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Holland K, Lee JUJ, Gomeniouk O, Owen GS, Raad R, Bhayani M. Is ductoplasty required following transoral sialolithotomy? - A case series. Eur Arch Otorhinolaryngol 2025:10.1007/s00405-025-09324-w. [PMID: 40102226 DOI: 10.1007/s00405-025-09324-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2024] [Accepted: 03/03/2025] [Indexed: 03/20/2025]
Abstract
OBJECTIVE This study aimed to determine if there was a difference in postoperative outcomes and complications between patients who underwent traditional two-layer closure (ductoplasty and floor of mouth) after Wharton's duct sialolithatomy during hybrid sialendoscopy compared to those who underwent single layer closure of only the floor of mouth. METHODS Retrospective case series of a single surgeon's patients who underwent hybrid sialendoscopy at an urban tertiary care hospital. Demographic, preoperative, intraoperative, and postoperative information was collected from patients who underwent hybrid sialendoscopy with transoral sialolithotomy of Wharton's duct from 2020 to 2023. Data included salivary glands explored, intraoperative complications, ductal repair, postoperative complications, and recurrence of salivary symptoms. RESULTS 32 patients underwent hybrid sialendoscopy. Of those, 28.1% (n = 9) underwent traditional two-layer closure, and in 71.9% (n = 23) had single layer closure. 2.6% (n = 1) had a postoperative infection. There were no immediate postoperative complications reported in those with single layer closure. There was no statistical difference in postoperative complications between the two groups (p = 0.10). In patients with follow up, 86.7% of (n = 13) patients had documented salivary flow through the natural papilla after one layer closure compared to 80% (n = 4) in the two-layer group. There was no significant difference between the groups (p = 0.72). CONCLUSIONS The results of this study support that single layer closure without ductoplasty after hybrid sialendoscopy allows for ductal recanalization and may produce the same postoperative outcomes as traditional two-layer closure while increasing operative efficiency.
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Affiliation(s)
- Katie Holland
- Department of Otolaryngology - Head & Neck Surgery, Rush University Medical Center, 1611 W Harrison St Suite 550, Chicago, IL, 60612, USA.
| | - Jinnee U J Lee
- Chicago Medical School, Rosalind Franklin University of Medicine and Sciences, North Chicago, IL, USA
| | | | - Grant S Owen
- Department of Otolaryngology - Head & Neck Surgery, Emory University Hospital, Atlanta, GA, USA
| | - Richard Raad
- Department of Otolaryngology - Head & Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Mihir Bhayani
- Department of Otolaryngology - Head & Neck Surgery, Rush University Medical Center, 1611 W Harrison St Suite 550, Chicago, IL, 60612, USA
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2
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Sideris G, Konstantinidis I, Kourklidou M, Chatziavramidis A, Delides A. Holmium:YAG laser-assisted intraductal sialendoscopic lithotripsy under local anesthesia. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101643. [PMID: 37742998 DOI: 10.1016/j.jormas.2023.101643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/30/2023] [Accepted: 09/21/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVES This retrospective multi-institutional chart review study aims to present results from patients treated with Holmium:YAG laser-assisted sialendoscopic intraductal lithotripsy under local anesthesia. METHODS Preoperative ultrasound and/or CT were used for location and measurement of the stones. Local anesthesia was applied in all patients, Marchal all-in- one 1.3 mm and Erlangen 1.6 sialendoscopes were used. The laser was used with power settings limited by discomfort or pain. Inclusion criteria were stone size (all >5 mm) and fixed stones. RESULTS 42 patients, 48 stones were treated (30 males/12 females), 21 submandibular and 21 parotid. Ages ranged from 20 to 70 years (95 % CI: 43.37-51.58). Mean size was 6.2 mm (95 % CI: 5.71-6.72). Complete fragmentation was achieved in 66.7 % and incomplete in 33.3 %. Out of the incomplete fragmented 14 cases, seven (50 %) remained symptom free on follow-up. Maximum duration was 120 min. Minimum power settings of the laser was 4.8 Watts and maximum 18 Watts. Six patients expressed pain or discomfort that limited power increase and duration of the procedure. Total follow up time was 10 years. There were no major complications such as hemorrhage, nerve paresis or skin ulceration. CONCLUSION The procedure is safe under local anesthesia, well tolerated by most patients and should be used in cases of small fixed and "intermediate-sized" stones as a single modality. Discomfort may limit power settings and duration. The later is the major disadvantage of the method.
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Affiliation(s)
- Giorgos Sideris
- School of Medicine, 2nd Otolaryngolgy Department, National & Kapodistrian University of Athens, "Attikon" University Hospital, Rimini 1, Chaidari, Athens 124 62, Greece.
| | - Iordanis Konstantinidis
- 2nd Academic ORL Department, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece
| | - Melina Kourklidou
- School of Medicine, 2nd Otolaryngolgy Department, National & Kapodistrian University of Athens, "Attikon" University Hospital, Rimini 1, Chaidari, Athens 124 62, Greece
| | - Aggelos Chatziavramidis
- 2nd Academic ORL Department, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece
| | - Alexander Delides
- School of Medicine, 2nd Otolaryngolgy Department, National & Kapodistrian University of Athens, "Attikon" University Hospital, Rimini 1, Chaidari, Athens 124 62, Greece
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3
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Tulasi N, Prithvi B, Aditya M. Sialendoscopic Management and Gland Preservation in an Unusual Case of Extensive Submandibular Sialolithiasis. J Maxillofac Oral Surg 2024; 23:171-173. [PMID: 38312961 PMCID: PMC10830997 DOI: 10.1007/s12663-023-01890-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 03/01/2023] [Indexed: 03/31/2023] Open
Abstract
Sialolthiasis is one of the most common benign pathologies of the salivary glands. It is associated with frequent bacterial infections and significant discomfort. Large &/or multiple stones are traditionally treated by ductal marsupialisation or gland excision. Sialendoscopy, a relatively new minimally invasive technique is a useful technique which can preserve a functioning gland and reduce postoperative morbidity. The current report demonstrates the successful use of sialendoscopy in evacuating 13 stones from a submandibular gland.
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Affiliation(s)
- Nayak Tulasi
- Department of Oral and Maxillofacial Surgery, Trustwell Hospitals, JC Road, Bengaluru, 560002 India
| | - Bachalli Prithvi
- Department of Oral and Maxillofacial Surgery, Trustwell Hospitals, JC Road, Bengaluru, 560002 India
| | - Moorthy Aditya
- Department of Oral and Maxillofacial Surgery, Trustwell Hospitals, JC Road, Bengaluru, 560002 India
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4
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Rogalska M, Antkowiak L, Kasperczuk A, Scierski W, Misiolek M. Transoral Robotic Surgery in the Management of Submandibular Gland Sialoliths: A Systematic Review. J Clin Med 2023; 12:jcm12083007. [PMID: 37109343 PMCID: PMC10140901 DOI: 10.3390/jcm12083007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/15/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
This study aimed to systematically review the literature to determine the efficacy and safety of transoral robotic surgery (TORS) in the management of submandibular gland (SMG) sialolithiasis. PubMed, Embase, and Cochrane were searched for English-language articles evaluating TORS in the management of SMG stones published up to 12 September 2022. Nine studies with a total of 99 patients were included. Eight patients underwent TORS followed by sialendoscopy (TS); 11 patients underwent sialendoscopy followed by TORS and sialendoscopy (STS); 4 patients underwent sialendoscopy followed by TORS only (ST); and 4 patients underwent TORS without sialendoscopy (T). The mean operative time amounted to 90.97 min. The mean procedure success rate reached 94.97%, with the highest for ST (100%) and T (100%), followed by the TS (95.04%) and STS (90.91%) variants. The mean follow-up time was 6.81 months. Transient lingual nerve injury occurred in 28 patients (28.3%) and was resolved in all of them within the mean of 1.25 months. No permanent lingual nerve injury was reported. TORS is a safe and effective management modality for hilar and intraparenchymal SMG sialoliths, with high procedural success in terms of successful sialolith removal, SMG preservation, and reduced risk of permanent postoperative lingual nerve damage.
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Affiliation(s)
- Marta Rogalska
- Faculty of Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Lukasz Antkowiak
- Department of Pediatric Neurosurgery, Medical University of Silesia in Katowice, 40-752 Katowice, Poland
| | - Anna Kasperczuk
- Faculty of Mechanical Engineering, Institute of Biomedical Engineering, Bialystok University of Technology, 15-351 Bialystok, Poland
| | - Wojciech Scierski
- Department of Otorhinolaryngology and Oncological Laryngology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 41-800 Zabrze, Poland
| | - Maciej Misiolek
- Department of Otorhinolaryngology and Oncological Laryngology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 41-800 Zabrze, Poland
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Nomura T, Ohki M, Kikuchi S. New Modified Transoral Approach to Remove a Hilar Stone of the Submandibular Gland: A Case Report. Indian J Otolaryngol Head Neck Surg 2022; 74:6391-6393. [PMID: 36742560 PMCID: PMC9895177 DOI: 10.1007/s12070-022-03122-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 07/10/2022] [Indexed: 02/07/2023] Open
Abstract
Nerve damage and intraoperative bleeding for the removal of the hilar stones are possible. We used the new modified lateral oral floor approach with a 2-3 cm longitudinal mucosal incision outside of the Wharton's. There were no complications and our technique seemed to be effective.
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Affiliation(s)
- Tsutomu Nomura
- Department of Otolaryngology, Meikai University School of Dentistry, 1-1 Keyakidai, Sakado, Saitama 350-0283 Japan
| | - Masafumi Ohki
- Department of Otolaryngology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe-shi, Saitama 380-8550 Japan
| | - Shigeru Kikuchi
- Department of Otolaryngology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe-shi, Saitama 380-8550 Japan
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Badash I, Raskin J, Pei M, Soldatova L, Rassekh C. Contemporary Review of Submandibular Gland Sialolithiasis and Surgical Management Options. Cureus 2022; 14:e28147. [PMID: 36148182 PMCID: PMC9482556 DOI: 10.7759/cureus.28147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2022] [Indexed: 11/29/2022] Open
Abstract
One of the most common disorders of the salivary glands is obstructive sialolithiasis. Salivary gland obstruction is important to address, as it can significantly impact patient quality of life and can progress to extensive cellulitis and abscess formation if left untreated. For small and accessible stones, conservative therapies often produce satisfactory outcomes. Operative management should be considered when stones are inaccessible or larger in size, and options include sialendoscopy, laser lithotripsy, extracorporeal shockwave lithotripsy, transoral surgery, and submandibular gland adenectomy. Robotic approaches are also becoming increasingly used for submandibular stone management. The purpose of this review is to summarize the modern-day management of submandibular gland obstructive sialolithiasis with an emphasis on operative treatment modalities. A total of 77 articles were reviewed from PubMed and Embase databases, specifically looking at the pathophysiology, clinical presentation, diagnosis, and management of submandibular sialolithiasis.
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Huang Y, Liang PS, Yang YC, Cai WX, Tao Q. Nomogram to predict the risk of endoscopic removal failure with forceps/baskets for treating submandibular stones. World J Clin Cases 2022; 10:2710-2720. [PMID: 35434109 PMCID: PMC8968823 DOI: 10.12998/wjcc.v10.i9.2710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/26/2021] [Accepted: 02/13/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Endoscopic removal with forceps/baskets is favored in treating submandibular stones due to its minimal invasiveness. However, recent studies have found that endoscopic removal failure (ERF) is not unusual, and stones in such cases still need to be removed with other surgical methods. If the risk of ERF can be predicted preoperatively, it could be helpful for surgeons when choosing the appropriate therapy.
AIM To develop a predictive nomogram for the risk of ERF when treating submandibular stones based on their preoperative clinical features.
METHODS A total of 180 patients with 211 submandibular stones treated from January 2012 to December 2020 were included in the current study. Based on the preoperative clinical features of the stones, independent risk factors for ERF were identified by logistic regression analysis. The stones were then randomly divided into training and testing sets. A nomogram was constructed to predict the risk of ERF using the training set and then validated using both sets. The predictive performance of the nomogram was assessed by calibration curves and the concordance index (C-index).
RESULTS Three independent predictors, location (P = 0.040), transverse diameter (P < 0.001) and longitudinal diameter (P < 0.001) measured on the cone beam computed tomography (CBCT) images of the submandibular stones, were identified and included in the predictive nomogram. Calibration curves of the nomogram showed good agreement between the predicted and observed probabilities in both sets. The C-index in the training set was 0.917 (95%CI, 0.875-0.959) and that in the testing set was 0.925 (95%CI, 0.862-0.989).
CONCLUSION A nomogram based on the location, transverse and longitudinal diameters on CBCT images of submandibular stones showed satisfactory efficacy in predicting the risk of ERF preoperatively when treating submandibular stones.
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Affiliation(s)
- Yun Huang
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou 510055, Guangdong Province, China
- Department of Oral and Maxillofacial Surgery, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510055, Guangdong Province, China
| | - Pei-Sheng Liang
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou 510055, Guangdong Province, China
- Department of Oral and Maxillofacial Surgery, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510055, Guangdong Province, China
| | - Yao-Cheng Yang
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou 510055, Guangdong Province, China
- Department of Oral and Maxillofacial Surgery, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510055, Guangdong Province, China
| | - Wei-Xin Cai
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou 510055, Guangdong Province, China
- Department of Oral and Maxillofacial Surgery, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510055, Guangdong Province, China
| | - Qian Tao
- Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-Sen University, Guangzhou 510055, Guangdong Province, China
- Department of Oral and Maxillofacial Surgery, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510055, Guangdong Province, China
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Koch M, Mantsopoulos K, Müller S, Sievert M, Iro H. Treatment of Sialolithiasis: What Has Changed? An Update of the Treatment Algorithms and a Review of the Literature. J Clin Med 2021; 11:231. [PMID: 35011971 PMCID: PMC8746135 DOI: 10.3390/jcm11010231] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 12/27/2021] [Accepted: 12/28/2021] [Indexed: 12/04/2022] Open
Abstract
Treatment for sialolithiasis has undergone significant changes since the 1990s. Following the development of new minimally invasive and gland-preserving treatment modalities, a 40-50% rate of gland resection was reduced to less than 5%. Extracorporeal shock-wave lithotripsy (ESWL), refinement and extension of methods of transoral duct surgery (TDS), and in particular diagnostic and interventional sialendoscopy (intSE) are substantial parts of the new treatment regimen. It has also become evident that combining the different treatment modalities further increases the effectiveness of therapy, as has been especially evident with the combined endoscopic-transcutaneous approach. In the wake of these remarkable developments, a treatment algorithm was published in 2009 including all the known relevant therapeutic tools. However, new developments have also taken place during the last 10 years. Intraductal shock-wave lithotripsy (ISWL) has led to remarkable improvements thanks to the introduction of new devices, instruments, materials, and techniques, after earlier applications had not been sufficiently effective. Techniques involving combined approaches have been refined and modified. TDS methods have been modified through the introduction of sialendoscopy-assisted TDS in submandibular stones and a retropapillary approach for distal parotid sialolithiasis. Recent trends have revealed a potential for significant changes in therapeutic strategies for both major salivary glands. For the submandibular gland, ISWL has replaced ESWL and TDS to some extent. For parotid stones, ISWL and modifications of TDS have led to reduced use of ESWL and the combined transcutaneous-sialendoscopic approach. To illustrate these changes, we are here providing an updated treatment algorithm, including tried and tested techniques as well as promising new treatment modalities. Prognostic factors (e.g., the size or location of the stones), which are well recognized as having a strong impact on the prognosis, are taken into account and supplemented by additional factors associated with the new applications (e.g., the visibility or accessibility of the stones relative to the anatomy of the duct system).
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Affiliation(s)
- Michael Koch
- Department of Otorhinolaryngology and Head and Neck Surgery, University of Erlangen–Nuremberg, 91054 Erlangen, Germany; (K.M.); (S.M.); (M.S.); (H.I.)
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9
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Wen CZ, Douglas JE, Elrakhawy M, Paul EA, Rassekh CH. Nuances and Management of Hilar Submandibular Sialoliths With Combined Transoral Robotic Surgery-Assisted Sialolithotomy and Sialendoscopy. Otolaryngol Head Neck Surg 2020; 165:76-82. [PMID: 33371823 DOI: 10.1177/0194599820973231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To describe the management, technical nuances, and success rates of transoral robotic surgery (TORS)-assisted sialolithotomy. STUDY DESIGN Retrospective database review. SETTING Quaternary academic medical center. METHODS Between the months of January 2015 and May 2019, patients with hilar submandibular gland stones underwent 2 main variations of TORS-assisted sialolithotomy and sialendoscopy: (1) TORS followed by sialendoscopy for patients with palpable predominantly single stones and (2) either sialendoscopy followed by TORS and sialendoscopy or sialendoscopy followed by TORS only for patients with nonpalpable or multiple stones. Clinical charts were reviewed to collect data, including stone size (imaging review, intraoperative measurement), palpability, duration of operation, TORS variation, operative challenges, symptom improvement, gland preservation rate, and complications. RESULTS Thirty-seven patients were identified. Patients were 26 to 80 years old (mean, 57.2 years), and 40.5% were female. Twenty-four patients (64.9%) underwent TORS followed by sialendoscopy; 10 (27.0%), sialendoscopy followed by TORS and sialendoscopy; and 3 (8.1%), sialendoscopy followed by TORS only. The mean stone size was 12.4 mm (range, 4-28 mm). Eleven patients had multiple stones with a mean 4 stones per patient (range, 2-9). Procedural success was 91.9% (34/37) at a mean follow-up of 34.2 weeks (range, 1.4-262.1), and the gland preservation rate was 97.3% (36/37). No patients reported symptoms of lingual nerve injury at 3-month follow-up. CONCLUSION TORS combined with sialendoscopy for hilar submandibular gland sialolithiasis allows for improved visualization of critical anatomy, tissue manipulation, and operative flexibility. In our experience, the operative success rate is high, and duration of surgery compares favorably with conventional combined hilar approaches.
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Affiliation(s)
- Christopher Z Wen
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jennifer E Douglas
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Mohamed Elrakhawy
- Department of Otolaryngology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA
| | - Ellen A Paul
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Christopher H Rassekh
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
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10
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Robot-assisted sialolithotomy with sialoendoscopy: a review of safety, efficacy and cost. J Robot Surg 2020; 15:229-234. [DOI: 10.1007/s11701-020-01097-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/25/2020] [Indexed: 01/30/2023]
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11
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Capaccio P, Montevecchi F, Meccariello G, D’Agostino G, Cammaroto G, Pelucchi S, Vicini C. Transoral robotic surgery for hilo-parenchymal submandibular stones: step-by-step description and reasoned approach. Int J Oral Maxillofac Surg 2019; 48:1520-1524. [DOI: 10.1016/j.ijom.2019.07.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 05/20/2019] [Accepted: 07/02/2019] [Indexed: 11/29/2022]
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Capaccio P, Di Pasquale D, Bresciani L, Torretta S, Pignataro L. 3D video-assisted trans-oral removal of deep hilo-parenchymal sub-mandibular stones. ACTA ACUST UNITED AC 2019; 39:367-373. [PMID: 31388194 PMCID: PMC6966778 DOI: 10.14639/0392-100x-2282] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 09/25/2018] [Indexed: 12/21/2022]
Abstract
The aim of this paper is to describe the intra-operative findings and surgical results of the first application of 3D high-definition (HD) endoscopic support to the trans-oral surgical treatment of five patients with deep hilo-parenchymal sub-mandibular stones who underwent clinical and ultrasonographic (US) follow-up examinations at one month after the procedure. Five patients undergoing 2D-HD video-assisted transoral surgery for the same condition were used as controls. The results were classified as successful (US - demonstrated complete clearance) or unsuccessful (US - demonstrated total or partial persistence). Visual analogue scales (VAS) were used post-surgically to evaluate the sharpness and brightness of the 2D and 3D images on the screen and stereoscopic depth perception (SDP) of the 3D-HD endoscope. Successful stone removal and significant subjective improvement (lack of obstructive symptoms) was obtained in all but one of the patients in the 3D group, in whom the one-month US evaluation revealed a residual 3 mm asymptomatic hilo-parenchymal stone that was successfully treated by sialendoscopy-assisted intra-corporeal laser lithotripsy. Wharton’s duct and the lingual nerve were identified and preserved in all cases. The mean 3D-HD VAS results were brightness 7 (range 6-8), sharpness 7.8 (range 7-9) and SDP 8.2 (range 8-9); the mean 2D-HD results were brightness 7.8 (range 7-9) and sharpness 7 (range 7-8). Our findings confirm the safety and efficacy of conservative transoral surgical treatment of hilo-parenchymal sub-mandibular stones. From a surgeon’s perspective, 3D-HD guided exploration of the oral floor seems to provide a better view of Wharton’s duct and the lingual nerve, especially near the sub-mandibular parenchyma. The 3D-HD video-assisted transoral removal of deep hilo-parenchymal sub-mandibular stones can therefore be considered a useful new means of preserving the function of an obstructed salivary gland.
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Affiliation(s)
- P Capaccio
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.,Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Italy
| | - D Di Pasquale
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - L Bresciani
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - S Torretta
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Italy
| | - L Pignataro
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Italy
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13
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Capaccio P, Bresciani L, Di Pasquale D, Gaffuri M, Torretta S, Pignataro L. CT Navigation and sialendoscopy-assisted transfacial removal of a parotid stone: A technical note. Laryngoscope 2018; 129:2295-2298. [PMID: 30585329 DOI: 10.1002/lary.27621] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 08/31/2018] [Accepted: 09/21/2018] [Indexed: 12/18/2022]
Affiliation(s)
- Pasquale Capaccio
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Lorenzo Bresciani
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniele Di Pasquale
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Michele Gaffuri
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sara Torretta
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lorenzo Pignataro
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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14
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Jackson EM, Walvekar RR. Surgical Techniques for the Management of Parotid Salivary Duct Strictures. Atlas Oral Maxillofac Surg Clin North Am 2018; 26:93-98. [PMID: 30077327 DOI: 10.1016/j.cxom.2018.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Erica M Jackson
- Department of Otolaryngology Head and Neck Surgery, LSU Health Sciences Center, 533 Bolivar Street, Suite 566, New Orleans, LA 70112, USA
| | - Rohan R Walvekar
- Department of Otolaryngology Head and Neck Surgery, LSU Health Sciences Center, 533 Bolivar Street, Suite 566, New Orleans, LA 70112, USA.
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Schwarz Y, Bezdjian A, Daniel SJ. Sialendoscopy in treating pediatric salivary gland disorders: a systematic review. Eur Arch Otorhinolaryngol 2017; 275:347-356. [DOI: 10.1007/s00405-017-4830-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 11/28/2017] [Indexed: 11/24/2022]
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16
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Capaccio P, Gaffuri M, Rossi V, Pignataro L. Sialendoscope-assisted transoral removal of hilo-parenchymal sub-mandibular stones: surgical results and subjective scores. ACTA OTORHINOLARYNGOLOGICA ITALICA 2017; 37:122-127. [PMID: 28516974 PMCID: PMC5463519 DOI: 10.14639/0392-100x-1601] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 12/12/2016] [Indexed: 11/23/2022]
Abstract
It has been suggested that a conservative trans-oral approach to proximal and hilo-parenchymal submandibular stones (HPSMS) is a valid alternative to the more frequently used sialadenectomy. The aim of this study was to evaluate the surgical, ultrasonographic and patients' subjective outcomes of results of the trans-oral removal of HPSMS. Between January 2003 and September 2015, sialendoscope-assisted trans-oral surgery was used to remove symptomatic, large (> 7 mm), fixed and palpable HPSMS from 479 patients under general anaesthesia. All patients were followed clinically and ultrasonographically to investigate symptom relief and recurrence of stones, and were telephonically interviewed to assess saliva-related subjective outcomes with a questionnaire. Stones were successfully removed from 472 patients (98.5%); the seven failures (1.5%) concerned pure parenchymal stones. One year after the procedure, 408 patients (85.1%) were symptom free, 59 (12.3%) had recurrent obstructive symptoms and 12 (2.6%) had recurrent infections. Of the 54 patients who developed a recurrent stone (11.2%), 52 underwent a second procedure: 29 interventional sialendoscopies, two sialendoscope-assisted intra-corporeal pneumatic lithotripsy, eight secondary transoral surgery to remove residual stones, six a cycle of extra-corporeal lithotripsy and seven submandibular sialadenectomy. Most patients (75.2%) reported mild surgery-related pain. The symptoms of 454 patients (94.8%) improved after adjunctive treatment and, at the end of follow-up, the affected gland was preserved in 98.5% of patients. A sialendoscope-assisted trans-oral removal of large HPSMS is a safe, effective, conservative surgical procedure, and functional preservation of the main duct and parenchyma of the obstructed gland allows sialendoscopic access through the natural ostium in case of recurrence. Combining a trans-oral approach with other minimally invasive, conservative procedures ensures symptomatic relief and salivary duct system clearance in the majority of patients.
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Affiliation(s)
- P Capaccio
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Biomedical, Surgical, Dental Sciences
| | - M Gaffuri
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - V Rossi
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Biomedical, Surgical, Dental Sciences
| | - L Pignataro
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Italy
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17
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Ng SK, Chan JYK, Wong EWY, Vlantis AC. Diagnostic accuracy of sialendoscopy referenced to current imaging modalities. SURGICAL PRACTICE 2017. [DOI: 10.1111/1744-1633.12239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Siu-Kwan Ng
- Department of Otorhinolaryngology, Head and Neck Surgery; The Chinese University of Hong Kong, Prince of Wales Hospital; Hong Kong
| | - Jason Ying-Kuen Chan
- Department of Otorhinolaryngology, Head and Neck Surgery; The Chinese University of Hong Kong, Prince of Wales Hospital; Hong Kong
| | - Eddy Wai-Yeung Wong
- Department of Otorhinolaryngology, Head and Neck Surgery; The Chinese University of Hong Kong, Prince of Wales Hospital; Hong Kong
| | - Alexander Chris Vlantis
- Department of Otorhinolaryngology, Head and Neck Surgery; The Chinese University of Hong Kong, Prince of Wales Hospital; Hong Kong
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18
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Sialodochoplasty Stents: Cost Analysis and Outcomes. J Oral Maxillofac Surg 2017; 75:536-542. [DOI: 10.1016/j.joms.2016.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 09/04/2016] [Accepted: 09/05/2016] [Indexed: 11/23/2022]
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Ong AA, Carroll WW, Nguyen SA, Gillespie MB. Cost-effectiveness of transfacial gland-preserving removal of parotid sialoliths. Laryngoscope 2016; 127:1080-1086. [PMID: 27873327 DOI: 10.1002/lary.26342] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 08/22/2016] [Accepted: 08/31/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Examine outcomes of transfacial gland-preserving removal of difficult parotid stones and compare the cost and operative time to traditional parotidectomy. STUDY DESIGN Cost-effectiveness analysis and retrospective chart review. METHODS Patients who underwent transfacial removal of symptomatic parotid sialoliths at a tertiary medical center from June 2010 to July 2015 were evaluated. Outcomes included operative technique, stone size, stone location, complications, and symptom relief. In addition, patients who underwent traditional parotidectomy for chronic sialadenitis were identified. The charges and times for both procedures were reviewed and compared. RESULTS Forty-four patients underwent transfacial resection for symptomatic parotid sialolithiasis. Stones were most often located in the main duct and hilum (53.3%), with fewer intraglandular stones (46.7%). No facial nerve weakness was observed. Of those with follow-up, 33 (87%) patients reported at least partial resolution of symptoms. Overall transfacial technique charges were significantly less expensive (U.S.$) than parotidectomy (mean difference -8,064.09; 95% confidence interval [CI] -13,472.78 to -2,655.40; P = 0.033). Anesthesia charges (mean difference -2,997.85; 95% CI, -5,748.81 to -246.89; P = 0.035) and operating room charges (mean difference -4,793.91; 95% CI, -8,958.09 to -629.72; P = 0.028) were also less expensive for the transfacial technique. Finally, mean procedure time for transfacial removal of parotid stones was shorter than for parotidectomy (120.2 ± 49.9 vs. 178.4 ± 41.3 minutes, respectively; P = 0.002). CONCLUSION Transfacial gland-preserving removal of difficult parotid stones is a well tolerated and effective alternative to parotidectomy. Moreover, it is faster and less expensive than parotidectomy, maximizing both surgeon time and hospital resources. LEVEL OF EVIDENCE 4. Laryngoscope, 127:1080-1086, 2017.
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Affiliation(s)
- Adrian A Ong
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - William W Carroll
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - M Boyd Gillespie
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
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20
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Foletti JM, Wajszczak L, Gormezano M, Guyot L, Zwetyenga N, Chossegros C. Transoral Stensen's Duct Approach: A 22-case retrospective study. J Craniomaxillofac Surg 2016; 44:1796-1799. [DOI: 10.1016/j.jcms.2016.07.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 06/27/2016] [Accepted: 07/29/2016] [Indexed: 10/21/2022] Open
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Schwartz N, Hazkani I, Goshen S. Combined approach sialendoscopy for management of submandibular gland sialolithiasis. Am J Otolaryngol 2015; 36:632-5. [PMID: 26052045 DOI: 10.1016/j.amjoto.2015.04.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 04/03/2015] [Indexed: 01/01/2023]
Abstract
PURPOSE Sialolithiasis is the primary cause of obstructive sialadenitis, affecting the submandibular gland in 80-90% of cases. Sialendoscopy has dramatically changed the diagnosis and management of salivary gland diseases. However, in cases in which endoluminal removal via sialendoscopy is not successful, a combined approach using a limited intraoral incision under guidance of sialendoscopy can facilitate stone removal. We reviewed our institution's experience with combined approach sialendoscopy and evaluated its role in managing sialolithiasis of the submandibular gland. MATERIALS AND METHODS Retrospective study of the treatment of sialolithiasis in the submandibular gland via combined approach sialendoscopy from January 2010 through March 2014. Demographics, clinical data, intraoperative findings and post-operative course were reviewed. RESULTS Most sialoliths (56.5%) were over 10 mm in size and were in the hilus of the gland (56%). The success rate of the combined approach was 87%. No significant complications were documented. Symptoms resolved in 75.7% of patients; however, this did not correlate with placement of an intraductal stent (p=0.7) or steroid irrigation (p=0.1). An overall gland preservation rate of 94.9% was achieved. CONCLUSIONS Combined approach sialendoscopy offers a minimally invasive technique for treating refractory sialolithiasis not amenable to removal via sialendoscopy alone. The procedure is well-tolerated, performed under local anesthesia with low morbidity and a high success rate.
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Affiliation(s)
- Nofrat Schwartz
- Department of Otolaryngology, Meir Hospital, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Inbal Hazkani
- Department of Otolaryngology, Meir Hospital, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sivan Goshen
- Department of Otolaryngology, Meir Hospital, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Razavi C, Pascheles C, Samara G, Marzouk M. Robot-assisted sialolithotomy with sialendoscopy for the management of large submandibular gland stones. Laryngoscope 2015; 126:345-51. [DOI: 10.1002/lary.25396] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2015] [Indexed: 12/22/2022]
Affiliation(s)
| | | | - Ghassan Samara
- Department of Surgery; Division of Otolaryngology; Stony Brook Medicine, Stony Brook University School of Medicine; Stony Brook New York U.S.A
| | - Mark Marzouk
- Department of Otolaryngology and Communication Sciences; SUNY Upstate Medical University; Syracuse New York
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Kalia V, Kalra G, Kaur S, Kapoor R. CT Scan as an Essential Tool in Diagnosis of Non-radiopaque Sialoliths. J Maxillofac Oral Surg 2015; 14:240-4. [PMID: 25838703 DOI: 10.1007/s12663-012-0461-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2012] [Accepted: 11/16/2012] [Indexed: 11/26/2022] Open
Abstract
Sialolithiasis is the second most common disease of the salivary glands and the main cause of salivary gland obstruction. Diagnosis of calculi/sialoliths can be made by means of an elaborate history, precise clinical examination and radiographic support. But all sialoliths do not present with predictable signs and symptoms and radiographic appearance. Sialoliths have a variety of manifestations and they may or may not be radiopaque. Non-radiopaque sialoliths are difficult to diagnose radiographically. Although newer techniques like CBCT, CT virtual sialandoscopy and established techniques like sialography, xeroradiography can be useful in selected cases. A regular CT scan is an excellent tool in the diagnosis of a non-radiopaque sialolith and associated salivary gland changes. CT scan should be considered as an important tool of imaging for diagnosis, treatment planning and follow-up of all cases of sialoliths and associated pathologies of the salivary gland.
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Affiliation(s)
- Vimal Kalia
- Department of Oral and Maxillofacial Surgery, BRS Dental College and Hospital, Panchkula, India ; Dantantra, House no 731, Sector 2, Panchkula, India
| | - Geeta Kalra
- Department of Oral and Maxillofacial Surgery, BRS Dental College and Hospital, Panchkula, India
| | | | - Rajeev Kapoor
- Department of Radiology, General Hospital, Sector-6, Panchkula, India
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Mikolajczak S, Bremke M, Beutner D, Luers JC. Combined endoscopic and transcutaneous approach for immobile parotid stones. Acta Otolaryngol 2015; 135:85-9. [PMID: 25496180 DOI: 10.3109/00016489.2014.953204] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Salivary stones in the parotid gland that are not amenable to endoscopic extraction can safely be removed by a combined, endoscopic-external approach. OBJECTIVE Limitations for endoscopic removability of salivary stones from the parotid gland are immobile stones in the deeper salivary duct system. A combined endoscopic and transcutaneous approach gives access to these stones with possible preservation of the parotid gland. METHODS A total of 10 consecutive patients were treated using the combined approach for the management of sialolithiasis of the parotid gland. The patients had previously undergone a sialendoscopy under local anesthesia and were proven to have large, immobile salivary stones in the salivary duct. RESULTS In all patients, the procedure was successfully conducted with extraction of impacted stones. In 60% of the patients, a temporary stenting of the salivary duct was performed. All patients showed good clinical results with restored drainage of the salivary duct system and preserved gland function.
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Affiliation(s)
- Stefanie Mikolajczak
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne , Cologne , Germany
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25
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Konstantinidis I, Chatziavramidis A, Iakovou I, Constantinidis J. Long-term results of combined approach in parotid sialolithiasis. Eur Arch Otorhinolaryngol 2014; 272:3533-8. [DOI: 10.1007/s00405-014-3391-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Accepted: 11/04/2014] [Indexed: 10/24/2022]
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Pace CG, Hwang KG, Papadaki M, Troulis MJ. Interventional Sialoendoscopy for Treatment of Obstructive Sialadenitis. J Oral Maxillofac Surg 2014; 72:2157-66. [DOI: 10.1016/j.joms.2014.06.438] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 05/12/2014] [Accepted: 06/04/2014] [Indexed: 10/25/2022]
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27
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Endoscopically Assisted Removal of a Fish Bone Penetrating the Parotid Duct: An Unusual Case. J Oral Maxillofac Surg 2014; 72:1343-9. [DOI: 10.1016/j.joms.2014.02.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Revised: 02/06/2014] [Accepted: 02/06/2014] [Indexed: 11/23/2022]
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28
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Robotic Surgery for Salivary Gland Disease. CURRENT OTORHINOLARYNGOLOGY REPORTS 2014. [DOI: 10.1007/s40136-014-0046-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Modest MC, Galinat L, Rabinowitz MR, Curry JM, Rosen D, Cognetti DM. Learning Progression in the Use of Sialendoscopy for Sialolithiasis. Otolaryngol Head Neck Surg 2014; 151:240-5. [DOI: 10.1177/0194599814533658] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 04/09/2014] [Indexed: 11/15/2022]
Abstract
Objective Evaluate how learning progression affects outcomes for the use of sialendoscopy for sialolithiasis. Study Design Case series with chart review. Setting Academic tertiary care center. Subjects and Methods A retrospective chart review was conducted on 81 patients presenting with sialolithiasis between 2008 and 2012 who underwent surgical intervention on 85 salivary glands. Outcomes compared between the first 43 and subsequent 42 consecutive glands included successful removal, surgical method, and need for further intervention. Results For the first 43 patients (group A), mean age was 47.3 years (range, 15-77), and 44.2% were male. For the second 38 patients (group B), mean age was 49.9 (range, 23-76), and 50% were male. Mean stone size was similar in both groups; 8.3 versus 7.6 mm, respectively. In cases of stone visualization and removal, complete removal without gland excision was accomplished in 78.4% of cases in group A versus 94.3% in group B ( P = .04). Endoscopic removal occurred in 24.3% of patients in group A, versus 45.8% in group B. A combined approach was used in 54.1% of patients in group A versus 48.6% in group B. In group A, 18.9% underwent gland removal as part of initial intervention versus 0% in group B ( P = .007). Overall gland preservation was 81.4% in group A versus 97.6% in group B ( P = .015). Conclusion This study documents the effect of learning curve on sialendoscopy for the management of sialolithiasis. With experience, the success of sialendoscopy increases with a significant decrease in the number of gland excisions.
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Affiliation(s)
- Mara C. Modest
- Department of Otolaryngology, Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Lauren Galinat
- Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mindy R. Rabinowitz
- Department of Otolaryngology, Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Joseph M. Curry
- Department of Otolaryngology, Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - David Rosen
- Department of Otolaryngology, Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - David M. Cognetti
- Department of Otolaryngology, Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Objective and subjective outcome in 42 patients after treatment of sialolithiasis by transoral incision of Warthon's duct: a retrospective middle-term follow-up study. Eur Arch Otorhinolaryngol 2014; 271:3059-66. [PMID: 24493562 DOI: 10.1007/s00405-014-2905-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 01/19/2014] [Indexed: 10/25/2022]
Abstract
In this retrospective follow-up study, we present the middle-term results of transoral removal of submandibular calculi by incision in the floor of the mouth together with a patient satisfaction survey. These results will be compared with those of international studies. This is an individual retrospective cohort follow-up study. Forty-two patients had salivary calculi removed by incision in the mouth in the period from August 2009 to July 2012 at the Ear-nose-throat department of the North Zealand Hospital, Hillerød, Denmark. A retrospective study was carried out, focusing on the effects of the surgery and on patient satisfaction. The patients completed a questionnaire and underwent an objective physical exam. We found a high success rate (93 %), high patient satisfaction (94 %) and a high number of patients with no symptoms (92 %). In 94 % of the patients the gland was preserved, and there were no infections. One patient (3 %) suffered from damage to the lingual nerve, and 6 % (n = 2) claimed to suffer from continuous tingling of the tongue. Based on the present study and previous studies on transoral removal of calculi by incision in the floor of the mouth, we find this procedure effective, brief and safe for removal of large, immobile calculi from the hilum of the submandibular gland to the papilla.
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Kopeć T, Wierzbicka M, Szyfter W, Leszczyńska M. Algorithm changes in treatment of submandibular gland sialolithiasis. Eur Arch Otorhinolaryngol 2013; 270:2089-93. [PMID: 23568038 PMCID: PMC3669508 DOI: 10.1007/s00405-013-2463-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 03/20/2013] [Indexed: 11/28/2022]
Abstract
Our research was conducted to determine the algorithm changes during the treatment of submandibular sialolithiasis. Two time periods were compared between 2004-2008 and 2009-2012. The turning point was December 2008, when sialendoscopy procedure was introduced. In the first period, 48 patients were treated: 31 outpatient duct incisions with stone evacuation and 17 surgical excision of submandibular gland. In the second period, 207 sialendoscopy procedures were performed on 197 patients. Out of this particular group, 158 patients were diagnosed with pathological obstruction of salivary glands and 64 of them were confirmed to have sialolithiasis of submandibular gland. Deposits of calcifications in 40 individuals (62.5 %) affected by sialolithiasis were removed endoscopically; however, in 21 patients, due to the increased circumference of the stone, the intimate association of deposits within the wall of the duct along with its presence inside the deep portions of the gland, double approach (incision of the floor of the mouth in hilar area and sialendoscopy) was performed. Three individuals had their salivary glands totally removed due to the presence of calcified deposits within the glandular parenchyma. Our results allow us to affirm that sialendoscopy is the current treatment of choice for submandibular glands affected by sialoliths. Indication for a complete removal of the gland is becoming uncommon as a first line treatment although still indispensable in chosen cases.
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Affiliation(s)
- Tomasz Kopeć
- ENT Department, Medical University Poznan, Przybyszewski Street 49, 60355 Poznań, Poland.
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Basheeth N, Sheahan P, Murphy M. Combined percutaneous ultrasound and fluoroscopic-guided recanalization of Stensen's duct. Laryngoscope 2013; 124:659-61. [PMID: 23794230 DOI: 10.1002/lary.24277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Revised: 06/04/2013] [Accepted: 06/04/2013] [Indexed: 11/12/2022]
Affiliation(s)
- Naveed Basheeth
- Department of Otolaryngology and Head and Neck Surgery, South Infirmary Victoria University Hospital, Cork, Ireland
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Pagliuca G, Martellucci S, de Vincentiis M, Greco A, Fusconi M, De Virgilio A, Rosato C, Gallo A. Wharton's duct repair after combined sialolithectomy: is ductoplasty necessary? Otolaryngol Head Neck Surg 2013; 148:775-7. [PMID: 23396595 DOI: 10.1177/0194599813477839] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this prospective study is to establish whether ductoplasty is necessary to repair the Wharton's duct after a combined endoscopic and external approach to remove large submandibular gland stones or if simple suturing of the oral floor mucosa after stent placement may be sufficient to achieve proper duct healing. Ten patients were enrolled. Ductoplasty was performed in 6 cases, whereas in 4 cases, only the mucosa of the oral floor was sutured. The stent was removed about 3 weeks after surgery. Sialoliths were completely removed in all cases. During follow-up, patient symptom evaluation, ultrasound, and physical examination showed no signs of recurrence or complications. In our limited experience, ductoplasty after the combined approach was not necessary. After stent placement, the mere suture of the oral mucosa overlying the damaged ductal wall allowed a correct recanalization of the ductal lumen as commonly observed after careful ductoplasty.
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Affiliation(s)
- Giulio Pagliuca
- Department of Surgical Biotechnologies and Science, ENT Section, Sapienza University of Rome, Rome, Italy.
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Carroll WW, Walvekar RR, Gillespie MB. Transfacial ultrasound-guided gland-preserving resection of parotid sialoliths. Otolaryngol Head Neck Surg 2012; 148:229-34. [PMID: 23239807 DOI: 10.1177/0194599812471514] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Review surgical techniques and outcomes of ultrasound-guided, transfacial, gland-preserving removal of difficult parotid stones. STUDY DESIGN Case series with chart review. SETTING Two academic tertiary care centers. METHODS Patients who underwent ultrasound-guided, combined transfacial-endoscopic operation for symptomatic parotid sialolithiasis from June 2010 through June 2012 at 2 tertiary care university hospitals were evaluated. Outcome measurements included stone size, stone location, complications, symptom relief, and gland preservation rate. RESULTS A total of 14 patients underwent ultrasound-guided, transfacial operation for symptomatic parotid sialolithiasis. Ten of 14 patients (71%) had completely successful therapy defined by no symptoms postoperatively with a preserved, functional gland. Three of the 4 patients without complete symptom resolution did endorse symptom improvement, whereas the fourth patient eventually underwent parotidectomy. Needle localization was used to aid in transfacial stone retrieval in 57% of cases. CONCLUSION Ultrasound-guided, combined transfacial-endoscopic removal of certain parotid stones is an alternative to parotidectomy for patients in whom endoscopy or shock wave therapy for stone retrieval is ineffective, unavailable, or contraindicated. Needle localization is a useful adjunct in stone retrieval.
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Affiliation(s)
- William W Carroll
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina 29425-5500, USA.
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Combined endoscopic–transcutaneous surgery in parotid gland sialolithiasis and other ductal diseases: reporting medium- to long-term objective and patients′ subjective outcomes. Eur Arch Otorhinolaryngol 2012; 270:1933-40. [DOI: 10.1007/s00405-012-2286-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 11/08/2012] [Indexed: 10/27/2022]
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Gary C, Kluka EA, Schaitkin B, Walvekar RR. Interventional sialendoscopy for treatment of juvenile recurrent parotitis. J Indian Assoc Pediatr Surg 2012; 16:132-6. [PMID: 22121310 PMCID: PMC3221154 DOI: 10.4103/0971-9261.86865] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To evaluate our preliminary experience with interventional sialendoscopy for the diagnosis and treatment of juvenile recurrent parotitis (JRP). MATERIALS AND METHODS Three consecutive pediatric patients with JRP who underwent interventional sialendoscopy were identified. Interventional sialendoscopy consisted of serial dilation of the Stenson's duct, endoscopy of the ductal system and saline irrigation followed by instillation of triamcinolone acetate. Clinical, demographic, procedure-related data and complications were documented. End points of the study were technical success, defined as completion of the procedure, subjective improvement in symptoms as indicated by the patients or their parents and assessment of safety in terms of complications. RESULTS Three male patients with a mean age of 9 years (range 6-11 years) underwent interventional sialendoscopy for JRP. Endoscopic findings included a blanched stenotic duct with intraductal debris in those who were symptomatic. Technical success was 100%. The mean number of episodes of JRP in the year prior to presenting to our service among the three patients was 5 (range 4-6 per year). There were no new episodes of JRP reported at the last follow-up. There were no major complications. CONCLUSION Our preliminary experience concurs with the current literature and suggests that interventional sialendoscopy is effective for the management of JRP and can be considered for patients who fail conservative medical management.
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Affiliation(s)
- Celeste Gary
- Department of Otolaryngology Head Neck Surgery, LSU Health Sciences Center, New Orleans, LA
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Kopeć T, Szyfter W, Wierzbicka M. Sialoendoscopy and combined approach for the management of salivary gland stones. Eur Arch Otorhinolaryngol 2012; 270:219-23. [PMID: 22875066 PMCID: PMC3535358 DOI: 10.1007/s00405-012-2145-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Accepted: 07/27/2012] [Indexed: 10/28/2022]
Abstract
UNLABELLED The introduction of minimally invasive surgical procedures has significantly reduced the rate of major salivary gland removal due to sialolithiasis. The aim of this study is to assess the effectiveness of sialoendoscopy, rate of salivary fistula or natural ostium stenosis in parotid sialolithiasis treatment. The endpoint was to analyse the efficiency of a combined transcutaneous and endoscopic approach in the removal of refractory and impacted stones in most difficult cases. STUDY DESIGN prospective study, tertiary university centre, between XII 2008 and XI 2011, 185 sialendoscopies (SE) were performed in 162 patients. Within the group of 29 patients with parotid sialolithiasis endoscopy was the definite treatment in 15 cases (53 %), in 9 cases lithotripsy (ESWL) was necessary and in 5 patients who failed SE and lithotripsy, a combined approach was performed. This approach comprised both SE and open surgery. We observed no salivary fistula formation after the incision of the duct. Stenosis of the natural ostium thanks to the insertion of stent was observed only in one case. Sialoendoscopy is the method of choice with a high rate of success and gland preservation in small and medium stones. The combined transcutaneous and endoscopic approach is indicated for large stones, for complications after and contraindications in using minimally invasive procedures. Short and medium term follow up shows that surgery can be performed with a high rate of success.
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Affiliation(s)
- Tomasz Kopeć
- ENT Department, K. Marcinkowski Medical University, Przybyszewski Street 49, 60355, Poznan, Poland.
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Luers JC, Stenner M, Schinke M, Helmstaedter V, Beutner D. Tolerability of sialendoscopy under local anesthesia. Ann Otol Rhinol Laryngol 2012; 121:269-74. [PMID: 22606931 DOI: 10.1177/000348941212100413] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES We sought to investigate patients' tolerance of sialendoscopy of the parotid and submandibular glands with local anesthesia. METHODS In a retrospective case series of 84 adult patients who underwent sialendoscopy with local anesthesia at an academic tertiary referral hospital, we analyzed patients' demographic data, American Society of Anesthesiologists (ASA) status score, perioperative cardiovascular parameters, and results on a 2-question survey. RESULTS Of the 84 patients, 44 were female and 40 were male (mean age, 48.6 years). The patients had a mean ASA status score of 1.57. On average, 2.16 mL of local anesthetic was used. The mean systolic blood pressure was 137 mm Hg, and the mean diastolic blood pressure was 80 mm Hg. The duration of the procedure showed a significant correlation with the maximum systolic blood pressure (r = 0.35; p = 0.001), the mean systolic blood pressure (r = 0.25; p = 0.02), the maximum diastolic blood pressure (r = 0.37; p = 0.001), and the mean diastolic blood pressure (r = 0.31; p = 0.005). The mean heart rate was 77 beats per minute. The majority of patients considered the procedure to be tolerable. In this series, the indications for conducting sialendoscopy under general anesthesia were procedures of greater invasiveness and complex situations with multiple sialolithiases, difficult anatomic preconditions, or a very long expected operation time. CONCLUSIONS Sialendoscopy performed with local anesthesia is well tolerated, provided that the patient has a good general health status and the operative procedure is not expected to be complex or long-lasting.
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Affiliation(s)
- Jan Christoffer Luers
- Department of Otorhinolaryngology-Head and Neck Surgery University of Cologne, Köln, Germany
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Singh PP, Gupta N, Goyal A, Tomar S. Interventional sialendoscopy for parotid ductal calculi: our preliminary experience. Indian J Otolaryngol Head Neck Surg 2011; 64:252-6. [PMID: 23998030 DOI: 10.1007/s12070-011-0361-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Accepted: 11/10/2011] [Indexed: 11/26/2022] Open
Abstract
With this article we present our initial experience with interventional sialendoscopy of the parotid duct for the parotid calculi. We carried out a prospective study of patients of parotid calculi in a tertiary referral centre. Diagnostic and interventional sialendoscopy was performed in five cases of parotid calculi. The outcome was classified on the basis of clearance of the lumen of the duct and resolution of symptoms. Diagnostic sialendoscopy was able to diagnose the calculus in all cases. Interventional sialendoscopy was done under general anesthesia in all cases and calculus was successfully removed. The average size of sialolith was 8.2 mm. No complications occurred in any of the cases. Check sialendoscopy was done in all cases after a minimum follow up of 6 months, which showed the duct lumen to be free of stone with no stricture of the duct. Sialendoscopy is an optimal technique for removal of intraductal parotid calculi and avoids removal of the gland. In our series there was no associated morbidity and complication.
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Affiliation(s)
- P P Singh
- Department of Otorhinolaryngology, University College of Medical Sciences and GTB Hospital, A-304, Abhyant Apartments, 2, Vasundhara Enclave, Delhi 110096 India
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Transoral removal of hiloparenchymal submandibular calculi: a long-term clinical experience. Eur Arch Otorhinolaryngol 2011; 268:1081-6. [DOI: 10.1007/s00405-011-1508-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Accepted: 01/20/2011] [Indexed: 10/18/2022]
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Gillespie MB, Intaphan J, Nguyen SA. Endoscopic-assisted management of chronic sialadenitis. Head Neck 2011; 33:1346-51. [DOI: 10.1002/hed.21620] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Revised: 08/03/2010] [Accepted: 08/12/2010] [Indexed: 01/18/2023] Open
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Bowen MA, Tauzin M, Kluka EA, Nuss DW, DiLeo M, McWhorter AJ, Schaitkin B, Walvekar RR. Diagnostic and interventional sialendoscopy: A preliminary experience. Laryngoscope 2011; 121:299-303. [DOI: 10.1002/lary.21390] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2010] [Revised: 09/12/2010] [Accepted: 09/15/2010] [Indexed: 11/05/2022]
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Walvekar RR, Tyler PD, Tammareddi N, Peters G. Robotic-assisted transoral removal of a submandibular megalith. Laryngoscope 2010; 121:534-7. [PMID: 21344429 DOI: 10.1002/lary.21356] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Revised: 08/29/2010] [Accepted: 08/31/2010] [Indexed: 01/07/2023]
Abstract
The majority of salivary stones are less than 8 mm in size and most frequently occur in the submandibular gland. Traditional management of larger stones involves gland resection. Sialendoscopy combined with an external or a transoral sialolithotomy, also called the combined approach technique, permits stone removal and gland preservation. A 31-year-old male presented to our service with a 20-mm megalith in the left submandibular gland. Here we report the first description of a combined approach using the da Vinci Si Surgical System to facilitate transoral stone removal and salivary duct repair.
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Affiliation(s)
- Rohan R Walvekar
- Department of Otolaryngology/Head Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA.
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Extra-oral approach to removal of parotid duct stones. The Journal of Laryngology & Otology 2010; 124:1100-2. [DOI: 10.1017/s0022215110000563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractThere are many different management strategies for salivary calculi within the parotid ducts. Commonly, the stones can be extracted via an intra-oral approach. Stones that are farther from the papillae require more complex management. This article describes a technique for extra-oral excision of palpable salivary calculi using known external facial landmarks and dissection. Two cases are discussed and illustrations shown, and a brief discussion of other techniques for the management of salivary stones is included.
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Wallace E, Tauzin M, Hagan J, Schaitkin B, Walvekar RR. Management of giant sialoliths: Review of the literature and preliminary experience with interventional sialendoscopy. Laryngoscope 2010; 120:1974-8. [DOI: 10.1002/lary.21082] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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