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Seif-Elnasr M, Magdy EA, Fung E, Deot NS, Marzouk MF. Intraoral Microscopic Versus Robot-Assisted Sialolithotomy and Sialendoscopy for Submandibular Stones. Laryngoscope 2024; 134:2170-2176. [PMID: 38041581 DOI: 10.1002/lary.31215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/03/2023] [Accepted: 11/22/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVE Sialendoscopy has remained the standard of treatment for sialolithiasis; however, large stones impacted in the submandibular gland hilum often require an intra-oral combined approach. METHODS Patients treated for submandibular hilar sialolithiasis from 2015 to 2021 at two tertiary centers were stratified into two groups based on the surgical technique: Intraoral Microscopic-Assisted Sialolithotomy (IMAS) versus Robot-Assisted Sialolithotomy and Sialendoscopy (RASS). We compared the characteristics of retrieved stones, surgical success rate, operative time, and post-operative complications in both techniques. True surgical success was defined as successful stone extraction without reoccurrence within 12 months. RESULTS The RASS technique was attempted in 60 patients and successful in 56 (93.3%) cases whereas the IMAS technique was performed in 52 patients and successful in 48 (92.3%) cases. The longest dimension of the predominant retrieved calculi was 9.6 ± 3.1 mm (range, 5-18 mm) for the robotic technique and 10 ± 4.8 mm (range, 5-30 mm) for the microscopic technique. The operative time for the robotic technique excluding robot setup time was 70.6 ± 24.8 min compared to 61.9 ± 42.4 min for microscopic technique (p = 0.018). No major adverse outcomes were reported; however, temporary lingual paresthesia was found in ten robotic (16.7%) and five microscopic (9.6%) cases. CONCLUSION The two techniques were comparable in terms of efficacy and safety for large stones. The robot has the advantage of intraoral high dynamic maneuverability and improved surgeon posture while the microscopic technique has the advantage of intraoral tactile feedback. The procedure was significantly shorter in duration with the microscope. LEVEL OF EVIDENCE 3 Laryngoscope, 134:2170-2176, 2024.
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Affiliation(s)
- Mahmoud Seif-Elnasr
- Department of Otorhinolaryngology-Head & Neck Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Emad A Magdy
- Department of Otorhinolaryngology-Head & Neck Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ethan Fung
- Department of Otolaryngology and Communication Sciences, Upstate Medical University, Syracuse, New York, U.S.A
| | - Neal S Deot
- Department of Otolaryngology and Communication Sciences, Upstate Medical University, Syracuse, New York, U.S.A
| | - Mark F Marzouk
- Department of Otolaryngology-Head and Neck Surgery, Upstate Medical University, Syracuse, New York, U.S.A
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Nomura T, Ohki M, Kikuchi S. New Modified Transoral Approach to Remove a Hilar Stone of the Submandibular Gland: A Case Report. Indian J Otolaryngol Head Neck Surg 2022; 74:6391-6393. [PMID: 36742560 PMCID: PMC9895177 DOI: 10.1007/s12070-022-03122-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 07/10/2022] [Indexed: 02/07/2023] Open
Abstract
Nerve damage and intraoperative bleeding for the removal of the hilar stones are possible. We used the new modified lateral oral floor approach with a 2-3 cm longitudinal mucosal incision outside of the Wharton's. There were no complications and our technique seemed to be effective.
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Affiliation(s)
- Tsutomu Nomura
- Department of Otolaryngology, Meikai University School of Dentistry, 1-1 Keyakidai, Sakado, Saitama 350-0283 Japan
| | - Masafumi Ohki
- Department of Otolaryngology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe-shi, Saitama 380-8550 Japan
| | - Shigeru Kikuchi
- Department of Otolaryngology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe-shi, Saitama 380-8550 Japan
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Superficial parotidectomy for chronic parotid sialadenitis: a case series and review of the literature. The Journal of Laryngology & Otology 2021; 135:883-886. [PMID: 34353395 DOI: 10.1017/s0022215121002115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To report the clinical outcomes of patients with chronic parotid sialadenitis treated with superficial parotidectomy, and to review the literature. METHODS A retrospective case series was conducted of all patients undergoing parotidectomy for chronic parotid sialadenitis at our institution between 2009 and 2018. RESULTS Eighteen superficial parotidectomies were performed, resulting in complete symptom resolution in 17 patients. There was only one recurrence, of a milder form of the disease, requiring no specific treatment. Eight temporary post-operative facial nerve palsies and one permanent palsy occurred. Further complications included post-operative wound haematoma, seroma, Frey's syndrome, neuropathic pain and wound infection. CONCLUSION Superficial parotidectomy is sufficient to control patient symptoms, avoiding the increased morbidity associated with near-total parotidectomy. The literature does not point to a clear difference in either the incidence of recurrence or the risk of a facial nerve palsy between the two procedures. Furthermore, the symptoms attributed to recurrence are often not severe enough to warrant salvage near-total parotidectomy.
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Magdy EA, Seif-Elnasr M, Fathalla MF. Combined sialendoscopic/mini-preauricular microscopic approach for large proximal parotid sialolithiasis. Auris Nasus Larynx 2021; 48:983-990. [PMID: 33581935 DOI: 10.1016/j.anl.2021.01.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/12/2020] [Accepted: 01/20/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To describe and evaluate a combined approach for sialendoscopic stone localization with microscopic mini-preauricular incision external stone extraction as a gland-sparing minimally invasive surgical management in cases of large proximal duct or intraparenchymal parotid gland sialolithiasis. METHODS A retrospective chart review of a single primary surgeon's patient series of 21 cases operated in a 5-year period in a tertiary care university and private practice hospitals. RESULTS Study included 16 males and five females, with age range 12-68 years (mean 40.9 ± 14.5). Nineteen out of the 21 patients had their stones completely removed (90.5%), with two not completing the procedure due to inability of intraoperative endoscopic stone visualization. In total 25 stones were extracted with six patients having two stones. Longest diameter of single (or first) stone was 5-16 mm (mean 9.1 ± 2.9) and second was 3-5 mm (mean, 3.9 ± 0.6). Endoscopic findings showed 14/25 stones in the proximal main parotid duct and 11/25 in one of its secondary parenchymal branches. Stents were used in 4/19 cases (21.1%). No major complications occurred. Minor complications included two postoperative conservatively managed seromas. All 19 cases had completely intact facial nerve function, good parotid salivary flow and acceptable esthetic result after median follow-up period of 26 months (range 6-62). CONCLUSION The combined sialendoscopic/microscopic mini-preauricular approach is a highly effective and safe gland-preserving method for large proximal parotid sialolithiasis management with a main limitation being inability to visualize the stone endoscopically.
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Affiliation(s)
- Emad A Magdy
- Department of Otorhinolaryngology-Head & Neck Surgery, Faculty of Medicine, Alexandria University Main Hospital, El-Khartoum Square, Azarita Medical Campus, Alexandria 21542, Egypt.
| | - Mahmoud Seif-Elnasr
- Department of Otorhinolaryngology-Head & Neck Surgery, Faculty of Medicine, Alexandria University Main Hospital, El-Khartoum Square, Azarita Medical Campus, Alexandria 21542, Egypt
| | - Mohamed F Fathalla
- Department of Otorhinolaryngology-Head & Neck Surgery, Royal Private Hospital, Alexandria, Egypt
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Lambiel S, Dulguerov N, Courvoisier DS, Dulguerov P. Minor Parotidectomy Complications: A Systematic Review. Laryngoscope 2020; 131:571-579. [PMID: 32678921 DOI: 10.1002/lary.28912] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 05/12/2020] [Accepted: 05/26/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To report descriptive statistics for minor parotidectomy complications. METHODS A systematic review was performed, selecting 235 studies for analysis. The incidence of complications was tabulated, and descriptive statistics calculated. Outlier studies, 1 standard deviation above the mean, were reexamined to determine potential causal factors for each complication. All studies were examined for statistically significant differences for any potential causal factor. RESULTS The pooled incidence of minor complications reported were hematoma 2.9% (95% confidence interval [CI]: 2.4-3.5), wound infection 2.3% (95% CI: 1.8-2.9), sialocele 4.5% (95% CI: 3.5-5.7), salivary fistula 3.1% (95% CI: 2.6-3.7), flap necrosis 1.7% (95% CI: 1.1-2.5), scar issues 3.6% (95% CI: 2.4-5.4), numbness 33.9% (95% CI: 25.6-43.4), and deformity 11.8 (95% CI: 6.9-19.5). Implants result in more wound complications, such as hematoma, sialocele, or salivary fistula. Sialocele and salivary fistula appear more frequently after less extensive parotid surgery, whereas hematoma, wound infections, flap necrosis, and aesthetic considerations are worse with more extensive resections. CONCLUSIONS Minor parotidectomy complications are more frequent than generally assumed and related to certain factors that should be investigated. Laryngoscope, 131:571-579, 2021.
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Affiliation(s)
- Silvia Lambiel
- Department of Otorhinolaryngology-Head and Neck Surgery, Geneva University Hospital, Geneva, Switzerland
| | - Nicolas Dulguerov
- Department of Otorhinolaryngology-Head and Neck Surgery, Geneva University Hospital, Geneva, Switzerland
| | | | - Pavel Dulguerov
- Department of Otorhinolaryngology-Head and Neck Surgery, Geneva University Hospital, Geneva, Switzerland.,Center for Otorhinolaryngology-Maxillofacial and Head and Neck Surgery, La Tour Hospital, La Tour Medical Group, Meyrin, Switzerland
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Chiesa-Estomba CM, Saga-Gutierrez C, Larruscain E, González-García JÁ, Sistiaga-Suarez JA, Altuna X. A Pilot Study to Assess the Sialendoscopy-Assisted Transfacial Approach in Parotid Gland Sialolithiasis. EAR, NOSE & THROAT JOURNAL 2019; 100:404S-408S. [PMID: 31625405 DOI: 10.1177/0145561319882115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Twenty percent of the total lithiasis that affect a major salivary gland will be found in the parotid gland. An exclusive sialoendoscopic approach has achieved success rates close to 80%. In a significant percentage of these remaining cases, combined transfacial approaches assisted by sialendoscopy are presented as an option to be taken into account. PATIENTS AND METHODS A prospective analysis of cases treated by combined transfacial approach assisted by sialendoscopy for lithiasis of the parotid gland and the impact of the facial nerve stimulator used during surgery. RESULTS Five patients were included; all of them operated satisfactorily. In 4 of them, the approach proposed by McGurk and modified by Capaccio was used, and in 1 of them, the approach proposed by Nahlieli was used. We suffered a complication in just case due to the appearance of postoperative sialocele. CONCLUSION According to our results and those previously published, the transfacial approach assisted by sialendoscopy can be considered a useful technique. Proper planning ensures an optimal result in the treatment of parotid gland lithiasis. The use of facial nerve stimulator guarantees extra security when working near to a branch of the facial nerve is suspected.
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Affiliation(s)
- Carlos Miguel Chiesa-Estomba
- Department of Otorhinolaryngology-Head & Neck Surgery,16881Hospital Universitario Donostia, Donosti-San Sebastian, Guipuzkoa, Basque, Spain
| | - Carlos Saga-Gutierrez
- Department of Otorhinolaryngology-Head & Neck Surgery,16881Hospital Universitario Donostia, Donosti-San Sebastian, Guipuzkoa, Basque, Spain
| | - Ekhiñe Larruscain
- Department of Otorhinolaryngology-Head & Neck Surgery,16881Hospital Universitario Donostia, Donosti-San Sebastian, Guipuzkoa, Basque, Spain
| | - José Ángel González-García
- Department of Otorhinolaryngology-Head & Neck Surgery,16881Hospital Universitario Donostia, Donosti-San Sebastian, Guipuzkoa, Basque, Spain
| | - Jon Alexander Sistiaga-Suarez
- Department of Otorhinolaryngology-Head & Neck Surgery,16881Hospital Universitario Donostia, Donosti-San Sebastian, Guipuzkoa, Basque, Spain
| | - Xabier Altuna
- Department of Otorhinolaryngology-Head & Neck Surgery,16881Hospital Universitario Donostia, Donosti-San Sebastian, Guipuzkoa, Basque, Spain
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Eaton KJ, Smith HF. Clinical implications of aberrant neurovascular structures coursing through the submandibular gland. PeerJ 2019; 7:e7823. [PMID: 31592354 PMCID: PMC6778428 DOI: 10.7717/peerj.7823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 09/03/2019] [Indexed: 02/04/2023] Open
Abstract
Background Variation within the submandibular triangle, including variant paths of facial neurovasculature, could increase risk of neurovascular derangement during submandibular gland (SMG) dysfunction, enlargement, interventions, or removal. Methods Frequency of anatomical variants enveloped within or piercing the SMG, including facial artery, vein, or branches of CN VII, were assessed in 70 cadaveric submandibular glands (39M/31F). Results Eighteen of 70 SMGs (25.7%) were pierced by at least one aberrant neurovasculature structure: Facial artery most frequently (n = 13), followed by facial vein (n = 2), inferior labial artery and vein (n = 1), and CN VII cervical branch (n = 1). This study demonstrated the high variability of neurovasculature within submandibular parenchyma. These aberrant neurovascular structures, especially facial artery, are in danger of compromise during surgical and other medical procedures on the SMG. To avoid potential neurovascular compromise, ultrasonographic or other imaging is recommended prior to procedures involving the SMG.
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Affiliation(s)
- Kelsey J Eaton
- Department of Osteopathic Manipulative Medicine, Midwestern University, Glendale, AZ, United States of America
| | - Heather F Smith
- Department of Anatomy, Midwestern University, Glendale, AZ, United States of America.,School of Human Evolution and Social Change, Arizona State University, Tempe, AZ, United States of America
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Razmara F, Mahmoudi X. Noninvasive treatment for chronic sialadenitis: Case report. Clin Case Rep 2019; 7:1870-1873. [PMID: 31632672 PMCID: PMC6787942 DOI: 10.1002/ccr3.2379] [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: 05/15/2019] [Revised: 07/19/2019] [Accepted: 07/29/2019] [Indexed: 11/07/2022] Open
Abstract
This reporter expresses a patient with a history of tender neck swelling. After clinical and graphical examinations, the patient was diagnosed with submandibular sialolithiasis. Instead of invasive removal of the gland, a more conservative treatment was used. Eventually, after a 1-year-long follow-up, the patient's conditions were found to be acceptable.
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Affiliation(s)
- Farnoosh Razmara
- Department of Oral and Maxillofacial SurgeryTehran University of Medical SciencesTehranIran
| | - Xaniar Mahmoudi
- School of Dentistry, International Campus, Department of Oral and Maxillofacial SurgeryTehran University of Medical SciencesTehranIran
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Sproll C, Naujoks C, Holtmann H, Kübler NR, Singh DD, Rana M, Lommen J. Removal of stones from the superficial lobe of the submandibular gland (SMG) via an intraoral endoscopy-assisted sialolithotomy. Clin Oral Investig 2019; 23:4145-4156. [PMID: 30834990 DOI: 10.1007/s00784-019-02853-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 02/13/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Sialolithiasis is the most common cause of chronic sialadenitis of the submandibular gland (SMG). Symptomatic superficial lobe stones are often treated by submandibulectomy. A gland preserving operation allows for transoral stone removal through endoscopically assisted sialolithotomy. Herein, we provide clinical and sonographical follow-up data in patients who underwent sialolithotomy under general anesthesia. MATERIALS AND METHODS Sixty patients treated at the Department of Oral and Maxillofacial Surgery at Düsseldorf University Hospital for superficial lobe sialolithiasis of SMG were included in this study. All received transoral sialolithotomy under general anesthesia. Follow-up was conducted via standardized patient questionnaires, clinical examination, and B-mode and color Doppler sonography. RESULTS Mean patient age was 48.9 years. 56.6% of right and 43.4% of left SMG were affected. Mean follow-up was 45 months. Fifty-five of 59 detected stones could be removed. Mean operation time was 71 min. 3.3% of patients reported recurrent episodes of postoperative pain and 10% felt recurrent episodes of gland swelling. Persistent postoperative lingual nerve hypesthesia was described in one patient. No facial nerve damages occurred. Salivary flow rates remained reduced in most of the affected glands upon stone removal. Sonographical follow-up data of the previously affected SMG after intraoral endoscopy-assisted sialolithotomy showed a regular gland size in 70.8% of cases, a parenchyma free of inflammation in 93.8%, and without signs of fibrosis in 72.9% of cases. 68.7% of patients showed a regular structure of Wharton's duct at time of follow-up. In total, 89.6% of patients were diagnosed stone-free within both glands on follow-up. No case required subsequent submandibulectomy. CONCLUSIONS Sialolithotomy of Wharton's duct for removal of stones from the SMG's superficial lobe is a promising alternative to submandibulectomy. CLINICAL RELEVANCE Reduction of postoperative morbidity through endoscopically assisted sialolithotomy for removal of superficial lobe stones from SMG. TRIAL REGISTRATION Ethics Committee of Heinrich-Heine-University Düsseldorf (no. 5586).
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Affiliation(s)
- Christoph Sproll
- Department of Oral and Maxillofacial Surgery, Heinrich-Heine-University, Moorenstraße 5, 40225, Düsseldorf, Germany
| | | | - Henrik Holtmann
- Department of Oral and Maxillofacial Surgery, Heinrich-Heine-University, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Norbert R Kübler
- Department of Oral and Maxillofacial Surgery, Heinrich-Heine-University, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Daman Deep Singh
- Department of Oral and Maxillofacial Surgery, Heinrich-Heine-University, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Majeed Rana
- Department of Oral and Maxillofacial Surgery, Heinrich-Heine-University, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Julian Lommen
- Department of Oral and Maxillofacial Surgery, Heinrich-Heine-University, Moorenstraße 5, 40225, Düsseldorf, Germany.
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van der Lans RJL, Lohuis PJFM, van Gorp JMHH, Quak JJ. Surgical Treatment of Chronic Parotitis. Int Arch Otorhinolaryngol 2019; 23:83-87. [PMID: 30647789 PMCID: PMC6331305 DOI: 10.1055/s-0038-1667006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 05/20/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction
chronic parotitis (CP) is a hindering, recurring inflammatory ailment that eventually leads to the destruction of the parotid gland. When conservative measures and sialendoscopy fail, parotidectomy can be indicated.
Objective
to evaluate the efficacy and safety of parotidectomy as a treatment for CP unresponsive to conservative therapy, and to compare superficial and near-total parotidectomy (SP and NTP).
Methods
retrospective consecutive case series of patients who underwent parotidectomy for CP between January 1999 and May 2012. The primary outcome variables were recurrence, patient contentment, transient and permanent facial nerve palsy and Frey syndrome. The categorical variables were analyzed using the two-sided Fisher exact test. Alongside, an elaborate review of the current literature was conducted.
Results
a total of 46 parotidectomies were performed on 37 patients with CP. Near-total parotidectomy was performed in 41 and SP in 5 cases. Eighty-four percent of patients was available for the telephone questionnaire (31 patients, 40 parotidectomies) with a mean follow-up period of 6,2 years. Treatment was successful in 40/46 parotidectomies (87%) and 95% of the patients were content with the result. The incidence of permanent and transient facial nerve palsy was 0 (0%) and 12 (26.1%), respectively. Frey syndrome manifested in 20 (43.5%) patients. Neither this study nor careful review of the current literature resulted in evident difference between SP and NTP regarding the primary outcome variables.
Conclusion
parotidectomy is a safe and effective treatment for CP in case conservative therapy fails. There is no evidence of a distinct difference between SP and NTP regarding efficiency, facial nerve palsy or Frey syndrome.
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Affiliation(s)
| | - Peter J F M Lohuis
- Department of ENT & Head and Neck Surgery, Diakonessenhuis, Utrecht, Netherlands
| | | | - Jasper J Quak
- Department of ENT & Head and Neck Surgery, Diakonessenhuis, Utrecht, Netherlands
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Ryan WR, Plonowska KA, Gurman ZR, Aubin-Pouliot A, Chang JL. One-Year symptom outcomes after sialolithiasis treatment with sialendoscopy-assisted salivary duct surgery. Laryngoscope 2018; 129:396-402. [DOI: 10.1002/lary.27398] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 05/10/2018] [Accepted: 05/29/2018] [Indexed: 11/08/2022]
Affiliation(s)
- William R. Ryan
- Division of Head and Neck Oncologic and Endocrine Surgery, Salivary Gland Surgery Center; Department of Otolaryngology-Head and Neck Surgery; San Francisco California
| | - Karolina A. Plonowska
- the University of California; San Francisco School of Medicine; San Francisco California
| | - Zev R. Gurman
- the Division of General Otolaryngology, Salivary Gland Surgery Center, Department of Otolaryngology-Head and Neck Surgery; University of California; San Francisco California
| | - Annick Aubin-Pouliot
- the Division of General Otolaryngology, Salivary Gland Surgery Center, Department of Otolaryngology-Head and Neck Surgery; University of California; San Francisco California
| | - Jolie L. Chang
- the Division of General Otolaryngology, Salivary Gland Surgery Center, Department of Otolaryngology-Head and Neck Surgery; University of California; San Francisco California
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Lee C, Kim JE, Huh KH, Yi WJ, Heo MS, Lee SS, Choi SC. Therapeutic effect of intraductal irrigation of the salivary gland: A technical report. Imaging Sci Dent 2017; 47:123-127. [PMID: 28680849 PMCID: PMC5489668 DOI: 10.5624/isd.2017.47.2.123] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 04/26/2017] [Accepted: 05/02/2017] [Indexed: 11/18/2022] Open
Abstract
Purpose Obstructive and inflammatory disease often occurs in the major salivary glands, and no predictive treatment has yet been developed for this condition. The aim of this report was to introduce an intraductal irrigation procedure and to illustrate its application to practical patient cases. Materials and Methods Two patients complaining of pain and swelling in the parotid gland during meals who underwent sialography were diagnosed as having sialodochitis with sialadenitis. Intraductal irrigation was then performed on the parotid gland on the side of the complaint. The irrigation procedure was conducted in the same manner as the sialography procedure, except that saline was used as the filling solution. Symptom severity was evaluated with a numerical rating scale (NRS) at the initial visit and a month after the irrigation. Results The initial NRS value of patient 1 was 10. The value decreased to 6 and then to 0 after 2 irrigation procedures. The NRS value of patient 2 regarding the symptoms involving the left parotid gland decreased from 4-5 to 1 after 4 irrigation procedures performed at 1-month intervals. Conclusion Intraductal irrigation of the salivary gland may be a simple, safe, and effective treatment option for patients with obstructive and inflammatory disease of the salivary gland that is capable of resolving their symptoms.
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Affiliation(s)
- Chena Lee
- Department of Oral and Maxillofacial Radiology, Yonsei University College of Dentistry, Seoul, Korea
| | - Jo-Eun Kim
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Kyoung-Hoe Huh
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Won-Jin Yi
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Min-Suk Heo
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Sam-Sun Lee
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Soon-Chul Choi
- Department of Oral and Maxillofacial Radiology and Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
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Roland LT, Skillington SA, Ogden MA. Sialendoscopy-assisted transfacial removal of parotid sialoliths: A systematic review and meta-analysis. Laryngoscope 2017; 127:2510-2516. [PMID: 28480577 DOI: 10.1002/lary.26610] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To review the literature and conduct a meta-analysis to determine the effectiveness and safety of the combined endoscopic-transfacial approach for parotid sialolith management. DATA SOURCES PubMed 1946-, Embase 1947-, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Database of Systematic Reviews, Cochrane Database of Abstracts of Review Effects, Cochrane Central Register of Controlled Trials, clinicaltrials.gov, Proquest Dissertations and Theses, and FirstSearch Proceedings to March 2015. REVIEW METHODS Published prospective or retrospective English-language studies with reported outcomes of more than one patient undergoing the combined endoscopic-transfacial procedure for parotid sialolithiasis were included. Two independent authors screened all eligible studies and reviewed and extracted data from relevant publications. Weighted pooled proportions for stone removal, symptom improvement, gland preservation, and complications were calculated. RESULTS Ten studies, primarily retrospective single-institution studies, were included in the final analysis, with a total of 184 patients. Overall, the procedure was noted to be successful with low risk; the weighted pooled proportions were 0.99 (95% confidence interval [CI]: 0.97 to 1.00) for stone removal, 0.97 (95% CI: 0.93 to 0.99) for symptom improvement, 1 (95% CI: 0.99 to 1.00) for gland preservation, and 0.06 (95% CI: 0.01 to 0.15) for complications. CONCLUSIONS Although our analysis is primarily based on retrospective data, the evidence shown here suggests that the combined endoscopic-transfacial technique is an effective treatment for parotid gland sialolithiasis not amenable to intraoral or purely endoscopic removal. This approach results in high rates of symptom improvement and gland preservation. The complication rates are low, further supporting the use of this technique. Laryngoscope, 127:2510-2516, 2017.
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Affiliation(s)
- Lauren T Roland
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri, U.S.A
| | - S Andrew Skillington
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri, U.S.A
| | - M Allison Ogden
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri, U.S.A
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Schapher M, Mantsopoulos K, Messbacher ME, Iro H, Koch M. Transoral submandibulotomy for deep hilar submandibular gland sialolithiasis. Laryngoscope 2017; 127:2038-2044. [PMID: 28052363 DOI: 10.1002/lary.26459] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 10/30/2016] [Accepted: 11/14/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS To assess the long-term results after transoral submandibulotomy for stones located in the deep hilar and intraparenchymal submandibular region. STUDY DESIGN Retrospective cohort analysis. METHODS Retrospective evaluation including all patients treated with transoral submandibulotomy for sialolithiasis at a tertiary referral center. RESULTS Complete stone removal at the first transoral surgical treatment was achieved in 185 of 234 patients (79.1%). One hundred seventy-five of the 234 patients were followed up for a mean of 31.2 ( ± 20.5) months. During the follow-up period, 140 of the 175 patients (80.0%) became symptom free after one operation. In patients with residual symptoms, no further treatment was needed in 12 patients (6.9%) due to the mildness of the symptoms; 23 patients (13.1%) received further therapy, which was successful in 15 cases. Submandibulectomy only had to be performed in 3.4% of the patients with follow-up (6/175). In a questionnaire survey, 91.4% of the patients stated that they would be prepared to have the same operation again. CONCLUSIONS These findings show that transoral removal of submandibular sialoliths located in the deep hilum or adjacent intraglandular parenchyma is an effective treatment that can be assisted by additional measures. The techniques described show high success rates, good long-term results, low complication rates, and they avoided the need for submandibulectomy in >95% of cases. LEVEL OF EVIDENCE 4. Laryngoscope, 127:2038-2044, 2017.
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Affiliation(s)
- 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
| | - Maria-Elena Messbacher
- 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
| | - Michael Koch
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
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Ong AA, Carroll WW, Nguyen SA, Gillespie MB. Cost-effectiveness of transfacial gland-preserving removal of parotid sialoliths. Laryngoscope 2016; 127:1080-1086. [PMID: 27873327 DOI: 10.1002/lary.26342] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 08/22/2016] [Accepted: 08/31/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Examine outcomes of transfacial gland-preserving removal of difficult parotid stones and compare the cost and operative time to traditional parotidectomy. STUDY DESIGN Cost-effectiveness analysis and retrospective chart review. METHODS Patients who underwent transfacial removal of symptomatic parotid sialoliths at a tertiary medical center from June 2010 to July 2015 were evaluated. Outcomes included operative technique, stone size, stone location, complications, and symptom relief. In addition, patients who underwent traditional parotidectomy for chronic sialadenitis were identified. The charges and times for both procedures were reviewed and compared. RESULTS Forty-four patients underwent transfacial resection for symptomatic parotid sialolithiasis. Stones were most often located in the main duct and hilum (53.3%), with fewer intraglandular stones (46.7%). No facial nerve weakness was observed. Of those with follow-up, 33 (87%) patients reported at least partial resolution of symptoms. Overall transfacial technique charges were significantly less expensive (U.S.$) than parotidectomy (mean difference -8,064.09; 95% confidence interval [CI] -13,472.78 to -2,655.40; P = 0.033). Anesthesia charges (mean difference -2,997.85; 95% CI, -5,748.81 to -246.89; P = 0.035) and operating room charges (mean difference -4,793.91; 95% CI, -8,958.09 to -629.72; P = 0.028) were also less expensive for the transfacial technique. Finally, mean procedure time for transfacial removal of parotid stones was shorter than for parotidectomy (120.2 ± 49.9 vs. 178.4 ± 41.3 minutes, respectively; P = 0.002). CONCLUSION Transfacial gland-preserving removal of difficult parotid stones is a well tolerated and effective alternative to parotidectomy. Moreover, it is faster and less expensive than parotidectomy, maximizing both surgeon time and hospital resources. LEVEL OF EVIDENCE 4. Laryngoscope, 127:1080-1086, 2017.
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Affiliation(s)
- Adrian A Ong
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - William W Carroll
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - M Boyd Gillespie
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
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Preoperative percutaneous nerve mapping of the mandibular marginal branch of the facial nerve. J Craniofac Surg 2015; 26:411-4. [PMID: 25668116 DOI: 10.1097/scs.0000000000001408] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE In this study, we introduce a reliable method for mapping the location of the mandibular marginal branch of the facial nerve. The utility of preoperative percutaneous mandibular marginal branch mapping and continuous intraoperative nerve monitoring during operation with a submandibular approach is reported. MATERIALS AND METHODS The mapping technique was performed in 40 patients. Electromyography surface electrodes were placed on the orbicularis oris muscles. A modified bipolar probe with an adjustable distance between the 2 tips was used to apply surface stimulation at a frequency of 1 Hz to 2 Hz. The stimulating current most frequently used was 5.0 mA to 5.5 mA. By moving the electrode at right angles across the suspected path of the nerve around the marginal border of the mandible, 4 to 5 points were marked and connected, where the orbicularis oris contracted and the action potential was evoked. After general anesthesia, the mapping path was verified using needle electrodes with different needle-to-nerve distances. RESULTS The nerve could be mapped preoperatively in all patients and were protected in 39 patients. The thresholds of the needle electrode on the mapping path were at or below 0.5 mA, verifying the accuracy of mapping. CONCLUSIONS Preoperative percutaneous nerve mapping was a precise method of identifying the location of the nerve and could protect the nerve from accidental injury.
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17
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The Treatment of Large Sialoliths by Sialendoscopic Combined Approach. J Oral Maxillofac Surg 2014; 72:737-43. [DOI: 10.1016/j.joms.2013.09.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 08/29/2013] [Accepted: 09/02/2013] [Indexed: 11/22/2022]
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18
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Basheeth N, Sheahan P, Murphy M. Combined percutaneous ultrasound and fluoroscopic-guided recanalization of Stensen's duct. Laryngoscope 2013; 124:659-61. [PMID: 23794230 DOI: 10.1002/lary.24277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Revised: 06/04/2013] [Accepted: 06/04/2013] [Indexed: 11/12/2022]
Affiliation(s)
- Naveed Basheeth
- Department of Otolaryngology and Head and Neck Surgery, South Infirmary Victoria University Hospital, Cork, Ireland
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19
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Sharma R. Superficial parotidectomy for chronic parotid sialadenitis. Int J Oral Maxillofac Surg 2013; 42:129-32. [DOI: 10.1016/j.ijom.2012.04.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Revised: 02/02/2012] [Accepted: 04/04/2012] [Indexed: 11/24/2022]
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20
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Park HS, Pae SY, Kim KY, Chung SM, Kim HS. Intraoral removal of stones in the proximal submandibular duct: Usefulness of a surgical landmark for the hilum. Laryngoscope 2012; 123:934-7. [DOI: 10.1002/lary.23825] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2012] [Indexed: 11/09/2022]
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21
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Overton A, Combes J, McGurk M. Outcome after endoscopically assisted surgical retrieval of symptomatic parotid stones. Int J Oral Maxillofac Surg 2012; 41:248-51. [DOI: 10.1016/j.ijom.2011.10.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Revised: 08/31/2011] [Accepted: 10/10/2011] [Indexed: 10/16/2022]
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Lim HK, Kim SM, Kim MJ, Lee JH. Clinical, statistical and chemical study of sialolithiasis. J Korean Assoc Oral Maxillofac Surg 2012. [DOI: 10.5125/jkaoms.2012.38.1.44] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Ho-Kyung Lim
- Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital, Seoul, Korea
| | - Soung-Min Kim
- Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital, Seoul, Korea
| | - Myung-Jin Kim
- Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital, Seoul, Korea
| | - Jong-Ho Lee
- Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital, Seoul, Korea
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Complicaciones quirúrgicas de la cirugía submaxilar. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2012; 63:42-6. [DOI: 10.1016/j.otorri.2011.08.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Revised: 07/26/2011] [Accepted: 08/11/2011] [Indexed: 01/08/2023]
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25
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Maresh A, Kutler DI, Kacker A. Sialoendoscopy in the diagnosis and management of obstructive sialadenitis. Laryngoscope 2011; 121:495-500. [DOI: 10.1002/lary.21378] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Accepted: 09/09/2010] [Indexed: 11/11/2022]
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26
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Zhang L, Escudier M, Brown J, Capaccio P, Pignataro L, McGurk M. Long-term outcome after intraoral removal of large submandibular gland calculi. Laryngoscope 2010; 120:964-6. [DOI: 10.1002/lary.20839] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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27
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Capaccio P, Torretta S, Pignataro L. The Role of Adenectomy for Salivary Gland Obstructions in the Era of Sialendoscopy and Lithotripsy. Otolaryngol Clin North Am 2009; 42:1161-71, Table of Contents. [DOI: 10.1016/j.otc.2009.08.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Combes J, Karavidas K, McGurk M. Intraoral removal of proximal submandibular stones – an alternative to sialadenectomy? Int J Oral Maxillofac Surg 2009; 38:813-6. [DOI: 10.1016/j.ijom.2009.02.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2008] [Revised: 08/04/2008] [Accepted: 02/13/2009] [Indexed: 10/20/2022]
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Kruegel J, Winterhoff J, Koehler S, Matthes P, Laskawi R. Botulinum toxin: A noninvasive option for the symptomatic treatment of salivary gland stenosis-A case report. Head Neck 2009; 32:959-63. [DOI: 10.1002/hed.21150] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Wang S, Marchal F, Zou Z, Zhou J, Qi S. Classification and management of chronic sialadenitis of the parotid gland. J Oral Rehabil 2008; 36:2-8. [PMID: 18976271 DOI: 10.1111/j.1365-2842.2008.01896.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Saliva has numerous oral functions and multiple functions in relation to digestion in the upper gastrointestinal tract. Chronic salivary hypofunction can lead to severe adverse health outcomes. Chronic sialadenitis is one of the major conditions that can cause salivary hypofunction. A correct diagnosis and management of chronic sialadenitis is essential for the recovery of salivary hypofunction. Chronic sialadenitis of the parotid gland is often seen in the clinic, sometimes also referred to as recurrent pyogenic parotitis, recurrent parotitis, non-obstructive parotitis, sialadenitis or obstructive parotitis, among other terms. The literature describes several different classifications and denominations for chronic sialadenitis of the parotid gland. These various classifications and denominations complicate the definition and diagnostic criteria, and if chronic sialadenitis of the parotid gland can develop into Sjogren's syndrome remains unclear. Treatment of this condition is also a challenging problem. Here, we review the presented classification and denomination of chronic sialadenitis of the parotid gland, proposing a classification based on the disease entities identified in a long-term follow-up investigation, and discuss the treatment principles for the condition.
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Affiliation(s)
- S Wang
- Salivary Gland Disease Center and the Molecular Laboratory for Gene Therapy, Capital Medical University School of Stomatology, Beijing, China.
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31
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Salles F, Chossegros C, Guyot L, Brignol L, Cheynet F, Blanc JL. Exérèse endobuccale des lithiases submandibulaires postérieures : 36 cas. ACTA ACUST UNITED AC 2008; 109:139-42. [DOI: 10.1016/j.stomax.2008.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2008] [Accepted: 03/11/2008] [Indexed: 10/22/2022]
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Patel RS, Low THH, Gao K, O'Brien CJ. Clinical Outcome After Surgery for 75 Patients With Parotid Sialadenitis. Laryngoscope 2007; 117:644-7. [PMID: 17415134 DOI: 10.1097/mlg.0b013e318030acc0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To analyze the clinical outcome of patients treated surgically for chronic parotid sialadenitis. STUDY DESIGN A retrospective cohort study of patients whose clinicopathologic information had been collected prospectively onto a dedicated head and neck database. METHODS Between 1987 and 2006, a total of 75 patients had 78 parotidectomies, 17 superficial and 61 near-total, to treat chronic parotid sialadenitis. The clinicopathologic data including treatment morbidity and outcome were analyzed. RESULTS Temporary postoperative facial weakness occurred in 26 (33%) patients, and this was permanent, although partial, in one (1%) patient. There was no significant difference (P > .05) in the incidence of temporary facial nerve neuropraxia in the superficial (35%) and near-total parotidectomy (33%) groups. Recurrence of symptoms was noted in two patients who had undergone near-total parotidectomy and none of the patients who had undergone superficial parotidectomy. Chronic parotid sialadenitis was effectively treated in 97% of patients undergoing parotidectomy. CONCLUSION Near-total parotidectomy is a safe and efficacious surgical treatment in the management of patients with debilitating severe chronic parotid sialadenitis.
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Affiliation(s)
- Rajan S Patel
- Sydney Head and Neck Cancer Institute, Sydney Cancer Centre, Royal Prince Alfred Hospital and University of Sydney, New South Wales, Australia.
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Marchal F. A Combined Endoscopic and External Approach for Extraction of Large Stones With Preservation of Parotid and Submandibular Glands. Laryngoscope 2007; 117:373-7. [PMID: 17204984 DOI: 10.1097/mlg.0b013e31802c06e9] [Citation(s) in RCA: 137] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Francis Marchal
- Sialendoscopy Unit, Department of Otolaryngology, Head and Neck Surgery, University Hospital, Geneva, Switzerland.
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Abstract
BACKGROUND Sialolithiasis as a cause of sialadenitis within Wharton's duct accounts for more than 80% of all cases. In the past extirpation of the gland was carried out in nearly all cases. Gland-preserving therapies such as transoral removal have so far been seldom examined. PATIENTS AND METHODS In 683 patients suffering from submandibular lithiasis with a mean age of 45 years (8-87 years) transoral removal of the stones were carried out. The follow-up period was 1-7 years. The stone location was distal to the edge of the mylohyoid muscle in 283 cases and more proximal to the gland within the hilum in 296 patients (single concrements). Fifty-nine patients had two separate stones, one within the area of the hilum and other smaller ones proximal within the gland. RESULTS All patients with distal stone location, 89% of patients with single stones of the perihilar region, and 63% of the patients with two separate stones in the hilum and parenchyma were free of stones. Another 8 and 23%, respectively, had small residual concrements without any complaints. Recurrence of lithiasis or damage of the lingual nerve remained below 1%. CONCLUSION Transoral removal in palpable sialoliths should be considered as the treatment of choice in patients suffering from submandibular stones located within the floor of the mouth or within the perihilar region of the gland. Ultrasound imaging is important for exact location of the stones.
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Affiliation(s)
- J Zenk
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenkranke der Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen.
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35
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36
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McGurk M, Makdissi J, Brown JE. Intra-oral removal of stones from the hilum of the submandibular gland: report of technique and morbidity. Int J Oral Maxillofac Surg 2004; 33:683-6. [PMID: 15337182 DOI: 10.1016/j.ijom.2004.01.024] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2004] [Indexed: 10/26/2022]
Abstract
There is increasing evidence to show that the submandibular gland regains function after stone removal and sialoadenectomy may not be the treatment of choice for proximal calculi. A technique of hilar stone removal is described with results and morbidity reported in a series of 55 patients. Stones were retrieved in 54 patients (98%) but four glands (8%) were subsequently removed due to recurrent obstruction. There were no complications related to the procedure (nerve injury, bleeding, infection or scarring) and the morbidity was less than reported for sialoadenectomy.
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Affiliation(s)
- M McGurk
- Salivary Gland Service, Department of Oral and Maxillofacial Surgery, Guy's Hospital, London SE1 9RT, UK.
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O'Brien CJ. Current management of benign parotid tumors--the role of limited superficial parotidectomy. Head Neck 2004; 25:946-52. [PMID: 14603455 DOI: 10.1002/hed.10312] [Citation(s) in RCA: 154] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Parotid tumors are mostly benign, but their evaluation and treatment require a thorough knowledge of the relevant anatomy and pathology. Surgical treatment of benign tumors is aimed at complete removal of the mass with facial nerve preservation. The aim of this study was to evaluate the results of treatment of benign parotid neoplasms when surgery entailed limited superficial parotidectomy. METHODS All patients with benign parotid tumors treated by the author from 1988 to 2002 were reviewed. Data had been prospectively accessioned onto the computerized database of the Department of Head and Neck Surgery, RPAH. Limited superficial parotidectomy was carried out in all previously untreated patients with tumors superficial to the plane of the facial nerve. Median follow-up time was 6 years (range, 1-14 years). RESULTS A total of 363 parotidectomies was carried out on 355 patients, 29 of whom (8%) were previously treated. Tumors arose deep to the plane of the facial nerve in 40 patients (11%), and, of these, 16 occupied the parapharyngeal space. Pleomorphic adenoma (70%) and Warthin's tumors (15%) were the most common pathologic types. Temporary postoperative facial weakness occurred after 98 operations (27%). Facial weakness was permanent in 2.5% of patients (9 cases) who had normal preoperative function; however, in this group the facial nerve was intentionally resected in 2 patients, 3 others had had previous surgery, and 1 had a deep lobe tumor. Tumor recurrence developed in three patients (0.8%), two of whom had been previously treated. CONCLUSION Complete superficial parotidectomy is unnecessary in the treatment of benign localized parotid tumors. Limited parotidectomy is associated with very low rates of morbidity and recurrence. Preoperative investigations should be used selectively; however, the author recommends routine (or at least liberal) use of fine-needle aspiration biopsy.
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Affiliation(s)
- Christopher J O'Brien
- Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital Medical Centre, 100 Carillon Avenue, Newtown, NSW 2042, Australia.
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Re: Amin MA, Bailey BMW, Patel SR. Clinical and radiological evidence to support superficial parotidectomy as a treatment of choice for chronic parotid sialadenitis: a retrospective study. Br J Oral Maxillofac Surg 2001; 39: 348–352. Br J Oral Maxillofac Surg 2002. [DOI: 10.1016/s0266-4356(02)00112-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
Acute and chronic inflammatory diseases of the major and minor salivary glands constitute the most common clinical syndrome of salivary glands. During the past decade, the use of antibiotics along with fluid hydration and electrolyte management has almost eliminated the development of fulminating acute suppurative parotitis in hospital surgical patients. Although acute bacterial and viral sialadenitis persists, the clinical challenge has changed, with more focus on the chronic inflammatory group of diseases. The pathogenesis of the chronic salivary inflammatory disease spectrum has also changed, with the interplay between sialadenitis, sialectasia, and sialolithiasis. There also exists a heterogeneous group of disorders in chronic inflammatory sialadenitis, which include the group of specific and nonspecific granulomatous diseases.
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Affiliation(s)
- Patrick J. Bradley
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital, Queens Medical Centre, Nottingham NG7 5EU, England.
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Vieira MBM, Pereira RDA, Santos Júnior NBD, Pinto RV. Ressecção subcapsular da glândula submandibular. ACTA ACUST UNITED AC 2001. [DOI: 10.1590/s0034-72992001000600011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Introdução: A cirurgia das patologias inflamatórias das glândulas salivares está associada a uma maior incidência de paralisias temporárias pós-operatórias se comparada a cirurgia dos tumores. Tal fato se deve à dissecção mais laboriosa e mais traumática dos ramos motores do nervo facial, e sua exposição ao processo inflamatório dos tecidos vizinhos. A glândula submandibular é o tecido salivar mais freqüentemente ressecado devido à patologia inflamatória e a não rara paresia temporária do ramo mandibular é fonte de desconforto para o paciente. A remoção da gordura peri-glandular com seus linfonodos não tem a mesma importância que para os tumores. Objetivo: Portanto, temos realizado para sialolitíase e sialoadenites crônicas da submandibular a ressecção subcapsular da glândula. Forma de estudo: Propectivo randomizado. Material e método: Após uma incisão cervical transversa, a cápsula é aberta na parte inferior da glândula e descolada da mesma em sentido superior. O ramo mandibular do nervo facial não é identificado e os vasos faciais são preservados após cuidadosa ligadura dos ramos para a glândula. Na suspeita de patologia neoplásica mudamos o procedimento para a cirurgia tradicional. Resultados: Nos 5 casos estudados, 2 femininos e 3 masculinos, não foi observada paresia pós-operatória. Outras vantagens são a economia do tempo cirúrgico normalmente necessário para a dissecção do nervo e a preservação dos vasos faciais que podem ser usados no futuro como base de retalhos.
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Amin MA, Bailey BM, Patel SR. Clinical and radiological evidence to support superficial parotidectomy as the treatment of choice for chronic parotid sialadenitis: a retrospective study. Br J Oral Maxillofac Surg 2001; 39:348-52. [PMID: 11601814 DOI: 10.1054/bjom.2001.0671] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We present a retrospective series of 23 consecutive parotidectomies, over a 10-year period (1989-1999) for 22 patients with chronic sialadenitis unresponsive to conservative measures. There were 10 male and 12 female patients. Mean age was 52 years (range 12-72), and mean duration of symptoms 4.5 years (range 8 months-30 years). All patients had preoperative sialography and 2 had computed tomography to exclude a neoplasm. A complete superficial parotidectomy with preservation of the main duct was done in all cases. Fifteen patients developed temporary facial nerve weakness postoperatively and 7 developed Frey's syndrome. There were no cases of permanent facial nerve palsy. Nineteen patients reported complete resolution of their symptoms and 3 patients had mild persisting symptoms that did not necessitate any further treatment. Histologically there was evidence of sialadenosis in one case and benign lymphoepithelial lesion in another; the others showed evidence of chronic sialadenitis of varying degrees of severity. Fifteen patients had postoperative sialograms, of which 11 showed evidence of some filling of residual parotid gland parenchyma and in 8 patients there was filling of a normal-looking accessory lobe. In this series, superficial parotidectomy with preservation of the main duct was safe and effective, with minimal long-term complications, for most patients with chronic parotid sialadenitis that was unresponsive to conservative measures and, in some patients, it allowed some preservation of function. The potential damage to the facial nerve and the cosmetic problems associated with a total or near-total parotidectomy were avoided.
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Affiliation(s)
- M A Amin
- SW London Maxillofacial Service, Queen Mary's University Hospital, Roehampton, London, UK
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Ching AS, Ahuja AT, King AD, Tse GM, Metreweli C. Comparison of the sonographic features of acalculous and calculous submandibular sialadenitis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2001; 29:332-338. [PMID: 11424098 DOI: 10.1002/jcu.1044] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE The purpose of this study was to compare the sonographic features of acalculous and calculous sialadenitis of the submandibular gland. METHODS A retrospective review of sonograms of the neck was performed in 25 patients with submandibular sialadenitis: 8 with acalculous and 17 with calculous disease. The submandibular glands were assessed for size, shape, border, and echogenicity; presence of dilated ducts or other intraglandular lesions; inflammatory changes in adjacent tissues; lymphadenopathy; and involvement of other salivary glands. RESULTS In the group with acalculous sialadenitis, 4 (50%) of the 8 patients had unilateral disease, and 11 (92%) of 12 glands were rounded. In all cases (100%), multiple hypoechoic lesions were diffusely distributed throughout the submandibular glands against a heterogeneous parenchymal background. The lesions ranged from 3 to 15 mm and were oval or round. Confluent lesions were noted in 2 glands (17%). There was no sonographic evidence of duct dilatation, calculi, or abnormal lymph nodes. All patients with calculous sialadenitis had unilateral disease; 9 had a main duct calculus (53%), 7 had intraglandular calculi (41%), and 1 had both (6%). In 14 (82%) of 17 glands, normal shape was maintained, and 11 (65%) of 17 had duct dilatation. CONCLUSIONS Acalculous submandibular sialadenitis differs from the calculous form of the disease. The former has characteristic sonographic features, including a round gland with numerous hypoechoic lesions in a heterogeneous parenchymal background. Sonographic imaging in conjunction with fine-needle aspiration is useful for detection of this disorder.
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Affiliation(s)
- A S Ching
- Department of Diagnostic Radiology and Organ Imaging, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong
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Moody AB, Avery CM, Walsh S, Sneddon K, Langdon JD. Surgical management of chronic parotid disease. Br J Oral Maxillofac Surg 2000; 38:620-622. [PMID: 11092780 DOI: 10.1054/bjom.2000.0478] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This is a retrospective review of a single surgeon's experience over a 20-year period, and covers the presentation, investigation, histology, management and complications of the surgical treatment of chronic parotid disease. There were 46 superficial parotidectomies (23 with ductal ligation); 3 required removal of calculi and there was one ductoplasty and one total parotidectomy. There were 28 cases of temporary palsy of the VIIth cranial nerve (55%, mean duration 4 months) and this was predominantly panfacial (79%). There were no cases of permanent palsy. Five patients who initially had a superficial parotidectomy required subsequent total parotidectomy for recurrent disease (11%). We have now adopted a policy of near total parotidectomy for the surgical treatment of chronic parotid disease.
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Affiliation(s)
- A B Moody
- Department of Maxillofacial Surgery, Royal Surrey County Hospital, Guildford, UK
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Tighe JV, Bailey BM, Khan MZ, Stavrou M, Todd CE. Relation of preoperative sialographic findings with histopathological diagnosis in cases of obstructive sialadenitis of the parotid and submandibular glands: retrospective study. Br J Oral Maxillofac Surg 1999; 37:290-3. [PMID: 10475651 DOI: 10.1054/bjom.1999.0121] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The clinical records, preoperative sialograms and histopathological slides of 33 patients who had been operated on for symptoms of obstructive salivary gland disease were reviewed. Twenty patients had had superficial parotidectomy and 13 excision of the submandibular gland. Among those who had required parotidectomy, preoperative sialograms tended to suggest more architectural damage than was actually noted on definitive histopathological examination. Patients whose symptoms had been present for longer had more severe sialographic and histopathological changes. In the submandibular group, there was a closer relation between sialographic and histopathological changes, and a positive correlation between a short history and the severity of histopathological grading. These differences may reflect the different aetiology and course of obstructive disease in the two types of gland.
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Affiliation(s)
- J V Tighe
- Royal Surrey County Hospital, Guildford, UK
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