Transoral per punctum excision of an impacted parotid duct stone of unfavorable direction: a case report

Abstract

BackgroundIn the literature, the reported parotid duct stones that did not respond to the conservative measures are few. The present work reported and described the diagnosis and treatment of a case of impacted parotid duct stone that was surgically removed through minimally invasive transoral per punctum approach.Case presentationOn examination of a 27-year-old male with left intermittent parotid swelling and pain for 1 year, a stone was palpated in the left buccal mucosa region near the orifice of the parotid duct. Ultrasonography (US) showed left Stensen’s duct distal stone. Under general anesthesia and oral intubation, the stone measuring about 1 cm in length was felt transversely located (directed at a right angle with the orifice of the duct). A small mucosal incision was done at the upper lateral part of the punctum; pus came out, and then the stone bulged from the orifice and was pushed outside. Recovery was event-less; postoperative paracetamol was sufficient to relieve pain, and the patient was discharged a few hours after the surgery.ConclusionThe transoral per punctum excision of an impacted parotid duct stone appears to be a reliable minimally invasive effective and safe procedure. The unfavorable direction of the parotid duct stone might be a cause of failure of the conservative treatment for this stone.