Management of the Submandibular Duct Papilla and Other Approaches to Salivary Ducts

Introduction

Papilla crossing is one of the key points for sialendoscopy, especially in submandibular sialendoscopy. After the papilla has been crossed, the sialendoscopy can begin. Instead of papilla crossing, other approaches to the salivary duct may also be needed. For example, the retropapillary approach can replace the papillary crossing when this crossing is not feasible. However, when the lithiasis removal procedure is over, the surgeon must check for the absence of remaining lithiasis in combined approaches procedures; in such cases, a retrograde approach to the duct is helpful ( Fig. 15.1 ).

Usual papillary crossing is performed with probes of increasing diameter, as described by Marchal et al. In 20% of cases, usual papillary crossing does not work, giving place to another papilla crossing technique – the guided puncture technique.

Anterior Approaches to the Duct