTION
Sialendoscopy is a minimally invasive technique, which offers direct
intraluminal visualization of both the submandibular and the parotid
glandular ducts. It offers diagnostic and therapeutic possibilities and
can be performed under local or general anesthesia. This technique
preserves the gland, using smaller or no incisions, improves glandular
function and shortens the recovery period as compared to gland removing
approaches.1
Minimally invasive techniques are a trend seen in every field of
surgery.2 Gundlach and Katz introduced flexible
endoscopes into the salivary duct for the first time in the early
‘90s.1 Marchal was the first to introduce a more
practical semirigid modular endoscope.3 Progressively,
micro-instruments were developed allowing treatment, like the retrieval
of stones with forceps or baskets, the dilatation of stenotic ducts, the
removal of granulation tissue, and the treatment of radioiodine-induced
sialadenitis and recurrent parotitis of childhood
(RPC).4-6 Association with extracorporeal shock wave
or intracorporeal pneumatic or laser lithotripsy now also enables us to
remove stones larger than 4mm, which initially formed a restriction of
the endoscopic approach.4
Studies have shown that salivary gland diseases have a significant
impact on the patient’s quality of life.7
Sialolithiasis is the major cause of salivary gland diseases, estimated
to contribute to 50-66% of all observed problems.4 It
is most common in the submandibular gland (80-95%), followed by the
parotid gland (5-20%), and rarely occurs in the sublingual gland and
the minor salivary glands (2%).4,8 Salivary duct
scarring is seen in 25%, making it the second most common cause of
obstructive disease. It is most common in the parotid gland
(75%).2 In patients with obstructive gland disease,
initial treatment should be conservative.4 If this
approach fails, sialendoscopy should be considered rather than an open
surgical approach. Success rates of therapeutic sialendoscopy range
between 85% and 95%, thus drastically reducing the need for removal of
the gland and the risk of complications.4 The
patient-perceived benefit and the improvement in quality of life has
been demonstrated earlier.9-12 This study aims to
evaluate the results and complications that were encountered during our
12-year experience with sialendoscopy at the <Blinded for
review> department of Otorhinolaryngology, Head and Neck
Surgery, to see whether the alleged advantages could also be confirmed
in our cohort.