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

This study aims to describe a novel and practical modification of the standard Marchal's dilator to facilitate atraumatic ductal cannulation and sialendoscope insertion in sialendoscopy. The proposed technique integrates a detachable handpiece and a guidewire, streamlining the most technically challenging steps of the procedure.

A modified version of the "000" Marchal's dilator was developed by incorporating an internal guidewire and a detachable handle. Following initial ductal cannulation, the handle is removed, leaving the guidewire in place to preserve intraductal access. A conical dilator with a central lumen is then advanced over the guidewire to achieve stepwise, controlled dilation. Subsequently, the sialendoscope is inserted using the Seldinger technique, allowing atraumatic entry into the salivary duct. This approach was applied and evaluated in a series of routine sialendoscopy procedures. No patient-identifiable data were collected, and ethics committee exemption was granted.

The modified dilator enabled consistent ductal access, significantly reduced cannulation and dilation times, and minimized the need for repeated instrument exchanges. Surgeons, including those with limited experience, were able to perform the procedure efficiently and with fewer complications. The guidewire-assisted technique reduced trauma to the ductal orifice and surrounding tissues, contributing to improved visualization and procedural success.

The guidewire-assisted modification of the Marchal's dilator offers a safe, reproducible, and user-friendly enhancement to standard sialendoscopy techniques. By simplifying access and minimizing tissue trauma, this method may reduce operative times and improve patient outcomes. Its ease of use and compatibility with existing sialendoscopic systems make it particularly advantageous in training settings and low-resource environments.