Sialoendoscopy-A New Scope & Sphere for Diagnosis of Disorders

Dr. S. Bhavana Dr. V. Nagalaxmi Sr. Lecturer, Professor & HOD Dept. of Oral Medicine & Radiology, Dept. of Oral Medicine & Radiology Drs. Sudha & Nageswara Rao Siddhartha Dental College, Vijayawada, Andhra Pradesh. Sri Sai College of Dental , Vikarabad.

Abstract compact and modular endoscopes were when sialolith is >5mm4. (Fig. C) ialolithiasis and are the compact is used for therapeutic purpose and Methods of Retrieving The Sialolith most common salivary gland modular for diagnostic, irrigation and Endoscopic techniques which are used to Sdisorders. Many conventional surgical purposes. (Figure A,B) Semirigid remove the sialolith include: modalities have been tried yet unsatisfactory. endoscopes are most commonly used as it 1. Basket Technique: This is the oldest New endoscopic techniques have been incorporates both flexible and rigid technique. Basket is introduced in close pioneered with sialoendoscopy a novel endoscope, with peculiar features like clear position to bypass the and open therapy for optical exploration of salivary view, small diameter, stiffness which allows the prongs, basket is then pulled out in ductal system which incorporates diagnostic modification of salivary gland anatomy open position with the stone entrapped.4,3,6 and therapeutic procedures. It can be used hence endoscope can be easily introduced.1 It (Fig. E). effectively for salivary gland , consists of working and rinsing channel with 2. Grasper : In grasper there are three strictures and kinks. It is a simple procedure external diameter of 1.3mm.5 prongs which are used to hold the which can be performed under local Types of sialoendoscopes include: calculus. It need not be bypassed as in anesthesia. Hence forth, diagnostic and Diagnostic Sialoendoscope: 0.8 mm basket system.4,3,6 (Fig. D). interventional sialoendoscopy will be soon diameter/120-mm length/6000-pixel port for 3. Minigrasping Forceps: It is newly emerged into clinical practice. Thus this irrigation. designed with two prongs namely a) article reviews and focuses the importance of Multi functional Sialoendoscope: 1.1- Flexible b) Rigid.4 (Fig. E). in salivary gland pathologies. mm diameter / 120-mm length / 6,000 pixels. 4. Balloon Technique: It uses 2 techniques Key Words : Sialoendoscopy, Sialolith, Surgical Sialoendoscope: 1.6mm a. Irrigate thoroughly and wash out the Endoscope. diameter/ 120mm length 6000 pixels 4. stone. Introduction Indications b. Pull the balloon in inflated position and Sialolith is one of the major cause for 1. When calculus removal by conventional retrieve the stone. salivary gland disorders and symptoms method is difficult to perform as in C. Calculus is crushed with minigrasp preclude pain, swelling, tenderness of posterior portion of Wharton's duct with forceps and removed piece by piece. involved salivary glands and altered salivary proximity to lingual nerve or in stenson's 5. Mechanical Fragmentation: can be 1 flow . Over the last few years, many duct posterior to sigmoid area.1 done by intracorpeal laser fragmentation techniques have been introduced but still 2. For screening of ductal system to rule out or combined intracorpeal laser there is a increasing demand for minimally any residual calculi after surgical lithotriptor, basket and minigrasp invasive surgery and sialoendoscopy is one sialolithotomy.2 forceps.6,8 such technology with new promising method 3. When there is positive evidence of ductal Ductal catheterization is carried out with for treatment of non neoplastic obstructive dilatation or stenosis on .1 a polymeric sialostent into the duct for two to disease of salivary glands. It is an efficient yet 4. Cases of recurrent major salivary gland four weeks to prevent post operative oedema, simple mode of treatment for major salivary 1,2 and allow crushed particles of calculus to be 1,2 swellings without obvious cause. gland obstructions and strictures. It can be 5. When the calculus diameter does not washed out by saliva. A total of 100mg of easily performed under local anesthesia .Thus exceed 7 mm in Wharton's duct and 5mm hydrocortisone solution should be injected the advancements have resulted with major in stenson’s duct. 6 intraductally after the procedure. progress in this field. 6. When there are strictures, bends within Postoperative antibiotics, analgesics are History of Salivary Gland Endoscopy ductal system or presence of intraductal given with follow up.6,2 Koingsberger and colleagues introduced adenoids or foreign bodies .1,2 Complications their first successful application of Contraindications Complications of sialoendoscopy while endoscopically controlled intracorporeal retrieving a sialolith may result in temporary 3 1. Absolute contraindication include acute lithotripsy of salivary gland stones in 1990. inflammatory conditions like acute lingual nerve parasthesia, Post operative Later in 1993 he introduced the use of sialedinitis and non-functioning gland. 4 , bleeding, development of combined flexible miniendoscopes and 2. Relative contraindication include traumatic ranula, ductal strictures, tears and intracorporeal lithotriptor for sialolith perforations.6,9,4 intraparenchymal stones and when the fragmentation. In 2004, Zenk and colleagues ductal lumen cannot be enlarged more Advantages reported their experiences with a new highly than 1.3mm.2,6 1. It is a minimally invasive technique flexible, semirigid Sialoendoscope with which enhances removal of sialolith 4 Procedure of sialoendoscopy high-quality imaging (6,000 pixels) . In 2006 Preoperative assessment is done using from the deeper portions of ducts, within Nahlieli and Nazarian reported the results of conventional, digital radiographs or the glands, and openings of strictures, preliminary study of endoscopic treatment of ultrasound. The average time of kinks and duct strictures through 4 1 radioactive iodine sialedinitis . sialoendoscopy is 60min .Before introducing endoscopic guided visualization. Instrumentation the endoscope into the gland it should be 2. It is the only endoscopic technique that The use of miniature endoscopic imaging dilated either by using papillotomy or ensures complete removal of stones.2,6 tools makes the procedure uncomplicated. sialolothomy procedure7,then lubrication is 3. Surrounding tissues are minimally Miniendoscopes are traditionally divided into done using isotonic saline, and anesthetized damaged. three types namely rigid, flexible, and 4. The status of glandular tissues from 4 with 2 percent lidocaine. Intra ductal semirigid endoscopes. The semirigid approach is used when the sialolith diameter appearance of ductal lining can be endoscopes can be further divided into <5mm while extra ductal approach is used observed. In healthy gland, shiny Heal Talk | January-February 2013 | Volume 05 | Issue 03 41 Bhavana, et al. : Sialoendoscopy-A New Scope & Sphere for Diagnosis of Salivary Gland Disorders appearance of duct and proliferating sialolith is easy. It is an outpatient procedure 5. Paul S.Sialoendoscope Journal of Oral Maxillofacial Surgery 2001; 59(5): 484-490. blood vessels can be appreciated .In performed under local anesthesia without 6. Nahlieli O, Shacham R ,BarT, Eliav.E Endoscopic chronic sialedinitis, matted lining, major complications, and a solution for mechanical retrieval of Sialoliths. journal of oralsurg echymosis and small blood vessels can be managing intricated and perplexing oral med oralpathol oral radol 2003; 95: 396-402. percieved.10 inflammatory salivary gland pathology. As 7. Baptista PM, GimenoVC, Reymartinez JA, Casale FM. A new alternative for treatment of Salivary 5. It can identify radiolucent stones, polyps, the technique advances with endoscopy, more gland pathology Our Experience. Acta stenosis, mucous plugs and foreign findings, innovations and uniqueness will be Otorrinolaringol Esp200; 59(3):120-123. bodies.2 forthcoming, adding to its effectiveness. 8. Jacob D, Niels W, HelgeA, Preben H. Sialoendoscopy for diagnosis and treatment of non- Success Rate References neoplastic obstruction in Salivary glands. Danish • Success rate of parotid endoscopic 1. Suma GN, RaoD. Sialoendoscopy Review and medical Bulletin 2011; 58(2):A4232. sialolithotomy is 86% update. Journal of oral sign 2010; 2(1). 9. Capaccio P, Torretta S, OttavianiF,SambataroG, 2. Nallan CSK, Shashikanth MC, Ali IM. Pignataro L. Moderen management of Obstructive • Success rate of submandibular Sialoendoscopy a new diagnostic and treatment 1, 4 Salivary diseases. Acta Otorhinolaryngol Ital 2007; sialolithotomy is 89%. modality. JIAOMR 2007;19: 341-344. 27(4) 161-172. 3. Zenk J, Koch M, Bozzato A, Iro H. Sialoscopy Initial 10. Nahlieli O, Baruchin AM Sialoendoscopy a 3year Conclusion experience with new Endoscope. British Journal of Sialoendoscopy is a promising and experience as a diagnostic and treatment modality. Oral and Maxillofacial Surgery 2004; 2(4):293-298. Journal of Oral maxillofacial surgery1997; 66: 954- proficient method in diagnosing and treating 4. Nahlieli O, Nakar LH ,Nazarian Y,Michael.DT. 962. inflammatory conditions of major salivary Sialoendoscopy a new approach to Salivary gland Obstructive pathology. JADA 2006; 137(10): 1394- glands. The post operative management of 1400.

Fig. C: Introduction of a Sialoendoscope through the orifice of the Whartonís duct (after dilatation) into the gland. Note the transilluminating effect. (courtesy Nahlieli O ; JADA 2006).

Fig. A: The new set of diagnostic and multifunctional sialoendoscopes (0.8-millimeter diameter [top right], 1.1-mmdiameter [top left] and 1.6-mm diameter [lower right]). The instruments at the lower left are minigrasping forceps. (Courtesy Nahlieli O; JADA 2006).

Fig. D: Grasper used to retrieve sialolith. Fig. E: A: Endoscopic view of a basket retrieving a sialolith from the submandibular hilum. B: Endoscopic view a minigrasping forceps retrieving a sialolith from the submandibular hilum. (Courtesy Nahlieli O; JADA 2006)

Fig. E: A: Endoscopic view of a basket retrieving a sialolith from the submandibular hilum. B: E n d o s c o p i c v i e w a minigrasping forceps retrieving a sialolith from the submandibular hilum. (Courtesy Nahlieli O; JADA 2006) Fig. B: Sialoendoscope with telescope inside cover sheath and surgical unit. (Courtesy Nahlieli O ; OOOO 2003) .

4212 Heal Talk | January-February 2013 | Volume 05 | Issue 03