Download Chronic Obstructive Sialadenitis

Chronic Obstructive Sialadenitis
&
Sialendoscopy
Anatomy--Salivary gland
Parotid Ductal System
Nicolaus Stenonius
1660
Stensen’s duct
Anatomy--Salivary gland
Bartholin’s duct
• Submandibular Ductal System
Thomas Wharton, 1659
• Sublingual Ductal System
Casparus Bartholinus, 1690
Wharton’s duct
Chronic Obstructive
Sialadenitis
 Chronic
Obstructive
Parotitis
 Submandibular
sialadenitis
Chronic Obstructive Parotitis

Etiology

Clinical manifestations

Diagnosis

Treatment
Etiology of
Chronic Obstructive Parotitis

Scar

Sialolithiasis

Anatomy
Clinical manifestations

Recurrent swelling and pain
of the gland

Purulent discharge
Diagnostic methods

Plain radiographs

Sialography

Ultrasound

Scintigraphy(闪烁扫描法)

CT

MRI
Sialography
“Sausage like” appearance
of enlarged duct
MRI
Appearance of enlarged duct
Sialendoscopy
Dilation
Sialography
Stenosis
Endoscopy
Differentiating diagnosis

Chronic recurrent parotitis

SjÖgren syndrome
Treatment

systemic antibiotic administration

Sialogogues(促唾剂)

Gland massage

Drug lavage(灌洗) and perfusion

Duct ligation

Parotidectomy

Tympanic(鼓室) neurectomy
Submandibular sialadenitis
and
Sialolithiasis
Etiology of
Submandibular
sialadenitis

Sialolithiasis

Trauma

Infection

Foreign body
Sialolithiasis
1. Anatomy



Upwarding route
Longer duct
Curve duct
Reasons of arising
2.Components of saliva

Mucus protein

Calcium content
Manifestations

Intermittent swelling of the
gland

Aggravating with taking food

Acute infection
Diagnostic methods

plain radiographs

sialography

ultrasound

CT scan

Sialoendoscopy
Plain radiographs
One
Two
Three
Sialography &
CT
Sialolith
Sialoendoscopy
Stone in main duct
Stone in second
branch duct
Stone embedded
Differentiating diagnosis

Tumor in sublingual gland

Tumor in submandibular gland

KÜtter tumor

Space infection in submandibular region

Lymphadenopathy
Traditional treatment

Intraoral route

Sialadenectomy via external
approach
New technique
Sialendoscopy

Diagnostic Sialendoscopy

Interventional Sialendoscopy
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
Diagnostic Sialendoscopy
First generation branches
Second generation branches
Types of obstructions

Sialolith

Polyps

Stricture

Kink

Foreign body

Anatomic malformation
Sialolith
80%~90% in Submandibular gland
First branch of duct
Main duct
Polyps and Mucous Plug
Sialolith
10%~30% in Parotid gland
Mucous Plug
Sialolith?
Interventional Sialendoscopy

Grasping wire basket

Biopsy forceps

Balloon-tipped catheter

Custom papilla dilator

Electrohydraulic lithotripter

Holmium laser probe
Grasping wire basket
diameter<4mm
Balloon-tipped catheter
Ductal Stenosis
Stenosis in the second branch
Close-up view of
the same site
Electrohydraulic Shockwave
Lithotripsy
diameter>4mm
• Stone was fragmentized by Lithotripter
• Debris extracted by wire basket
Holmium laser probe
Laser fragmentation
Stone debris extracted by wire basket
Sialendoscopy in our department
1999
2002
2003
Sialolith removal by grasper
Radiolucent sialolith
Mucus plug---Lavage and
dilation
Thank you