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

by Karen Appold •

Opportunities Await

Sialendoscopy is a challenging field. Patient outcomes depend upon understanding a patients’ symptoms and planning intervention to meet patient expectations without doing further harm. “The technology is amazing, but it has limitations,” Dr. Walvekar said. A surgeon must always holistically evaluate patients who are referred to them; patients with salivary stones may have a coincidental salivary neoplasm that creates calcifications or other otolaryngologic or systemic conditions that may contribute to the salivary gland symptoms.

With a procedure like sialendoscopy, one must constantly be a student and be open to learning new tricks and tips; continuing education by participating in courses, case discussions, and joining sialendoscopy forums and groups is very helpful, Dr. Walvekar concluded.

Karen Appold is a freelance medical writer based in Lehigh Valley, PA.

Applying Sialendoscopy to Pediatric Patients

Juvenile recurrent parotitis (JRP) is the most common salivary gland disorder in children and the most common reason for sialendoscopy in this age group, said Kristina W. Rosbe, MD, professor and chief of the division of pediatric otolaryngology in the department of otolaryngology–head and neck surgery at the University of California, San Francisco, and Benioff Children’s Hospitals, San Francisco and Oakland, Calif.

Recurrent acute parotitis can present with gland swelling, fevers, and pain, and sometimes requires antibiotics. Frequent episodes can impact quality of life. Historically, before sialendoscopy received FDA approval, there weren’t great treatment options for JRP—it was either wait until a child grows out of it or perform a parotidectomy, an invasive procedure with significant risks.

“Sialendoscopy has led to a paradigm shift in the approach to JRP, allowing surgeons to offer a minimally invasive solution with low risk of complications or side effects,” Dr. Rosbe said. Sialendoscopy is used to flush out the parotid ducts, which can contain sludge-like salivary secretions, leading to intermittent blockage and acute parotitis. The procedure takes less than one hour and has minimal recovery time. Children can be discharged the same day and return to their normal activities the next day.

The technique of sialendoscopy is generally the same in children as in adults, with some variation, said M. Allison Ogden, MD, professor and vice chair for clinical operations in the department of otolaryngology–head and neck surgery at Washington University School of Medicine in St. Louis, Mo. The size of the endoscope may be smaller. Children are typically sedated under general anesthesia, whereas sialendoscopy in adults can be done under general, monitored anesthesia care, and occasionally local anesthesia.

Less commonly, children develop salivary stones, although it’s more common in teenagers and in the submandibular ducts. Sialendoscopy allows for minimally invasive removal of stones if they’re small enough and in a favorable location in the duct, Dr. Rosbe said.

When a pediatric patient has a sialolith, Dr. Ogden said the approach is generally the same as in managing an adult patient. She would attempt stone removal prior to gland excision in a pediatric patient.