1. Chronic Obstructive Sialadenitis & Sialendoscopy

2. Anatomy--Salivary gland
Parotid Ductal System
Nicolaus Stenonius
1660
Stensen’s duct

3. Anatomy--Salivary gland
Bartholin’s duct
Submandibular Ductal System Thomas Wharton, 1659
Sublingual Ductal System Casparus Bartholinus, 1690
Wharton’s duct

4. Chronic Obstructive Sialadenitis
Chronic Obstructive Parotitis
Submandibular sialadenitis

5. Chronic Obstructive Parotitis
Etiology
Clinical manifestations
Diagnosis
Treatment

6. Etiology of Chronic Obstructive Parotitis
Scar
Sialolithiasis
Anatomy

7. Clinical manifestations
Recurrent swelling and pain of the gland
Purulent discharge

8. Diagnostic methods Plain radiographs Sialography Ultrasound
Scintigraphy(闪烁扫描法) CT
MRI

9. Sialography
“Sausage like” appearance of enlarged duct

10. MRI
Appearance of enlarged duct

11. Sialography Endoscopy
Sialendoscopy
Dilation
Stenosis
Sialography Endoscopy

12. Differentiating diagnosis
Chronic recurrent parotitis
SjÖgren syndrome

13. Treatment systemic antibiotic administration Sialogogues(促唾剂)
Gland massage
Drug lavage(灌洗) and perfusion
Duct ligation
Parotidectomy
Tympanic(鼓室) neurectomy

14. Submandibular sialadenitis and Sialolithiasis

15. Etiology of Submandibular sialadenitis
Sialolithiasis
Trauma
Infection
Foreign body

16. Sialolithiasis Reasons of arising
1. Anatomy
Upwarding route
Longer duct
Curve duct
2.Components of saliva
Mucus protein
Calcium content

17. Manifestations Intermittent swelling of the gland
Aggravating with taking food
Acute infection

18. Diagnostic methods plain radiographs sialography ultrasound CT scan
Sialoendoscopy

19. Plain radiographs
One Two Three

20. Sialography & CT
Sialolith

21. Sialoendoscopy Stone in second branch duct Stone embedded
Stone in main duct

22. Differentiating diagnosis
Tumor in sublingual gland
Tumor in submandibular gland
KÜtter tumor
Space infection in submandibular region
Lymphadenopathy

23. Traditional treatment
Intraoral route
Sialadenectomy via external approach

24. New technique Sialendoscopy
Diagnostic Sialendoscopy
Interventional Sialendoscopy

25. History of the Sialendoscopy
1991 Katz Flexible mini-endoscope
1993 Konigsberger Endoscopic intracorporeal lithotripsy
1994 Arzoz Endoscopic intracorporeal lithotripsy
Nahlieli Sialendoscopy
1995 Marchal Sialendoscopy
1999 Our Dept. Yu

26. Diagnostic Sialendoscopy
First generation branches
Second generation branches

27. Types of obstructions Sialolith Polyps Stricture Kink Foreign body
Anatomic malformation

28. 80%~90% in Submandibular gland
Sialolith
80%~90% in Submandibular gland
First branch of duct
Main duct

29. Polyps and Mucous Plug Sialolith 10%~30% in Parotid gland

30. Interventional Sialendoscopy
Grasping wire basket
Biopsy forceps
Balloon-tipped catheter
Custom papilla dilator
Electrohydraulic lithotripter
Holmium laser probe

31. Grasping wire basket
diameter<4mm

32. Balloon-tipped catheter
Ductal Stenosis
Stenosis in the second branch
Close-up view of the same site

33. Electrohydraulic Shockwave Lithotripsy
Stone was fragmentized by Lithotripter
Debris extracted by wire basket
diameter>4mm

34. Holmium laser probe Laser fragmentation
Stone debris extracted by wire basket

35. Sialendoscopy in our department
2002
1999
2003

36. Sialolith removal by grasper

37. Radiolucent sialolith

38. Mucus plug---Lavage and dilation

39. Thank you