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Aim The aim of the present study was to determine the accuracy of diagnostic sialendoscopy in patients with suspected obstructive salivary duct disease referenced to current imaging modalities. Patients and Methods A retrospective study of patients with symptoms suggestive of obstructive salivary duct disease who underwent one or more imaging modalities, and then sialendoscopy at an academic hospital, were reviewed. The radiological and sialendoscopic findings were compared, and the diagnostic accuracy of various imaging modalities was determined using sialendoscopy as a reference. Results Seventy-five sialendoscopies were performed in 68 patients (39 females, 29 males). Obstructive lesions were identified in 71 of the 75 sialendoscopies; 18 stones and 53 nonstone obstructive lesions were identified. Imaging consisting of plain X-ray ( n = 4), radiosialography ( n = 18), ultrasonography ( n = 58), computed tomography ( n = 13) and magnetic resonance imaging (n = 10) detected disease in 25, 70.6, 69.1, 69.2 and 100 per cent of diseased ducts, respectively. Conclusion Sialendoscopy is more sensitive, and thus more useful, in diagnosing obstructive salivary duct disease in symptomatic patients than current imaging modalities. Symptomatic patients with negative imaging should be considered for sialendoscopy when therapy, such as stone retrieval or stricture dilation, can instituted at the time of diagnosis. [ABSTRACT FROM AUTHOR]