Classic Approaches to Sialoendoscopy for Treatment of Sialolithiasis

Obstructive sialadenitis, with or without sialolithiasis, represents the main inflammatory disorder of the major salivary glands. The diagnosis and treatment of obstructions and inflammations of these glands can be problematic due to the limitations of standard imaging techniques. Satisfactory treatment depends on our ability to reach a precise diagnosis and, in the case of sialoliths, to accurately locate the obstruction. Until recently many of these glands required complete removal under general anesthesia. Sialolithiasis is a common finding, accounting for 50% of major salivary gland disease. The submandibular gland is the most prone to sialolithiasis. In various studies it was found that /80% of all sialolithiasis cases are in the submandibular glands, 19% occur in the parotid gland, and /1% are found in the sublingual gland. Sialolithiasis is most often found in adults, but it may be diagnosed in children. Sialoliths may vary in size, shape, texture, and consistency. They may occur as a solitary stone or as multiple stones. Bilateral submandibular stones are a rare condition (5% of submandibular sialolithiasis cases). Sialolithiasis of submandibular and parotid gland together has not been reported in the literature. The amount of symptomatic and nonsymptomatic sialolithiasis cases is 1% of the population, found in autopsy material. The symptomatic group of patients admitted to the hospital each year has been estimated as 57 cases per million per annum in the British population, representing 3420 patients per annum. If this incidence is applied to the European or the American population (300 million), then /17,100 patients per annum will require hospital treatment for sialolithiasis and its complication sialoadenitis. These data do not include patients who were treated as ambulatory (outpatient) cases. There is a male preponderance, and the peak incidence is between the ages of 30 and 60. Sialoliths grow by deposition and range in size from 0.1 to 30 mm. Presentation is typically with a painful swelling of the gland at meal times, when the obstruction caused by the calculus becomes most acute. During the past decade, with the introduction of salivary gland endoscopy there has been a major step forward, not only in providing an accurate means of diagnosing and locating intraductal obstructions, but also in permitting minimally invasive surgical treatment that can successfully manage those blockages that are not accessible intraorally. 20