Sialendoscopy-assisted transoral approach for parotid gland lithiasis.

INTRODUCTION: Although lithiasis represents more than 60% of all cases of salivary gland obstruction, only 20% occurs in the Stensen´s duct. Nonetheless, the potential complications related to parotid gland surgery due to facial nerve injury, makes the development of minimally invasive techniques highly relevant. MATERIALS AND METHODS: A pilot study was conducted to assess results of patients treated by sialendoscopy-assisted trans-oral approach to treat Stensen´s duct lithiasis. RESULTS: Eight patients were included; all of them operated satisfactorily. Six of them were male, and 2 were female. The mean size of the stones was 9.6 mm (Min: 6 mm/Max: 16 mm). Regarding to lithiasis location: it was anterior to the masseter line in the distal third of the Stensen's duct in seven patients and in another patient was immediately below the buccinator muscle. During the follow-up, all patients presented a healthy functioning of the gland after the compressive massage. Regarding complications, one patient presented a Stensen's duct stenosis, which required reintervention. CONCLUSION: The transoral Stensen´s duct approach represents a safe technique for lithiasis bigger than 3 mm in the distal portion of the Stensen´s duct, anterior to the Masseter Muscle line and when other minimal invasive techniques fail.

Sialolitectomía transoral combinada con sialoendoscopia versus submaxilectomía abierta para el manejo de litiasis hiliares de la glándula submaxilar / Transoral sialolitectomy combined with sialoendoscopy versus open submaxilectomy for the management of hilar lithiasis of the submandibular gland

Introducción: El tratamiento de la enfermedad obstructiva salival mediante técnicas mínimamente invasivas ha sido objeto de valoración por diferentes estudios desde hace décadas. Las litiasis a nivel del conducto salival serán la causa más frecuente de obstrucción, representando más del 50% de la enfermedad de las glándulas salivales mayores afectando hasta en un 80% de casos al conducto de Wharton. Material y métodos: Estudio prospectivo, comparando los resultados de las técnicas de sialolitectomía transoral combinada (STC) y submaxilectomía abierta mediante cervicotomía en 2 grupos de pacientes tratados por cálculos a nivel del hilio de la glándula submaxilar. Resultados: Veintidós pacientes fueron incluidos en el estudio, 16 (72,7%) eran hombres y 6 (27,3%) eran mujeres, la edad promedio fue de 54,41 años ± 12,75 (mín: 30/máx: 77). En cuanto a las variables asociadas a la enfermedad: promedio de litiasis, tamaño medio de la litiasis, tiempo medio de estancia, alteración del nervio lingual o complicaciones para ambas técnicas, no se encontraron diferencias para ambos grupos. Existiendo solo diferencias estadísticamente significativas en la estancia promedio a favor de la STA (p = 0,001). Conclusión: Los abordajes mínimamente invasivos al sistema ductal salival, asociados o no a sialoendoscopia, han demostrado una eficacia contrastada y un menor número de complicaciones en su variante submaxilar transoral. La tendencia natural debería ir dirigida a sustituir paulatinamente las técnicas de sialoadenectomía abierta, reservando su indicación para el tratamiento de enfermedad tumoral

Introduction: The treatment of salivary obstructive pathology by minimally invasive techniques has been an object of assessment by different studies for decades. Lithiasis at the level of the salivary duct will be the most frequent cause of obstruction, representing more than 50% of the pathology of the major salivary glands and almost 80% of these affecting the Wharton duct. Material and methods: A prospective study comparing the results of combined transoral sialolitectomy (CTS) and open submaxillectomy techniques by cervicotomy in 2 groups of patients treated by lithiasis at the level of the hilum of the submaxillary gland. Results: 22 patients were included in the study 16 (72.7%) were men and 6 (27.3%) were women, the average age was 54.41 years ± 12.75 (Min: 30/Max: 77). Regarding the variables associated with the disease: average lithiasis, size of the stone, hospital stay, lingual nerve alteration or complications for both techniques, differences were not found between both groups. There were only statistically significant differences in the average stay in favor of the CTS (P=.001). Conclusion: The minimally invasive approaches to the salivary ductal system, associated or not with sialoendoscopy, can be efficacy and can be associated with lower number of complications. The natural tendency should be aimed to gradually replacing open sialoadenectomy techniques, reserving its indication for the treatment of tumor pathology

Transoral Sialolitectomy as an Alternative to Submaxilectomy in the Treatment of Submaxillary Sialolithiasis.

INTRODUCTION: Sialolithiasis is the most common pathology in the submaxillary gland. The introduction of minimally invasive techniques isolated or associated with sialoendoscopy is replacing glandular resection as a treatment. The conservation of the gland is justified by the recovery of function and a low recurrence rate. The rate of complications is lower in conservative techniques than in submandibular gland resection. PATIENTS AND METHODS: Thirty-three patients with fixed stones in the hilum of the submaxillary gland were treated by transoral sialolitectomy between July 2015 and July 2018, demographic data of the patients such as the number of stones, size, time of hospital stay, complications, pre- and postoperative lingual nerve function, and lithiasis recurrence were collected. RESULTS: The average volume of the stones was 1.02 cm. Complete removal of the stone was possible in 32 patients. All the patients were operated in the outpatient clinic. Seven (21%) patients reported some degree of alteration of the lingual nerve function, of which the only one presented a persistence of more than 4 weeks due to an inadvertent injury that required a microsurgical anastomosis. CONCLUSIONS: Transoral sialolitectomy is a reproducible technique with good results and lower complication rates than submandibular gland resection. Our results in the first 33 cases encourage us to maintain the combined techniques as standard in the treatment of submaxillary sialolithiasis. Current experience guides the definitive substitution of submandibular gland resection by conservative techniques in obstructive pathology.

Transoral sialolitectomy combined with sialoendoscopy versus open submaxilectomy for the management of hilar lithiasis of the submandibular gland. / Sialolitectomía transoral combinada con sialoendoscopia versus submaxilectomía abierta para el manejo de litiasis hiliares de la glándula submaxilar.

INTRODUCTION: The treatment of salivary obstructive pathology by minimally invasive techniques has been an object of assessment by different studies for decades. Lithiasis at the level of the salivary duct will be the most frequent cause of obstruction, representing more than 50% of the pathology of the major salivary glands and almost 80% of these affecting the Wharton duct. MATERIAL AND METHODS: A prospective study comparing the results of combined transoral sialolitectomy (CTS) and open submaxillectomy techniques by cervicotomy in 2 groups of patients treated by lithiasis at the level of the hilum of the submaxillary gland. RESULTS: 22 patients were included in the study 16 (72.7%) were men and 6 (27.3%) were women, the average age was 54.41 years ± 12.75 (Min: 30/Max: 77). Regarding the variables associated with the disease: average lithiasis, size of the stone, hospital stay, lingual nerve alteration or complications for both techniques, differences were not found between both groups. There were only statistically significant differences in the average stay in favor of the CTS (P=.001). CONCLUSION: The minimally invasive approaches to the salivary ductal system, associated or not with sialoendoscopy, can be efficacy and can be associated with lower number of complications. The natural tendency should be aimed to gradually replacing open sialoadenectomy techniques, reserving its indication for the treatment of tumor pathology.

Mutational profiling can identify laryngeal dysplasia at risk of progression to invasive carcinoma.

Early diagnosis of laryngeal squamous cell carcinoma (LSCC) at the stage of dysplasia could greatly improve the outcome of affected patients. For the first time we compared the mutational landscape of non-progressing dysplasia (NPD; n = 42) with progressing dysplasia (PD; n = 24), along with patient-matched LSCC biopsies; a total of 90 samples. Using targeted next-generation sequencing identified non-synonymous mutations in six genes (PIK3CA, FGFR3, TP53, JAK3, MET, FBXW7), and mutations were validated by Sanger sequencing and/or qPCR. Analysis was extended in silico to 530 head and neck (HNSCC) cases using TCGA data. Mutations in PIK3CA and FGFR3 were detected in PD and LSCC cases, as well as other HNSCC cases, but absent in NPD cases. In contrast, mutations in JAK3, MET and FBXW7 were found in NPD cases but not PD, LSCC or other HNSCC cases. TP53 was the most frequently mutated gene in both PD and NPD cases. With the exception of R248W, mutations were mutually exclusive. Moreover, five of seven PD mutations were located in motif H2 of p53, whereas none of the NPD mutations were. In summary, we propose that the mutational profile of laryngeal dysplasia has utility for the early detection of patients at risk of progression.

Direct drug application to the round window: a comparative study of ototoxicity in rats.

OBJECTIVE: To assess the validity of inducing ototoxicity in rats by applying a sponge soaked in kanamycin and furosemide on the round window. STUDY DESIGN: Basic, randomized, nonblind experimental study. SETTING: Animal models of cochlear damage and reliable methods of local drug delivery are fundamental to study hearing loss and to design new therapies. SUBJECTS AND METHODS: Four experimental groups of six Wistar rats with different methods of drug administration were used: (1) injection of subcutaneous kanamycin (400 mg/kg) and intravenous furosemide (100 mg/kg); (2) local application of a sponge soaked in saline close to the round window; (3) animals for which the sponge was soaked in a solution containing kanamycin (200 mg/mL) and furosemide (50 mg/mL); and (4) sham-operated rats. The tympanic bulla was exposed using a ventral approach, and a bullostomy was performed to visualize the round window membrane. Cochlear function was assessed by measuring the auditory brainstem response, and hearing thresholds in response to click and tone burst stimuli were determined as peak and interpeak latencies. At the end of the study, cochlear histology was analyzed. RESULTS: Systemic administration of kanamycin and furosemide induced profound hearing loss and severe hair cell damage. Local delivery of these ototoxic drugs caused comparable damage but avoided the systemic side effects of the drug. Sham-operated and saline control animals did not experience functional alterations. CONCLUSION: Situating a sponge soaked in kanamycin and furosemide on the round window membrane through the ventral approach is a reliable method to provoke local ototoxicity in rats.