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Upstate offers minimally invasive alternative to traditional salivary gland surgery

Upstate offers minimally invasive alternative to traditional salivary gland surgery

SYRACUSE, N.Y.-- Upstate University Hospital is the only hospital in New York state, outside of Rochester and New York City, to offer salivary endoscopy or sialendoscopy, a minimally invasive alternative to open salivary gland surgery.

The FDA-approved endoscopic procedure allows the surgeon to simultaneously detect, diagnose and treat inflammatory and obstructive disorders of the salivary ductal system without having to remove the salivary gland.

Sialolithiasis, or salivary stones (calculi), is the most common disorder treated with this technique. Other disorders that can benefit from sialendoscopy include stenosis, radioactive iodine-induced sialoadenitis, and recurrent juvenile parotitis.

Mark F. Marzouk, M.D., is one of a few surgeons in New York, and the only physician in central New York, who is trained in sialedenoscopy. Marzouk is the chief of the Division of Head and Neck Surgery at Upstate’s Department of Otolaryngology with specialty in minimally invasive salivary endoscopy, transoral robotic surgery and minimally invasive thyroid and parathyroid surgery.

According to Marzouk, sialendoscopy is a simple, safe and a less-invasive alternative to traditional treatment which requires removal of the salivary gland made through an incision in the neck, after which time the patient is required to remain hospitalized overnight.

“Undergoing the sialendoscopy procedure is highly beneficial to patients in that normal function of their salivary gland is maintained,” said Marzouk. He adds that there are other benefits as well.

“Our ability to visualize and treat the specific cause of the inflammation or obstruction allows us to save the salivary gland, leaving the patient with no external scars and at a no risk of facial nerve injury, as opposed to open surgery” he said. “Other benefits include less recovery time, same day discharge, and the resumption of normal activity the next day.”

Marzouk uses a Marchal endoscope to perform the procedure. The scope is connected via fibro-optic cable to a high definition camera, allowing images of the ductal system to be projected on to a monitor for optimal visualization. Other micro instrumentation that can be used through the scope include balloon dilators, forceps, special baskets for stone retrieval and laser fibers that are used to break up larger stones. The interventional scopes come in three sizes, 1.1 mm, 1.3 mm or 1.6 mm., with use based on the complexity of the procedure. Karl Storz, headquartered in Tuttlingen, Germany, manufactures the scopes.

During the procedure, the scope is passed through the affected gland through its opening in the mouth. The scope includes a rinsing system that flushes the gland with saline solution and local anesthetic, giving the surgeon greater visibility of the ductal system and offering the patient greater comfort. Depending on the severity of the condition, the procedure can be performed as an outpatient procedure using local anesthesia or in the operating room using general anesthesia. The procedure is usually completed in 20 minutes, but can take up to an hour, based on its complexity. Francis Marchal, M.D., Ph.D., of Geneva, Switzerland, pioneered the procedure more than 20 years ago.

The procedure is performed on one of two major glands that comprise the salivary glandular system--the parotid gland, located in the upper part of each cheek or the submandibular gland, located under the jaw.

Causes of salivary gland problems include infections, obstructions or cancer or may be due to other disorders such as Sjogren’s syndrome. According to the American Academy of Otolaryngology - Head and Neck surgery, it is important to drink plenty of liquids daily as dehydration is a risk factor for salivary gland disease.

Among its many services, Upstate’s Department of Otolaryngology also offers transoral robotic surgery for oropharyngeal cancer and minimally invasive Thyroid and Parathyroid surgery. It is only one of three hospitals in the country to treat larger salivary stones with robotic technology.

Marzouk is accepting new patients who either self-refer or receive a physician referral. For more information about sialendoscopy or other services offered by Upstate’s Department of Otolaryngology, call 315-464-8668.

Caption: Mark F. Marzouk, M.D., chief of the Division of Head and Neck Surgery at Upstate, is the only physician in central New York who is trained in sialedenoscopy.