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Minimally Invasive Solution for Gland Obstructions

Life for people with blockages in their salivary glands can be miserable. Swelling, inflammation, pain and interruption of saliva can cause a host of problems, says Washington University otolaryngologist, Allison Ogden, MD.

“Before this new treatment option, people with salivary gland blockages, especially in the parotid gland, had two main options: massage the gland, eat sour foods, stay hydrated, and take antibiotics as needed for infection (in essence, live with it); or have the gland removed,” Ogden says. “Taking out the gland has real surgical risks, particularly for the parotid because of the facial nerve bisecting the gland. A new tool recently introduced in the United States — sialendoscopy — gives us a third, much more acceptable option.” Sialendoscopy or salivary endoscopy involves the use of a small endoscope to look into the salivary ducts and identify blockages from stones, thickened saliva or strictures in the ducts and then potentially treat them on the spot.

Ogden and her colleague Brian Nussenbaum, MD, are among the most experienced in the use of sialendoscopy in the St. Louis area. They have been seeing patients for this procedure since 2009, and trained in Geneva, Switzerland, with Francis Marchal, MD, who developed the technique.

Blockages caused by stones occur in roughly one percent of the adult population, but do not always cause problems. Obstructions can also be caused by strictures or narrowing in the gland ducts that block passage of the saliva as effectively as stones. Certain diseases, such as Sjogren’s syndrome, can cause changes in the duct system and glands. Ogden and Nussenbaum also see these strictures frequently in patients who have been treated with radioactive iodine for thyroid cancer.

At Washington University, sialendoscopy is performed under general anesthesia as an outpatient procedure. The salivary endoscope can be used to diagnose the cause of the blockage and, at the same time, dilate strictures or remove stones. “The camera and sheath can be used to dilate strictures or narrowing of the duct. We can even use balloon catheters through a side port to widen strictures, or put tiny forceps through the sheath to grasp and remove thick saliva or small stones. We also have a basket tool that can grab and remove stones,” Nussenbaum says.

For stones that are too large or wedged too tightly, or for strictures that have been too tight for too long, the endoscope intervention can be used to help pinpoint the location of the obstruction and limit the incision needed.

“This procedure is deceptively difficult,” Ogden says. “The endoscope is the key to making this system unique and provides salivary gland patients with a less invasive and less risky correction to a troubling problem.”
 
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