Sialadenoscopy in salivary glands, head and neck surgery

1. SialADENOSCOPY
Preparedby :
Mohamed Ramadan
Assistant lecturer of Faciomaxillary surgery
Assiut university

2. A Journey through
salivary ducts ;
Are you ready ?

3. An interview with
a new friend

4. What is this device ?
It is a highly flexible semirigid
endoscope . It is 75mm long . The whole
diameter of the port used in parotid duct
is 1.2 mm , while thse diameter of that
used for the submandibular duct is 1.6
mm .

5. There are 3 conductors in the
device :
• One for the camera
• One for irrigation
• One for the working channel
The operator has the choices
to use :
dormia basket, forceps, drill,
and cleaning brush .

6. The Technique :
1 – Under general or local anesthesia .
2 – Identification of the duct ostium .
3 – Dilatation of the opening of the duct by dilator :

7. 4 – Using gentle irrigation with 0.9% saline or Ringer’s solution -
through the irrigator conductor - can be introduced up to the hilum of
the duct system .
5 – Deal with the pathology ???

8. The sialoscope can extend to be of both diagnostic and therapeutic use :
1 – Diagnosis and treatment of both intraductal and intra glandular
stones . Parotid gland stones up to 5mm in size can be extracted by either
dormia basket or gland forceps - A study done by Tomasz Kopec´ et al in
Poland and was published in British journal of oral and maxillofacial in April
2016 - . A trial of use of ESWL for dissemination and fragmental extraction
of larger stones was done successfully . With continuous and forcible
irrigation , no further complaint of small fragments residual .
Indications of sialadenoscopy :

9. It is still a debatable argument for head and neck surgeons : Will the gland
to be excised or not ? A study published by J. Zenk an Otorhinolaryngologist
, University of Erlangen-Nuremberg, Germany 2004 , claimed that the
operator must make his decision upon :
A ) Pre interventional clinical and radiological features of the gland .
B ) The longer the patient history , the more the gland is pathologized .
C ) Depending on his study ; Among 88 cases of parotid gland stones only
one case that necessitated superficial parotidectomy over a period of 20
months follow up , compared to 6 cases of submandibular calcular
sialopathy of total 122 cases that necessitate submandibular
sialadenectomy . SO , hands can be lifted up regarding surgical excision of
the gland as long as effective sialoscopic procedure and careful follow up
will be done .

11. 2- Diagnosis and treatment of Salivary gland strictures.
In a 2011 retrospective review of 138 pts, Koch et al showed that
Wharton's duct stenosis was associated with previous therapy and/or
existing disease in 51.4% of pts . The most common conditions were
surgical manipulation of the ductal system (13.8%) , Radiotherapy in
17.7% of cases and autoimmune disease was associated with 5.1% of the
cases .
Dilatation , irrigation with or without stenting of ha duct were the
effective measures for strictures . Massage, heat, and lemon water were
post operatively advised . Placement of the inraluminal stent for a period
of 3-6 weaks according to severity of the stricture .
3 - Diagnosis and biopsies from intrductal masses or polyps .

12. An absolute contraindication of
sialoscopy is ?

13. Complications of sialoscopy :
* stricture of the duct.
* Bleeding.
* Ranulas, which are benign cysts filled
with saliva

14. Thank you