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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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anatomy salivary gland
Anatomy--Salivary gland

Parotid Ductal System

Nicolaus Stenonius

1660

Stensen’s duct

anatomy salivary gland3
Anatomy--Salivary gland

Bartholin’s duct

  • Submandibular Ductal SystemThomas Wharton, 1659
  • Sublingual Ductal SystemCasparus Bartholinus, 1690

Wharton’s duct

chronic obstructive sialadenitis
Chronic Obstructive Sialadenitis
  • Chronic Obstructive Parotitis
  • Submandibular sialadenitis
chronic obstructive parotitis
Chronic Obstructive Parotitis
  • Etiology
  • Clinical manifestations
  • Diagnosis
  • Treatment
clinical manifestations
Clinical manifestations
  • Recurrent swelling and pain of the gland
  • Purulent discharge
diagnostic methods
Diagnostic methods
  • Plain radiographs
  • Sialography
  • Ultrasound
  • Scintigraphy(闪烁扫描法)
  • CT
  • MRI
sialography
Sialography

“Sausage like” appearance of enlarged duct

slide10
MRI

Appearance of enlarged duct

sialography endoscopy
Sialography Endoscopy

Sialendoscopy

Dilation

Stenosis

differentiating diagnosis
Differentiating diagnosis
  • Chronic recurrent parotitis
  • SjÖgren syndrome
treatment
Treatment
  • systemic antibiotic administration
  • Sialogogues(促唾剂)
  • Gland massage
  • Drug lavage(灌洗) and perfusion
  • Duct ligation
  • Parotidectomy
  • Tympanic(鼓室) neurectomy
etiology of submandibular sialadenitis
Etiology of Submandibular sialadenitis
  • Sialolithiasis
  • Trauma
  • Infection
  • Foreign body
sialolithiasis reasons of arising
1. Anatomy

Upwarding route

Longer duct

Curve duct

2.Components of saliva

Mucus protein

Calcium content

SialolithiasisReasons of arising
manifestations
Manifestations
  • Intermittent swelling of the gland
  • Aggravating with taking food
  • Acute infection
diagnostic methods18
Diagnostic methods
  • plain radiographs
  • sialography
  • ultrasound
  • CT scan
  • Sialoendoscopy
plain radiographs
Plain radiographs

One Two Three

sialoendoscopy
Sialoendoscopy

Stone in second branch duct

Stone embedded

Stone in main duct

differentiating diagnosis22
Differentiating diagnosis
  • Tumor in sublingual gland
  • Tumor in submandibular gland
  • KÜtter tumor
  • Space infection in submandibular region
  • Lymphadenopathy
traditional treatment
Traditional treatment
  • Intraoral route
  • Sialadenectomy via external approach
new technique sialendoscopy
New technique Sialendoscopy
  • Diagnostic Sialendoscopy
  • Interventional Sialendoscopy
history of the sialendoscopy
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
diagnostic sialendoscopy
Diagnostic Sialendoscopy

First generation branches

Second generation branches

types of obstructions
Types of obstructions
  • Sialolith
  • Polyps
  • Stricture
  • Kink
  • Foreign body
  • Anatomic malformation
slide28

Sialolith

80%~90% in Submandibular gland

First branch of duct

Main duct

slide29

Polyps and Mucous Plug

Sialolith

10%~30% in Parotid gland

Mucous Plug Sialolith?

interventional sialendoscopy
Interventional Sialendoscopy
  • Grasping wire basket
  • Biopsy forceps
  • Balloon-tipped catheter
  • Custom papilla dilator
  • Electrohydraulic lithotripter
  • Holmium laser probe
balloon tipped catheter
Balloon-tipped catheter

Ductal Stenosis

Stenosis in the second branch

Close-up view of the same site

electrohydraulic shockwave lithotripsy
Electrohydraulic Shockwave Lithotripsy
  • Stone was fragmentized by Lithotripter
  • Debris extracted by wire basket

diameter>4mm

holmium laser probe
Holmium laser probe

Laser fragmentation

  • Stone debris extracted by wire basket