A cutting-edge procedure, called sialendoscopy, offers an alternative to surgery for non-cancerous issues affecting the salivary glands, such as stones and other obstructions.
Last month, Mass Eye and Ear became one of a handful of hospitals in the country to perform a procedure called sialendoscopy during an outpatient office visit. This minimally-invasive technique, which diagnoses and treats issues affecting the salivary glands, is more commonly performed in an operating room under general anesthesia. Wais Rahmati, MD recently brought sialendoscopy to Mass Eye and Ear, and Focus spoke with him about it along with which patients might be candidates.
“Sialendoscopy has dramatically changed our approach to obstructive salivary gland disease,” said Dr. Rahmati, a physician and surgeon in the Department of Otolaryngology—Head and Neck Surgery at Mass Eye and Ear. “Patients are able to have the procedure done in the office and leave immediately afterwards, and the recovery can be faster.”
Dr. Rahmati answered some frequently-asked questions about sialendoscopy.
What is sialendoscopy?
Sialendoscopy involves the insertion of a tiny telescope (sialendoscope), through the openings of salivary glands that are found inside the mouth, in order to diagnose and treat various conditions. The sialendoscopes are 0.8 to 1.6 mm in diameter and allow for irrigation (rinsing) of the glands, delivery of steroids and insertion of instruments such as baskets and balloon to treat stones and strictures (narrowing) inside the salivary glands. It is a minimally-invasive and gland-sparing procedure that has fewer side effects than open salivary gland surgery.
With experience and the proper resources in place, we can perform a sialendoscopy under local anesthesia during an outpatient office visit. Unlike usual preparation for surgery in the operating room, patients can eat and drink prior to the procedure and do not need anyone to take them home.
What issues can affect the salivary glands?
We have three pairs of major salivary glands – the parotid glands, submandibular glands and sublingual glands – which altogether produce up to 1.5 liters of saliva daily. All these glands empty saliva into the mouth through small openings called ducts. If the ducts are damaged or obstructed, people can experience issues with taste, difficulty chewing and swallowing, and an increased risk for other mouth problems such as cavities, tooth loss and infections.
Small stones that form in the ducts may obstruct the flow of saliva causing pain, swelling and infection. Mucus buildup can also cause a blockage. There are some diseases, such as the autoimmune disease Sjogren’s syndrome, which can inflame the salivary glands and cause narrowing of the ducts. Patients with thyroid cancer who have been treated with radioactive iodine may also experience buildup in the salivary glands. Those with these issues may benefit from sialendoscopy, which may also help children with recurrent inflammation of the parotid glands.
What are the symptoms of a salivary gland obstruction that should prompt an appointment?
Salivary gland problems can catch people off guard. Oftentimes, people will have gland pain, swelling and dry mouth, which might result in a trip to the doctor. These symptoms can indicate an infection or happen recurrently around mealtime. Some people experience symptoms for months or years before checking in with a doctor.
A primary care doctor, emergency room, or ENT might be sought out by someone experiencing significant pain and swelling of the salivary gland. For recurrent or complex issues, patients may get referred to a clinic like ours that specializes in salivary gland disorders. Those who are interested may reach out to our clinic directly for an appointment to determine whether they are a candidate for sialendoscopy.
When might a patient need an intervention or surgery?
When the cause of salivary gland swelling or pain is unclear, sialendoscopy may be offered as a diagnostic tool in the office setting. If a problem is identified, it may be addressed right there during the same procedure. For a more complex issue, a trip to the operating room may be necessary. We tailor the treatment to each patient’s preference and unique condition.
For patients with salivary stones, the size and location of the stone will determine the possibility of an in-office sialendoscopy. Stones smaller than 5 mm are generally successfully treated in the office. Sometimes, a small incision is required to release the stone from the duct. For larger stones, the procedure may be recommended in an operating room.
Other salivary gland issues, such as benign or malignant tumors, will require open salivary gland surgery in an operating room. A proper diagnosis can help determine the best course of treatment.
About Our Expert
Dr. Wais Rahmati is a member of the Department of Otolaryngology—Head and Neck Surgery at Mass Eye and Ear who specializes in endoscopic management of salivary gland disorders. Dr. Rahmati developed one of the largest practices for sialendoscopy in the New York tri-state area before recently joining Mass Eye and Ear. He sees patients at the Main Campus.