Guidewire-Assisted dilation in sialendoscopy: How I use the modified Marchal's dilator.

Area of Science:

• Otolaryngology
• Minimally Invasive Surgery
• Medical Device Innovation

Background:

• Sialendoscopy is crucial for diagnosing and treating salivary gland ductal issues.
• Standard Marchal's dilator modifications can improve procedural efficiency and patient safety.
• Atraumatic cannulation and dilation are key challenges in sialendoscopy.

Purpose of the Study:

• To introduce a novel, practical modification of the Marchal's dilator for sialendoscopy.
• To enhance atraumatic ductal cannulation and sialendoscope insertion.
• To streamline technically challenging steps in sialendoscopy procedures.

Main Methods:

• A modified Marchal's dilator was developed with an integrated guidewire and detachable handle.
• The guidewire preserves intraductal access after initial cannulation.
• The Seldinger technique was employed for atraumatic sialendoscope insertion over the guidewire.

Main Results:

• The modified dilator consistently enabled ductal access, reducing cannulation and dilation times.
• Fewer complications and instrument exchanges were observed, even with less experienced surgeons.
• Reduced trauma to the ductal orifice and surrounding tissues improved visualization and success rates.

Conclusions:

• The guidewire-assisted Marchal's dilator modification is a safe, reproducible, and user-friendly enhancement for sialendoscopy.
• This technique simplifies access, minimizes tissue trauma, potentially reducing operative times and improving outcomes.
• Its ease of use makes it valuable for training and in resource-limited settings.