Minimal surgery for parotid stones: a 7-year endoscopic experience.

The results of endoscope-assisted parotid surgery are presented as a minimally invasive alternative to parotidectomy for large parotid stones. From 1999 to 2007, 70 patients with parotid sialoliths were treated by minimally invasive surgical techniques in three specialist centres. At surgery a combination of sialoendoscopic and ultrasound examination was used to locate the stone within the duct. The calculus was released by incising the duct through a pre-auricular approach (40 patients) or by direct transcutaneous incision over the stone (27 patients). Four patients were treated using other minimally invasive procedures. Local anesthesia was used in 22 patients and general anesthesia in 48. The average follow-up was 25.5 months with two patients lost to review. In 3 patients treatment had long-term complications (persistent stone fragment; obstructive symptoms due to a fibrous stricture; a visible scar on the cheek). In one patient, endoscopy was abandoned due to stricture. 85 stones were retrieved successfully from 69 patients. The average size of the stones was 7.2 mm. There were no cases of facial nerve weakness or salivary fistula. The data suggest that endoscopic-assisted surgery is a viable alternate to adenectomy for the treatment of large or recalcitrant parotid stones.

Intraoral removal of proximal submandibular stones--an alternative to sialadenectomy?

Submandibular salivary stones account for most symptomatic sialoliths and most are treated by adenectomy. Transoral removal of proximal or hilar stones is an alternative approach that preserves the functioning gland. Between 1999 and 2006, 186 consecutive patients had transoral removal of 186 stones in the proximal third or hilum of the submandibular gland. Both patient and treatment details were recorded prospectively and outcome assessed by a structured questionnaire. Stone removal was achieved in 99% (185/186) of cases treated. Morbidity was low and there were no intra-operative complications. At median follow up of 28 months (range 4-62 months) 4% (7/186) had subsequently undergone sialadenectomy for persisting symptoms. 105/186 responded to a questionnaire, 76% (80/105) were symptom-free and in a further 17% (18/105) symptoms were mild. No patient had lingual nerve anaesthesia but 6% (6/105) reported a mild tingling. 93% (97/105) were pleased to have had the operation. Submandibular stones can be reliably retrieved from the proximal portion of the duct or hilum with minimal morbidity. Evolving review data suggests that the incidence of recurrent disease is low at 2 years, suggesting that this technique may be a viable alternative to adenectomy.