“Salivary gland Endoscopic Surgery (SES) – An alternative to salivary gland excision”
(No Scar, No Pain treatment for Salivary gland diseases)

Sialolithiasis (salivary gland stones) and chronic sialadenitis are the most common nonneoplastic disease of salivary gland. For these conditions total excision of the gland was the only solution available till now. At MCV ENT Trust hospital we have added Salivary gland Endoscopic Surgery (SES) to our armamentarium for the treatment of these diseases by using micro endoscopes.

We brought Endoscopic Sinus Surgery (FESS) to South India in 1990, now we are bringing Salivary gland Endoscopic Surgery (SES) in 2013.

Salivary gland Endoscopic Surgery (SES) is a relatively new OP based procedure, that allows endoscopic trans-luminal visualization of major salivary glands and offers a mechanism for diagnosing and treating both inflammatory and obstructive pathology related to the ductal system. Before the sialendoscopy we need a minimum of ultrasound of the gland and an X ray sialogram. Salivary gland Endoscopic Surgery (SES) is used to remove multiple stones from salivary ducts, intraductal masses and salivary sand (infected particles) from duct, dilate strictures, treat juvenile recurrent parotitis in children and to prevent external excision of salivary gland.

Following treatment of thyroid cancers with iodine 131 salivary gland ducts get swollen and patient gets recurrent painful swellings. This can be addressed by sialendoscopy and delivery of medicines intraductally to cure the problem.

Patients with refractory symptoms from any salivary gland pathology that does not respond to conservative management may benefit from interventional sialendoscopy, which yields success rates of 50-67%. Semirigid Compact Endoscopy (Fig:1) available at MCV ENT Trust Hospital gives an excellent optical quality and has a working channel for forceps, baskets, balloons, micro burr and laser probe. Additional channel for irrigation gives clear field while operating and also used to washout salivary sand. The cost of the operation is approximately the same as nasal endoscopic surgery. The procedure is done under local anaesthesia.

Disease Conventional Treatment Sialendoscopic Treatment
Submandibular & Parotid ductal Stones – Intra-oral excision or
– Gland excision.
– Silendoscopic removal with basket for small stones.
– Lithotripter for larger
stones.– less
than 5 mm stones can be removed by baskets,
balloons or forceps. Drill can
be used to make large stone smaller and then
Recurrent juvenile and i131 induced parotitis Only supportive treatment available till now. -Ductal system can be dilated, cleaned of fibrinous debris and intraductal medicines delivered.
Ductal strictures Gland excision – Intra ductal stenting.

Dr. Anand performing Salivary Endoscopy under local anesthesia,Large salivary calculi in the submandibular area. Upto 5mm stones can be extracted thru duct.We use drills to breakup larger stones to extract naturally. It is also possible to do cutdown through intraoral mucosa under endo guidance. Such cases may also get a stent for the duct.

Mr Sukumar, 45/M came with swelling below right side of jaw since one month which increases in size while having food. Sialogram showed large stone in right submandibular duct. He underwent sialendoscopy and removal of stone from right submandibular duct intraorally under LA on 13.08.2013.

46 yr old businessman from pollachi came with swelling below left side of jaw on and off increasing in size while having food. Sialogram showed 19X20 mm stone near hilum of left submandibular gland. He underwent sialendoscopy and removal of stone from left submandibular duct intraorally under LA on 19.08.2013.

Calculus extraction c basket

Calculus extraction c basket

Intraductal view of basket c stone

Calculus extraction c basket

Titanium basket c entrapped calculi

Removed calculi

Internal Mega Calculus Extraction

Extracted Mega Calculus from submandibular gland hilum during double

Sialendoscopy c Marchal endoscope

Sialendoscopy for ostial block DSC_0217.jpg – Removed calculi

Sialendoscopy c Erlangen sialendoscope

Sialendoscopy c Erlangen sialendoscope (black mark denote 1 cm)

Sialendoscopy c Erlangen sialendoscope

Sialendoscopy c drilling of Calculus

Multiple stones from one patient

Sialendoscope c basket and entrapped stone. Most of the stones are bigger than the scope & Scope has to be authodrawn out of extraction.

Multiple calculi.

Testimonials from Patients

Jayasuriya, 11 yr old boy from Negamam, a case of Recuurent Juvenile Parotitis.
My son has been absolutely fine with no pain or swelling after the endoscopic treatment. I am satisfied with the painless endoscopic treatment which was done under local anesthesia. My only worry is that my son’s condition is a recurrent problem but doctors at MCV have reassured that he will not need external operation and can be managed endoscopically…… Father.

Mohammad Ali, 54 yr old businessman from Erode, a case of Iodine 131 induced parotitis following radioablative treatment for papillary cancer thyroid.
I am totally satisfied with the endoscopic salivary gland treatment given at MCV. I don’t have any pain or swelling now, I am even able to enjoy pickles now which i couldn’t earlier because of severe pain. I am very grateful to not only Dr Anand and the other doctors at MCV but also to the nurses….. Md Ali.