Endoscopic diagnosis of salivary glands
Sialoendoscopy is a new and minimally invasive technique that gives a direct view of the inside of the large salivary glands’ ducts (i.e. submandibular and parotid gland). Due to small size of those ducts (from 1.2 to 1.5 mm), creation of miniature optical systems for their study became possible only recently thanks to the use of state-of-art materials and technology. This method will allow for diagnosis of significant percentage of patients with inflammatory and non-neoplastic diseases of the salivary glands, who had remained undiagnosed despite the use of modern radiological imaging techniques. Furthermore, pathologies can be removed from the ducts of the salivary glands during sialoendoscopy.
Indications for the examination:
Main indications to conduct sialoendoscopy include recurring painful and painless swelling of large salivary glands, which are a symptom of impaired patency of the ducts releasing saliva from the gland. The most common causes of obstruction include salivary stones and rarely narrowing of the duct. Other pathologies which hinder the outflow of saliva from the salivary glands include: mucous plugs, mucosal polyps, foreign bodies, bending of the duct.
Another indications to sialoendoscopy include: recurrent juvenile parotitis, Sjögren's syndrome, HIV infection and recently also benign tumours of the salivary glands.
Preparation and course of the procedure:
Sialoendoscopy is always preceded with a consult with an otolaryngologist or a maxillofacial surgeon and ultrasound examination of the salivary glands. Blood group determination, tests of morphology and coagulation system should also be performed. In adults, the procedure is usually performed under local anaesthesia and does not require any special preparations from the patient. If the case of children and if the duration of the procedure may exceed 2 hours, general anaesthesia is recommended and the patient must be fasting for 6 hours prior to surgery.
Sialoendoscope is entered to the lumen of the salivary glands through its natural opening in the oral cavity (opening of the submandibular gland is located under the tongue on the bottom of the oral cavity and near the frenulum of the tongue, whereas the opening of parotid duct is located in the buccal mucosa at the height of the second upper molar). At first, the opening of the duct becomes extended with a set of probes of increasing diameter. If the pathological lesions are observed in the duct, there is a possibility to remove them during the same procedure. This is performed with a microsurgical instruments (forceps, drills, baskets, etc.) entered through the working channel of the endoscope. Possible narrowing of the ducts are extended by low-pressure balloons or with use of a set of tubes with increasing diameter. In some cases, stent preventing scarring is entered to the duct and remains there for approx. 7-10 days.
After the procedure, patients are routinely administered an antibiotic, analgesic, anti-inflammatory and antispasmodic medicines. Furthermore, massage of the salivary gland treated is indicated.
What information are obtained during the examination?
Sialoendoscopy allows for diagnosis and treatment of the majority of pathologies which cause obstructive diseases of large salivary glands. Additionally, this method is used more frequently in diagnostics of benign tumours of salivary glands as it allows in a minimally invasive way to collect sample tissues for histopathological examination.