Concierge salivary care · London
Sialendoscopy and interventional sialography — keep the gland, remove the problem.
A minimally invasive alternative to open salivary gland surgery. A fine endoscope enters the salivary duct, treats the stone, stricture or plug from inside, and preserves the parotid or submandibular gland in 85–95% of cases.
Why patients choose us
- 01
A salivary endoscopist, not a generalist
Sialendoscopy is a niche skill. We route you to consultants who do this weekly at Guy’s, UCLH, KCH or Chelsea & Westminster — not to a general ENT list.
- 02
Gland-preserving from the outset
The whole point is to keep the parotid or submandibular gland. Open removal is the last resort, not the first offer.
- 03
Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Indicative pricing
What private sialendoscopy costs in London.
Indicative ranges across our partner clinics. Send the details and we quote firm figures across two or three options.
In short
Interventional sialendoscopy with laser lithotripsy in our network: £3,200–£4,800, home the same day.
| Procedure | Indicative range | Typical duration | Recovery |
|---|---|---|---|
| Diagnostic sialendoscopy (LA + sedation) | £2,000–£3,200 | 45 min | Same day |
| Interventional sialendoscopy — basket stone retrieval | £2,800–£4,200 | 60–90 min | Same day |
| Sialendoscopy + Ho:YAG laser lithotripsy | £3,200–£4,800 | 60–90 min | Same day |
| Sialendoscopy + balloon dilation (stricture) | £2,600–£3,800 | 45–60 min | Same day |
| Combined transoral + endoscopic (large submandibular stone) | £3,800–£5,500 | 90 min GA | Same day / overnight |
| Extracorporeal shock wave lithotripsy (ESWL) — parotid | £1,400–£2,400 per session | 45 min | Outpatient |
| Botulinum toxin injection (sialorrhoea / Frey’s) | £800–£1,600 | 20 min | Same visit |
| Consultation only | £250–£450 | 30 min | Same visit |
Prices vary by clinic, by which endoscopist runs the case, by the anaesthetic chosen, and by whether ESWL, laser lithotripsy or a combined transoral approach is added on the day. We come back with a firm quote within one working day.
The problem
The right endoscopist, the right adjunct, the right decision on the gland.
Salivary obstruction is still too often referred straight to open gland removal. In experienced hands, most stones and strictures can be cleared endoscopically — and the gland kept.
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Told you need the gland out?
Get a sialendoscopy opinion first. In 85–95% of obstructive cases the gland can be preserved.
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Recurrent mealtime swelling?
A single duct stone or stricture is often the cause — and often treatable in one outpatient sitting.
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Chronic sialadenitis flaring?
Endoscopic washout and intraductal steroid can quieten Sjögren’s, IgG4-related and radioiodine-induced disease.
The journey
From enquiry to recovery — what happens, in order.
One clinician from first message to review — including the recovery window.
Phase 1 · Before your procedure
Concierge, off-stage for you
Phase 2 · On the day
A few hours at the clinic
Phase 3 · After
Concierge, back on
- 01
Before
You tell us what is going on
A short, confidential form. Gland swelling with meals, palpable stone, previous imaging or open surgery discussed elsewhere.
- 02
Before
We come back with a recommendation
Within one working day: whether diagnostic sialendoscopy is the right first step, whether ESWL or combined transoral surgery might be needed, an indicative price.
- 03
Before
Imaging first, if it is missing
Ultrasound of the gland, sometimes MR-sialography or a low-dose CT, so the endoscopist knows the stone size and duct anatomy before you arrive.
- 04
On the day
Arrival at the clinic
Consent with the endoscopist and anaesthetist. Local plus light IV sedation for most parotids and many submandibulars; GA for children or complex combined cases.
- 05
On the day
The procedure itself
45 to 90 minutes. The papilla is dilated, a 0.8–1.6 mm scope enters the duct, saline irrigation opens the view, and the stone, stricture or plug is treated.
- 06
On the day
Home the same day
A short recovery, sialagogues to keep saliva flowing, warm compress and gentle gland massage. Someone should collect you if you had sedation.
- 07
After
Recovery and review
Gland swelling for 24 to 48 hours is expected — it is the gland responding to irrigation. A review at four to six weeks confirms the duct is clear.
Typical end-to-end: 2–3 weeks from enquiry to procedure. Full recovery: 1–2 weeks.
When it helps
When sialendoscopy is the right step.
The situations we see most, plus the one red flag that means an emergency rather than an appointment.
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Mealtime gland swelling
A cheek or under-jaw swelling that puffs up when you eat and slowly settles — the classic sign of an obstructed salivary duct.
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Submandibular stone (Wharton’s duct)
Roughly 80% of salivary stones sit in the submandibular duct. Often palpable under the tongue and treatable endoscopically.
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Parotid stone (Stensen’s duct)
The other 20%. Smaller, harder to reach, often combined with ESWL or laser fragmentation before basket retrieval.
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Recurrent duct stricture
Narrowing from previous stones, infection or radioiodine — balloon dilation via the scope reopens the duct without external surgery.
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Chronic sialadenitis
Sjögren’s, IgG4-related disease, juvenile recurrent parotitis and radioiodine-induced sialadenitis all respond to endoscopic washout and steroid instillation.
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Mucous plugs and cellular debris
Not every obstruction is a stone. Irrigation and gentle basket retrieval clears sticky plugs that repeatedly block the duct.
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Unexplained recurrent swelling
When ultrasound and MR-sialography are equivocal, diagnostic sialendoscopy sees the duct directly and often finds the cause.
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Red flag: acute infected gland
A hot, tender, rapidly swelling gland with fever is acute sialadenitis — antibiotics and same-day ENT review first, endoscopy later.
Procedure options
One duct, several ways in.
What each modality on the table actually involves — and which one fits which problem.
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Diagnostic sialendoscopy
A 0.8–1.6 mm semi-rigid scope enters the duct under saline irrigation. Direct view of stones, strictures and inflammation — often therapeutic in the same sitting.
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Wire-basket stone retrieval
A Dormia basket is passed alongside the scope, opened past the stone, and withdrawn — the least invasive option for small mobile stones.
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Ho:YAG laser lithotripsy
A holmium laser fibre fragments impacted stones up to about 5–7 mm inside the duct, so the pieces can be flushed or basketed out.
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Balloon dilation of stricture
A small balloon is passed over a wire and inflated across the narrowing — opens the duct without an external incision.
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Extracorporeal shock wave lithotripsy (ESWL)
External shock waves fragment parotid stones that are too deep to reach endoscopically. NICE-supported, usually adjunctive.
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Combined transoral surgery
For large or impacted submandibular stones, a small mouth-floor incision under endoscopic guidance removes the stone and preserves the gland.
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Intraductal steroid or contrast
Steroid washout for Sjögren’s and juvenile recurrent parotitis; contrast sialography where ductal anatomy still needs mapping.
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Botulinum toxin to the gland
For chronic drooling (sialorrhoea) or Frey’s syndrome after parotid surgery — reduces salivary output rather than clearing an obstruction.
Our vetted London network
A small panel of salivary endoscopists, we picked them.
Consultants at Guy’s and St Thomas’, UCLH, King’s College Hospital and Chelsea and Westminster — chosen for volume, not just title. Introductions are made privately, once we understand your case.
Selection criteria
How we choose every endoscopist in our network.
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Consultant salivary endoscopists doing sialendoscopy weekly, not occasionally
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Ho:YAG laser and ESWL available on the same pathway
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Combined transoral surgery under one team, not two referrals
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Gland-preservation rate published and shared honestly
Safety and recovery
What to expect afterwards — honestly.
Sialendoscopy is a safe day-case procedure with a low complication rate in experienced hands. The things worth planning are gland swelling for a day or two, keeping saliva flowing, and knowing what is normal after.
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Gland swelling for 24–48 hours is normal
The gland has just been irrigated — a firm, uncomfortable swelling that settles over one to two days is expected, not a complication.
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Sialagogues keep the duct flowing
Lemon drops, orange juice and gentle gland massage from day one help flush any residual debris and stop the duct closing down again.
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Papilla trauma is the commonest issue
The duct opening is delicate. A small tear at the papilla is uncommon and usually heals on its own without needing a stent.
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Duct perforation is rare
A true perforation of the duct wall happens in well under 1% of cases in experienced hands, and is managed conservatively.
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Transient facial nerve neuropraxia
For parotid work only, and rare with a careful technique — a temporary weakness that almost always recovers within weeks.
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Post-procedural sialadenitis
An infection of the gland after the procedure is uncommon; a short course of antibiotics settles it if it happens.
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Incomplete stone clearance
A minority of large or impacted stones need a second sitting, adjunctive ESWL, or a combined transoral approach — planned, not a surprise.
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Recurrence at five years
Roughly 5 to 20% of patients form a new stone within five years. Hydration, sialagogues and a low-salt, low-oxalate leaning diet reduce the risk.
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Red flags
Fever, spreading redness, uncontrolled pain or a rapidly enlarging gland after the procedure are not normal — call the clinic or A&E the same day.
Reading your operation note
Your operation note in four parts. Read the last one first.
Whichever modality was used, the note the endoscopist sends you keeps to the same shape.
A quiet reminder
Surgical language is precise and can read coldly — we translate it for you.
If you would like us to talk you through the note before your review, just ask.
- 01 Header
Gland, duct and indication
Which gland was treated (parotid or submandibular), which duct (Stensen’s or Wharton’s), and why — stone, stricture, chronic sialadenitis or diagnostic.
- 02 Technique
Scope, laser and adjuncts used
The scope size, whether Ho:YAG laser, balloon dilation, basket retrieval, steroid instillation or a combined transoral approach was needed.
- 03 Findings
Stone size, stricture grade, clearance
The stone size and location, any stricture and its grade, and whether the duct was completely cleared or partially treated.
- 04 Impression
Aftercare, recurrence risk, review plan
Read this first: sialagogue plan, hydration advice, when to resume normal activity, and when the endoscopist wants to see you again.
Recognised by major UK insurers
Cover for sialendoscopy and interventional sialography is usually funded when medically indicated — recurrent obstruction, symptomatic stones, chronic sialadenitis. We confirm cover with your insurer before booking.
Frequently asked
Everything we get asked about sialendoscopy.
Quick answers on pain, stone size limits, gland preservation, cost, and how likely a stone is to come back.
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What is sialendoscopy, and how is it different from open salivary surgery?
Sialendoscopy is a minimally invasive procedure that uses a very fine endoscope (0.8–1.6 mm) passed through the natural duct opening in your mouth to see and treat problems inside a salivary gland — most often stones, strictures or mucous plugs. It avoids an external incision and, in 85–95% of cases, avoids removing the gland altogether.
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Which salivary problems can be treated endoscopically?
Salivary stones (sialolithiasis) in the submandibular or parotid duct, duct strictures, mucous plugs, chronic sialadenitis (including radioiodine-induced and Sjögren’s-related), and juvenile recurrent parotitis. Diagnostic sialendoscopy is also used for unexplained recurrent gland swelling.
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Does the procedure hurt?
Most patients have it under local anaesthetic with light IV sedation and feel pressure and irrigation rather than pain. Complex cases, children and some combined procedures are done under general anaesthetic. Afterwards the gland feels swollen and firm for a day or two, easily managed with simple painkillers.
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How large a stone can be removed by sialendoscopy alone?
Mobile stones up to about 4 mm can often be caught with a wire basket alone. Impacted stones up to roughly 5–7 mm can be fragmented with a Ho:YAG laser inside the duct. Larger or deeply impacted stones usually need extracorporeal shock wave lithotripsy (ESWL) or a combined transoral procedure.
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How much does interventional sialography cost privately in the UK?
Diagnostic sialendoscopy is roughly £2,000–£3,200. Interventional sialendoscopy with basket retrieval is £2,800–£4,200, and laser lithotripsy £3,200–£4,800. Combined transoral surgery for larger submandibular stones runs £3,800–£5,500. We confirm a firm figure within one working day.
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Is sialendoscopy available on the NHS?
Yes, but only at a handful of specialist salivary centres — Guy’s and St Thomas’, UCLH, King’s College Hospital and Chelsea and Westminster among them. Waiting lists vary. Private access can be faster if your case is straightforward.
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How successful is it at avoiding gland removal?
In experienced hands, sialendoscopy and its adjuncts preserve the salivary gland in 85–95% of obstructed cases — versus historic rates of submandibulectomy or parotidectomy for the same problems.
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Can salivary stones come back after treatment?
Roughly 5 to 20% of patients form a new stone within five years. Staying well hydrated, using sialagogues (lemon drops, chewing gum), gentle gland massage after meals, and treating any underlying condition (Sjögren’s, IgG4-related disease) all reduce the risk.
Related tests
Looking for something else?
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Head and neck surgery
Open salivary gland surgery when endoscopic treatment is not enough.
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All tests and procedures
Every test and procedure we arrange.
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MRI scan
MR-sialography and head and neck imaging.
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CT scan
Low-dose CT for salivary anatomy and stone detection.
Learn more