Chronic Obstructive Sialadenitis & Sialendoscopy.
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Chronic Obstructive Chronic Obstructive
SialadenitisSialadenitis
&&
SialendoscopySialendoscopy
Chronic Obstructive Chronic Obstructive
SialadenitisSialadenitis
&&
SialendoscopySialendoscopy
Parotid Ductal System
Nicolaus Stenonius
1660
Anatomy--Salivary gland Anatomy--Salivary gland
Stensen’s duct
• Submandibular Ductal System
Thomas Wharton, 1659
• Sublingual Ductal System
Casparus Bartholinus, 1690
Anatomy--Salivary glandAnatomy--Salivary gland
Wharton’s duct
Bartholin’s duct
Chronic Obstructive Chronic Obstructive SialadenitisSialadenitis
Chronic Obstructive ParotitisChronic Obstructive Parotitis
Submandibular sialadenitisSubmandibular sialadenitis
Chronic Obstructive Chronic Obstructive ParotitisParotitis
EtiologyEtiology
Clinical manifestationsClinical manifestations
DiagnosisDiagnosis
TreatmentTreatment
Etiology ofEtiology of
Chronic Obstructive Chronic Obstructive
ParotitisParotitis ScarScar
SialolithiasisSialolithiasis
AnatomyAnatomy
Clinical Clinical manifestationsmanifestations
Recurrent swelling and pain Recurrent swelling and pain
of the gland of the gland
Purulent dischargePurulent discharge
Diagnostic methodsDiagnostic methods Plain radiographsPlain radiographs
SialographySialography
UltrasoundUltrasound
Scintigraphy(Scintigraphy( 闪烁扫描法闪烁扫描法 ) )
CT CT
MRIMRI
SialographySialography
“Sausage like” appearance of enlarged duct“Sausage like” appearance of enlarged duct
MRIMRI
Appearance of enlarged duct
Sialography EndoscopySialography Endoscopy Sialography EndoscopySialography Endoscopy
DilationDilation StenosisStenosis
SialendoscopySialendoscopy
Differentiating Differentiating diagnosisdiagnosis
Chronic recurrent parotitis
SjÖgren syndrome
Chronic recurrent parotitis
SjÖgren syndrome
TreatmentTreatment systemic antibiotic administration
Sialogogues(促唾剂 )
Gland massage
Drug lavage(灌洗 ) and perfusion
systemic antibiotic administration
Sialogogues(促唾剂 )
Gland massage
Drug lavage(灌洗 ) and perfusion
Duct ligation
Parotidectomy
Tympanic(鼓室 ) neurectomy
Duct ligation
Parotidectomy
Tympanic(鼓室 ) neurectomy
Submandibular Submandibular
sialadenitis sialadenitis
and and
SialolithiasisSialolithiasis
Submandibular Submandibular
sialadenitis sialadenitis
and and
SialolithiasisSialolithiasis
Etiology of Etiology of
Submandibular Submandibular
sialadenitis sialadenitis SialolithiasisSialolithiasis
TraumaTrauma
InfectionInfection
Foreign bodyForeign body
SialolithiasisSialolithiasis Reasons of Reasons of arisingarising
1. Anatomy1. Anatomy
Upwarding routeUpwarding route Longer ductLonger duct Curve duct Curve duct
2.Components of saliva2.Components of saliva
Mucus proteinMucus protein Calcium contentCalcium content
ManifestationsManifestationsManifestationsManifestations
Intermittent swelling of the Intermittent swelling of the
glandgland
Aggravating with taking foodAggravating with taking food
Acute infectionAcute infection
Diagnostic methodsDiagnostic methods
plain radiographsplain radiographs sialographysialography ultrasoundultrasound CT scan CT scan SialoendoscopySialoendoscopy
Plain radiographsPlain radiographs
One Two Three
Sialography Sialography && CT CT
Sialolith
SialoendoscopySialoendoscopy
Stone in main ductStone in second branch duct
Stone embedded
Differentiating diagnosisDifferentiating diagnosis
Tumor in sublingual glandTumor in sublingual gland
Tumor in submandibular glandTumor in submandibular gland
KKÜÜtter tumortter tumor
Space infection in submandibular regionSpace infection in submandibular region
LymphadenopathyLymphadenopathy
Traditional treatmentTraditional treatment
Intraoral routeIntraoral route
Sialadenectomy via external Sialadenectomy via external
approachapproach
New technique New technique
SialendoscopySialendoscopy
Diagnostic SialendoscopyDiagnostic Sialendoscopy
Interventional SialendoscopyInterventional Sialendoscopy
History of the History of the
SialendoscopySialendoscopy 19911991 KatzKatz Flexible mini-endoscopeFlexible mini-endoscope
19931993 KonigsbergerKonigsberger Endoscopic intracorporeal lithotripsyEndoscopic intracorporeal lithotripsy
19941994 Arzoz Arzoz Endoscopic intracorporeal lithotripsyEndoscopic intracorporeal lithotripsy
Nahlieli Nahlieli SialendoscopySialendoscopy
1995 1995 Marchal Marchal SialendoscopySialendoscopy
1999 1999 Our Dept.Our Dept. YuYu
Diagnostic Diagnostic SialendoscopySialendoscopy
First generation branches Second generation branches
Types of obstructionsTypes of obstructions
SialolithSialolith
Polyps Polyps
StrictureStricture
KinkKink
Foreign bodyForeign body
Anatomic malformationAnatomic malformation
SialolithSialolith
Polyps Polyps
StrictureStricture
KinkKink
Foreign bodyForeign body
Anatomic malformationAnatomic malformation
SialolithSialolith
Main ductFirst branch of duct
80%~90% in Submandibular gland
Polyps and Mucous Polyps and Mucous PlugPlug
Sialolith
10%~30% in Parotid gland
Mucous Plug Sialolith?
Interventional SialendoscopyInterventional Sialendoscopy
Grasping wire basketGrasping wire basket
Biopsy forcepsBiopsy forceps
Balloon-tipped catheterBalloon-tipped catheter
Custom papilla dilatorCustom papilla dilator
Electrohydraulic lithotripterElectrohydraulic lithotripter
Holmium laser probeHolmium laser probe
Grasping wire basketGrasping wire basket
diameter<4mmdiameter<4mm
Balloon-tipped catheterBalloon-tipped catheter
Stenosis in the second branchStenosis in the second branch
Ductal StenosisDuctal Stenosis
Close-up view of the same site
Close-up view of the same site
diameter>4mmdiameter>4mm • Stone was fragmentized by Lithotripter
• Debris extracted by wire basket
• Stone was fragmentized by Lithotripter
• Debris extracted by wire basket
Electrohydraulic Shockwave Electrohydraulic Shockwave LithotripsyLithotripsy
Holmium laser probeHolmium laser probe
Laser fragmentationLaser fragmentation
Stone debris extracted by wire basketStone debris extracted by wire basket
Sialendoscopy in our Sialendoscopy in our departmentdepartment
1999 2002 2003
Sialolith removal by Sialolith removal by graspergrasper
Radiolucent sialolithRadiolucent sialolith
Mucus plug---Lavage and Mucus plug---Lavage and dilationdilation
Thank youThank youThank youThank you
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