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Chang C, Wang H. Ultrasound shear wave elastography for patients with sialolithiasis undergoing interventional sialendoscopy. Laryngoscope Investig Otolaryngol 2023; 8:76-81. [PMID: 36846401 PMCID: PMC9948575 DOI: 10.1002/lio2.1007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 12/30/2022] [Indexed: 01/19/2023] Open
Abstract
Objective Ultrasound shear wave elastography is an objective tool to evaluate the stiffness of human tissues. Patients with sialolithiasis could be treated by interventional sialendoscopy with a high success rate. Sialolithiasis could be extracted, and the diseased gland could be preserved and evaluated after treatment. Whether ultrasound shear wave elastography could be used for objective outcome measurement and short-term follow-up of the parenchyma of gland in patients with sialolithiasis remains unclear. Methods This retrospective self-controlled study was conducted. Patients with sialolithiasis treated by interventional sialendoscopy and followed by high-resolution ultrasound shear wave elastography were selected between January and September 2017. Results Seventeen patients with sialolithiasis (mean age: 39.63 ± 12.49 years), including 10 women and 7 men, were enrolled. Fifteen patients had sialolithiasis in the submandibular gland and two in the parotid gland. The preoperative value of shear wave velocity was significantly higher in the diseased gland than in the contralateral normal gland (p < .001; 95% confidence interval [CI], 0.3915-0.6046). After successful treatment by interventional sialendoscopy surgery, the shear wave velocity of the diseased gland decreased significantly (p = 0.001; 95% CI, -0.38792 to -0.20474). However, there was a significant difference between the diseased and contralateral normal glands (p = 0.001; 95% CI, 0.0423-0.2895) after 1.55 months of surgery. Conclusion Ultrasound shear wave elastography could be an adjuvant tool to distinguish sialolithiasis-affected diseased glands from contralateral normal glands and assess the short-term treatment outcome objectively. The changing trend of shear wave velocity could help monitor the healing process of the parenchyma in the diseased gland after treatment. Level of Evidence 4.
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Affiliation(s)
- Chia‐Fan Chang
- Department of Otolaryngology‐Head and Neck SurgeryTaipei Veterans General HospitalTaipeiTaiwan,Faculty of Medicine, School of MedicineNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Hsin‐Kai Wang
- Department of RadiologyTaipei Veterans General HospitalTaipeiTaiwan,Department of Medical Imaging and Radiological TechnologyYuanpei University of Medical TechnologyHsinchuTaiwan
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Treatment of Sialolithiasis: What Has Changed? An Update of the Treatment Algorithms and a Review of the Literature. J Clin Med 2021; 11:jcm11010231. [PMID: 35011971 PMCID: PMC8746135 DOI: 10.3390/jcm11010231] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 12/27/2021] [Accepted: 12/28/2021] [Indexed: 12/04/2022] Open
Abstract
Treatment for sialolithiasis has undergone significant changes since the 1990s. Following the development of new minimally invasive and gland-preserving treatment modalities, a 40–50% rate of gland resection was reduced to less than 5%. Extracorporeal shock-wave lithotripsy (ESWL), refinement and extension of methods of transoral duct surgery (TDS), and in particular diagnostic and interventional sialendoscopy (intSE) are substantial parts of the new treatment regimen. It has also become evident that combining the different treatment modalities further increases the effectiveness of therapy, as has been especially evident with the combined endoscopic–transcutaneous approach. In the wake of these remarkable developments, a treatment algorithm was published in 2009 including all the known relevant therapeutic tools. However, new developments have also taken place during the last 10 years. Intraductal shock-wave lithotripsy (ISWL) has led to remarkable improvements thanks to the introduction of new devices, instruments, materials, and techniques, after earlier applications had not been sufficiently effective. Techniques involving combined approaches have been refined and modified. TDS methods have been modified through the introduction of sialendoscopy-assisted TDS in submandibular stones and a retropapillary approach for distal parotid sialolithiasis. Recent trends have revealed a potential for significant changes in therapeutic strategies for both major salivary glands. For the submandibular gland, ISWL has replaced ESWL and TDS to some extent. For parotid stones, ISWL and modifications of TDS have led to reduced use of ESWL and the combined transcutaneous–sialendoscopic approach. To illustrate these changes, we are here providing an updated treatment algorithm, including tried and tested techniques as well as promising new treatment modalities. Prognostic factors (e.g., the size or location of the stones), which are well recognized as having a strong impact on the prognosis, are taken into account and supplemented by additional factors associated with the new applications (e.g., the visibility or accessibility of the stones relative to the anatomy of the duct system).
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Li J, Xu XY, Lu ZW, Guan QB, Chen JF. Sialendoscopy-assisted intraoral incision approach for the treatment of posterior Wharton's duct stones: our experience and outcomes. Wideochir Inne Tech Maloinwazyjne 2021; 16:249-255. [PMID: 33786141 PMCID: PMC7991944 DOI: 10.5114/wiitm.2020.94430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 03/22/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Sialoliths can be removed by sialendoscopy in some cases. But sometimes it fails if the stone is located in the proximal or hilum of Wharton's duct. AIM To evaluate the clinical efficacy of the sialendoscopy-assisted intraoral incision approach to remove large stones located in the proximal or hilum of Wharton's duct, when sialendoscopy alone fails. MATERIAL AND METHODS Twenty patients with large stones located in the proximal or hilum of Wharton's duct were included in our study. We used a sialendoscopy-assisted intraoral incision approach to remove large stones located in the proximal or hilum of Wharton's duct when endoscopy failed. The complications and treatment effect were observed. RESULTS The stones were removed successfully in this way in all patients. Two cases had tongue numbness after the operation, and recovered 3 months later without additional intervention. No swelling or pain appeared during the 3-month to 1-year follow-up. Saliva could be observed from the orifice in 15 patients, with little or none in 5 patients. CONCLUSIONS The sialendoscopy-assisted intraoral incision approach to remove large stones located in the proximal or hilum of Wharton's duct is effective and safe.
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Affiliation(s)
- Jin Li
- Department of Oral and Maxillofacial Surgery, The People’s Hospital of Luoding and Affiliated Luoding Hospital of Guangdong Medical University, Luoding, China
- Department of Oral and Maxillofacial Surgery, Affiliated Foshan Hospital of Sun Yat-Sen University, Foshan, China
| | - Xiang Yang Xu
- Department of Oral and Maxillofacial Surgery, The People’s Hospital of Luoding and Affiliated Luoding Hospital of Guangdong Medical University, Luoding, China
| | - Zhi Wen Lu
- Department of Oral and Maxillofacial Surgery, The People’s Hospital of Luoding and Affiliated Luoding Hospital of Guangdong Medical University, Luoding, China
| | - Qing Bin Guan
- Department of Oral and Maxillofacial Surgery, The People’s Hospital of Luoding and Affiliated Luoding Hospital of Guangdong Medical University, Luoding, China
| | - Ju Feng Chen
- Department of Oral and Maxillofacial Surgery, The People’s Hospital of Luoding and Affiliated Luoding Hospital of Guangdong Medical University, Luoding, China
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Lommen J, Schorn L, Roth B, Naujoks C, Handschel J, Holtmann H, Kübler NR, Sproll C. Sialolithiasis: retrospective analysis of the effect of an escalating treatment algorithm on patient-perceived health-related quality of life. Head Face Med 2021; 17:8. [PMID: 33648547 PMCID: PMC7919083 DOI: 10.1186/s13005-021-00259-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 02/16/2021] [Indexed: 11/26/2022] Open
Abstract
Background Gland preserving techniques in the treatment of sialolithiasis have continuously replaced radical surgery. The aim of this study was to evaluate a multimodal treatment algorithm in the therapy of sialolithiasis and assess improvement of HRQoL perceived by patients. Methods Patients with sialolithiasis were treated by a multimodal treatment algorithm based on multiplicity of stones, stone size, affected gland, and stone position. The therapeutic spectrum ranged from conservative measures, extracorporeal shockwave lithotripsy, interventional sialendoscopy, combined endoscopic-surgical procedures to surgical gland removal as ultima ratio. Outcomes were evaluated by surgeons by means of the electronic patient record and by patients themselves using a standardized questionnaire. Results 87 patients treated for sialolithiasis were comprised in this study. The submandibular gland (SMG) was affected in 58.6% and the parotid gland (PG) in 41.4% of cases. Mean patient age was 41.67 years for SMG and 48.91 years for PG. In over 80% of cases sialolithiasis was associated with classic meal-related pain and swelling. Type and intensity of symptomatic sialolithiasis were not dependent on patient age or gender, nor could a relation between the affected gland and the occurrence of symptoms be demonstrated. Overall, 86.2% of cases were reported as cured using the multimodal step-by-step treatment algorithm. Resection of the affected gland could be dispensed in 98.9% of cases. According to patients pain could be reduced in 94.3% of cases. Conclusions The analyzed treatment algorithm of increasing invasiveness is a favorable and effective tool to successfully treat sialolithiasis in > 86% of cases. For the first time, the present study shows that patient-perceived improvement of HRQoL due to ease of symptoms has an even higher success rate of > 94%. Supplementary Information The online version contains supplementary material available at 10.1186/s13005-021-00259-1.
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Affiliation(s)
- Julian Lommen
- Department of Oral and Maxillofacial Surgery, Heinrich-Heine-University, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Lara Schorn
- Department of Oral and Maxillofacial Surgery, Heinrich-Heine-University, Moorenstraße 5, 40225, Düsseldorf, Germany.
| | - Benjamin Roth
- Department of Oral and Maxillofacial Surgery, Heinrich-Heine-University, Moorenstraße 5, 40225, Düsseldorf, Germany
| | | | - Jörg Handschel
- Clinic for Oral and Maxillofacial Surgery, Klinik am Kaiserteich, Reichsstraße 59, 40217, Düsseldorf, Germany
| | - Henrik Holtmann
- Department of Oral and Maxillofacial Surgery, Evangelisches Krankenhaus Bethesda, Ludwig-Weber-Straße 15, 41061, Mönchengladbach, Germany
| | - Norbert R Kübler
- Department of Oral and Maxillofacial Surgery, Heinrich-Heine-University, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Christoph Sproll
- Department of Oral and Maxillofacial Surgery, Heinrich-Heine-University, Moorenstraße 5, 40225, Düsseldorf, Germany
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Sialendoscopy plus laser lithotripsy in sialolithiasis of the submandibular gland in 64 patients: A simple and safe procedure. Auris Nasus Larynx 2019; 46:797-802. [DOI: 10.1016/j.anl.2019.01.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 10/25/2018] [Accepted: 01/23/2019] [Indexed: 11/20/2022]
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Zhang YQ, Ye X, Meng Y, Zhao YN, Liu DG, Yu GY. Evaluation of Parotid Gland Function Before and After Endoscopy-Assisted Stone Removal. J Oral Maxillofac Surg 2018; 77:328.e1-328.e9. [PMID: 30395822 DOI: 10.1016/j.joms.2018.09.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 09/21/2018] [Accepted: 09/24/2018] [Indexed: 12/12/2022]
Abstract
PURPOSE To quantify gland function before and after endoscopy-assisted lithectomy for patients with parotid stones and to analyze correlations among different evaluation modalities. MATERIALS AND METHODS This study investigated 58 patients (27 men and 31 women) with a stone larger than 5 mm or multiple parotid stones who underwent successful endoscopy-assisted surgery at the authors' center from August 2007 through September 2017. Meticulous postoperative manipulations were administered routinely for 3 to 6 months to promote functional recovery of the affected gland. Gland function was evaluated preoperatively and 6 to 36 months (mean, 12 months) postoperatively by sialography, scintigraphy, and sialometry. Statistical analyses were conducted to quantify gland function recovery and to distinguish correlations among the 3 objective tests. RESULTS Preoperative sialograms exhibited ductal ectasia at the stone site with ductal stenosis anterior to the stone (n = 53) or duct interruption at the stone site (n = 5). Postoperative sialograms of 45 patients without stones were categorized as approximately normal (type I; n = 17); showing ectasia or stenosis of the main duct without persistent contrast on the functional film (type II; n = 16); showing ectasia or stenosis of the main duct with mild contrast retention (type III; n = 6); or showing poor ductal shape with evident contrast retention (type IV; n = 6). Scintigraphy of 23 preoperative and 12 postoperative patients and sialometry of 24 preoperative and 12 postoperative patients indicated severe preoperative impairment and postoperative improvement of gland function. Postoperatively, although no relevant differences in saliva flow rate were found between the 2 sides, scintigraphy showed lower function of the affected gland compared with the control side. Statistical data showed positive correlations among the 3 methods. Sialography intuitively reflected the ductal shape, whereas sialometry and scintigraphy were more sensitive for evaluating gland function. CONCLUSION For patients with parotid stones, minimally invasive endoscopic surgery and meticulous postoperative manipulations help preserve the glands and facilitate recovery of gland function. The 3 evaluating modalities have certain positive correlations.
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Affiliation(s)
- Ya-Qiong Zhang
- Resident, Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology, the National Engineering Laboratory for Digital and Material Technology of Stomatology, and the Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Xin Ye
- Attending Doctor, Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology, the National Engineering Laboratory for Digital and Material Technology of Stomatology, and the Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Yuan Meng
- Resident, Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology, the National Engineering Laboratory for Digital and Material Technology of Stomatology, and the Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Ya-Ning Zhao
- Resident, Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology, the National Engineering Laboratory for Digital and Material Technology of Stomatology, and the Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Deng-Gao Liu
- Professor, Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology, the National Engineering Laboratory for Digital and Material Technology of Stomatology, and the Beijing Key Laboratory of Digital Stomatology, Beijing, China.
| | - Guang-Yan Yu
- Professor, Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, the National Engineering Laboratory for Digital and Material Technology of Stomatology, and the Beijing Key Laboratory of Digital Stomatology, Beijing, China
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Koch M, Schapher M, Mantsopoulos K, Goncalves M, Iro H. Intraductal Pneumatic Lithotripsy after Extended Transoral Duct Surgery in Submandibular Sialolithiasis. Otolaryngol Head Neck Surg 2018; 160:63-69. [DOI: 10.1177/0194599818802224] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Persistent, residual, or recurrent stones after transoral duct surgery are always associated with hilar to intraparenchymal and/or multiple sialolithiasis, causing difficulties in the treatment. This study was performed to assess the value of intraductal lithotripsy in the treatment of persistent, residual, or recurrent sialolithiasis after extended duct surgery in the submandibular gland. Study Design Retrospective study covering February 2015 to June 2018. Study Setting Tertiary referral center for salivary gland diseases. Subjects and Methods After extended ductal surgery, 39 patients presenting with persistent, residual, or recurrent stones were treated. Four patients had persistent stones; 16 had residual stones; and 19 presented with recurrent stones. Among these patients, 50 stones were treated with intraductal pneumatic lithotripsy. Fragmentation rate, stone-free rate, and symptom-free rate after treatment with intraductal lithotripsy were outcome measures. Results Of the 39 patients, 97.4% became stone-free, and all were symptom-free. Ninety-eight percent of the stones were completely fragmented. For 23.1% of the patients, >1 stone was treated with intraductal lithotripsy. All patients with persistent stones, 93.7% of those with residual stones, and all with recurrent stones became stone-free and symptom-free. No severe complications developed. Conclusions This study shows that patients presenting with difficult and/or multiple sialolithiasis after extended transoral submandibular duct surgery can be treated with success rates >97%. For multiple sialolithiasis in particular, a multimodal treatment approach with interventional sialendoscopy and intraductal lithotripsy as a central element is a prerequisite for success, as this enables the most difficult part to be performed with high success rates.
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Affiliation(s)
- Michael Koch
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Erlangen–Nuremberg, Erlangen, Germany
| | - Mirco Schapher
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Erlangen–Nuremberg, Erlangen, Germany
| | - Konstantinos Mantsopoulos
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Erlangen–Nuremberg, Erlangen, Germany
| | - Miguel Goncalves
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Erlangen–Nuremberg, Erlangen, Germany
| | - Heinrich Iro
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Erlangen–Nuremberg, Erlangen, Germany
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Foletti JM, Graillon N, Avignon S, Guyot L, Chossegros C. Salivary Calculi Removal by Minimally Invasive Techniques: A Decision Tree Based on the Diameter of the Calculi and Their Position in the Excretory Duct. J Oral Maxillofac Surg 2018; 76:112-118. [DOI: 10.1016/j.joms.2017.06.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 06/06/2017] [Accepted: 06/06/2017] [Indexed: 10/19/2022]
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9
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Xiao JQ, Sun HJ, Qiao QH, Bao X, Wu CB, Zhou Q. Advantages of submandibular gland preservation surgery over submandibular gland resection for proximal submandibular stones. Oral Surg Oral Med Oral Pathol Oral Radiol 2017. [PMID: 29530607 DOI: 10.1016/j.oooo.2017.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This study sought to compare surgical outcomes after the removal of submandibular gland (SMG) stones via 2 different surgical methods. MATERIALS AND METHODS From June 2015 to July 2016, a total of 40 patients with SMG stones were selected from the Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University (Shenyang, China), and were randomly assigned to 2 groups. Twenty patients underwent sialendoscopy-assisted stone removal via extraoral incision with preservation of the SMG, and 20 patients underwent traditional SMG resection. The outcomes of the 2 surgical procedures were assessed. RESULTS The operation time and hospital stay were shorter in the SMG preservation group than the SMG resection group. There were no significant differences in stone size or location between the groups. The mean visual analog scale (VAS) score was lower in the SMG preservation group than the SMG resection group. All patients in the SMG resection group exhibited varying degrees of scarring and concave deformity on the face and neck, whereas all patients in the SMG preservation group retained intact facial morphology. CONCLUSIONS Sialendoscopy-assisted stone removal with preservation of the SMG exhibited many advantages relative to traditional SMG resection.
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Affiliation(s)
- Jin-Qing Xiao
- Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University, Liaoning Institute of Dental Research, Shenyang, Liaoning Province, China
| | - Hai-Jiang Sun
- Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University, Liaoning Institute of Dental Research, Shenyang, Liaoning Province, China
| | - Qi-Hui Qiao
- Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University, Liaoning Institute of Dental Research, Shenyang, Liaoning Province, China
| | - Xin Bao
- Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University, Liaoning Institute of Dental Research, Shenyang, Liaoning Province, China
| | - Chuan-Bin Wu
- Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University, Liaoning Institute of Dental Research, Shenyang, Liaoning Province, China
| | - Qing Zhou
- Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University, Liaoning Institute of Dental Research, Shenyang, Liaoning Province, China.
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Capaccio P, Gaffuri M, Rossi V, Pignataro L. Sialendoscope-assisted transoral removal of hilo-parenchymal sub-mandibular stones: surgical results and subjective scores. ACTA OTORHINOLARYNGOLOGICA ITALICA 2017; 37:122-127. [PMID: 28516974 PMCID: PMC5463519 DOI: 10.14639/0392-100x-1601] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 12/12/2016] [Indexed: 11/23/2022]
Abstract
It has been suggested that a conservative trans-oral approach to proximal and hilo-parenchymal submandibular stones (HPSMS) is a valid alternative to the more frequently used sialadenectomy. The aim of this study was to evaluate the surgical, ultrasonographic and patients' subjective outcomes of results of the trans-oral removal of HPSMS. Between January 2003 and September 2015, sialendoscope-assisted trans-oral surgery was used to remove symptomatic, large (> 7 mm), fixed and palpable HPSMS from 479 patients under general anaesthesia. All patients were followed clinically and ultrasonographically to investigate symptom relief and recurrence of stones, and were telephonically interviewed to assess saliva-related subjective outcomes with a questionnaire. Stones were successfully removed from 472 patients (98.5%); the seven failures (1.5%) concerned pure parenchymal stones. One year after the procedure, 408 patients (85.1%) were symptom free, 59 (12.3%) had recurrent obstructive symptoms and 12 (2.6%) had recurrent infections. Of the 54 patients who developed a recurrent stone (11.2%), 52 underwent a second procedure: 29 interventional sialendoscopies, two sialendoscope-assisted intra-corporeal pneumatic lithotripsy, eight secondary transoral surgery to remove residual stones, six a cycle of extra-corporeal lithotripsy and seven submandibular sialadenectomy. Most patients (75.2%) reported mild surgery-related pain. The symptoms of 454 patients (94.8%) improved after adjunctive treatment and, at the end of follow-up, the affected gland was preserved in 98.5% of patients. A sialendoscope-assisted trans-oral removal of large HPSMS is a safe, effective, conservative surgical procedure, and functional preservation of the main duct and parenchyma of the obstructed gland allows sialendoscopic access through the natural ostium in case of recurrence. Combining a trans-oral approach with other minimally invasive, conservative procedures ensures symptomatic relief and salivary duct system clearance in the majority of patients.
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Affiliation(s)
- P Capaccio
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Biomedical, Surgical, Dental Sciences
| | - M Gaffuri
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - V Rossi
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Biomedical, Surgical, Dental Sciences
| | - L Pignataro
- Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Italy
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