Abstract
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.
Highlights
Sialolithiasis is the most common cause of inflammatory disease of large salivary glands and occurs in about 1.2 % of the population [9, 18]
The aim of this study is to assess the effectiveness of sialoendoscopy, rate of salivary fistula or natural ostium stenosis in parotid sialolithiasis treatment
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
Summary
Sialolithiasis is the most common cause of inflammatory disease of large salivary glands and occurs in about 1.2 % of the population [9, 18]. It most often occurs in the submandibular gland—(87 %), followed by the parotid gland—(10 %) and the sublingual gland—(3 %). Sialoliths can occur as single or multiple stones of various shapes and sizes. They are distally and proximally located in the efferent duct, but they may be found intraparenchymally (outside the main tree of secretory ducts). The annual increase in the size of salivary stones is estimated at 1 mm [11]
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