London Salivary Gland Centre

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Upcoming Courses at Guy's Hospital

last updated November 2011

International Salivary Gland courses are held at Guys Hospital: These are usually two day hands on courses limited to a small number of participants. One day is spent in the operating theatre with endoscope assisted surgery and ECD demonstrated. The second day involves instruction in Head & Neck ultrasound, lithotripsy and radiologically retrieved stones.

(Updated by the Team as required)

New edition of Controversiers in the Management of Salivary Gland Disease (in press Oxford University Press)

The major advances in the management of salivary gland disease in recent years have taken place in the treatment of salivary gland stones and in surgery for salivary tumours.

Two major advances in recent years have changed the management of disease.

· First, stones can now be reliably retrieved by minimally invasive techniques, preserving gland function and avoiding traditional sialoadenectomy, although the service is restricted to a few specialised centres.

· Second, there has been an appreciation in the surgical community that benign salivary tumours can be safely treated by procedures much less extensive than a superficial parotidectomy.

Patricia Taylor

THE PATIENT

"I was very run down, with almost constant infections, and I'd lost lots of weight.

Then my dentist told me about Professor McGurk's pioneering work at Guy's Hospital in London. She had been to one of his lectures and was very impressed. My GP agreed to refer me to him.

Professor McGurk pinpointed the position of the stone. He agreed to treat me using his new technique.

Two months later, on January 4 this year, I had my operation.

Professor McGurk was delighted with the outcome. He also gave me the salivary stone, which I still have. Two days later, I was discharged. The operation was a complete success with no side effects. Since the operation, I feel like a new person"

Mark McGurk

THE SURGEON

"Patricia had been suffering from a salivary stone for some time when she came to see me. Doctors had already tried to blast it into pieces with ultrasound, but this had not worked. They had also tried the basket method, to hook the stone out with a wire trap, but that had failed, too. This works in 75 per cent of cases, but Patricia was unlucky.

She did not want to have the gland taken out - the normal procedure when all else has failed. She had the classic symptoms. During a meal, she would notice a lump developing on the right side of her face. This is because the stone had caused an obstruction.

Guys & St Thomas Hospiatal

THE OPERATION

Two months after the initial consultation, Patricia came to Guy's for her operation. After she had been given a general anaesthetic, I dilated the duct inside her mouth with a probe. This allowed me to insert the endoscope, which is 1.1mm wide.

This has a camera with a light on the end, so I can see what I am doing on a monitor. I inserted the endoscope until I could see the stone up ahead.

Then I made a cut down the ear and just below the jaw and peeled back the skin to reveal the gland under the cheek. I turned the light down in the theatre, so I could see the light in the endoscope through the tissue of the gland. That way, I could see the duct and the position of the stone.

Using the light as a beacon, I made a cut over the duct, being careful to avoid the branches of the facial nerve. I then cut down to the stone and removed it carefully with small forceps. Once I had done that, I put the duct back together with tiny stitches and closed up the gland. Then I put the skin over the area and sewed it back in place with invisible stitches. The whole operation took 40 minutes.

The operation went very well, and there were no complications at all.

Patricia recovered very quickly and was out of hospital two days later.

The scar is almost invisible and her facial nerve is undamaged.

The cost to the NHS was two nights in hospital (around £700 per night) and one hour's operating time (£500). If done in a private hospital, where arrangements are more flexible, the patient may have been treated as a day case (£2,000) or kept in for one night (additional £1,000)"

Source: Daily Mail; London

Patricia - full story