Sialendoscopy Updates: A Look at New Technology, Cost, and Frequency of Use

Before the FDA approved sialendoscopy in 2005, treatments for chronic obstructive salivary disease were quite limited. Antibiotics, steroids, and salivary stimulants were used in an attempt to resolve an infection or inflammation caused by an obstruction.

In some fortunate patients, simply expressing an obstructive stone out of the duct was possible, said Kenneth Hsu, MD, an otolaryngologist at The ENT & Allergy Centers of Texas in Plano. But for many patients, either an open surgical excision of a stone or, even worse, removing the gland would be needed to fully address the condition.

Procedures had significant potential complications and long-term consequences. Glands or ducts could be damaged, leading to further chronic obstructive disease that required gland removal. Surgery can risk nerve damage, and without a salivary gland, an individual can have dry mouth, visible facial and neck scars, and soft tissue deformity, Dr. Hsu said.

Sialendoscopy offers minimal risk, downtime, and adverse long-term consequences via a minimally invasive approach. “It’s an elegant solution to obstructive salivary disease, and in the right circumstances it can be nothing short of miraculous,” Dr. Hsu said. “There is no other satisfactory solution for patients with this disease.”

So how often is this game-changing procedure performed today since first being described in the 1990s (Ann Radiol (Paris). 1991;34:110-113), what newer technologies are available in the field, and how much does it cost to add the specialty to a practice?

Frequency of Use

It was once thought that when a salivary gland was obstructed due to a stone or stenosis, it had to be removed. However, scientific research has shown that when a stone is removed or stenosis is resolved, a gland will continue to show valuable function (Laryngoscope. 2009;119:646-652).

Sialendoscopy has grown tremendously in availability in the United States since receiving FDA approval. Studies have shown that it’s a safe and effective procedure for managing ductal pathologies of salivary glands (Sialendoscopy. Medscape. Nov. 30, 2017; Int J Otolaryngol Head Neck Surg. 2016;5:28-33).

Approximately 100 or more centers or practices in the United States now offer this procedure, and a growing number of otolaryngology surgeons and oral maxillofacial surgeons are being trained in sialendoscopy in their residency programs, said Rohan R. Walvekar, MD, a clinical professor in the department of otolaryngology–head and neck surgery at Louisiana State University Health Sciences Center in New Orleans.

One reason it isn’t performed more widely is that there aren’t any specific CPT codes reflecting this newer procedure’s value. “It can be very time intensive, and the procedure isn’t reimbursed as adequately as other, comparable new techniques such as balloon sinuplasty,” said J. Randall Jordan, MD, a professor in the department of otolaryngology–head and neck surgery at the University of Mississippi Medical Center in Jackson.