Diagnostic and Interventional Sialendoscopy: A Four-Year Retrospective Study of 89 Patients

<b>Background/Objectives:</b> Obstructive salivary gland disorders-primarily sialolithiasis and ductal stenosis-remain a significant source of morbidity, often requiring surgical intervention. Sialendoscopy has emerged as a minimally invasive, gland-preserving technique for both diagnosis and treatment. This retrospective study aimed to evaluate diagnostic and interventional sialendoscopy outcomes in a Romanian patient cohort and to identify gland-specific considerations in the management of salivary gland obstruction; <b>Methods:</b> A total of 89 patients with confirmed obstructive salivary gland disease (parotid or submandibular) were included. The most common indications included lithiasis, ductal stenosis, sialadenitis, and mixed pathologies; two cases of juvenile recurrent parotitis (JRP) were also managed. All patients underwent clinical evaluation, imaging (ultrasound, CBCT, CT, MR sialography), and sialendoscopic treatment between 2021 and 2025 in two centers. Data on demographics, imaging, calculus size, procedural technique, anesthesia, and complications were collected and analyzed using descriptive and inferential statistics; <b>Results:</b> The submandibular gland was more frequently involved (70.8%), with larger calculi compared to the parotid (mean 7.6 mm vs. 5.1 mm; <i>p</i> = 0.004). Minimally invasive techniques were predominantly used: sialolithotomy and intracorporeal lithotripsy were each performed in 32.6% of cases. Submandibulectomy was required in only 5.6% of patients. Most procedures (93.3%) were conducted under local anesthesia. Complication rates were low and primarily minor and self-limiting; <b>Conclusions:</b> Sialendoscopy is a safe and effective gland-preserving approach in managing obstructive salivary gland disorders. Gland-specific anatomy influences diagnostic pathways and therapeutic choices. These findings support broader adoption of sialendoscopy in routine practice and highlight the need for tailored management protocols based on gland involvement and stone characteristics. However, the study is limited by the absence of standardized post-intervention quality-of-life assessments and structured follow-up data on symptom recurrence.