Saving Face with Sialendoscopy

Saving Face with Sialendoscopy

See how surgeon's help save a little girl's face.
If you suffer from salivary gland stones, you know how irritating they can be. The standard treatment is surgery, which can be risky and leave a huge scar.

For a teenage girl, that can be emotionally scarring. Now, there is a new, super tiny technology that allows surgeons to remove those stones without using the scalpel.

13-year-old Seara Schoenbeck enjoyed a healthy childhood, until about two years ago, when she started having pain in her mouth.

"I thought it was a cold sore," Seara Schoenbeck, told Ivanhoe.  "But then it kept on getting bigger and burst, and it kept on doing that over and over."

A stone was stuck in one of her submandibular glands and had to come out. The standard procedure is to surgically remove the entire gland.

"I was so scared about them going inside my neck," says Seara.

That's because there are several important nerves nearby that could get damaged. The thought of having an inch and a half long scar was also tough for Seara to swallow.

"To see her scared and worried hurt me," Richard Schoenbeck, Seara's father, told Ivanhoe.

That's when Richard went online and discovered a minimally-invasive alternative called sialendoscopy, performed by Doctor Gary Josephson at Nemours Children's Clinic.

"We can leave the glands alone and we can go in and take care of the problem," Doctor Josephson, told Ivanhoe.

Doctor Josephson entered the salivary duct and gland through the floor of the mouth using a diagnostic scope with a camera the size of a toothpick.

"While you're doing this, you're watching," says Dr. Josephson. "You're doing it off the monitor, so it looks to me like it's a giant!"

Once the camera is in, saline is run through the duct to keep it open, and a tiny drill is inserted to break up the stone and flush out the pieces.

If needed, a tiny wire basket is used to catch and pull out any remains.

"When we're done with this, there's minimal pain and you usually just need Tylenol or Motrin for a day and they're good to go," Doctor Josephson, explained.

Good to go, and extremely grateful.

"Grateful that I live in a technology world," says Seara.

Seara was put under anesthesia for the procedure, but was able to leave the hospital the same day.

She was back to normal in less than 24 hours. Compare that to the standard procedure that would require at least one or two days in the hospital and a longer recovery due to the incision and removal of the gland.

Doctor Josephson says Seara is his oldest sialendoscopy patient to date. He's performed the procedure on children as young as six-years-old.

If a surgeon is unable to remove the stone endoscopically, the gland would still have to be removed.

If you suffer from salivary gland stones, talk to your specialist about the best options for you.

Insurance companies typically cover this procedure.

BACKGROUND: A salivary gland stone, also called salivary duct stone, is a calcified structure that may form inside a salivary gland or duct. It can block the flow of saliva into the mouth. The majority of stones affect the submandibular glands located at the floor of the mouth. Less commonly, the stones affect the parotid glands, located on the inside of the cheeks, or the sublingual glands, which are under the tongue. Many people with the condition have multiple stones. (SOURCE: www.mayoclinic.com/health/kidney-stones)

CAUSES: The cause for salivary gland stones is unknown, but factors contributing to less saliva production and/or thickened saliva may be risk factors for salivary stones. These factors include: dehydration, poor eating, and use of certain medications, such as antihistamines. Trauma to the salivary glands may also raise the risk for salivary stones. (SOURCE: www.mayoclinic.com/health/kidney-stones)

SYMPTOMS: The stones cause no symptoms as they form, but if they reach a size that blocks the duct, saliva backs up into the gland, causing pain and swelling. Inflammation and infection within the affected gland may follow. (SOURCE: www.mayoclinic.com/health/kidney-stones)

TREATMENT: More and more, doctors are using a newer and less invasive technique called sialendoscopy to remove salivary gland stones. Developed and used successfully in Europe for a decade, sialendoscopy uses tiny lighted scopes, inserted into the gland's opening in the mouth, to visualize the salivary duct system and locate the stone. Then, using micro instruments, the surgeon can remove the stone to relieve the blockage. The procedure is performed under local or light general anesthesia, which allows the patient to go home right after the procedure. (SOURCE: www.mayoclinic.com/health/kidney-stones)

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FOR MORE INFORMATION, PLEASE CONTACT:

Erin Wallner
Nemours Children Hospital
Erin.Wallner@nemours.org

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