Endoscopic technique effective for salivary blockages

מתוך medicontext.co.il
By Robert James Parsons

GENEVA (Reuters Health) – Submandibular ductal disorders can be resolved in many cases under local anesthetic with minimal damage to the gland using sialendoscopy, a Swiss clinician reported on Wednesday.

The technique allows for the removal of sialoliths and correction of strictures as far as the hilum of a gland, otorhinolaryngologist Dr. Francis Marchal of Geneva University Hospital said. He described the technique, and a specific instrument for performing it, here at the 1st International Interdisciplinary Conference on Salivary Gland Diseases.

The sialendoscopy device was developed with support from Karl Storz, a German company specializing in endoscopic technology. It allows almost complete exploration of the ductal system of both the submandibular and parotid glands, Dr. Marchal said.

The endoscope contains two canals, one to rinse and dilate and the other for instruments to remove a stone or for a laser fibre to break it. The laser, however, poses a problem because of the high power needed to break the stone.

This, noted Dr. Pavel Dulguerov, also of the Geneva University Hospital, leaves little room for error. Further development of this aspect, he told Reuters Health, will improve safety.

Dr. Marchal and colleagues reported initial findings with submandibular sialendoscopy in disorders of Wharton's duct in the January issue of Annals of Otology, Rhinology and Laryngology.

They treated 129 patients with suspected ductal disorders, using sialendoscopy to classify and treat lesions.

Diagnostic sialendoscopy was possible in 131 of 135 glands, they report. In 110 attempts at intervention using the technique, success was achieved in 82%.

Multiple sialendoscopies were necessary in 25% of cases and general anesthesia was used in 12% of cases. Submandibular gland resection was performed in 4%, the researchers write.

Dr. Willy Lehmann, director of the otorhinolaryngology clinic at the Geneva University hospital, praised the technique.

"It is essentially preservation surgery," he told Reuters Health, "with all that that implies for the quality of life. This sort of technique preserves the gland, for it is no longer necessary to remove it to heal the patient."

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