A Comprehensive Study of Combined Approach Sialendoscopy in Managing Salivary Gland Sialolithiasis

Obstructive salivary gland diseases were traditionally managed conservatively, with surgical treatment reserved for refractory cases only. These surgeries, ranging from papillotomy to sialadenectomy, often involved numerous complications. In the past two decades, sialendoscopy, a minimally invasive technique, has made tremendous progress due to its advantages. This study aims to describe the efficacy of combined approach sialendoscopy as a minimally invasive option for large-sized sialolithiasis that is not amenable to sialendoscopy alone.

It is an ambispective study of 12 patients over a span of 3.5 years at a tertiary care center conducted with all consenting patients who were treated with combined approach sialendoscopy. Ultrasonography and computed tomography of the patients was done. Therapeutic intervention in the form of combined approach sialendoscopy was done at the same sitting as diagnostic sialendoscopy and postoperative follow-up was conducted for a duration of six months.

In this study of 12 patients undergoing sialendoscopy, glandular swelling was a universal presenting symptom, with 80% patients exhibiting meal-stimulated exacerbation and post-massage relief. Submandibular involvement predominated (83%), with parotid cases comprising the remainder. All patients had sialoliths >6 mm and underwent combined approach sialendoscopy, yielding a 100% immediate symptomatic resolution rate. Recurrence occurred in 16%, successfully managed with repeat sialendoscopy.

As endoscopy is integral to otorhinolaryngology, sialendoscopy represents the evolution of minimally invasive salivary gland surgery. This study highlights the different methods of combined approach sialendoscopy in managing larger as well as distally placed sialoliths, thus reinforcing its role as a superior gland-preserving modality.