Management of the difficult papilla: Current techniques and review of literature

Objective: To develop an algorithm to manage dilation of the papilla that is one of the rate-limiting steps in sialendoscopy. Study design: Review of literature. Methods: A Pubmed literature search was performed with key words, "sialoendoscopy, duct dilatation, sialendoscopy, salivary endoscopy, Seldinger technique". Results: Currently, there are several described techniques that are used to dilate the papilla. Commonest described techniques include serial duct dilation and the Seldinger's technique. Other techniques include using arterial stents, staining techniques, sialdochotomy preserving the papilla, and papillotomy. Conclusion: There is still no consensus on the best option for managing the salivary duct. Broadly, techniques can be divided into invasive and non invasive. Technical points and an algorithm for management of the difficult papilla are proposed.