Doctors don’t know why some people will develop a
stone in a tiny salivary duct. It may be no bigger
than the tip of a pen, but it can be just big enough
to block the duct and lead to a painful swollen
gland, trouble eating and other symptoms. The good
news is that doctors are learning that removing such
a stone doesn’t always have to be a major process.
Yale is a leader in the region—and one of only a few
providers in Connecticut—to offer a minimally
invasive technique to treat salivary blockages using
salivary endoscopy. “The salivary endoscopy
procedure can be the difference between open surgery
in the head and neck area, which carries more
risk—and a minimally invasive experience with a lot
less pain,” said Saral M ehra, M.D., a Yale head and
neck cancer and reconstructive surgeon.
James Clinton, 62, who lives in Meriden, came to
Mehra after four years of frustrating glandular
swelling and facial pain, restricted jaw movement,
and other symptoms that had stumped his doctors and
been diagnosed more than once as a virus. “It was
like having a constant toothache,” said Clinton, who
resorted to eating soft foods.
The endoscopy procedure involved general anesthesia
in the hospital, but Clinton said it was worth it.
“Once I was home and the medication wore off, I saw
that my face wasn’t puffy, and I had the freedom of
opening my mouth properly again,” he said.
Yale specialists perform an average of one to two
salivary endoscopies a week, often on “young,
healthy patients,” although they are especially
common among the elderly and turn up in other age
groups, including infants in the first weeks of
life.
Patients typically complain about painful glandular
swelling that gets worse when the salivary flow is
stimulated by hunger or chewing, or the smell or
taste of food. A workup with a CT scan or MRI often
shows that they have sialolithiasis—one or more
benign salivary stones—blocking a duct.
A salivary endoscopy can take anywhere from one to
three hours, and typically involves general
anesthesia. The surgeon inserts an endoscope that is
.8 to 1.6 millimeters in size, with a small camera
attached into the salivary duct through the mouth.
After the procedure the patient goes home with a
little acetaminophen for pain. “For small stones,
the patient will be eating and drinking the next
day,” said Mehra.
“For small to medium-sized stones, this is the way
to go, this is the way of the future,” Mehra said.
Larger stones, sometimes as big as a pencil eraser,
may require a combined open/endoscopic procedure
that could involve incisions in the floor of the
mouth, he said.
While the majority of patients have stones, some
have salivary blockage for other reasons. Thyroid
cancer patients may develop duct obstructions as a
side effect of radioactive iodine treatments; others
have blockage linked to an autoimmune disease,
taking certain medications, and age-related function
decline. “It all comes down to duct obstruction,
whether it’s a stone, stenosis or a mucous plug. The
gland swells up, they start eating and making saliva
and the gland gets obstructed,” said Mehra.
While most ear, nose and throat providers know about
salivary endoscopy, Mehra believes the procedure
will become more common as patients and primary care
physicians learn about it.
Meanwhile, Mehra, is tracking his outcomes, and is a
participant in an international group that is
studying the procedure to learn more about its
short- and long-term success. “We know we’re helping
with the stones; we want to know more about
blockages caused by other problems, such as
Sjögren's syndrome and juvenile recurrent parotitis,
and why some patients have recurrent swelling,” he
said. “We want to learn more about how this
procedure can help.”
For more information
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