Department of Otorhinolaryngology - Head and Neck Surgery

UT Health Medical School

Newsletters

Sialendoscopy: An Innovative Minimally Invasive Approach to the Treatment of Sialolithiasis

When Vida Smith Compton first saw otorhinolaryngologist Sancak Yuksel, M.D., in late summer 2013, she had pain and swelling beneath the ventral surface of her tongue on the right side, and in her neck under the mandible.

“I looked like I had the mumps under my right jaw, and I could hardly swallow,” says the 67-year-old Wharton, Texas, resident, who has a history of blocked salivary gland ducts going back to her teenage years. “Years ago, my ENT showed me how to manipulate the glands to release trapped saliva. But this time I was sore from my right ear all the way down to the middle of my chin, and it was too painful to touch.”
A CT scan revealed three large sialoliths – calcified masses also known as salivary stones – in the submandibular gland, the most common location. Sialoliths are found less commonly in the parotid gland, and rarely in the sublingual gland or minor salivary glands.

SY by-line“We suspect sialolithiasis if swelling occurs when salivary flow is stimulated by the sight, smell or taste of food,” says Dr. Yuksel, an assistant professor in the department of Otorhinolaryngology—Head and Neck Surgery at UTHealth Medical School. “If we’re lucky, we can see the swollen gland or locate the stones by palpating around the orifice of the gland duct or in the floor of the mouth. Otherwise, we rely on a CT scan to reveal density in the gland.”

The traditional method of treating sialolithiasis unresponsive to conservative management has been surgical excision of either the stone or the involved gland. Compton, however, was the beneficiary of a relatively new procedure called sialendoscopy. Used both diagnostically and therapeutically, sialendoscopy is a technically challenging procedure that allows endoscopic visualization of the gland and nonsurgical removal of stones small enough to fit through the duct, usually 5 millimeters or less in diameter.

Dr. Yuksel took Compton to the OR in October 2013. Using a very fine 1.1-millimeter endoscope equipped with a wire basket, he visualized the three stones, which ranged in size from 8 to 12 millimeters in diameter. “The stones were situated back to back like train cars and were so large that they were beyond the grasp of the basket,” he says. “I was able to maneuver the endoscope behind the farthest stone and use the basket to pull all three stones to the orifice of the duct.”

Sialendoscopy REV

After making a tiny nick in the orifice, Dr. Yuksel removed all three sialoliths successfully. He re-scoped to check for smaller stones, cleaned the entire duct system of debris and sutured a tiny piece of plastic tubing in place as a stent to hold the orifice open. “The beauty of sialendoscopy is being able to provide patients relief with no external scar, no nerve damage and a lower risk of surgery-related complications,” he says.
Compton, who healed quickly, believes her salivary stones may have been caused by dehydration. Other causes may include abnormalities in calcium metabolism, reduced salivary flow rate, altered acidity of saliva caused by oropharyngeal infections and receiving radioactive iodine.

“I think Dr. Yuksel was shocked when he saw how big my stones were,” says Compton, who says that bad situations bring out her sense of humor. “Personally, I think he’s a really, really good doctor and a very thorough surgeon. I feel truly blessed to have been referred to him for a problem that came up in a matter of days. After the surgery, I told him I wanted the stones back so I could make a necklace. They’re mine, after all. I made them.”

Subscribe to our newsletters!

ORL Update UT ORL Update, our first on-line departmental newsletter, summarizes current topics in otorhinolaryngology. The newsletter’s target audience includes both physicians and other healthcare providers, although subscriptions are not limited to members of these groups.

ORL Progress Notes ORL Progress Notes, our second on-line departmental newsletter, provides information about developments in the Department. The newsletter’s target audience includes physicians and healthcare professionals as well as patients and members of the general public.

To subscribe, please fill in your contact information and select the newsletter(s) you would like to receive. Of course, you may opt out of any of the newsletters at any time.

UT ORL Progress Notes

A Gift of Hearing
In 2014, Houston-based MicroSeismic, Inc., made a $50,000 donation to the Memorial Hermann Foundation to help Children’s Memorial Hermann Hospital... Read the full article...

Breath of Fresh Air
Many of us have a touch of “sinus” from time to time. But for Sandra Butcher, a sinus problem turned... Read the full article...

Current Pediatric Guidelines for Tonsillectomy
Tonsillectomy is the third most common procedure performed on children in the United States – after circumcision and myringotomy with... Read the full article...

Profile in Caring: José Elías, RN, CORLN
When José Elías was 10 years old, his mother, a Red Cross nurse, began making neighborhood house calls after hours... Read the full article...

Amber Luong, MD, PhD, Awarded CCTS Grant in Support of Continued Chronic Rhinosinusitis Investigations
An immune-mediated inflammatory disease involving the paranasal sinuses, chronic rhinosinusitis (CRS) affects more than 10 percent of the population and... Read the full article...

UT ORL Update

Coding for Innovation
Otorhinolaryngologists, like other physicians, consider innovation to be a core driver in improving the health of patients, since innovation offers... Read the full article...

Management of Thyroid Nodules in Children
In contrast to adults, the diagnosis of a thyroid nodule in children is rare. In these cases, the workup and... Read the full article...

What is Laryngoplasty?
Often in medicine, our ability to treat disease outpaces our reconstructive capacity.  This was long the case in Otolaryngology which... Read the full article...

New Clinical Practice Guideline for Tonsillectomy
A tremendous amount of media attention has been paid recently to tonsillectomy surgery in children, partially due to President Obama’s... Read the full article...

2011 CPT Introduces New Codes for Balloon Dilatation of Paranasal Sinus Ostia and Surgical Navigation
The 2011 edition of Current Procedure Terminology introduces several new codes that will likely have a major impact on the... Read the full article...