Sialendoscopy in the Diagnosis and Treatment of Sialolithiasis

Abstract

Objective Sialendoscopy and other gland-preserving techniques such as extracorporeal shockwave lithotripsy (ESWL), transoral stone removal, and combinations of these methods have fundamentally changed the therapeutic approach to salivary stones. Since 2003, all patients presenting with sialolithiasis have been diagnosed and treated with the same algorithm and routine salivary gland endoscopy (SGE). Study Design Case series with chart review of patients with sialolithiasis treated between 2003 and 2008 using an algorithm for gland preservation. Setting Tertiary referral academic medical center. Subjects and Methods A total of 1154 patients with suspected sialolithiasis were identified and reviewed. Factors analyzed included stone location, size, surgical method, rate of stone clearance, complications, and rate of short- and long-term symptom resolution. Successful treatment was defined as freedom from symptoms at follow-up. Results Diagnostic sialendoscopy confirmed 221 parotid stones and 812 submandibular stones, of which 206 and 736, respectively, were treated. Transoral stone removal was the most frequently used method to remove submandibular stones (92%), with a smaller percentage able to be removed by SGE alone (5%) with long-term success rates ≥90%. Only 4% (29/736) required submandibular gland removal. Parotid stones were removed by SGE (22%), combined SGE and incisional technique (26%), or ESWL (52%), with long-term success rates of 98%, 89%, and 79%, respectively. Only 8 of 206 (4%) patients eventually required parotidectomy. Conclusion Salivary gland endoscopy is an important diagnostic and therapeutic tool in the management of sialolithiasis but must be combined with additional techniques to ensure a high rate of stone clearance, symptom resolution, and gland preservation.

Sialendoscopy: A Review of 133 Cases

“…Only three patients had recurrence of calculi in whom a repeat procedure relieved the symptoms. Hence the success rate of sialendoscopy for sialolithiasis is 94.64% which is concordant with other studies [13].…”

Sialoendoscopic treatment of parotid gland diseases

“…Between 2003 and 2008, 206 out of 221 parotid gland stones were treated in a tertiary referral academic medical centre by salivary gland endoscopy and other gland-preserving techniques such as extracorporeal shockwave lithotripsy, transoral stone removal, and combinations of these methods (39). The parotid gland stones were removed by salivary gland endoscopy in 22%, by combined salivary gland endoscopy and incisional technique in 26%, or by extracorporeal shockwave lithotripsy in 52% of the cases, with long-term success rates of 98%, 89%, and 79%, respectively.…”

Sialendoscopy: Introduction, Indications and Technique

“…Currently, sialendoscope is being most commonly used for removing submandibular and parotid duct calculi which is the most common obstructive pathology affecting the salivary glands [1][2][3].…”

“…As compared to submandibular stones, a significantly higher number of parotid stones can be removed with sialendoscopy alone. This can be attributed to the facts that the average size of submandibular stones is larger as compared to parotid stones and that the submandibular stones are less mobile and far more adherent to the surrounding ductal tissue [1]. Large, immobile submandibular stones are removed transorally (intraoral incision) but we prefer not to use this method for parotid stones in view of high probability of severe ductal stricture after these procedures.…”

“…Sialadenitis secondary to obstructive pathologies including sialoliths, strictures and ductal polyps, remains the most common disorder of the salivary gland [1][2][3]. Patients would receive sorts of treatment like antibiotics, steroids, sialogogues, anticholinergics or would undergo surgeries like intraoral incision and removal of the sialolith or even gland removal.…”