Technique for Difficult Wharton's Duct Cannulation

Area of Science:

• Otolaryngology
• Surgical Innovation
• Salivary Duct Anatomy

Background:

• Cannulating Wharton's duct is challenging compared to Stensen's duct.
• Existing methods may require invasive floor-of-mouth incisions.
• A minimally invasive approach is desirable for Wharton's duct cannulation.

Purpose of the Study:

• To present a novel, minimally invasive technique for cannulating Wharton's duct.
• To describe the use of a tapered Prolene suture as a guide for Wharton's duct cannulation.
• To evaluate the efficacy of this technique in patients with difficult ductal anatomy.

Main Methods:

• A tapered 4-0 Prolene suture was used as a guide for Wharton's duct cannulation.
• A modified Seldinger technique facilitated the initial placement of a 26-gauge angiocatheter.
• Progressive dilation using guidewires and larger angiocatheters was performed after saline infusion.

Main Results:

• The Prolene suture-guided technique was successful in all 4 patients with difficult Wharton's duct access.
• One patient also underwent successful cannulation of Bartholin's duct using this approach.
• The technique facilitated sialography and potential therapeutic interventions in challenging cases.

Conclusions:

• This novel technique offers a viable alternative for cannulating Wharton's duct, especially in cases of difficult anatomy.
• The use of a Prolene suture guide simplifies the procedure and avoids the need for open incision.
• This method represents a significant advancement in salivary duct interventions.