Sialendoscopy and CT navigation assistance in the surgery of sialolithiasis.

BACKGROUND: A sialendoscopy-assisted combined approach is well established in the surgery of sialolithiasis. In cases of proximal salivary stones, transcutaneous sialendoscopy-assisted extractions with parotid and submandibular gland preservation is the primary intention of treatment. We recently added computer tomography (CT) navigation to improve the results of this challenging surgery equally in both localizations. PATIENTS AND METHODS: Al l the patients who submitted to sialendoscopy and sialendoscopy-assisted procedures at the tertiary institution between January 2012 and October 2020 were included in the present study. From November 2019, CT navigation was added in cases with sialolithiasis and a presumably poor sialendoscopic visibility. We evaluated the parameters of the disease, diagnostic procedures, sialendoscopic findings and outcomes, with or without optical surgical navigation. RESULTS: We performed 178 successful salivary stone removals in 372 patients, of which 118 were combined sialendos-copy-assisted approaches, including 16 transcutaneous proximal, 10 submandibular and 6 parotid stone operations. Surgical navigation was used in six patients, four times for submandibular and twice for parotid sialolithiasis. These were all non-palpable, sialendoscopically invisible or partially visible stones, and we managed to preserve five of the six salivary glands. CONCLUSIONS: The addition of CT navigation to sialendoscopy-assisted procedures for non-palpable, sialendoscopically invisible and fixed stones is a significant advantage in managing sialolithiasis. By consistently performing sialendoscopy and related preservation procedures, we significantly reduced the need for sialoadenectomies in patients with obstructive salivary gland disease.

Sialolithectomy done with a CO2 laser: clinical and scintigraphic results.

PURPOSE: This study reviews the results of sialolithectomy performed with the CO2 laser. PATIENTS AND METHODS: Forty-nine patients were treated under local anesthesia at initial presentation in the outpatient clinic. RESULTS: All patients had immediate relief after surgery. Clinical and scintographic follow-up of up to 28 months on 27 patients showed that all but 1 were asymptomatic. The single exception required excision of the submandibular gland because of two recurrences of sialoliths in Wharton's duct. Although some glands had no function clinically and scintigraphically, they were asymptomatic and needed no further treatment. CONCLUSIONS: Salivary glands that are nonfunctioning clinically and scintigraphically should only be removed when there is a recurrence of symptoms.

Parotid sialography with a new Zonarc program.

The use of panoramic zonography with the Zonarc-MLA and LAT-PA program for parotid sialography is presented. It provides curved layer tomograms, and shadows of the bony structures are therefore not disturbingly superimposed on the image of the sialogram. The visibility in the retromandibular region tended to be better. Radiation doses in plain film radiography are up to 60 times higher than in Zonarc radiography.

Computed tomography of parotid masses.

Fifty-six patients with parotid masses, benign tumors in 22, malignant tumors 26 and other diseases 8, were examined by CT scan, which can differentiate intrinsic from extrinsic parotid lesions, especially deep lobe from parapharyngeal tumors and typical benign tumors from malignant ones, but may fail to differentiate aggressive benign tumors from low-grade malignant ones. CT sialography was done to detect the relation between the trunk of the facial nerves and tumor according to the band of normal parotid tissue between the tumor and posterior border of the mandibular ramus, and incremental dynamic CT with intravenous bolus injection of contrast medium to detect the relation between the tumor and carotid sheath. We conclude that the images of CT sialography are much better than those of plain CT and intravenous enhancement CT.