Sialendoscopy is an ENT medical diagnostic and therapeutic procedure for visualization and treatment of ductal systems of the large cephalic salivary gland. An indication for endoscopy arises primarily when salivary stones are suspected. The procedure is also popular for recurrent salivary gland swelling.
What is sialendoscopy?
Sialendoscopy is an ENT diagnostic and therapeutic procedure used to visualize and treat ductal systems of the major cephalic salivary gland. The salivary gland is a complex system that contains a variety of ducts and other anatomical structures. When swelling of the salivary gland occurs, patients consult an otolaryngologist for further clarification. Sialendoscopies are often performed in this context. These are ENT endoscopic diagnostic procedures. Endoscopies are minimally invasive examinations that allow the physician to see inside a patient using an endoscope. Silendoscopy is an endoscopy of the large cephalic salivary gland and its salivary ducts. For this reason, the procedure is often referred to as salivary duct endoscopy. The procedure has been in existence since the early 2000s. As a rule, only larger ENT centers and ENT university hospitals offer the examination and use it primarily when obstructive salivary stones are suspected. In combination with sialendoscopy, additional imaging procedures are often used, especially sonography, magnetic resonance imaging, or computed tomography. Ultrasound examination of the salivary gland is part of standard diagnostics. Sialography or salivary gland scintigraphy is used in combination with sialendoscopy only in absolutely exceptional cases.
Function, effect, and goals
Sialendoscopy is a diagnostic endoscopy that provides the physician with still and moving images of the major pancreatic ducts of the head. In exceptional cases, fluid and tissue samples are additionally taken from the ducts of the salivary gland in the sense of biopsies. The aim of sialendoscopy is always to establish a diagnosis. To perform the procedure, ENT physicians in most cases use a semi-flexible mini-endoscope with shaft diameters between 0.8 and 2.0 millimeters. The endoscope is inserted through the natural ostium within the oral cavity into the parotid gland or submandibular gland. Salivary duct endoscopy is the only procedure for direct visualization of the salivary duct systems. In addition to diagnosing obstructive disorders of the major cephalic salivary gland, endoscopy may also have therapeutic goals and in this case is referred to as therapeutic endoscopy. In this context, the physician uses sialendoscopy to treat salivary stones, for example. The sialendoscope carries interventional channels that allow treatment of the calculi. All potential salivary stones are picked up by sialendoscope into tiny catch baskets and removed from the salivary ducts in this way. Interventional dilatation for stenosis and targeted treatment of inflammation in the salivary ducts is also possible using the sialendoscope. If one of the salivary glands swells repeatedly before, during or after food intake, the physician assumes an obstructive cause and suspects a blockage of the ducts, so to speak, as the trigger of the swellings. This obstruction corresponds to a salivary stone in more than half of all cases. Suspected diagnoses of a salivary stone are predominantly made on the basis of the characteristic clinical picture. The patient’s medical history and palpation allow the physician to develop the suspicion. Confirmation or exclusion of the suspected diagnosis takes place via a combination of procedures such as sialensoscopy and sonography. MRI and CT are usually not used initially because they expose the patient to radiation and contrast agents. Until a few years ago, the only treatment option for salivary stones of any size was removal of the associated salivary gland. With sialendoscopy, this has changed. Today, after diagnosis, the sialendoscope is transformed when necessary and allows therapeutic intervention on the salivary stone thanks to the catch basket and small forceps. Due to the immediate therapeutic option, sialendoscopy is now superior to other procedures for mere diagnostics.If no stone is found during the procedure, outflow obstructions caused by scarring stenoses may be the cause of recurrent swelling of the salivary glands, which can also be treated using the sialendoscope. During sialendoscopy, the physician can even expand the ostium to ten times its size and insert devices such as the balloon catheter. During the endoscopic procedure, irrigation fluid washes around the gland. This effect can be a therapeutic effect in connection with inflammation, and drugs can be given directly into the duct system with the help of the sialendoscope to treat such.
Risks, side effects, and hazards
Sialendoscopies offer many advantages over diagnostic procedures such as MRI or CT. Sialendoscopy is also now considered superior to sonography. With MRI, CT, and X-ray, the patient must expect radiation exposure. Although this exposure is now low, it can still involve risks and side effects. Side effects also present themselves with contrast agents. The agents can cause headaches and nausea. In addition, the substances put a strain on the kidneys in the long run. Although sialendoscopy is a minimally invasive procedure, it is associated with fewer risks. The procedure has few overall risks and can usually be performed on an outpatient basis. The patient often receives a local anesthetic for this purpose. The risks and side effects of sialendoscopy are worth mentioning almost exclusively in connection with the anesthetic used. For example, some patients react to anesthetics with nausea or vomiting. Even fewer risks than with sialendoscopy are offered to the patient exclusively with examination procedures such as sonogorafy. However, sonography is superior to endoscopy in that it is not a purely diagnostic procedure and can be converted to a therapeutic intervention if necessary.
