View source for Sialoendoscopy

{{Orphan|date=February 2009}}
{{DiseaseDisorder infobox |
  Name        = Sialoendoscopy |}}

'''Sialoendoscopy''' is a [[Minimally invasive procedure|minimally invasive technique]] that allows for [[salivary gland]] [[surgery]] for the safe and effective treatment of [[sialadenitis]] and other conditions of the salivary glands.  During sialoendoscopy a small [[camera]] is placed into the salivary glands through the [[salivary duct]]s that empty into the [[mouth]].  Sialoendoscopy is an efficient yet simple mode of treatment for major salivary gland obstructions, strictures and [[salivary calculi|sialoliths]] (salivary stones).  Depending on the obstruction, sialoendoscopy can be conducted under [[local anesthesia]] in an [[outpatient]] office or in the [[operating room]] under [[general anesthesia]]. 

== Conditions indicating sialoendoscopy ==
Salivary gland [[Calculus (medicine)|stones]] are one of the major causes of salivary gland infections (sialadenitis). These types of stones can be found in 1.2 percent of the general population. <ref>Rauch S GR: Diseases of the salivary glands. (ed. 6th). St. Louis: Mosby, 1970:997</ref> 

The second leading cause of salivary obstruction is from strictures and adhesions, which can happen from prior salivary gland infections, including childhood [[infection]]s like [[mumps]]. Most strictures could be seen in the [[parotid duct]] and mostly in the disease process of chronic recurrent sialadenitis.

== Description of the technique ==
Generally, the salivary duct opening needs to be either [[Wiktionary:dilate|dilate]]d or incised prior to introduction of the [[endoscope]].  Once the sialoendoscope is in place, [[saline (medicine)|saline]] is utilized to dilate the salivary duct and its branching.  

Once the endoscopes are introduced into [[gland]], the internal anatomy is explored either for [[diagnosis]] or for treatment of a specific disease entity.  The endoscope is introduced into the gland through its natural [[Body orifice|orifice]] in the mouth or by a making a small incision in the duct opening.  These techniques for introduction are completely intraoral techniques. 

===Salivary gland stone removal<ref>Nahlieli O, Nakar LH, Nazarian Y, Turner MD: Sialoendoscopy: A new approach to salivary gland obstructive pathology. J Am Dent Assoc 2006;137:1394 </ref>  ===
 
*When the diameter of the stone is 5mm or less, it can be removed purely by an endoscopic technique, particularly when the stone is located above the muscles that comprise the floor of the mouth. The four common techniques used to remove the salivary gland stones are:
#The grasping technique
#Using a small wire basket retrieval system
#Mechanical Fragmentation
#Laser fragmentation

*When the diameter is larger than 5 mm, a twofold (endoscopic assisted) approach can be utilized. The endoscope is introduced and the stone localized, and then [[dissect]]ed and removed in an intraoral approach.  After a sialolith is removed from an affected gland, a sialastic [[stent]] is inserted into the duct for two to four weeks for the duration of the healing process of the oral region and until normal function of the gland is restored.  This prevents [[scar]] formation which can develop overlying the ductal opening into the mouth.  

===Treatment of strictures and adhesions===
In the case of [[stenosis|stricture]]s or [[adhesion]]s, the following technique can be used as a treatment [[modality]]. First the surgeon will makes his diagnosis and find the exact location of the obstruction using a [[sialogram]].  Following this, the surgeon can use the endoscopic method. The first step in this is anesthetizing and laving the duct with 2 percent [[lidocaine]] and saline. If there is no improvement, the surgeon then can insert a [[Balloon catheter|dilation balloon]], which can be inflated up to 3 mm. The pressure created by the inflation can be sufficient to dilate most strictures. Another technique for dilating strictures is to expand the stricture region with grasping [[forceps]] used as a dilator.

==Instrumentation==  
The ability to perform this technique is the result of the development of miniaturized endoscopic imaging tools.  The majority of sialoendoscopes that are currently in use are of the semirigid type. The semirigid endoscope allows for visualization of the diseased process, but the stiffness allows manipulation and navigation of the internal salivary anatomy. 

Multiple types of micro instrumentation are available, including grasping forceps, biopsy forceps, [[drill]]s, [[needle]]s, [[laser]] fibers, and [[lithotripter]]s (although the last is currently unavailable in the US pending [[U.S. Food and Drug Administration]] approval).  Multiple companies make various types of sialoendoscopes and instrumentation.  There are advantages and disadvantages to all of the systems and none are recommend over the other.  Different practitioners utilize different systems due to the experience and clinical training of the surgeon. 
 
== Milestones in sialoendoscopy ==
*1990: Konigsberger and Gundlach separately performed sialoendoscopy when they introduced an endoscope into the major salivary glands. <ref> Konigsberger R, Feyh J, Goetz A et al.: [Endoscopic controlled laser lithotripsy in the treatment of sialolithiasis]. Laryngorhinootologie 1990;69:322</ref><ref>Gundlach P, Scherer H, Hopf J et al.: [Endoscopic-controlled laser lithotripsy of salivary calculi. In vitro studies and initial clinical use]. Hno 1990;38:247 </ref> 
*1991, Katz introduced a 0.8-millimeter flexible endoscope to diagnose and treat salivary gland stones.<ref>Katz P: [Endoscopy of the salivary glands]. Ann Radiol (Paris) 1991;34:110 </ref>  
*1994, Nahlieli used a rigid miniendoscope to diagnose and treat major salivary gland obstructions. <ref>Nahlieli O, Neder A, Baruchin AM: Salivary gland endoscopy: A new technique for diagnosis and treatment of sialolithiasis. Journal of Oral and Maxillofacial Surgery 1994;52:1240 </ref>

==References==
{{reflist}}

==External links==
* [http://www.emedicine.com/ent/topic600.htm eMedicine]
* [http://www.patientsforum.com/ Parotitis Patients' Forum]

{{Operations and other procedures on the digestive system}}

[[Category:Diseases and disorders]]
[[Category:Inflammations]]
[[Category:Gross pathology]]

[[de:Parotitis]]
[[nl:Parotitis]]
[[no:Kusma]]
[[zh:腮腺炎]]
[[Category:2Fix]]