Sialendoscopy: Office-Based Techniques & Best Practices

[Dr. Ashley Agan]:
Got you. Who is a good candidate to do it in the office? Because I'm sure you still do it in the OR a fair amount, depending on the patient. As you're moving patients to the office, who's the best person to do a sialendoscopy in the office?

[Dr. Wais Rahmati]:
Anyone who I'm concerned has an obstructive problem with their salivary gland. Then patients with small stones either found on imaging or where I have suspicion that they have a stone where you can't palpate it, but sometimes you may actually see it. You may see it, so I use a microscope in my office for every patient encounter.

[Dr. Ashley Agan]:
Rather than loops. Microscope instead of loops. Okay.

[Dr. Wais Rahmati]:
Correct. I have the microscope set up there. I immediately just do an oral cavity examination with the microscope and under high power magnification, sometimes you see these small 2, 3-millimeter stones that they're actually mobile. You can see them move in and out to the distal duct at the punctum. Someone like that, where you can see a small stone, or it just seems like it's very classic recurrent symptoms at mealtime, where it's probably a small floating stone that you can't palpate. That's a perfect setup for sialendoscopy. Then almost every patient who has at least a single gland, single parotid gland, who comes in with a story of recurrent swelling or even chronic pain or intermittent pain, these are all patients that I offer office-based sialendoscopy to.

I think that when someone comes in and they have multiglandular involvement and you're worried about an inflammatory autoimmune process, those are patients initially, I would say, are better in the operating room setting to evaluate. They can be quite tender as well due to the underlying inflammation in the glands, but even in my practice, as it's evolved, most of those patients get four-gland sialendoscopy in the office now, unless they're particularly tender or they're very concerned about pain.