Salivary Endoscopy

Sialadenitis, a recurrent salivary gland infection associated with pain and swelling of the major salivary glands, is a common disease. Conservative treatment is the first line of therapy and includes treatment with antibiotics, salivary stimulants and anti-inflammatory agents. However, conservative therapy fails in up to 40 percent of people with sialadenitis.

In the past, the recommended treatment for unmanageable sialadenitis was removal of the involved salivary gland. However, surgical removal of the gland carries numerous risks. In the last decade, a new minimally invasive treatment for sialadenitis called salivary endoscopy was developed and pioneered to help patients across the globe.

MUSC Health has been a leader in salivary endoscopy training and procedures since M. Boyd Gillespie, M.D. brought the technique to Charleston in 2008 after training with world experts in Erlangen, Germany. In 2016, he passed the MUSC Health Salivary Program leadership to Eric J. Lentsch, M.D.

More than 900 salivary endoscopy procedures have been performed at MUSC Health on patients from 25 different states. MUSC Health remains one of the busiest endoscopic salivary gland programs in the United States.

About the Procedure

Salivary endoscopy involves placement of a small endoscope – usually 0.8 to 1.6 millimeters in size – into the salivary duct and can be done with patients under local or general anesthesia. First, the papilla of the duct is dilated transorally with probes increasing in size. Then the endoscope is introduced into the duct so the anatomy can be visualized. This provides 360-degree visualization of the lumen from papilla to the actual gland. At this point treatment can be performed for any pathology found. For example, stenotic ducts can be dilated using a balloon dilator, biopsies can be taken of abnormal tissue and stones up to 5 millimeters in size can be removed using a wire basket. Steroids can also be injected in cases of inflammatory sialadenitis. In cases of larger stones, a combined approach can be utilized in which endoscopic manipulation of the stone is done with transoral sialodochoplasty to remove the stone with marsupialization. This provides markedly less risk of morbidity compared to an open approach.

Results

With respect to diagnostic sialendoscopy, the success rate is reported to be as high as 98 percent. In the interventional setting, the success rate for stone removal is reported to be 80 to 90 percent – mainly dependent on the size and mobility of the stones. For ductal scars and stenoses, success is generally reported to be 75 to 85 percent. And for inflammatory diseases – such as Sjogren’s, juvenile recurrent parotitis and radioiodine sialadenitis – the success rates are somewhat lower due to the chronicity and severity of the underlying diseases. However, across all disease processes, gland preservation is one of the major benefits of sialendoscopy and is also reported to be between 80 and 90 percent.

MUSC Health ENT would be pleased to assist you or your loved ones. Please give us a call at 843-792-3531 to schedule an appointment with our team. We look forward to meeting you, to help you on your path to a healthy quality of life.