Introduction
Interventional sialendoscopy has evolved into a range of endoscopic approaches and combined (transoral and external) approaches to manage salivary stones and ductal stenosis in an effort to facilitate gland preservation. Intervention may involve endoscopic therapies like mechanical or balloon dilations, lithotripsy, or open sialodochotomy with or without repair. A constant area of questioning debate around these interventions in the use of a salivary stent – specifically: is stenting indicated, what are types of stents to be used, duration of stenting, and medical management around stenting with antibiotics.
Indications for Salivary Duct Stenting
There is a lack of consensus among experts and in the literature on the benefits of stenting. However, common indications for short-term salivary duct stenting (ranging from 2–8 weeks) include: sialodochotomy, either in the distal papilla to avoid or treat papillary stenosis; mid-ductal or proximal sialodochotomy as a part of a combined approach procedure for stone or stenosis; duct repair after transection of the duct; post-dilation of ductal stenosis; or after traumatic laser sialolithotripsy causing endoluminal thermal damage. Intraoperative stenting of the submandibular and parotid duct can be very useful to help identify and preserve these structures during surgical excision of floor of the mouth lesions (e.g., sublingual gland excision for ranula) and buccal space masses, respectively.
Types of Stents
Common stents used for stenting the salivary ducts have included hypospadias Silastic tubes, pediatric feeding tubes, shape-memory starch-based stents, sialostents, Venflon tubes (BD, Franklin Lakes, NJ), epidural catheters, vascular radiologic flexible catheters, polyurethane-based stents, polymeric stents, and coronary stents. In addition, a number of proprietary salivary stents have been developed and are available commercially. The commercially available stents in North America include stents manufactured by Hood Laboratories, Pembroke, MA (Walvekar Salivary Duct Stent 0.6 mm, 1.0 mm, 1.2 mm with guidewire and 1.4 mm with guidewire and irrigating catheter, Schaitkin Salivary Cannula 1.5 mm and 2 mm) ( Figs. 30.1 , 30.2 ), as well as those made by Ad-Tech-Med (Types 1, 2, and 3).
