42505 Plastic repair of salivary duct, sialodochoplasty; secondary or complicated

Name of the Procedure:

Plastic repair of salivary duct, sialodochoplasty; secondary or complicated

Summary

Sialodochoplasty is a surgical procedure aimed at repairing or reconstructing the ducts of the salivary glands. When it's labeled as "secondary or complicated," it often means it is being performed to correct issues from a previous surgery or due to complex conditions involving the salivary ducts.

Purpose

This procedure addresses obstructions, strictures, or damages in the salivary ducts that prevent normal saliva flow. The goals are to restore proper salivary function, alleviate pain or swelling, and prevent recurrent infections or sialadenitis.

Indications

• Recurrent salivary gland infections
• Chronic pain or swelling in the salivary glands
• Strictures or blockages in the salivary ducts
• Failed previous salivary duct repair attempts

Preparation

• Fasting for at least 8 hours before the procedure.
• Adjusting or stopping certain medications (e.g., blood thinners) as instructed by the doctor.
• Pre-operative imaging tests such as sialography or MRI to assess the ductal system.

Procedure Description

1. The patient is given anesthesia (local or general, depending on the case).
2. The surgeon makes a small incision to access the affected salivary duct.
3. Any scar tissue or strictures are removed, and the duct is reshaped or restructured using microsurgical techniques.
4. The duct is then sutured to ensure proper flow of saliva.
5. The incision is closed with sutures, and a small drain may be placed to prevent fluid buildup.

Tools used include microsurgical instruments, sutures, and sometimes stents to keep the duct open.

Duration

The procedure typically takes 1 to 2 hours, depending on the complexity.

Setting

This procedure is performed in a hospital's operating room or an outpatient surgical center.

Personnel

• Surgeon specialized in otolaryngology or maxillofacial surgery
• Surgical nurses
• Anesthesiologist

Risks and Complications

• Infection at the surgical site
• Bleeding
• Recurrence of ductal obstruction
• Salivary fistula (abnormal connection between the duct and skin)
• Damage to surrounding structures

Benefits

• Restoration of normal saliva flow
• Reduction or elimination of pain and swelling
• Decreased risk of recurrent infections
• Improved quality of life

Recovery

• Patients may need to stay in the hospital for observation, especially if general anesthesia was used.
• Pain management with prescribed medications.
• Avoiding strenuous activities for a few weeks.
• Regular follow-up appointments to monitor healing.
• Normal activities can usually be resumed within 1 to 2 weeks.

Alternatives

• Conservative management with antibiotics and sialogogues (saliva stimulants).
• Endoscopic dilation or stenting of the duct.
• Total excision of the affected gland (sialadenectomy) if duct repair is not feasible.

Patient Experience

During the procedure, patients under general anesthesia will be asleep and feel nothing. Local anesthesia may cause numbness but the patient remains awake. Post-procedure, there might be mild to moderate discomfort managed with pain relief medications. Patients may experience some swelling and need to follow specific care instructions to ensure proper healing.

Pain management typically includes prescribed analgesics, and keeping the surgical site clean and dry is crucial for comfort and to prevent infections.