Sialoendoscopy: Prognostic Factors for Endoscopic Removal of Salivary Stones | Otolaryngology | JAMA Otolaryngology–Head & Neck Surgery | JAMA Network
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1.
Marchal  FDulguerov  P Sialolithiasis management: the state of the art.  Arch Otolaryngol Head Neck Surg 2003;129 (9) 951- 956PubMedGoogle ScholarCrossref
2.
Koch  MBozzato  AIro  HZenk  J Combined endoscopic and transcutaneous approach for parotid gland sialolithiasis: indications, technique, and results.  Otolaryngol Head Neck Surg 2010;142 (1) 98- 103PubMedGoogle ScholarCrossref
3.
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- 377PubMedGoogle ScholarCrossref
4.
Iro  HDlugaiczyk  JZenk  J Current concepts in diagnosis and treatment of sialolithiasis.  Br J Hosp Med (Lond) 2006;67 (1) 24- 28PubMedGoogle Scholar
5.
Iro  HZenk  JEscudier  MP  et al.  Outcome of minimally invasive management of salivary calculi in 4,691 patients.  Laryngoscope 2009;119 (2) 263- 268PubMedGoogle ScholarCrossref
6.
Koch  MZenk  JIro  H Diagnostic and interventional sialoscopy in obstructive diseases of the salivary glands.  HNO 2008;56 (2) 139- 144PubMedGoogle ScholarCrossref
7.
McGurk  MEscudier  MPBrown  JE Modern management of salivary calculi.  Br J Surg 2005;92 (1) 107- 112PubMedGoogle ScholarCrossref
8.
McGurk  M Surgical release of a stone from the hilum of the submandibular gland: a technique note.  Int J Oral Maxillofac Surg 2005;34 (2) 208- 210PubMedGoogle ScholarCrossref
9.
Zenk  JConstantinidis  JAl-Kadah  BIro  H Transoral removal of submandibular stones.  Arch Otolaryngol Head Neck Surg 2001;127 (4) 432- 436PubMedGoogle ScholarCrossref
10.
Nahlieli  ONakar  LHNazarian  YTurner  MD Sialoendoscopy: a new approach to salivary gland obstructive pathology.  J Am Dent Assoc 2006;137 (10) 1394- 1400PubMedGoogle ScholarCrossref
11.
Marchal  FBecker  MDulguerov  PLehmann  W Interventional sialoendoscopy.  Laryngoscope 2000;110 (2, pt 1) 318- 320PubMedGoogle ScholarCrossref
12.
Walvekar  RRRazfar  ACarrau  RLSchaitkin  B Sialoendoscopy and associated complications: a preliminary experience.  Laryngoscope 2008;118 (5) 776- 779PubMedGoogle ScholarCrossref
13.
Luers  JCDamm  MKlussmann  JPBeutner  D The learning curve of sialoendoscopy with modular sialoendoscopes: a single surgeon's experience.  Arch Otolaryngol Head Neck Surg 2010;136 (8) 762- 765PubMedGoogle ScholarCrossref
14.
Marchal  FDulguerov  PBecker  MBarki  GDisant  FLehmann  W Specificity of parotid sialoendoscopy.  Laryngoscope 2001;111 (2) 264- 271PubMedGoogle ScholarCrossref
15.
Katz  PHartl  DMGuerre  A Clinical ultrasound of the salivary glands.  Otolaryngol Clin North Am 2009;42 (6) 973- 1000PubMedGoogle ScholarCrossref
16.
Wittich  GRScheible  WFHajek  PC Ultrasonography of the salivary glands.  Radiol Clin North Am 1985;23 (1) 29- 37PubMedGoogle Scholar
17.
Walvekar  RRCarrau  RLSchaitkin  B Endoscopic sialolith removal: orientation and shape as predictors of success.  Am J Otolaryngol 2009;30 (3) 153- 156PubMedGoogle ScholarCrossref
Original Article
May 16, 2011

Sialoendoscopy: Prognostic Factors for Endoscopic Removal of Salivary Stones

Author Affiliations

Author Affiliations: Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Cologne, University of Cologne, Cologne, Germany.

Arch Otolaryngol Head Neck Surg. 2011;137(4):325-329. doi:10.1001/archoto.2010.238

Sialoendoscopy allows endoscopic intraluminal visualization of the duct system of major salivary glands and enables the surgeon to diagnose and treat inflammatory and obstructive disorders of the ducts.1 Although other pathologic conditions are regularly diagnosed and treated by sialoendoscopy, sialolithiasis accounts for about 50% of indications yet represents the most frequent cause of unilateral gland swelling. When a salivary stone (sialolith) is not amenable to endoscopic removal, various techniques, such as extracorporeal or intracorporeal fragmentation or a combined endoscopic-external approach, come into play.2,3 In the case of large submandibular sialoliths located far away from the ostium, some surgeons incise Wharton duct beyond the hilum of the gland into parenchymal areas, a procedure that carries risk of damage to the lingual nerve.3-9 When sialoendoscopy includes additional interventional techniques, overall sialolith extraction rates between 70% and 95% have been reported.1,4,5,10,11 Excellent removal rates exceeding 90% must be interpreted carefully, as they most often represent late case series of experienced surgeons.12 Despite its apparent simplicity, sialoendoscopy is a technically challenging procedure with a notable learning curve; therefore, success rates are proportional to the experience and endoscopic skills of the surgeon.12,13 However, there is disagreement about what situations necessitate fragmentation and which technique should be used preferentially. It is unclear when external lithotripsy is superior to internal lithotripsy, when lasers should be used instead of a manual burr, or when a combined procedure or removal of the entire salivary gland should be performed in lieu of invasive fragmentation, such as duct incisions. Fragmentation techniques are not universally allowed because of early reported complications, as well as additional instrument cost and legal requirements.12 Limitations for endoscopic sialolith removal must first be clarified to evaluate indications for application of other complex, expensive, and possibly hazardous methods (eg, open surgery, combined endoscopic-external approach, extracorporeal or intracorporeal lithotripsy, and incisions of the main excretory salivary duct >1 cm). Because limitations and prognostic factors influence each other, we sought to investigate the latter to elucidate the probability of endoscopic sialolith. With knowledge of prognostic factors, further research can investigate ways to obtain information about the characteristics of sialolith s to allow evidence-based triage of patients with sialolithiasis.

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