No abstract

Sialendoscopy is a relatively new technique that is safe, minimally invasive and effective as a diagnostic as well as a therapeutic tool for the management of deep seated, proximal, salivary ductal obstruction. However, more than 20 years since its inception it is still not in mainstream use worldwide. Objectives Our aim of this study was to ascertain the awareness of sialendoscopy amongst the medical fraternity in South Africa. More specifically, to determine whether it was frequently used amongst practitioners and the type of cases managed using sialendoscopy. Methods An exploratory survey design involving 100 practitioners was used to collect data, using an online survey involving 10 closed-ended multiple choice questions. Results The results of the study revealed that while practitioners saw patients who could benefit from sialendoscopy, most practitioners did not feel comfortable performing the procedure independently, and as such, most patients were referred on to other professionals for management. The majority of attending practitioners believed that they would benefit from further practical and theoretical training in the field of sialendoscopy, illustrating the need for continued professional development in this area.

Within the area of salivary gland pathology, obstructive sialadenitis is the most common inflammatory condition of the salivary glands.1 It has been well established in the literature that salivary calculi occur most commonly in the submandibular gland, whereas fewer cases are found in the parotid gland, while the sublingual gland and the minor salivary glands form no more than 2% of cases.2 The early treatment of sialadenitis is usually conservative and involves hydration, anti inflammatory medication in conjunction to antibiotics when a bacterial infection is suspected. However, when initial treatment fails, further intervention is needed. The traditional external approach is sialadenectomy. However, with this exists the potential for injury to the lingual and facial nerves. Further complications including bleeding, infection and an unsightly scar are also found with this procedure.3,4 Sialendoscopy is a relatively new technique that only became available once optics had improved to the extent that fiber-optic endoscopes could be miniaturized to a diameter of 0.9 mm to 1.6 mm. This has ushered in a new era for the management of sialadenitis, particularly in cases where sialadenitis was caused by salivary duct obstruction. It must be noted that in South Africa, there are currently no generally accepted guidelines on the management of sialadenitis secondary to salivary ductal obstruction as well as in the role of sialendoscopy within the treatment algorithm.

Sialendoscopy is a relatively new technique that offers the potential to be both diagnostic and therapeutic. It follows the principle of gland sparing therapy to manage conditions such as ductal stenoses and sialolithiasis. The procedure is relatively easy to learn and more affordable than the traditional methods of intervention. It is well suited to the African continent in that the equipment is relatively portable and may be taken to peripheral and rural areas, while still providing world-class care and minimal disruption to the patients. We hereby present the evolution of sialendoscopy.

The coronavirus disease (COVID-19) pandemic has resulted in an increased number of patients that require respiratory support in terms of oxygen and ventilation. Due to the burden on the healthcare system there has been a shortage of hospitals beds in both the public and private sector. This has led to many patients being managed at home. Currently there is no consensus regarding best practice guidelines in terms of treatment of this subset of patients.We hereby present a case of a patient who was treated using appropriate respiratory support (a combination of low flow oxygen therapy via nasal prongs or face mask as high flow oxygen was not available), oral corticosteroids and anti-coagulants managed by remote clinician intervention. We also include our home management protocol.