Endoscopic technique for the diagnosis and treatment of obstructive salivary gland diseases

Purpose: This article describes the use of endoscopy for diagnostic and surgical intervention in the major salivary glands of patients who have obstructive pathology, reviews past experience with this technique, and describes the microanatomy and pathophysiologic findings encountered during endoscopy of these glands. Patients and Methods: A total of 154 salivary glands (96 submandibular glands, 57 parotid glands, 1 sublingual gland) suspected of having obstructive pathology (89 males, 65 females; aged 5 to 72 years) were treated using a mini-endoscope. Most procedures were performed under local anesthesia in an outpatient clinic. All patients underwent preoperative and postoperative screening by routine radiography, sialography, and ultrasound. The indications for endoscopy were: 1) calculus removal that could not be performed by conventional methods, 2) screening of the salivary ductal system for residual calculi after sialolithotomy, 3) positive evidence of ductal dilatation or stenosis on the sialogram or ultrasound examination, and 4) recurrent episodes of major salivary gland swellings without known cause. Results: Of the 154 endoscopies performed, 9 were immediate failures as a result of technical problems. Of the remaining 145 glands, 112 had obstructions and 33 had sialadenitis alone. The success rate was 82% for calculus removal. Thirty-two percent of the submandibular and 63% of the parotid sialoliths, and the 1 stone in the Bartholin's duct, were undetected before sialoendoscopy. Multiple endoscopic findings were encountered. No major complications were noted. Conclusions: Sialoendoscopy is a minimal invasive technique for the diagnosis and removal of obstructive pathologic tissue in the major salivary glands.