Stensen's Duct Stenosis Balloon Dilatation: Long-term Evaluation of Clinical Outcomes and Quality of Life Impacts.

OBJECTIVE: To conduct a long-term retrospective evaluation of the safety and effectiveness of sialographic balloon dilatation in Stensen's duct stenosis (SDS). STUDY DESIGN: Retrospective cohort. SETTING: Single-institution academic tertiary referral center. METHODS: All SDS balloon dilatations (SSBDs) performed from 2011 to 2017 were monitored. Pain relief was evaluated by a numeric rating scale at 3-year follow-up at least. Long-term glandular swelling frequency patterns, quality of life (QoL), and drug consumption were retrospectively assessed. Procedure-related complications were recorded. RESULTS: Twenty-one SSBD procedures were recorded (mean ± SD age, 55 ± 12 years), all performed under local anesthesia. SSBD led to complete dilatation in 7 patients (33%), residual stenosis in 8 (38%), and no dilatation (failure) in 6 (29%). Retrospective analysis of clinical outcomes was possible for 17 patients, 71% of whom presented with long-term pain relief, at a mean relief of 3.2 points on the numeric rating scale (P < .001). Long after SSBD, patients presented with a mean decrease of 15.4 glandular swellings per month (P < .001). Medical consumption was reduced to 18% of patients taking some drugs because of SDS after SSBD vs 71% before. SSBD showed an impact on QoL in >80% of patients, with mean improvements of 26% and 25% in the percentage point reduction of physical and mental QoL, respectively (P < .001). No complications were noted except temporary discomfort due to the procedure. CONCLUSION: Despite the advent of sialendoscopy-guided techniques, SSBD should be considered for SDS treatment, as it is a safe procedure and provides sustained pain relief.

Is minor surgery safe during the COVID-19 pandemic? A multi-disciplinary study.

BACKGROUND: To assess the risk of postoperative SARS-CoV-2 infection during the COVID-19 pandemic. METHODS: The CONCEPTION study was a cohort, multidisciplinary study conducted at Conception University Hospital, in France, from March 17th to May 11th, 2020. Our study included all adult patients who underwent minor surgery in one of the seven surgical departments of our hospital: urology, digestive, plastic, gynecological, otolaryngology, gynecology or maxillofacial surgery. Preoperative self-isolation, clinical assessment using a standardized questionnaire, physical examination, nasopharyngeal RT-PCR and chest CT scan performed the day before surgery were part of our active prevention strategy. The main outcome was the occurrence of a SARS-CoV-2 infection within 21 days following surgery. The COVID-19 status of patients after discharge was updated during the postoperative consultation and to ensure the accuracy of data, all patients were contacted again by telephone. RESULTS: A total of 551 patients from six different specialized surgical Departments in our tertiary care center were enrolled in our study. More than 99% (546/551) of included patients underwent a complete preoperative Covid-19 screening including RT-PCR testing and chest CT scan upon admission to the Hospital. All RT-PCR tests were negative and in 12 cases (2.2%), preoperative chest CT scans detected pulmonary lesions consistent with the diagnosis criteria for COVID-19. No scheduled surgery was postponed. One patient (0.2%) developed a SARS-CoV-2 infection 20 days after a renal transplantation. No readmission or COVID-19 -related death within 30 days from surgery was recorded. CONCLUSIONS: Minor surgery remained safe in the COVID-19 Era, as long as all appropriate protective measures were implemented. These data could be useful to public Health Authorities in order to improve surgical patient flow during a pandemic.

Salivary Gland Lithiasis Recurrence After Minimally-Invasive Surgery: Incidence, Risk Factors and Prevention.

OBJECTIVE: The aim of this study was to evaluate the recurrence rate of lithiasis following minimally invasive surgery to identify risk factors and mechanisms for recurrence of salivary gland lithiasis. STUDY DESIGN: Retrospective case series. METHODS: A retrospective study was conducted including all patients treated for salivary gland lithiasis by minimally invasive surgery, such as sialendoscopy, intracorporeal lithotripsy, extracorporeal lithotripsy, transoral approach, and combined approach in our Department. We analyzed the recurrence rate of salivary lithiasis, their topography and timeline. RESULT: Three hundred four patients were included in this study, the mean age was 49 years (range 12-90 years), and the mean duration of follow-up was 19.8 months (range 0-66 months). Fifteen patients (5%) presented secondary lithiasis. In all but one case, recurrences involved the same gland as primary lithiasis, and most frequently the submandibular gland. Recurrences occurred from 3 to 46 months postoperatively. Fourteen patients, who presented recurrence, had been initially treated by transoral approach. Recurrent lithiasis were treated by transoral approach or submandibulectomy. CONCLUSION: Salivary gland lithiasis recurrence was rare after minimally invasive salivary gland surgery. This study reinforced the concept that salivary gland lithiasis should be considered as a duct pathology. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:794-799, 2021.

Salivary side effects after radioiodine treatment for differentiated papillary thyroid carcinoma: Long-term study.

BACKGROUND: Although many studies focus on short-term side effects of radioiodine therapy, almost none studied long-term side effects. We assessed radioiodine long-term salivary side effects after radioiodine treatment for differentiated papillary thyroid carcinoma and compared it to short-term morbidity within the same population. METHODS: A standardized self-administrated questionnaire was submitted in 2019 by patients treated with radioiodine between January 2011 and December 2012. These patients had already answered the same questionnaire 6 years before. RESULTS: Our study showed a significant reduction for salivary side effects: discomfort in submandibular or parotid area, swelling, pain, a bad or salty taste in the mouth, allowing to get back to a "normal" diet. CONCLUSIONS: Our study suggests that a significant rate of patients will recover from I131 therapy salivary side effects. As almost 30% of these remissions happened during our late stage follow-up, we highlight the necessity of a long-term follow-up in these patients.

Could mastication modify the shape of the orbit? A scannographic study in humans.

PURPOSE: Since prehistory, changes of the facial skeleton have been related to the modification of diet. More recent studies have shown changes in the morphology of the mandible and maxilla due to variations of strain during mastication. The temporal muscle (TM) is a strong masticatory muscle, with its insertions extending through the temporal fossa. Our objective is to observe the relations between the TM and the lateral orbital wall (LOW) which could indicate an influence of mastication on the shape of the LOW. METHODS: We conducted a retrospective study using 100 CT scans. The length of the lateral orbital wall (LLOW), the angle between LOW and the medial orbital wall (MOW), the cross-sectional areas of LOW and of the TMs were measured on both sides of each CT scan. The correlation between TMs and other three parameters was studied by Pearson correlations. RESULTS: A correlation was found between TMs and LOWs, a lower with LLOW, and a very weak and negative correlation between LOW/MOW angle. CONCLUSIONS: Anatomical knowledge about TM and investigation of masticatory strains lead us to think that mastication have minimal effect on the morphology of the LOW, only on the frontal process of zygomatic. This may explain, in part, why the LOW is the strongest wall of the orbit.

Stensen duct dilation: Case series of minimally invasive treatment.

Stensen's duct dilation is a rare condition characterized by a global or partial idiopathic dilation of the Stensen duct. Affected individuals usually show either aesthetically compromised features, such as a tubular-shaped swelling in the cheek, or with mildly painful inflammatory episodes. Three women between ages 61 and 67 years were diagnosed with Stensen duct dilation after sialo-magnetic resonance imaging (MRI). They were treated with botulinum toxin A (BTX-A). Our preliminary results suggest that BTX-A was efficient as a suspensive treatment. BTX-A should remain a first-line treatment of the early silent symptoms of Stensen duct dilation, such as swelling and aesthetic issues. The use of BTX-A avoids more serious procedures and further complications.

Cystinuria: One Possible Reason for Kidney and Salivary Gland Lithiasis Relationship.

Salivary gland lithiasis affects 1 to 2% of adults. The submandibular glands are concerned in 87% of cases. An association between kidney and salivary lithiases, although often mentioned, has rarely been observed. We relate an exceptional case of parotid and submandibular cystine sialolithiasis with kidney cystine lithiasis in a patient with cystinuria. Cystine lithiasis occurs in 1% of kidney lithiasis cases. The purpose of this article is to discuss the arguments, diagnosis, and therapeutic attitude in front of salivary cystine lithiasis. The patient was a 56-year-old woman treated for cystinuria undergoing a consultation for parotid lithiases. We obtained a panoramic view and performed a cervicofacial computed tomography scan, sialo-magnetic resonance imaging, and sialendoscopy. We found multiple lithiases in the distal portions of the Stensen duct, and 2 days after sialendoscopy, the patient expelled small sialoliths. Salivary lithiasis in patients with cystinuria has the same biochemical composition as kidney lithiasis. A computed tomography scan is efficient in most cases, but sialo-magnetic resonance imaging may be the only noninvasive method to diagnose small cystine salivary lithiases, such as those that can be seen in patients with cystinuria. Sialendoscopy is still an efficient diagnostic and therapeutic method for every type of salivary lithiasis.

Salivary Calculi Removal by Minimally Invasive Techniques: A Decision Tree Based on the Diameter of the Calculi and Their Position in the Excretory Duct.

PURPOSE: To suggest a decision tree for the choice of the best minimally invasive technique to treat submandibular and parotid calculi, according to the diameter of the calculi and their position in the excretory duct. MATERIALS AND METHODS: Submandibular and parotid ducts can both be divided into thirds, delineated by easily recognizable landmarks. The diameter of calculi is schematically classified into 1 of these 3 categories: floating, slightly impacted, or largely impacted. RESULTS: Using 3 criteria, the type of gland involved (G), the topography (T) of the calculus and its diameter (D), a 3-stage GTD classification of calculi was established. Next, the best indication for each available minimally invasive technique (sialendoscopy, transmucosal approach, a combined approach, intra- or extracorporeal stone fragmentation) was determined for each calculus stage. CONCLUSIONS: The minimally invasive treatment options are numerous and have replaced invasive resection surgical approaches (submandibulectomy and parotidectomy) in the management of salivary calculi, significantly improving the prognosis of these diseases. We emphasize the need for flexibility in the surgical indications and challenge the dogma of "all endoscopic" management of salivary calculi.

Transoral Stensen's Duct Approach: A 22-case retrospective study.

INTRODUCTION: Parotid gland duct lithiasis is preferentially managed using minimally-invasive techniques such as sialendoscopy and lithotripsy. However, these 2 techniques cannot remedy all obstructions and other techniques such as the Transoral Stensen's Duct Approach (TSDA) may sometimes be helpful. MATERIAL AND METHODS: A retrospective study of patients treated with TSDA was conducted to evaluate this procedure between 2006 and 2013. Criteria for inclusion were: failures for lithiases (22 patients and 28 lithiases) treated with sialendoscopy and/or lithotripsy for parotid gland duct obstruction. Mean follow-up was 47.4 months. Pain intensity, swelling and occurrence of infectious episodes were evaluated immediately and after middle-term and long-term follow-up (up to 36 months). RESULTS: The best results were obtained for anterior lithiasis, with an 87.5% immediate success rate. Morbidity was low with 2 transient facial nerve upper buccal branch palsies and 2 post-operative stenoses. DISCUSSION: TSDA is an easy-to-perform and safe technique that can be recommended in cases of sialendoscopy or lithotripsy failure for anterior-third parotid duct lithiasis. Even if this technique has shown limitations for more posterior lithiases, or other causes of obstruction (stenosis, megaduct), it requires no specific material and may be useful. It may avoid an external combined approach or a parotidectomy.

Update on orbital decompression as emergency treatment of traumatic blindness.

INTRODUCTION: Blindness is a rare and severe complication of craniofacial trauma. The management of acute orbital compartment syndrome (AOCS) is not well defined and there is no standard treatment. Our objective was to find indications for orbital decompression, the best time for treatment, and the appropriate techniques. MATERIALS AND METHODS: A literature review was made from articles published between 1994 and 2014 in the PubMed database, on the emergency treatment of AOCS. RESULTS: 59 of the 89 patients treated surgically for AOCS presented with significant improvement of visual acuity (VA) after orbital decompression. The delay between trauma and surgery was short. A lateral canthotomy with inferior cantholysis (LCIC) was the most frequently used technique. DISCUSSION: AOCS with a risk of visual impairment must be decompressed in emergency, at best in the 2 hours following trauma, most often by LCIC to have the best chance of recovering VA. Adjuvant medical treatment (acetazolamide, mannitol, corticosteroids) should not delay surgery. Postoperative corticosteroid therapy is not indicated, especially in patients with severe head trauma.

Position paper from the IBRA Symposium on Surgery of the Head--the 2nd International Symposium for Condylar Fracture Osteosynthesis, Marseille, France 2012.

BACKGROUND: This is a position paper from the 2nd International Bone Research Association (IBRA) Symposium for Condylar Fracture Osteosynthesis 2012 was held at Marseille, succeeding the first congress in Strasbourg, France, in 2007. The goal of this IBRA symposium and this paper was to evaluate current trends and potential changes of treatment strategies for mandibular condylar fractures, which remain controversial over the past decades. METHODS: Using a cross-sectional study design, we enrolled the consensus based on the panel of experts and participants in the IBRA Symposium 2012. The outcomes of interest were the panel and electronic votes on management of condylar base, neck and head fractures, and panel votes on endoscopic and paediatric condylar fractures. Appropriate descriptive and univariate statistics were used. RESULTS: The consensus derived from 14 experts and 41 participant surgeons, using 12 case scenarios and 27 statements. The experts and participants had similar decision on the treatment of condylar base, neck and head fractures, as well as similar opinion on complications of condylar fracture osteosynthesis. They had a parallel agreement on using open reduction with internal fixation (ORIF) as treatment of choice for condylar base and neck fractures in adults. Endoscopic approaches should be considered for selected cases, such as condylar base fractures with lateral displacement. There was also a growing tendency to perform ORIF in condylar head fractures. The experts also agreed to treat children (>12 years old) in the same way as adults and to consider open reduction in severely displaced and dislocated fractures even in younger children. Nevertheless, non-surgical treatment should be the first choice for children <6 years of age. The decision to perform surgery in children was based on factors influencing facial growth, appropriate age for ORIF, and disagreement to use resorbable materials in children. CONCLUSIONS: The experts and participating surgeons had comparable opinion on management of condylar fractures and complications of ORIF. Compared to the first Condylar Fracture Symposium 2007 in Strasbourg, ORIF may now be considered as the gold standard for both condylar base and neck fractures with displacement and dislocation. Although ORIF in condylar head fractures in adults and condylar fractures in children with mixed dentition is highly recommended, but this recommendation requires further investigations.

Wharton's duct retropapillary approach.

Salivary lithiasis is more frequently encountered in patients with Wharton's duct. They are often treated with a minimally invasive technique, such as sialendoscopy. The problem with sialendoscopy, in some cases, has been that it will not be possible to cannulate the papilla and, thus, sialendoscopy will not be feasible. Therefore, we have developed and detailed a retropapillary approach to cannulate Wharton's duct in such cases.

Post-operative orbital haematomas over a 12-year period. A description of three cases among 280 orbital procedures.

PURPOSE: To evaluate the incidence of orbital haematoma requiring surgical treatment following procedures including fracture repairs and orbital osteotomies over a 12-year period and to discuss their management. METHODS: The records of all the patients who underwent a procedure involving the orbits from 1998 to 2011 were reviewed for evidence of post-operative haematomas. Medical data including clinical presentation, time between diagnosis and treatment, management and subsequent outcome were collected. RESULTS: 280 patients were included, 257 procedures for orbital or zygomato orbital fractures and 23 osteotomies for dysthyroid orbitopathy or malunited orbital fractures. Three cases (1.07%) of post-operative haematomas were observed as follows: 2/257 orbital fractures (0.77%) and 1/23 osteotomies (4.34%). All cases occurred in the early post-operative period of less than 6 h. No spontaneous loss of vision or pain was described by patients. All could be operated on as soon as the diagnosis was established; no CT-scans were required. Orbital drainage was successfully performed in all cases. CONCLUSION: Post-operative orbital haematomas are uncommon complications. Diagnosis is based on a clinical examination, including pain, proptosis and alteration in visual acuity. Surgical treatment should be undertaken immediately following diagnosis.

Transoral approach for Stensen's duct lithiasis.

INTRODUCTION: Extracorporeal lithotripsy (ECL) and interventional sialendoscopy are the classical treatments for Stensen's duct salivary stones, but some cases cannot be treated using these techniques. Another technique is now available, transoral Stensen's duct approach. TECHNICAL NOTE: Transoral Stensen's duct approach can be performed under local anesthesia. The exact location of Stensen's duct is confirmed after introduction of a 0000 probe (Storz(®) ) in the duct that is stopped by the impacted stone. This may be confirmed on preoperative noninjected CT-scan. During this approach, the surgeon passes the mucosa and buccinator muscle, tracts the buccal fat pad laterally, and then finds the duct. During this procedure one must avoid harming the superior buccal branch of the facial nerve by dissecting gently close to the duct. When the duct is found, the stone is easily removed with a ductal lateral incision or better 12 o'clock ductal incision. DISCUSSION: Transoral approach of Stensen's duct salivary lithiasis is an easy, fast, and inexpensive technique that can be recommended in case sialendoscopy surgery fails. Morbidity for patients is much lower than that of classical parotidectomy.

Third molar extraction with massive hemorrhage treated by embolization.

Impaction of the third molar is relatively frequent in oral and maxillofacial surgery, and its removal is a usual operation with mostly unremarkable outcome. We report a case of bleeding that occurred after a left upper third molar extraction, which necessitated in emergency an angiography with embolization.

Long-term radiological findings following reconstruction of the condyle with fibular free flaps.

AIM: Fibular bone grafts are considered as one of the best choices for reconstruction of the condyle. However, little data are available on bone remodelling after such reconstruction. The purpose of this study was to evaluate the long-term radiological outcome. PATIENTS AND METHODS: Eleven patients underwent condylar reconstruction with a free fibular transplant. In all cases the end of the fibular graft was placed into the glenoid fossa under the intact temporomandibular joint (TMJ) disc. Evaluation consisted of digital width and length measurement of the end of the fibula on panorex studies. RESULTS: Remodelling of the end of the neocondyle was found and consisted of rounding off and narrowing of the end of the transplant. CONCLUSION: The most likely explanation for these changes is the fact that the TMJ disc was preserved.