Gland‐Preserving Transfacial Removal of Parotid Stones

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Objectives: (1) Analyze the evolving technique for gland-preserving transfacial removal of parotid stones including ultrasound, needle localization, and the combination of endoscopy with transfacial removal. (2) Review the success rate for patients treated with gland-preserving transfacial removal of parotid stones in an updated cohort. Methods: Case series with chart review at a tertiary care university hospital from 2010 to 2014. Disease: Parotid sialolithiasis. Subjects: Patients with parotid sialolithiasis unmanageable with endoscopy alone. Intervention: Transfacial removal. Outcome measurements: Symptom relief, gland preservation, use of ultrasound, use of needle localization, stone size, stone location, facial nerve visualization, complications, and endoscopic confirmation of stone location prior to stone removal. Results: A total of 25 patients underwent transfacial operation for symptomatic parotid sialolithiasis. Ultrasound was used in 88% of cases and needle localization was used in 64% of cases. Sixteen out of 25 patients (64%) had completely successful therapy defined by no symptoms postoperatively with a preserved, functional gland. Ten of the remaining eleven patients without complete symptom resolution did endorse significant symptom improvement, while the final patient eventually underwent parotidectomy. Fifteen out of 25 patients (60%) had a stone that was localized with the endoscope prior to transfacial resection. Conclusions: Transfacial removal of certain parotid stones is a functional alternative to parotidectomy for patients in whom endoscopy or shock wave therapy for stone retrieval is ineffective, unavailable, or contraindicated. Ultrasound and needle localization are useful adjuncts in stone retrieval.