Submandibular diagnostic and interventional sialendoscopy: new procedure for ductal disorders

We present our initial experience with submandibular sialendoscopy, a new therapeutic approach for disorders of Wharton's duct. We review the sialendoscopes used and discuss their respective merits. We evaluated and treated 129 consecutive patients with suspected ductal disorders. Diagnostic sialendoscopy was used for classifying ductal lesions as sialolithiasis, stenosis, sialodochitis, or polyps. Interventional sialendoscopy was used to treat these disorders. The type of endoscope used, the type of sialolith fragmentation and/or extraction device used, the total number of procedures, the type of anesthesia, and the number and size of the sialoliths removed were the dependent variables. The outcome variable was the endoscopic clearing of the ductal tree and resolution of symptoms. Diagnostic sialendoscopy was possible in 131 of 135 glands (97%), with an average (+/-SD) duration of 28 +/- 15 minutes. Interventional sialendoscopy was attempted in 110 cases, with an average duration of 71 +/- 41 minutes, with a success rate of 82%. Multiple sialendoscopies were necessary in 25% of cases. General anesthesia was used in 12% of cases. Submandibular gland resection was performed in 4%. The average size of the stones was 4.9 +/- 2.9 mm. Multiple sialoliths were found in 31 cases (29%). Sialolith fragmentation was required in 26%. Larger and multiple stones often required longer and multiple procedures and general anesthesia, and more often resulted in failures. Semirigid endoscopes had a higher success rate (85%) than flexible sialendoscopes (54%). Complications were mostly minor, but were encountered in 10% of cases. Diagnostic sialendoscopy is a new technique for evaluating salivary duct disorders that is associated with low morbidity. Interventional sialendoscopy allows the extraction of sialoliths in most patients, thus preventing open gland excision.