In this episode of BackTable ENT, Dr. Agan and Dr. Shah invite Dr. Rohan Walvekar, Chair in Head and Neck Surgery at Louisiana State University, to discuss his experience with innovating procedures for sialendoscopy and ranula excision.

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SHOW NOTES

First, Dr. Walvekar shares his insights on how to differentiate between cysts and sublingual gland masses. He explains the importance of examining the normal side of the floor of the mouth and comparing it to the abnormal side. He also discusses the advantages of using ultrasound in the office and when to consider imaging such as CT or MRI. Finally, he explains the importance of understanding different malformation types when making treatment decisions. Next, Dr. Rohan Walvekar talks about the importance of being familiar with the floor of mouth anatomy to avoid injuring the lingual nerve. He also explains his preferred approach to intubation and emphasizes the importance of examining the papilla.

Familiarity with floor of mouth anatomy is important for safe cannulation of the duct. Dr. Walvekar's stent is designed to have a flange that anchors itself to the floor of the mouth and can be used for both parotid and submandibular ducts. The stent helps to identify the duct and ensure the incision for the sublingual gland removal is made in the right place. Dr. Walvekar explains his approach to decompressing a pseudocyst, which includes transoral dissection and, if needed, aspirating with a thick 18 gauge needle. Finally, he discusses the importance of not injuring the submandibular duct and lingual nerve during closure and the possible use of a transcervical approach if needed.

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RESOURCES

Walvekar Salivary Duct Stent:

https://hoodlabs.com/salivary-management/walvekar-salivary-duct-stent/