Sialoendoscopy is an endoscopic procedure used to visualize and treat disorders of the major salivary gland ductal systems. It was first developed in the 1990s and allows for both diagnostic evaluation and minimally invasive therapeutic interventions for conditions such as salivary duct stones, strictures, tumors and foreign bodies. The procedure involves cannulating the duct with increasingly larger dilators and then inserting an endoscope to directly visualize the ductal system and perform interventions if needed. Sialoendoscopy has advantages over conventional external surgical approaches as it is less invasive and allows for complete evaluation and clearance of ductal obstructions.

3. Introduction
 Sialoendoscopy is specialized procedure that allows
endoscopic transluminal visualization of major
salivary gland ductal system.
 Sialoendoscopy is both diagnostic and therapeutic
modality

4. History
 In 1990 - Katz and Gundlach.
 In 1994 - Nahlieli et al(Israel).
 In 1995 - Marshal (Switzerland).
 In 1997 - flexible endoscope with irrigation.
 In 2002 - European Sialendoscopy Training Center was started .

5. Indication
1. Conventional method is hazardous for calculus
removal.
2. Ductal stenosis, intraductal adenoids /foreign bodies.
3. Recurrent major salivary gland swelling without cause.
4. Determination & treatment of anatomic
variations/malformations
5. Diagnosing autoimmune diseases of salivary gland.
6. Follow up & control of treatment success rate.

6. contraindication
 Acute inflammatory disease

7. Pre operative evaluation
 History
 Number of infections
 Previous treatments
 History of radiation therapy & radio iodine exposure
 Evaluation of anatomical limitation

8. Armamentarium

9. Types of endoscopes
Erland all in one endoscope Marchal all in one endoscope

10. Conical Dilator

11. Dilator of varying sizes

12. Bougies of varying sizes

13. Types of dormia basket

14. Types of balloon catheter

15. Foreign body forceps Biopsy forceps

16. Pre operative preparation
 Anesthesia
 Patient positioning

17. Technique
Wharton’s duct Stenson’s duct

18. Identification of papilla
 microscope or surgical loupes and massage of glands
to express saliva.
 Next inject 2 ml of Lidocaine with epinephrine in
periphery .

19. Dilation of salivary duct
 Standard dilation:
Non toothed tissue forceps - straighten the tortuous
duct and fix the papilla .
Salivary duct probe in the
papilla.
Salivary canula Canulated duct

20. Salivary dilator inserted in the papilla. Dilated papilla

21.  Seldinger technique:

22.  papillotomy (Nahlieli et al) - prevents creation of
mucosal seal around endoscope resulting in leakage of
irrigates thereby preventing maximum dilation of
duct.

24. Interventional Sialendoscopy

25. Stenosis After dilation

26. Post operative follow
 Intra venous antibiotics and steroids to decrease
post operative infection and edema.
 Normal diet.

27. Advantages
1. Minimal invasive procedure done on outpatient basis.
2. Ensure complete removal of any obstructions.
3. The status of glandular tissues from appearance of
ductal lining is appreciated.
4. Identify radiolucent stone, polyps, stenosis, mucous
plugs and foreign body.

28. Complication
1.Avulsion of duct and ductal wall perforation.
2. Development of post operative infections.
3. Ranula formation.
4. Lingual nerve parasthesia.
5. Temporary swelling of gland.
6. Superficial mucosal necrosis at LA site.

29. Conclusion
Successful application of sialoendoscopy requires a
well-organized training program.
 more advances it is the future solution for
management of obstructive salivary gland disease.

30. Bibliography
1) Is Sialendoscopy an effective treatment for obstructive salivary gland disease? The American
Laryngological, Rhinological and Otological society 2003.
3 ) Sialendoscopy allows for endoscopic removal of saliva stones. UCLA health.
4) A newly developed interventional sialendoscope for a completely non surgical sialolithectomy using
intracorporeal electro hydraulic lithotripsy. Journal of oral maxillofacial surgery 2007.
5) Therapeutic Sialendoscopy .National Institute for Health and Clinical Excellence may 2007. )
6) Sialendoscopy minimally invasive surgery for benign salivary gland diseases.MD Singapore March 2011.
7) Sialendoscopy the Endoscopic approach to Salivary Gland Ductal Pathologies. Author Francis Marshal
MD, FACS.
8) The open Access atlas of Otolaryngology, Head & Neck operative Surgery by Johan Fagan & Robert L
Witt
9) Sialoendoscopy: a new Diagnostic and Treatment Modality. The Journal of Indian Academy of Oral
medicine & Radiology.2007.
10)Sialendoscopy :endoscopic approach to benign salivary gland diseases, advances in endoscopic
surgery.
11) Sialoendoscopy meds cape reference drugs, diseases & procedures.