Sialendoscopy:

1. Obstructive Sialadenitis – Inflammation and/or infection of salivary gland secondary to obstruction to flow of saliva in the transporting ducts and the common causes of obstruction are Salivary calculi (Stones), Strictures of the ducts (Narrowing), Kinks (acute bends)in the ducts.

2. Acute viral infections of major salivary glands Eg: Mumps.

3. Autoimmune Salivary gland disorders Eg: Sjogren’s Syndrome.

4. Juvenile Recurrent Parotitis.

5. Radio Iodine induced Sialadenitis.

6. Benign tumors Eg: Pleomorphic adenoma.

7. Malignant tumors Eg: Mucoepidermoid carcinoma.

(Salivary Calculi and Strictures are the major causes of Non Neoplastic Inflammatory Salivary Gland Diseases).

1. Mealtime Syndrome :- Subject develops fullness or painless swelling over the involved major salivary gland / along the course of duct (Below or infront of the ear for parotid / below the lower jaw for Submandibular / Floor of mouth below the tongue for Sublingual Salivary Gland) during meals that resolves over few minutes after completion of meals.

2. Acute painful swelling over the involved salivary gland.

3. Purulent drainage from the orifice of the duct of the involved gland (Cheek for Parotid / floor of mouth for Submandibular and Sublingual glands).

4. Symptoms of Dry mouth – stickyness, difficulty in chewing and swallowing, bad breath, gum problems and tooth decay.

5. Painless swelling within the involved gland or the entire gland.

Salivary Calculi ( Sialolithiasis):
Sialolithiasis is a benign, obstructive condition involving the formation of stones within the ducts of the major salivary glands. Sialolithiasis is the most common cause of salivary gland swelling with a reported incidence of 1 in 10000 to 1 in 30000. The etiology of salivary calculus formation is not clearly understood. The factors believed to be contributing to the formation of salivary stone formation are

1. Inadequate water intake and inadequate sleep leading to reduced salivary output.

2. Poor oral hygiene .

3. Abnormal anatomy like ductal kinks /diverticula leading to stasis of saliva.

4. Association between Gall bladder and Renal Calculi.

5. Questionable role of excess calcium supplementation.

Salivary Duct structures:
Stricture is a luminal narrowing of the salivary duct . Usually associated with calculi,presenting similar to calculi. Strictures may be the reason for formation of calculi or the result of calculi from recurrent infection secondary to calculi. Many of the times an impacted calculus present just behind a stricture. At times stricture may be isolated pathology presenting with meal time syndrome or recurrent painful swelling of the involved gland.


Sialendoscopy

Sialendoscopy is the minimally invasive technique to diagnose and treat Non-neoplastic salivary gland diseases secondary to ductal system pathologies like calculi and strictures at an early stage, so that we can preserve functional gland, can avoid gland excision that is otherwise a fairly common procedure before the advent of this technique and we can prevent complications associated with gland excision and the consequences of hyposalivation secondary to gland excision.




Technique : Sialendoscopy usually done under General Anaesthesia. After careful identification and dilatation of natural orifice of the duct of involved gland, sialendoscope is passed into the duct from oral cavity through dilated orifice, ductal system irrigated with saline through irrigation channel of the scope so that duct is dilated giving a clear view of the interior of the ductal system as we advance the scope towards the gland. Findings like mucous strands, sludge, calculi and or strictures identified during initial diagnostic scopy. Treatment according to the findings can be done either in the same sitting or in a staged manner. Floating calculi (less than 3mm in Parotid duct and less than 4mm in Submandibular duct) can be removed either with basket or with forceps. Larger calculi embedded in the ductal system can be removed by Combined approach (Identification with sialendoscopy, retrieval by opening the duct and closing the duct over a stent) Strictures in the duct can be diaphragmatic (involving only mucosal lining) or transmural (involving entire thickness of the duct), can be isolated, multiple or diffuse. Strictures many of the times may be just distal to calculi making it difficult to remove the calculi. Strictures can be dilated with bougies over guide wire or with the beveled edge of modular sialendoscope itself and at the end suitable stent will be placed in the duct that can be kept insitu for few weeks. Juvenile Recurrent Parotitis (Repeated inflammation of one or both parotid glands in children) can be managed effectively by Sialendoscopy. Diagnostic scopy will be done for ductal system evaluation. Any sludge and debris will be flushed out and then ductal system will be irrigated with medication to reduce the frequency of episodes. Patients with Sjogren’s syndrome and Radio Iodine induced Sialadenitis can be offered good symptomatic improvement with Sialendocopy by irrigating and flushing out the epithelial debris and sludge as and when it is required. Sialendoscopy is the minimally invasive technique to deal with salivary ductal system pathologies. Early identification of these problems and their effective management with Sialendoscopy offers significant improvement in quality of life and avoids the need of future gland excision.