Indian Express
27 January 2011
By Pritha Chatterjee
New Delhi, India

The only hospital to offer Sialendoscopy in the Capital, GTB conducts the surgery free of cost VIR Sain’s two–year long agony is likely to end soon. The father of two was diagnosed with five stones in his salivary ducts – a relatively less known condition called Sialolithiasis.

"Whenever I eat, the glands under my jaw swell up and the pain is excruciating. Now, it also has pus formation. I think a mere look at food makes my gland swell. I have been trying to avoid food as much as possible," says Sain (33).

Next week, Sain will be undergoing a Sialendoscopy – a minimally invasive surgery technique to remove the stones through a miniature endoscope at the GTB Hospital, the only to offer the treatment in the Capital.

Head of department of the hospital’s ENT section Dr P P Singh said, "The conventional treatment for strictures or narrowing of glandular ducts and stones in the salivary glands is either management through antibiotics, or complete removal of the gland. The surgery involves the risk of possible damage to the facial nerves. Antibiotics are not an effective long–term solution." Dr Singh has been through a special training for the technique at Geneva. While Sialolithiasis is not an uncommon ailment, low awareness of the condition means patients seek medical help only at an advanced stage.

"There is a sense of disbelief among patients when we tell them about stones in the salivary glands. People think stones are found only in the gall bladder and kidney," said Dr Singh.

During the surgery, the instru ment is inserted into the duct of the salivary gland, and the stone is removed without any incision on the face or the mouth. While the cost of the treatment may run up to Rs 1 lakh at private hospitals, GTB offers for free.

Opinion is divided on the cause of formation of these stones. "There are many hypotheses. The most commonly accepted one is that food particles enter the ducts and there is salt deposition around them, leading to formation of a stone. They (stones) cause obstructions in the ducts, which makes the gland swell whenever saliva is produced," said Dr Singh.

Salivary glands are founds in three pairs –parotid glands behind the lower jaw, submandibular glands on the floor of the mouth, and sublingual glands below the tongue. Surgery on the parotid glands is particularly dangerous as the critical nerves that control the movement of facial muscles are located in this region.

"This surgery will be most beneficial for stones in the parotid glands," said Dr Singh.

The technique was started by Dr Francis Marchal, HOD of the ENT department at the University of Geneva. Dr Marchal visited GTB Hospital in November last year as a guest faculty to train ENT surgeons on the technique.

Speaking to Newsline Dr Francis Marchal said: "I have conducted these trainings in 50–odd countries so far, and trained about 500 doctors. In India, I have already visited Delhi and Mumbai, and I am planning to travel to Gujarat next. Doctors from Hinduja Hospital in Mumbai plan to eventually replicate GTB Hospital’s model at the government–run KEM Hospital there." The technique, however, can only be used if the stones are in the ducts of the glands and not inside the glands themselves.

The size of the stone can also be a deterrent. "A s of now, techniques to fragment the stone through laser technology are not available in India. So we have to limit ourselves to stones of a maximum size of 6 mm," said a doctor.