Parotid Gland Proximal Stones, Combined Transoral and External Approach

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 be treated with extracorporeal shock wave lithotripsy or intraductal laser lithotripsy prior to sialendoscopic extraction. Intraductal laser lithotripsy is possible with working channels of only 0.4 mm. Therefore, it is often possible to reach the stone with the endoscope. However, intraductal laser lithotripsy is time consuming. Mechanical methods such as intraductal pneumatic lithotripsy are dependent on larger working channels and intraductal pneumatic lithotripsy is precluded if the ducts are narrow.

An additional approach uses sialendoscopy and/or ultrasonography as navigation methods to guide a minimally-invasive transcutaneous intervention. The first description of this type of approach was probably the use of a probe inserted into the duct for mechanical localization of the stone. Currently, this type of surgical approach is usually addressed by the term “combined approach”.