Combined Endoscopic-Transcutaneous Approach for Management of Large Parotid Stones

Document Type : Original

Authors

Department of Otorhinolaryngology and Head & Neck Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi-110095, India.

Abstract

Introduction:
The aim of this paper is to present our experience with combined endoscopic-transcutaneous approach in terms of effectiveness and safety in patients with large or impacted parotid stones.
 
Materials and Methods:
This is a prospective study carried out from August, 2012 to February, 2017 analyzing 21 patients with parotid sialolithiasis. The indication of combined approach was either failed attempt to remove the stone endoscopically, large size (>4mm), or impacted stone. The exact location of the stone was pointed out by endoscopic transillumination and the stone was removed via transcutaneous incision which could be linear incision or a preauricular incision followed by stenting for 3 weeks.
Results:
We were successfully able to remove the stone in all 21 cases using modified Blair’s incision in 18 cases, while a linear incision was used in remaining 3 cases. Two patients developed stricture in the post-operative period at 5 and 3 months, respectively. The strictures were successfully dilated endoscopically and the patients are asymptomatic ever since.
 
Conclusion:
Combined endoscopic-transcutaneous approach is a highly successful approach with few complications for removal of parotid stones and thus resulting in high gland preservation rates in patients of parotid sialolithiasis.

Keywords


  1.  Marchal F, Dulguerov P, Becker M, Barki G, Disant F, Lehmann W. Submandibular diagnostic and interventional sialendoscopy: new procedure for ductal disorders. Ann Otol Rhinol Laryngol. 2002;111(1):27-35.
  2.      Marchal F, Dulguerov P, Becker M, Barki G, Disant F, Lehmann W. Specificity of parotid sialendoscopy. Laryngoscope. 2001;111(2): 264-71.
  3.   McGurk M, Escudier MP, Brown JE. Modern management of salivary calculi. Br J Surg. 2005; 92(1):107-12.
  4.   Iro H, Zenk J, Escudier MP, Nahlieli O, Capaccio P, Katz P, Brown J, McGurk M. Outcome of minimally invasive management of salivary calculi in 4,691 patients. Laryngoscope. 2009; 119(2): 263-8. doi: 10.1002/lary.20008.   
  5.    Koch M, Bozzato A, Iro H, Zenk J. Combined endoscopic and transcutaneous approach for parotid gland sialolithiasis: indications, technique, and results. Otolaryngol Head Neck Surg. 2010; 142(1):98-103.
  6. Overton A, Combes J, McGurk M. Outcome after endoscopically assisted surgical retrieval of symptomatic parotid stones. Int J Oral Maxillofac Surg. 2012; 41: 248–251.
  7.   Guerre A, Katz P. [Extracorporeal shockwave lithotripsy (ESWL) for salivary gland stones: a retrospective study of 1571 patients]. Rev Stomatol Chir Maxillofac. 2011;112(2):75-9. doi: 10.1016/j.stomax.2011.01.007. 
  8. Capaccio P, Ottaviani F, Manzo R, Schindler A, Cesana B. Extracorporeal lithotripsy for salivary calculi: a long-term clinical experience. Laryngoscope 2004; 114(6):1069e1073.
  9. Durbec M, Dinkel E, Vigier S, Disant F, Marchal F, Faure F. Thulium-YAG laser sialendoscopy for parotid and submandibular sialolithiasis. Lasers Surg Med. 2012;44: 783–786.
  10. Nahlieli O, London D, Zagury A, Eliav E. Combined approach to impacted parotid stones. J Oral Maxillofac Surg. 2002;60(12):1418-23.
  11.  McGurk M, MacBean AD, Fan KF, Sproat C, Darwish C. Endoscopically assisted operative retrieval of parotid stones. Br J Oral Maxillofac Surg. 2006; 44(2):157-60.
  12.   Marchal F. A combined endoscopic and external approach for extraction of large stones with preservation of parotid and submandibular glands. Laryngoscope. 2007;117(2):373-7.
  13.  Walvekar RR, Bomeli SR, Carrau RL, Schaitkin B. Combined approach technique for the management of large salivary stones. Laryngoscope. 2009; 119(6):1125-9. doi: 10.1002/ lary. 20203.
  14.  Capaccio P, Gaffuri M, Pignataro L. Sialendoscopy-assisted transfacial surgical removal of parotid stones. J Craniomaxillofac Surg. 2014; 42(8):1964-9. doi: 10.1016/j.jcms.2014.08.009. 
  15.  Escudier MP, Brown JE, Drage NA, McGurk M. Extracorporeal shockwave lithotripsy in the management of salivary calculi. Br J Surg. 2003; 90(4):482-5.
  16.   Zenk J, Bozzato A, Winter M, Gottwald F, Iro H. Extracorporeal shock wave lithotripsy of submandibular stones: evaluation after 10 years. Ann Otol Rhinol Laryngol. 2004;113(5):378-83.
  17.   Koch M, Iro H, Zenk J. Combined endoscopic-transcutaneous surgery in parotid gland sialolithiasis and other ductal diseases: reporting medium- to long-term objective and patients' subjective outcomes. Eur Arch Otorhinolaryngol. 2013; 270(6):1933-40. doi: 10.1007/s00405-012-2286-y.
  18.   Capaccio P, Torretta S, Pignataro L. Extracorporeal lithotripsy techniques for salivary stones. Otolaryngol Clin North Am. 2009;42(6): 1139-59, Table of Contents. doi: 10.1016/j.otc. 2009.08.003.
  19.  Kopeć T, Szyfter W, Wierzbicka M.  Sialoendoscopy and combined approach for the management of salivary gland stones. European Archives of Oto-Rhino-Laryngology 2013;270(1): 219-223. doi:10.1007/s00405-012-2145-
  20. .  Numminen J, Sillanpää S, Virtanen J, Sipilä M, Rautiainen M. Retrospective analysis of a combined endoscopic and transcutaneous technique for the management of parotid salivary gland stones. ORL J Otorhinolaryngol Relat Spec. 2014; 76(5): 282-7. doi: 10.1159/000368719.
  21.   Konstantinidis I, Chatziavramidis A, Iakovou I, Constantinidis J. Long-term results of combined approach in parotid sialolithiasis.  Eur Arch Otorhinolaryngol. 2015; 272(11):3533-8. doi: 10.1007/s00405-014-3391-x.