Sialoendoscopy in the diagnosis and management of obstructive sialadenitis

Sialoendoscopy is a new technology being used at a limited number of institutions for the diagnosis and management of obstructive sialadenitis. This technique is promising for its superior diagnostic potential as well as its decreased morbidity compared to traditional more invasive techniques for managing obstruction. Our objective is to review the sialoendoscopy experience at our institution to identify successes, areas of improvement, and to provide guidance to other programs that may be interested in sialoendoscopy.

We did a retrospective review of all diagnostic and interventional sialoendoscopies performed at this institution from 2007 to 2009.

Charts were reviewed for epidemiologic and clinical data, as well as procedural techniques, findings, and outcomes.

We attempted 37 parotid and submandibular sialoendoscopies, with successful endoscopic canalization of the duct in 36 of these cases. Twenty of 25 stones were removed from 18 patients. Stones that were larger than 5 mm were more difficult to dislodge and remove without fragmentation. Other abnormal findings included strictures, scars, and mucoid debris. There were two failures of technique, and two patients had postoperative purulent sialadenitis that resolved after antibiotics.

As an institution that recently began performing sialoendoscopies, we show similar success rates compared to other programs. Obstacles included the initial cost of acquiring equipment and the associated learning curve of using a new technique. Similar to other programs, successful extraction of sialoliths was limited with larger stones. In the future, we hope to use laser lithotripsy for fragmentation, a technique already being trialed at some institutions.