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Transoral Robotic Surgery for Submandibular Sialolithiasis Transoral robotic surgery (TORS) was invented at the University of Pennsylvania and subsequently Food and Drug Administration (FDA) approved in 2009. Transoral surgery of the submandibular gland for tumors and inflammatory disease has not been popular because access to the hilum is difficult. TORS has been utilized in the author's institution to allow better visualization for transoral submandibular gland excision,…
Introduction Patients with stones of the parotid gland and its duct were usually treated by partial parotidectomy in previous years. Extracorporeal shock wave lithotripsy reduced the number of surgeries but is not generally available and is successful in only about two-thirds of cases. Today, sialendoscopy has led to a new, transoral approach. Smaller stones can be extracted with sialendoscopy and a basket. Larger stones can potentially…
Introduction Sialolithiasis is one of the major causes of sialadenitis and accounts for approximately 50% of major salivary gland diseases. Calculi in the salivary glands can be found in 1.2% of the general population. This chapter is dedicated to interventional sialendoscopy in cases of calculi of the parotid gland. Most salivary calculi (80–95%) occur in the submandibular gland and surgeons gain solid experience with these stones.…
Introduction Salivary gland obstruction accounts for about 50% of all benign salivary gland diseases. Sialolithiasis is one of the most frequent causes of inflammatory changes within the large salivary glands. Some salivary stones are expulsed with the saliva through the natural anatomic orifices and remain asymptomatic. The incidence of symptomatic stones requiring therapy amounts to 27.5–59 cases per million inhabitants. In a large group of patients…
Introduction Most patients presenting with obstructive symptoms of the submandibular gland (SMG) are afflicted with salivary stones rather than stenosis, and salivary gland stones are a more frequent cause of SMG obstruction than of parotid obstruction, in a ratio of 4 : 1. Traditionally, most stones in the proximal SMG and duct were treated with gland excision. Sialendoscopy has allowed for preservation of many of these glands. Functional…
Introduction Diagnostic sialendoscopy is fundamental in the assessment and the treatment of salivary gland ductal pathology. Because of this diagnostic modality, the main duct, secondary, and tertiary branches can practically all be explored and evaluated. Diagnostic sialendoscopy can either be done as a single procedure or it can be incorporated in a more complex surgery involving combined or purely endoscopic approaches. Diagnostic sialendoscopy must not be…
Introduction Papilla crossing is one of the key points for sialendoscopy, especially in submandibular sialendoscopy. After the papilla has been crossed, the sialendoscopy can begin. Instead of papilla crossing, other approaches to the salivary duct may also be needed. For example, the retropapillary approach can replace the papillary crossing when this crossing is not feasible. However, when the lithiasis removal procedure is over, the surgeon must…
14.1 The Marchal Instruments Salivary Endoscopy Relies on Several Factors 1. The size of the papilla and the difficulty to pass the papilla without traumatizing it 2. The caliber of the ducts 3. The diameter of the scope 4. The quality of the scope (number of pixels) 5. The limitations of maneuvering the scope in the ductal system due to the anatomy (sharp angles) and to…
Introduction The applications of sialendoscopy continue to increase. Whether in isolation or as an accessory to more invasive techniques, sialendoscopy has expanded gland-sparing options for the management of non-neoplastic salivary disorders. Appropriately, this has caused an increased interest in the use of sialendoscopy by physicians and patients alike. As with the implementation of any new technology, it is important that surgeons who are seeking to incorporate…
Stensen's Parotid Salivary Duct You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here
Introduction Chronic sialadenitis is the most common benign disease of the major salivary glands and is usually the result of obstruction of salivary flow due to calculi, strictures, or both. Chronic sialadenitis, particularly in the parotid gland, may also be associated with Sjögren syndrome, sarcoidosis, and other forms of granulomatous sialadenitis. In the pre-antibiotic era, the treatment of chronic and recurrent sialadenitis consisted of adequate hydration,…
Introduction There was a paradigm shift in the understanding of the pathogenesis of sialoliths, also known as salivary calculi, at the turn of the century. This was the result of experimental and clinicopathologic investigations that led to the discovery that sialolithiasis (the presence of a sialolith) was secondary to chronic sialadenitis. Rediscovery, however, would be more appropriate, because this conclusion had been reached in 1896 by…
9.1 Ranula Introduction A cyst can be defined as a pathologic cavity having fluid, semifluid, or gaseous contents, and not created by accumulation of pus. It does not necessarily have an epithelial or endothelial lining; inclusion of lining in the definition results in a somewhat artificial distinction between pseudocysts and “true” cysts. Benign cystic lesions of salivary glands may be developmental, degenerative, or neoplastic. In Sections…
8.1 Pediatric Salivary Gland Neoplasms Salivary neoplasms are uncommon in children. They may arise in the acini and ducts (epithelial tumors) or in mesenchymal tissue, e.g., the intraparotid lymphoid (lymphoma) or connective tissue (neurofibroma, schwannoma, rhabdomyosarcoma). They may be benign or malignant. Head and neck tumors of non-salivary origin may infiltrate the salivary glands, and the most common tumors encountered in children are lymphovascular lesions, which…
7.1 Bacterial Infection Bacterial Infections Salivary gland infections are in general not a common condition. The incidence, complications, and mortality rates of salivary gland infections have decreased largely due to improved oral hygiene and advances in health care. There remains a risk of mortality. Bacterial infection of the salivary glands is believed to be due to retrograde spread through the papillae of the ducts, salivary stasis,…
Prognostic Categories of Salivary Tumors The histologic classification of salivary tumors is difficult in a significant proportion of tumors. The main reasons are that they are rare compared with tumors of other organs, and they comprise an unusual large spectrum of benign ( n = 11) and malignant ( n = 20) tumor entities. Moreover, most entities show a heterogenous and overlapping spectrum of cytologic and…
Introduction The histology of salivary glands was established by the end of the 19th century, when some intracellular organelles could be demonstrated ( Fig. 5.1 ). Today, the familiar and reproducible routine histologic appearance of the salivary glands is a light microscopic picture prepared from pieces of gland fixed in formaldehyde and embedded in paraffin wax from which sections are cut and stained with hematoxylin and…
Introduction Open biopsies are contraindicated because of the risk of tumor cell seeding, which increases the risk of recurrence of both malignant neoplasms and pleomorphic adenomas. Facial nerve injury, wound infection, salivary fistula, or sialocele are reported after open biopsies; in addition, a curative parotid surgery can be complicated by a previous open biopsy. New surgical procedures for benign tumors such as extracapsular dissection, partial superficial…
3.1 Conventional Plain Films Conventional X-ray imaging of the salivary gland has diminished relevance. The soft tissue X-ray does not depict a salivary stone well, and the summation effects of conventional X-ray images can make it difficult to locate the few visible structures. The main importance lies in incidental findings of calcifications in the salivary glands. Key examples are X-rays of the cervical spine ( Fig.…