Office-Based Salivary Gland Surgery (2024 AMW)

Patients with obstructive salivary gland disease experience recurrent salivary gland swelling and pain due to ductal obstruction by pathology such as stones and stenosis. Sialendoscopy has transformed the management of obstructive disease, offering both a diagnostic evaluation of the ductal system and potential therapeutic intervention on obstructive pathology in a minimally invasive and gland sparing approach. While sialendoscopy can be performed under various anesthetic options, the intent of this session is to explore the benefits and feasibility of transitioning sialendoscopy and associated salivary gland procedures into the office-based setting utilizing local anesthesia techniques. A variety of otolaryngologic procedures are now offered under local anesthesia due to benefits to the patient, surgeon, practice, and healthcare system. Patient benefits include the convenience of presenting to a familiar office environment without the requirements of a lengthy period of pre-procedure fasting or the need for a post-procedure escort home. The overall time commitment for the procedure is shortened and cost is generally reduced with the exclusion of anesthesiology services and operating room charges. For the surgeon, the benefits include the potential for optimized use of critical operating room time for more complex surgeries and flexibility of working short procedures into a clinic schedule and maximizing volume by cohorting similar cases. For the healthcare system, optimizing allocation of operating room time for critical, complex, and time-sensitive cases can be facilitated by shifting more cases into the office setting. While there are many potential benefits, risks may be encountered if careful patient selection for the optimal type of anesthesia and setting of care are not considered. This session will provide a detailed approach to setting-up for office-based salivary gland surgery, included instrumentation, patient selection, surgical techniques, nursing assistance, after-care, and financial considerations.