Specificity of Parotid Sialendoscopy

Abstract

Objective: To present our initial experience with sialendoscopy of the parotid duct. Study Design: Methods: Diagnostic and interventional sialendoscopy procedures were performed in 79 and 55 cases, respectively. Diagnostic sialendoscopy was used to classify ductal lesions into sialolithiasis, stenosis, sialodochitis, and polyps. Interventional sialendoscopy was used to treat these disorders. The type of endoscope used, the type of sialolithiasis fragmentation and/or extraction device used, the total number of procedures, the type of anesthesia, and the number and size of the sialoliths removed were the dependent variables. The outcome variable was the endoscopic clearing of the ductal tree and resolution of symptoms. Results: Diagnostic sialendoscopy was possible in all cases, with an average duration of 26 ؎ 14 minutes and no complications. Interventional sialendoscopy was successful in 85% of cases, with an average duration of 73 ؎ 43 minutes (؎ standard deviation). Multiple procedures were performed in 45% of cases, general anesthesia was used in 24%, and parotidectomy in 2%. Multiple sialoliths were found in 58% of ducts and associated with more procedures under general anesthesia and longer operations. The average size of sialoliths was 3.2 ؎ 1.3 mm; larger stones were associated with more procedures under general anesthesia, longer and multiple procedures, use of fragmentation, and sialendoscopy failures. Sialolithiasis fragmentation was required in 10% of cases, with a success rate of 70%. Semirigid sialendoscopes performed better than flexible ones. Complications were mostly minor but were encountered in 12% of cases. Conclusions: Diagnostic sialendoscopy is a new technique for evaluating salivary duct disease, a technique which is associated with low morbidity. Interventional sialendoscopy allows the extraction of sialoliths in most patients, preventing open gland excision.

Interventional Sialendoscopy with Endoscopic Sialolith Removal Without Fragmentation

“…The purpose of treatment is to completely remove the stone. Previous studies suggest that the stone diameter should not be more than 5 mm for Stensen duct and 7 mm for Wharton duct if it is to be removed in one piece without fragmentation [11,12]. Sometimes it is possible to remove even larger stones without fragmentation if they have smoothly ellipsoid configuration [3].…”

“…These include external or internal lithotripsy, laser fragmentation or microdrill [15,16]. The success rate for endoscopic sialolithotomy of larger stones without fragmentation was as low as 35 % [4,12]. Furthermore complications like ductal tear or avulsion may occur if these large stones approached endoscopically [2].…”

“…Additionally there is no consensus on the maximum diameter of stones that could be removed without fragmentation. This size varies between 3 and 7 mm in different studies [11][12][13].…”

“…The overall success rate of mechanical retrieval or fragmentation was 85 %. In 55 cases with parotid sialoliths, Marshal et al [12] found that interventional sialendoscopy was successful in 85 % of cases. The average size of sialoliths was 3.2 ± 1.3 mm and sialolithiasis fragmentation was required in 10 % of cases with a success rate of 70 %.…”

Interventional Sialendoscopy for Parotid Ductal Calculi: Our Preliminary Experience

“…But with improved and more sensitive methods of detection now available, studies have reported up to 40% incidence of parotid stones in cases of sialolithiasis [5]. This also perhaps explains the higher reported incidence of multiple stones (58%) in the affected parotid gland.…”