The symptoms of obstructive salivary gland diseases include recurrent, painful swelling of the major salivary glands, and these symptoms can lead to a marked reduction in the patient’s quality of life [3, 9]. Previously, radiosialography, sonography, and MR sialography were used to diagnose salivary gland diseases. Radiosialography is the primary method of examination of salivary ducts, which can be used to diagnose gland lesions by acquiring images after injecting contrast media into the duct. However, it is contraindicated when there is an adverse reaction to the contrast media or an acute infection. Sonography is noninvasive and useful for the diagnosis of salivary gland calculi, but this technique depends on the experience and technique of the surgeon and is difficult to use for diagnosing disorders in the duct. MR sialography is another noninvasive method that can overcome the existing limitation by showing the entire salivary duct system, but it can cause distortion artifacts due to intraoral restorations. However, as the introduction of salivary endoscopy enabled direct visualisation of the duct system, these diagnostic limitations were overcome. Moreover, it is less invasive than conventional surgical methods for patients with stenosis or stones in the duct system or sialadenitis, which can reduce the discomfort of patients and alleviate symptoms [1, 4, 6, 10].
A few research groups have also investigated patient satisfaction after sialendoscopy-guided treatment for obstructive salivary gland diseases. Kroll et al., using the Short Form 36 (SF-36) questionnaire, found a high level of patient satisfaction [9, 11]. Aubin-Pouliot et al., using a questionnaire designed to obtain a chronic obstructive sialadenitis score showed similar results. The results showed that symptoms decreased significantly after sialendoscopy-assisted salivary duct surgery in submandibular glands more than in parotid glands [9, 12].
Recent studies have shown that microsialoliths play a major role in the pathogenesis of chronic sialadenitis. They can accumulate in normal salivary glands and lead to obstructive atrophy. This atrophy enables colonisation and proliferation of microbes, causing inflammation in the periphery duct system, followed by more severe atrophy and progressive infection, leading to chronic sialadenitis [3]. According to Quinn et al., intraductal instillation of penicillin allows antibiotics to reach the remaining microbes in the parenchyma, thus helping to relieve symptoms, but equally good results can be obtained with saline irrigation itself, which may be considered a more important factor [3, 13].
Radioactive iodine (RAI) therapy is another cause of salivary gland disease. According to Kim et al., chronic sialadenitis is the most common complication of RAI for the removal of remnant tissue after thyroidectomy. The prevalence of chronic RAI sialadenitis is 11–65% after RAI therapy. RAI-induced salivary gland damage results in obstructive sialadenitis, presenting recurrent swelling with or without pain at mealtime. In the chronic state, it further causes hypo-salivation and leads to other complications, such as speech and swallowing difficulties, taste alterations, oral candidiasis, and dental caries. Currently, RAI-induced chronic sialadenitis is treated conservatively by ensuring good oral hygiene and frequent hydration, using salivary substitutes and salivary stimulatory treatments, such as gland massage [14, 15]..
According to Kim’s study, sialendoscopy showing sialocentesis effect (intraductal irrigation with sterilized normal saline) could improve obstructive symptoms 3 months after sialendoscopic mechanical dilation; however, sialendoscopic treatment for chronic RAI sialadenitis was found to have some limitations in its ability to relieve xerostomia and improve weakened salivary gland functions [15].
This study was conducted to report the use of a sialendoscope in removing salivary stone. Recently, the development of salivary endoscopy has overcome the limitations of conventional methods and has become applicable in the diagnosis and treatment of salivary stones. Further, the patients’ discomfort is less compared with the conventional procedures. In this case, the patient had complete relief from foreign body sensation after surgery and showed slight relief from dryness. There were no significant complications after the operation and no significant side effects during the follow-up period.