with Dr. David Cognetti
BackTable, LLC (Producer). (2021, June 22). Ep. 25 – Sialendoscopy [Audio podcast]. Retrieved from https://www.backtable.com/ent
We talk with Dr. David Cognetti about sialendoscopy including the importance of patient selection as well as tips and tricks for success.
Dr. David Cognetti
Dr. David Cognetti is Chairman of Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University.
Dr. Gopi Shah
Host Dr. Gopi Shah is a practicing ENT at UT Southwestern Medical Center in Dallas, TX.
Dr. Ashley Agan
Co-host Dr. Ashley Agan is a practicing ENT and assistant professor at UT Southwestern Medical Center in Dallas, TX.
In this episode, Dr. David Cognetti joins Dr. Gopi Shah and Dr. Ashley Agan to discuss the workup for salivary gland obstruction and inflammation, the emerging use of sialendoscopy, and different approaches to sialolithotomy.
First, the doctors highlight key aspects of physical examination: observing swelling around the glands, bimanually palpating for stones, and massaging the glands to observe the quantity and quality of saliva produced. For imaging, Dr. Cognetti typically orders CT for suspected stones and MRI for suspected inflammatory disorders. He describes the process of sialography, noting that the outcome may be technician-dependent. The doctors also discuss inflammatory cases where laboratory tests may be appropriate and can reveal autoimmune disorders.
Then, Dr. Cognetti describes his preferred sialendoscopy tools and how he uses them to cannulate and dilate the parotid and submandibular ducts during surgery. He emphasizes the fragile nature of the scopes and the need to protect them from damage. For sialolithotomy, he describes various methods of lithotripsy and ways to prevent thermal damage. He also discusses how he deals with duct perforation and how he decides whether or not to use stents.
The doctors bring up management of patient expectations throughout the episode, as outcomes may vary depending on the individual’s history of stone recurrence.
“Sonopalpation: A Novel Application of Ultrasound for Detection of Submandibular Calculi” - https://journals.sagepub.com/doi/10.1177/0194599814545736?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
“Limited Distal Sialodochotomy to Facilitate Sialendoscopy of the Submandibular Duct” - https://onlinelibrary.wiley.com/doi/full/10.1002/lary.23801
4th Annual Jefferson Sialendoscopy Course- https://cme.jefferson.edu/content/sialendoscopy2021#group-tabs-node-course-default1
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