Reconstruction of the Palate Following Removal of Palatal Salivary Gland Tumors

Abstract

take miniaturized baskets and forceps for retrieval of stones under direct vision. To complement these developments new surgical techniques have been developed to retrieve stones by leaving a functioning gland intact. Used in combination these techniques can reliably relieve obstruction of salivary glands by stone or stricture and provide an alternative to gland excision for obstructive disease. Experience with gland preserving techniques in a series of 455 patients indicates that in at least 76% of cases stones and obstructions can be eradicated and only 2% of patients required gland removal. This is a radical deviation from current practice. A further advantage is that many of the techniques used in this series can be performed under local anesthetic or on an outpatient basis with low morbidity. The intra-oral removal of submandibular stones can also be undertaken under local anesthetic for appropriate patients but most stones are retrieved on a day case basis under general anesthetic. The scintigraphy results suggest that although gland function improves following treatment it does not return to normal values. However there is accumulating data to show significant gland regeneration following obstruction and with a medium follow-up of 4 years there is no evidence that patients are developing chronic sialoadenitis. Our results as well as others suggest that the optimum management of salivary obstruction should focus on gland preserving techniques.