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Chronic Obstructive Sialadenitis & Sialendoscopy

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.

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Chronic Obstructive Sialadenitis & Sialendoscopy

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  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 SystemThomas Wharton, 1659 • Sublingual Ductal SystemCasparus 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 ofChronic 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

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

  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 KatzFlexible mini-endoscope • 1993 KonigsbergerEndoscopic 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. Sialolith 80%~90% in Submandibular gland First branch of duct Main duct

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

  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

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