Pearls, Perils, and Learning Curve of Salivary Endoscopy

  • David M. CognettiEmail author
  • Joseph M. Curry


The use of sialendoscopy for non-neoplastic disorders of the salivary glands is increasing. This relatively new option for the treatment of obstructive and inflammatory salivary conditions, such as sialolithiasis and chronic sialadenitis, has allowed an increasing number of patients to enjoy symptom resolution without gland excision. The adoption of any technological advance, however, carries with it a learning curve. This chapter highlights strategies for both novice and experienced salivary endoscopists to maximize success. Tips for surgeon training, patient selection, and equipment management are included in addition to intraoperative steps and techniques. Common pitfalls are discussed with advice on how to avoid them. With attention to these strategies, sialendoscopy can be successfully incorporated into the treatment algorithm of salivary disorders with minimal risks and limitations.


Sialendoscopy Sialadenitis Sialolithiasis Parotid Submandibular Salivary Stone Stricture Endoscopy 

Supplementary material

Video 21.1

Expression of saliva from the Wharton’s duct. This can be accomplished by massaging the gland or by running a finger along the course of the duct (MOV 25507 kb)

Video 21.2

Dilation of Wharton’s papilla . The dilators are passed sequentially until the conical dilator can be used (MP4 68,057 kb)

Video 21.3

Papillotomy to remove a stone in basket. The incision must be made between the fibers of the basket to avoid cutting the basket (MOV 20721 kb)


  1. 1.
    Marchal F, Kurt AM, Dulguerov P, Becker M, Oedman M, Lehmann W. Histopathology of submandibular glands removed for sialolithiasis. Ann Otol Rhinol Laryngol. 2001;110(5 Pt 1):464–9.CrossRefPubMedGoogle Scholar
  2. 2.
    Su YX, Xu JH, Liao GQ, Zheng GS, Cheng MH, Han L, Shan H. Salivary gland functional recovery after sialendoscopy. Laryngoscope. 2009;119(4):646–52. doi: 10.1002/lary.20128.CrossRefPubMedGoogle Scholar
  3. 3.
    Zenk J, Koch M, Klintworth N, König B, Konz K, Gillespie MB, Iro H. Sialendoscopy in the diagnosis and treatment of sialolithiasis: a study on more than 1000 patients. Otolaryngol Head Neck Surg. 2012;147(5):858–63. doi: 10.1177/0194599812452837.CrossRefPubMedGoogle Scholar
  4. 4.
    Farneti P, Macrì G, Gramellini G, Ghirelli M, Tesei F, Pasquini E. Learning curve in diagnostic and interventional sialendoscopy for obstructive salivary diseases. Acta Otorhinolaryngol Ital. 2015;35(5):325–31. doi: 10.14639/0392-100X-352. Review. PubMed PMID: 26824914; PubMed Central PMCID: PMC4720929PubMedPubMedCentralGoogle Scholar
  5. 5.
    Luers JC, Damm M, Klussmann JP, Beutner D. The learning curve of sialendoscopy with modular sialendoscopes: a single surgeon's experience. Arch Otolaryngol Head Neck Surg. 2010;136(8):762–5. doi: 10.1001/archoto.2010.109.CrossRefPubMedGoogle Scholar
  6. 6.
    Modest MC, Galinat L, Rabinowitz MR, Curry JM, Rosen D, Cognetti DM. Learning progression in the use of sialendoscopy for sialolithiasis: effect on gland preservation. Otolaryngol Head Neck Surg. 2014;151(2):240–5.CrossRefPubMedGoogle Scholar
  7. 7.
    Marchal F, Dulguerov P. Sialolithiasis management: the state of the art. Arch Otolaryngol Head Neck Surg. 2003;129(9):951–6.CrossRefPubMedGoogle Scholar
  8. 8.
    Galinat L, Curry J, Luginbuhl, et al. Nonvisualization of sialoliths during sialendoscopy. Otolaryngol Head Neck Surg. 2016;154:1019–22.Google Scholar
  9. 9.
    Kiringoda R, Eisele DW, Chang JLA. Comparison of parotid imaging characteristics and sialendoscopic findings in obstructive salivary disorders. Laryngoscope. 2014;124(12):2696–701. doi: 10.1002/lary.24787.
  10. 10.
    Koch M, Bozzato A, Iro H, Zenk J. Combined endoscopic and transcutaneous approach for parotid gland sialolithiasis: indications, technique, and results. Otolaryngol Head Neck Surg. 2010;142(1):98–103. doi: 10.1016/j.otohns.2009.10.022.CrossRefPubMedGoogle Scholar
  11. 11.
    Luers JC, Stenner M, Schinke M, Helmstaedter V, Beutner D. Tolerability of sialendoscopy under local anesthesia. Ann Otol Rhinol Laryngol. 2012;121(4):269–74.CrossRefPubMedGoogle Scholar
  12. 12.
    Witt RL, Iro H, Koch M, McGurk M, Nahlieli O, Zenk J. Minimally invasive options for salivary calculi. Laryngoscope. 2012;122(6):1306–11. doi: 10.1002/lary.23272.CrossRefPubMedGoogle Scholar
  13. 13.
    Luers JC, Vent J, Beutner D. Methylene blue for easy and safe detection of salivary duct papilla in sialendoscopy. Otolaryngol Head Neck Surg. 2008;139:466–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Chossegros C, Guyot L, Richard O, Barki G, Marchal F. A technical improvement in sialendoscopy to enter the salivary ducts. Laryngoscope. 2006;116:842–4.CrossRefPubMedGoogle Scholar
  15. 15.
    Reddy R, White DR, Gillespie MB. Obstructive parotitis secondary to an acute masseteric bend. ORL J Otorhinolaryngol Relat Spec. 2012;74(1):12–5. doi: 10.1159/000334246.CrossRefPubMedGoogle Scholar
  16. 16.
    Chang JL, Eisele DW. Limited distal sialodochotomy to facilitate sialendoscopy of the submandibular duct. Laryngoscope. 2013;123(5):1163–7. doi: 10.1002/lary.23801.CrossRefPubMedGoogle Scholar
  17. 17.
    Luers JC, Ortmann M, Beutner D, Hüttenbrink KB. Intraductal pressure during sialendoscopy. J Laryngol Otol. 2014;128(10):897–901. doi: 10.1017/S0022215114001959.CrossRefPubMedGoogle Scholar
  18. 18.
    Laaksonen J, Haapaniemi A, Ojala J, Mäkitie A, Saarinen R. Sialendoscopy in sialadenitis: an unselected cohort of 228 patients. Clin Otolaryngol. 2016;41(4):416–20. doi: 10.1111/coa.12531.CrossRefGoogle Scholar
  19. 19.
    Walvekar RR, Carrau RL, Schaitkin B. Endoscopic sialolith removal: orientation and shape as predictors of success. Am J Otolaryngol. 2009;30(3):153–6. doi: 10.1016/j.amjoto.2008.03.007.CrossRefPubMedGoogle Scholar
  20. 20.
    Walvekar RR, Bomeli SR, Carrau RL, Schaitkin B. Combined approach technique for the management of large salivary stones. Laryngoscope. 2009;119(6):1125–9. doi: 10.1002/lary.20203.CrossRefPubMedGoogle Scholar
  21. 21.
    Nahlieli O. Complications of sialendoscopy: personal experience, literature analysis, and suggestions. J Oral Maxillofac Surg. 2015;73(1):75–80. doi: 10.1016/j.joms.2014.07.028.CrossRefPubMedGoogle Scholar
  22. 22.
    Patel NJ, Hashemi S, Joshi AS. Sonopalpation: a novel application of ultrasound for detection of submandibular calculi. Otolaryngol Head Neck Surg. 2014;151(5):770–5. doi: 10.1177/0194599814545736.CrossRefPubMedGoogle Scholar
  23. 23.
    Durbec M, Dinkel E, Vigier S, Disant F, Marchal F, Faure F. Thulium-YAG laser sialendoscopy for parotid and submandibular sialolithiasis. Lasers Surg Med. 2012;44(10):783–6. doi: 10.1002/lsm.22094.CrossRefPubMedGoogle Scholar
  24. 24.
    Su CH, Lee KS, Tseng TM, Hung SH. Endoscopic holmium:YAG laser-assisted lithotripsy: a preliminary report. B-ENT. 2015;11(1):57–61.PubMedGoogle Scholar
  25. 25.
    Schmitz S, Zengel P, Alvir I, Andratschke M, Berghaus A, Lang S. Long-term evaluation of extracorporeal shock wave lithotripsy in the treatment of salivary stones. J Laryngol Otol. 2008;122(1):65–71.CrossRefPubMedGoogle Scholar
  26. 26.
    Phillips J, Withrow K. Outcomes of holmium laser-assisted lithotripsy with sialendoscopy in treatment of sialolithiasis. Otolaryngol Head Neck Surg. 2014;150(6):962–7. doi: 10.1177/0194599814524716.CrossRefPubMedGoogle Scholar
  27. 27.
    Hoffman HT, Walvekar RR, Tracy CR, Kolenda J, Pagedar N. Endoscopic salivary stone fragmentation with pneumatic lithotripsy in a simulation model. Otolaryngol Head Neck Surg. 2016;154(3):454–9. doi: 10.1177/0194599815626138.CrossRefPubMedGoogle Scholar
  28. 28.
    Koch M, Mantsopoulos K, Schapher M, von Scotti F, Iro H. Intraductal pneumatic lithotripsy for salivary stones with the StoneBreaker: preliminary experience. Laryngoscope. 2016;126(7):1545–50. doi: 10.1002/lary.25849.CrossRefPubMedGoogle Scholar
  29. 29.
    Bhayani MK, Acharya V, Kongkiatkamon S, Farah S, Roberts DB, Sterba J, Chambers MS, Lai SY. Sialendoscopy for patients with radioiodine-induced sialadenitis and xerostomia. Thyroid. 2015;25(7):834–8. doi: 10.1089/thy.2014.0572.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Bomeli SR, Schaitkin B, Carrau RL, Walvekar RR. Interventional sialendoscopy for treatment of radioiodine-induced sialadenitis. Laryngoscope. 2009;119(5):864–7. doi: 10.1002/lary.20140.CrossRefPubMedGoogle Scholar
  31. 31.
    Jager DJ, Karagozoglu KH, Maarse F, Brand HS, Forouzanfar T. Sialendoscopy of salivary glands affected by Sjögren syndrome: a randomized controlled pilot study. J Oral Maxillofac Surg. 2016;74(6):1167–74. doi: 10.1016/j.joms.2015.12.019.CrossRefPubMedGoogle Scholar
  32. 32.
    Kim YM, Choi JS, Hong SB, Hyun IY, Lim JY. Salivary gland function after sialendoscopy for treatment of chronic radioiodine-induced sialadenitis. Head Neck. 2016;38(1):51–8. doi: 10.1002/hed.23844.CrossRefPubMedGoogle Scholar
  33. 33.
    Koch M, Iro H, Zenk J. Sialendoscopy-based diagnosis and classification of parotid duct stenoses. Laryngoscope. 2009;119(9):1696–703. doi: 10.1002/lary.20522.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Department of Otolaryngology—Head and Neck SurgerySydney Kimmel Cancer Center, Thomas Jefferson UniversityPhiladelphiaUSA

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