Sialendoscopy #1

DATE OF OPERATION:
08/19/2022

PREOPERATIVE DIAGNOSIS:
Diffuse sialadenitis involving submandibular and parotid glands with disseminated actinomycosis.

POSTOPERATIVE DIAGNOSIS:
Diffuse sialadenitis involving submandibular and parotid glands with disseminated actinomycosis.

PROCEDURES:
Four-gland sialendoscopy and sialodochoendoscopy with ductal irrigation and drainage.
Sialodochoplasty x4.

SURGEON:
Edward J. Hepworth, MD

ANESTHESIA:
General endotracheal.

FLUIDS:
1000 mL crystalloid.

ESTIMATED BLOOD LOSS:
None.

FINDINGS:
Obstruction of 4 glands, bilateral Stensen’s and Wharton’s duct, with a chalky debris and immediate improvement of salivary flow after flushing and endoscopic dilation of the duct.

DISPOSITION:
To recovery room in stable condition.

INDICATIONS FOR PROCEDURE:
John is 42 and has been a patient of mine for several years having presented with facial actinomycosis and inflammatory cellulitis. This has been undulating, fluctuating, and not quite ever definitively disappearing causing multiple head and neck and facial abscess infection problems including mastoiditis, sinusitis, facial cellulitis, and periodontitis. At this time, the main frustration Mr. Zoubek is having is facial parotid pain and sublingual submandibular gland and sublingual gland pain. This by palpation and other studies including imaging of his face seems to be due to obstruction and dilation of his salivary duct, so coming to address this today.

PROCEDURE DESCRIPTION:
The patient was brought to the operating room and placed supine on the table. General anesthesia was induced. An oral endotracheal tube was placed. After sufficient anesthesia was accomplished, the tongue was retracted anteriorly and superiorly to visualize the Wharton’s duct puncta, which were obstructive. A series of sharp dissections were used to carefully reopen the duct puncta in such a way that further larger dilation was allowable. The sialendoscope dilators were then passed into the duct openings so that a series of sialendoscopes could be passed more proximal to the glands through the ducts. Ultimately, endoscopy was performed, and under direct view, several concretions removed from each of the Wharton’s duct until the acinus of the submandibular gland was reached. No stones were seen within the gland. The duct was seen to have been obstructed and now unobstructed such that salivary flow gust out of the gland into the proximal duct and then eventually into the floor of the mouth.

Similarly, the parotid Stensen’s duct on each side was partially obstructed. A sharp instrument was used to re-access the duct and open it widely into the buccal mucosa. Through this was then passed punctal dilators until a 1.5 mm sialendoscope was easily passed into the duct, also to the acinus of the parotid gland. Transiting through the duct revealed several concretions behind, which would trap salivary collections. Ultimately, these were all lavaged until normal duct caliber with clear mucosal unobstructed lumen was restored. The patient was then suctioned, awakened from anesthesia, extubated, and brought to the recovery room in satisfactory condition.