Sialendoscopy: Getting started, how long does it take?

OBJECTIVES/HYPOTHESIS: Dilation of the salivary gland papilla for access is well-recognized as one of the major rate-limiting steps to sialendoscopy and has been shown to be a major challenge for beginners. The purpose of this study was to demonstrate that an algorithm involving multiple techniques for salivary duct access in sialendoscopy results in excellent success rates and acceptable operative times.

STUDY DESIGN: A retrospective, observational review of 61 patients who underwent sialendoscopy of the parotid or submandibular gland, for a total of 65 papillas accessed (31 parotid, 34 submandibular) with seven different trainees utilizing a standard protocol for duct access, was performed. The time interval from the case start to endoscopic visualization of the ductal lumen was measured. Average values for time to duct access were then calculated.

RESULTS: The papilla was identified in all but one case without difficulty. Five submandibular gland cases required sialodochotomy for access. The average time to duct access was 4.2 ± 4.7 minutes (range: 0.67-25 minutes). Exclusion of four difficult cases with access times over 15 minutes yielded an average access time of 3.2 ± 2.2 minutes.

CONCLUSION: This standardized protocol demonstrates high rates of success for salivary duct access via the papilla in a short time interval with infrequent need for sialodochotomy, even in the hands of novice surgeons.

LEVEL OF EVIDENCE: 4. Laryngoscope, 126:1083-1085, 2016.