A Novel Approach for the Treatment of Sialolithiasis that Preserves Salivary Duct Anatomy.

OBJECTIVE: The sialendoscopy era in the treatment of salivary gland stones has reduced the use of classical surgical methods. However, the miniature ducts and tools may cause difficulties in removing large sialoliths. Therefore, invasive combined oral surgeries or gland resection may be considered. We searched for the most suitable method in order to stay in line with the minimally invasive approach that preserves the ductus anatomy, and that can reduce the surgical fears of patients. MATERIALS AND METHODS: The study included 84 cases (23 parotid and 61 submandibular) in whom stones were fragmented by pneumatic lithotripsy and removed between January 2015 and January 2020. The parotid cases comprised 7 females and 16 males, and the submandibular cases comprised 25 females and 36 males. Intraductal lithotripsy was performed using pneumatic lithotripter. This study has fourth level of evidence. RESULTS: Based on total number of cases (n = 84), success rate was 67/84 (79.7%) immediately after sialendoscopy, and overall success rate was 77/84 (91.6%). Based on number of stones treated (n = 111), our immediate success rate was 94/111 (84.6%), and overall success rate was 104/111 (93.7%). The success criteria were complete removal of the stone and fragments in a single sialendoscopy procedure and resolution of symptoms. CONCLUSIONS: We successfully treated salivary gland stones, including L3b stones, in our patient cohort with sialendoscopy combined with pneumatic lithotripsy. The lithotripsy method that we have adapted seems to be more useful and cost-effective compared to its alternatives. We were also able to preserve the ductus anatomy and relieve patients' concerns.Level of Evidence: Level IV.

Sialendoscopy: experience with the first 60 glands in Turkey and a literature review.

OBJECTIVES: We performed a retrospective analysis to contribute to the increasing number of reports on sialendoscopy in the literature and give basic concepts for beginners at the same time. METHODS: Between 2004 and 2009, 83 patients with symptoms of ductal obstruction of the major salivary glands were admitted to our clinic. Diagnostic and/or interventional sialendoscopy was applied to 60 glands (33 submandibular and 27 parotid) of 54 patients. A holmium:yttrium-aluminum-garnet laser or a pneumatic lithotripter was used for intraductal stone fragmentation. RESULTS: Sialendoscopy revealed no disorder in 2 cases, and in 38 glands (28 submandibular and 10 parotid) sialolithiasis was the underlying disease. Fifteen glands (5 submandibular and 10 parotid) were found to have other main disorders such as stenosis, synechia, or kink formation. Other findings included sialodochitis in 6 glands (2 submandibular and 4 parotid), a polyp in 1 parotid gland, mucus plugs in 21 glands (6 submandibular and 15 parotid), ductal ectasia in 4 glands (2 submandibular and 2 parotid), and ductal collapse in 1 parotid gland. The overall interventional success rate was 83% of all cases, and no complications occurred. CONCLUSIONS: The success rate of the interventional sialendoscopy performed in the current study shows consistency with the results given in the related medical literature. In the age of sialendoscopy, the adjunctive intraoral surgeries can be argued to be safer, easier, and more successful than before. Sialendoscopy may be considered to be the best practice not only in sialolithiasis, but also in other treatments of obstructive ductal disorders.

Transnasal endoscopic approach for anterior skull base angiomatosis complicated by a meningocele.

A 42-year-old woman presented with symptoms of left-sided nasal obstruction, cerebrospinal fluid (CSF) rhinorrhea, and frequent sinus infections. Radiologic investigation revealed a tumor destructing the left cribriform plate and forming opacifications in the olfactory area. She had left-sided submucosal meningocele, deviating the septum to the right side. Intracranial involvement was not observed. Under endoscopic visualization, the tumor and the meningocele was meticulously dissected and excised using bipolar cautery. The CSF fistula in the anterior skull base was repaired with the same approach. Thanks to increasing experience with endoscopic sinus surgery, excision and removal of noncomplex tumors of the anterior skull base have become possible. This case report illustrates transnasal endoscopic approach to the anterior skull base using minimally invasive technique.

Tracheo-innominate artery fistula in a laryngectomized patient.

Tracheo-innominate artery fistula is a rare but usually fatal complication of tracheostomy or intubation. To our knowledge, this complication has been reported following laryngectomy only in two patients. A 45-year-old woman with hypopharynx carcinoma developed tracheo-innominate artery fistula one month after total laryngopharyngoesophagectomy, as a complication of permanent tracheostomy, induced by the erroneous use of a 12-mm diameter silver tracheostomy cannula. With a median sternotomy, the innominate artery was reconstructed with Gore-Tex vascular graft interposition and separated from the trachea by a pedicled pericardial patch. Unfortunately, the patient sustained intermittent postoperative hemorrhages due to mediastinitis and died on the 15th day. After this tragic result, our attention was focused on both prevention of tracheo-innominate artery fistulas and methods of preventing and dealing with hemorrhages.

Histopathologic study of minced and injected expanded polytetrafluoroethylene (Gore-Tex) in quadriceps muscle of rats for injection laryngoplasty.

OBJECTIVE: Gore-Tex has not yet been used as an injection material, and no animal study has been performed. The purpose of this study was to investigate the histopathological and volumetric changes of minced and injected expanded polytetrafluoroethylene (Gore-Tex) in the quadriceps muscle of rats to find out its possibility as an injection material in future injection laryngoplasty. DESIGN: A prospective study was performed in 13 Wistar rats. METHODS: The 50+/-5 mg Gore-Tex vascular graft was minced until it was fine enough to pass through a 16G injection cannula. To create viscosity in order to avoid precipitation, minced Gore-Tex was mixed with sodium hyaluronate (SH) gel. 0.5 ml of this mixture was injected into the middle part of the right quadriceps muscle of each subject. Then, pure SH (0.5 ml) was injected into the middle part of the left quadriceps muscle of each subject. To compare the volumetric and histopathological changes of the injection area occupied by the materials over the time, two rats were sacrificed 1 day after the procedure, four rats after 1 month, four rats after 3 months and three rats after 6 months. RESULTS: In pure SH: SH was observed as an effusion in the muscle of one subject on the first day only. We did not detect SH in the muscle in the first, third and sixth months and, as a result, there was no augmentation. Inflammation and fibrosis was not detected in any of these applications of SH. In minced Gore-Tex+SH gel mixture: SH was again eliminated from the muscle in a very short period of time, but the remaining Gore-Tex created a 15.8% volumetric gain. Fibrosis and capsule formation began in the first month and, in the sixth month; we observed connective tissue surrounding the Gore-Tex material. Ingrowth of connective tissue into the Gore-Tex, though not present in the first month, occurred partially in the third and significantly in the sixth month. In addition, we observed foreign body granuloma formation after the third month. CONCLUSIONS: Pure SH, though easily applicable, was immediately eliminated leaving no trace. In the relatively difficult applications of Gore-Tex mixed with SH, however, there was residual Gore-Tex present in all subjects throughout the study. Gore-Tex may be an applicable material for injection laryngoplasty.