Stones in Salivary Glands: A New Look
Date: April 1, 2013
David Eisele is one of a few U.S. head and neck surgeons to offer sialendoscopy, a minimally invasive approach to salivary stones and other salivary gland illness. Treatment options have been especially limited for the former condition—sialolithiasis. If stones are not removable transorally, the entire affected gland is excised—a procedure carrying a significant risk of nerve injury as well as a scar and loss of salivary ability.
Sialendoscopy, however, is a welcome option for diagnosis or therapy, Eisele says.
Developed in Europe nearly two decades ago, the technique uses a miniaturized endoscope to probe the submandibular and parotid salivary glands. Scopes are roughly a millimeter wide, allowing incisionless entry via salivary ducts and greater ease of examination.
Modified with wire baskets or graspers, they’re ideal for stone removal, Eisele adds, or allow the alternative of pulverizing stones with a YAG laser. And if open surgery should be necessary, the endoscope still helps visualize stones from within. It also clarifies the surgical route clearer—all for a less invasive procedure.
Eisele uses sialendoscopy to treat a variety of other salivary gland conditions. He dilates and flushes salivary ducts of patients with chronic sialadenitis, for example, or those who develop salivary gland inflammation following radioactive iodine treatment for thyroid disorders or cancer. The tactic can also relieve strictures of the salivary ducts caused by prior surgeries, stones or inflammation.
One of the first in this country to embrace sialendoscopy—he began in 2004—Eisele contributes regularly to scientific literature on the topic. He’s expanding a novel sialendoscopy program at Johns Hopkins, one geared to increase the numbers of head and neck surgeons skilled in the new methodology. And plans to improve sialendoscopy include the design of more flexible scopes with enhanced optics.
“It’s an excellent adjunct,” Eisele says, “to help us give better care to patients with salivary gland disorders.”