J Oral Maxillofac Surg 65:1865-1868, 2007 Arterial Stents for Access and Protection of the Parotid and Submandibular Ducts During Sialoendoscopy Maria Papadaki, DMD, MD,* Leonard Kaban, DMD, MD,† Christopher Kwolek, MD,‡ David Keith, DMD, FDSRCS, BDS,§ and Maria Troulis, DDS, MSc Sialoendoscopy has recently gained popularity as a minimally invasive alternative to ablative surgery for obstructive salivary duct disease resulting from stones and strictures. Sialoendoscopy has been performed in numerous patients with a high degree of success. 1-3 However, damage or perforation of the duct during repeated manipulation of the endoscope and surgical instruments is a known complication. 1-3 This can re- sult in a false passage that may compromise the suc- cess of the procedure. The purpose of this study was to assess the feasibility of using cardiovascular stents to dilate and maintain access to the parotid and sub- mandibular ducts during sialoendoscopy. The hypoth- esis was that stents would allow for easy instrumen- tation of the ducts with fewer traumatic injuries. To the best of our knowledge, this is the first report on the use of cardiovascular stents for this purpose. Materials and Methods Sialoendoscopy was performed on 10 Yorkshire pig cadaver heads. The parotid (n = 20) and submandib- ular (n = 20) ducts were identified and dilated using salivary gland dilators (Karl Storz GmbH & Co, Tut- tlingen, Germany). The submandibular and parotid gland ducts in Yorkshire pigs are 4 to 6 cm long and 1.5 to 2 mm in diameter, similar dimensions to the corresponding human ducts. 4 In the experimental group, 10 parotid and 10 sub- mandibular ducts, a 28-mm-long Cypher coronary stent (Cordis Corp, Miami Lakes, FL) was inserted into each duct (Fig 1). The balloon was inflated with a pressure pump to achieve 12 atm of pressure, which expanded the stent to a diameter of 3.5 mm (Fig 2). The balloon was then removed, and the stent was sutured in place to maintain the diameter, reinforce the duct, and maintain access (Figs 3, 4). In the control group of 10 parotid and 10 submandibular ducts, the endoscope was used without duct stenting (Fig 5). A Nahlieli Storz endoscope (Karl Storz, Tuttlingen, Germany) was used to navigate the duct system in both groups. This is a semirigid endoscope, 1 mm in diameter, with a 2.3-mm sheath for interventional endoscopy. The sheath has 3 channels: 1 for the scope, 1 for irrigation, and 1 for working instruments (Fig 5). Navigation of the ducts in both the experi- mental and control groups was repeated 5 times to replicate the clinical scenario of repeated instrumen- tation. The experimental technique was evaluated for ease of use, surgical time (in minutes), and duct injury. To evaluate duct injury, the total length of duct (5 cm) was harvested, dissected longitudinally, and photo- graphed under 5 magnification. A blinded evaluator scored the harvested ducts according to the following grading system: score 0, no damage, normal lining; score 1, fewer than 2 tears, less than 1 mm long; score Received from the Departments of Oral and Maxillofacial Surgery and General Surgery, Massachusetts General Hospital, Boston, MA. *AO-ASIF/Synthes Fellow in Pediatric Oral and Maxillofacial Surgery. †Walter C. Guralnick Professor and Chairman, Department of Oral and Maxillofacial Surgery. ‡Assistant Professor, Division of Vascular and Endovascular Surgery. §Clinical Professor, Department of Oral and Maxillofacial Surgery. Associate Professor, Director of Minimally Invasive Surgery Pro- gram, Director of Residency Program, Department of Oral and Maxillofacial Surgery. This study was presented in part at the 87th AAOMS meeting in Boston, MA, 2005. This study was funded in part by the Massachu- setts General Hospital Department of Oral and Maxillofacial Surgery Education and Research Fund, the AO-ASIF/Synthes Fellowship in Pediatric Oral and Maxillofacial Surgery, and the Hanson Founda- tion, NIH K23. Address correspondence and reprint requests to Dr Troulis: Department of Oral and Maxillofacial Surgery, Massachusetts Gen- eral Hospital, 55 Fruit Street, Boston, MA 02114; e-mail: mtroulis@ partners.org © 2007 American Association of Oral and Maxillofacial Surgeons 0278-2391/07/6509-0036$32.00/0 doi:10.1016/j.joms.2006.04.041 1865