Minimal surgery for parotid stones: a 7-year endoscopic experience

Minimally-invasive surgery in the management of symptomatic parotid stones

“…The rate of postoperative infection was 4%, most of which resolved with antibiotics, and only one patient required admission to hospital. This is comparable to the findings of Karavidas et al whose rate of postoperative infection was 3%, 14 and considerably lower than the 15% reported by Overton et al 15 Facial nerve injury is a common complication of parotidectomy 3,4 but is a rare consequence of this minimally-invasive approach. The buccal branch of the facial nerve runs in close association to Stensen's duct for about 2.5 cm, inferiorly in 75%, and across the duct to lie superiorly in 25% of cases.…”

Outcome after endoscopically assisted surgical retrieval of symptomatic parotid stones

“…Most notably, 10% of patients developed a postoperative sialocele; this has not been documented elsewhere. The rate of postoperative infection or recurrent parotitis was 15%, which is far higher than the 3% reported by KARAVIDAS et al 7 Whilst other studies have noted satisfactory cosmesis after this operation 7,10,12,14 patient perspectives are reported here for the first time with 25% (10/40) patients reporting a visible scar, but this was only of concern to one patient (3%). Persistent altered sensation over the ear or cheek was the commonest sequela noted (57.5%).…”

“…This seems to concord with the present results, which showed complete remission of symptoms in 70% of cases with 28% reporting symptoms as 'better, but still slightly or occasionally' troublesome (mean and median follow up, 37 months). Total remission of symptoms was reported in 8/9 (89%) patients by KOCH et al 8 and 65/67 (97%) patients by KARAVIDAS et al 7 in a three centre, international study (mean follow-up 25.5 months).…”

“…Five series with a combined total of 135 patients have been published with success rates for stone removal ranging from 75% to 100% 7,8,10,12,14 . Combined approaches (surgical and endoscopic) were used in all studies with either transcutaneous or pre-auricular incisions employed to access the duct and remove the stone.…”

Spontaneous cutaneous extrusion of a parotid gland sialolith

“…If ESWL is not available, larger or intraparenchymal parotid stones may be managed using a combined sialendoscopic and open approach 11–14. In these cases, a transcutaneous incision is made over the stone and duct, which has been transilluminated through the skin with the sialendoscope 11 13. The parotid gland is thereby preserved with a reduction in the risk of facial nerve damage 11…”