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Success rate and complications of sialendoscopy and sialolithotripsy in patients with parotid sialolithiasis: a systematic review

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Maarten Galdermans
Maarten Galdermans
Maarten Galdermans
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Bert Gemels at KU Leuven
Bert Gemels
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PurposeTo assess the success rate and complications of sialendoscopy and sialolithotripsy for parotid sialolithiasis.Materials and methodsA total of 228 articles were identified by the electronic database search regarding the topics sialendoscopy and sialolithotripsy. Following independent then joint review of titles and abstracts, 109 articles were selected for the full review. Thirteen of these were chosen for data extraction from which 1285 patients with parotid salivary stones were identified. Extracted data included number of patients, age, gender, location, management, and outcomes.ResultsAll articles combined, 1285 patients with parotid salivary stones were included with a successful treatment in 1139 patients. The success rated ranged from 71.4 to 100% with a mean of 88.7%. Both partial as complete success was achieved. Although minor complications were frequent, no major complications occurred.Conclusions Sialendoscopy and sialolithotripsy are best suited as first choice treatment—if conservative therapy failed—for the management of parotid gland sialolithiasis. It is a valuable and feasible treatment option with no major complications. Selection of cases will ensure the best prognosis. Although there is no indefinite stone size, the smaller the calculus, the greater the probability of a symptom-free patient.
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REVIEW ARTICLE
Success rate and complications of sialendoscopy and sialolithotripsy
in patients with parotid sialolithiasis: a systematic review
Maarten Galdermans
1
&Bert Gemels
2
Published online: 11 March 2020
#Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract
Purpose To assess the success rate and complications of sialendoscopy and sialolithotripsy for parotid sialolithiasis.
Materials and methods A total of 228 articles were identified by the electronic database search regarding the topics
sialendoscopy and sialolithotripsy. Following independent then joint review of titles and abstracts, 109 articles were selected
for the full review. Thirteen of these were chosen for data extraction from which 1285 patients with parotid salivary stones were
identified. Extracted data included number of patients, age, gender, location, management, and outcomes.
Results All articles combined, 1285 patients with parotid salivary stones were included with a successful treatment in 1139
patients. The success rated ranged from 71.4 to 100% with a mean of 88.7%. Both partial as complete success was achieved.
Although minor complications were frequent, no major complications occurred.
Conclusions Sialendoscopy and sialolithotripsy are best suited as first choice treatment—if conservative therapy failed—for the
management of parotid gland sialolithiasis. It is a valuable and feasible treatment option with no major complications. Selection
of cases will ensure the best prognosis. Although there is no indefinite stone size, the smaller the calculus, the greater the
probability of a symptom-free patient.
Keywords Sialolithiasis .Sialendoscopy .Sialolithotripsy .Parotid gland .Conservative treatment
Introduction
Sialolithiasis accounts for approximately 60–70% of major
salivary gland diseases caused by obstructive sialadenitis
and is the most common non-neoplastic disease of the salivary
glands. Most frequently, and mainly unilaterally, the stones
are located in the submandibular gland (83%) and less fre-
quently in the parotid (10%) or sublingual (7%) gland [1].
The estimated prevalence of sialolithiasis in the general pop-
ulation is about 1.2% [2].
Ultrasonography (US) is the method of choice for diagnos-
ing sialolithiasis after anamnesis and clinical examination [3].
The accuracy of US for the diagnosis of salivary calculi with a
diameter of more than 1.5 mm can reach up to 99% in expe-
rienced hands. Both radiopaque and nonradiopaque stones can
be detected and their size can be evaluated; however, these
results are greatly operator dependent [2]. Other imaging tech-
niques can additionally be used, including plain sialography,
radiography, scintigraphy, computed tomography (CT), or
magnetic resonance sialography [4]. With all these techniques
combined, most of the stones can easily be identified. US can
visualize both radiopaque as radiolucent stones, whereas the
other techniques are mostly specialized in identifying radi-
opaque stones. As a diagnostic tool, sialendoscopy is a mini-
mally invasive method withhigh sensitivity and specificity for
ductal pathology superior to US or sialography with an esti-
mate of 100% [5].
There are different therapeutic options to treat sialolithiasis
in patients where a conservative approach has not given the
desired results. Until a few years ago, surgical removal of the
gland was the method of choice in 40% of these patients, but
currently, alternative non-invasive or minimally invasive ap-
proaches are being used. The first choice of treatment when
the stones are small (< 5 mm) or mobile is interventional/
therapeutic sialendoscopy. The stones will first be approached
*Maarten Galdermans
maartengaldermans@hotmail.com
1
Department of Oral and Maxillofacial Surgery, University Hospitals
Leuven, Leuven, Belgium
2
Department of Oral and Maxillofacial Surgery, Rijnstate Hospital
Arnhem, Arnhem, Netherlands
Oral and Maxillofacial Surgery (2020) 24:145–150
https://doi.org/10.1007/s10006-020-00834-x
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... By applying therapeutic sialendoscopy, the placement of wire baskets, micro forceps, lasers, and balloons can be facilitated and, in this regard, relieving duct obstruction such as in the background of sialolithiasis and duct stenosis can be successfully managed (9). In addition, rinsing the duct, injecting steroids, removing duct sludge, and relieving glandular inflammation can also be done (10). ...
... However, recent advances have led to the development of a new technique, sialendoscopy, as an accurate, minimally invasive procedure with proper diagnostic and therapeutic capabilities. Some authors have claimed the accuracy of 100% for this procedure for detecting salivary calculi with different sizes and opacity (10). In the cases without proper response to conservative management, the use of sialendoscopy as a treatment approach has been accompanied by good treatment outcomes with minimal postoperative complications. ...
The Therapeutic Outcome of Sialendoscopy in Patients with Sialoadenitis
Article
Full-text available
  • Mar 2023
Introduction: Recent advances have led to the development of sialendoscopy, an accurate, minimally invasive procedure with high diagnostic and therapeutic capabilities in treating sialolithiasis. This study aimed to evaluate the results and complications of sialendoscopy in patients suffering from sialoadenitis. Materials and methods: This study was a prospective interventional case series study on patients with sialoadenitis due to sludge or stone formation preoperatively confirmed by sonography or computed tomography (CT) scanning. Diagnostic sialendoscopy was performed, and the presence of stenosis, sludge, or stones inside the gland or duct was examined, and surgery was done. During follow-up time (18.8 ± 7.4 months), recurrence of symptoms, the need for reoperation, and postoperative complications were also assessed. Results: The sialendoscopy was performed in 51 patients, including 55 glands. Forty-five Patients (88.2%) reported pain relief, and 46 patients (90.2%) reported that the treatment using sialendoscopy was better than conservative methods. The duct restenosis also occurred in one patient requiring open surgery. In assessing the main factors predicting the need for reoperation, the site of involvement (parotid versus submandibular glands) and the size of the stone were identified as the main determinants. The best cut-off value for stone size in predicting reoperation requirement was 7.0mm, with a sensitivity of 100% and a specificity of 85.7%. Conclusion: Intraoperative sialendoscopy is a successful diagnostic and therapeutic tool with minimal postoperative complications in salivary gland duct involvement patients.
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... Исследования F. Marshal, К.А. Банниковой и других хирургов показали высокую эффективность эндоскопической экстракции при сиалолитах размером до 3 мм, сомнительные результаты при размерах от 3 до 5 мм и отсутствие смысла в использовании при размерах сиалолитов большего размера [1][2][3][4][5][6] . Такие сиалолиты по-прежнему удаляются путем дуктотомии или удалением железы [ 2,3,5,6 ] . ...
Thulium laser safe mode selection for in vitro sialolithotripsy
Article
  • Mar 2024
Эндоскопическое удаление сиалолитов размером более 5 мм возможно только в сочетании с методом сиалолитотрипсии. В настоящее время самым эффективным методом эндоскопической сиалолитотрипсии признается лазерное дробление, при этом метод имеет ряд серьезных недостатков, среди которых эффект ретропульсии фрагментов, длительное время дробления, риск ожога тканей и пр. В последние годы в урологической литотрипсии растет популярность тулиевых лазеров, которые, по мнению ряда специалистов, превосходят аппараты иных типов. Вероятно, тулиевый лазер может быть использован и для сиалолитотрипсии, что подтолкнуло нас к проведению данного экспериментального исследования. Цель — оценить безопасность и время дробления сиалолитов тулиевым лазером in vitro. Исследование было проведено в 2 этапа с помощью тулиевого лазера FiberLase U2 в режимах Popcorning, Dusting и Fragmentation. Для каждого этапа отобраны 12 сиалолитов равного диаметра и созданы 2 экспериментальные модели, в которых конкременты были раздроблены поочередно. С помощью первой установки проведена оценка эффекта ретропульсии, с помощью второй модели и термопары исследовано изменение температуры при ирригации и времени, необходимого для дробления конкремента до частиц размером ≤1 мм. Фрагментировать сиалолиты до частей необходимого размера удалость во всех трех режимах. При максимальных значениях импульса процесс дробления происходил значительно быстрее и составил от 7 до 10 минут, при этом он сопровождался подъемом температуры ирригационного раствора до 48°C. Дробление при минимальных значениях лазерного импульса отличалось меньшим подъемом температуры во всех трех режимах, однако протекало значительно дольше и в режиме Popcorning составило 57 минут. Раздробить сиалолиты до необходимого размера удалось во всех трех режимах. Согласно исследованию, безопасными и эффективными режимами выступили Dusting и Popcorning. Экспериментальное исследование показало, что возможно проведение следующего этапа — исследования в клинических условиях. Endoscopic removal of sialoliths larger than 5 mm is possible only in combination with the method of sialolithotripsy. Currently, laser crushing is recognized as the most effective method of endoscopic sialolithotripsy, while the method has a number of serious drawbacks, including the effect of retropulsion of fragments, a long crushing time, the risk of tissue burns, etc. In recent years, the popularity of thulium lasers in urological lithotripsy has been growing, which, according to a number of experts, are superior to other types of devices. It is likely that the thulium laser can also be used for sialolithotripsy, which prompted us to conduct this experimental study. Aim — to evaluate the safety and time of crushing of sialoliths with a thulium laser FiberLase U2 in vitro. . The study was carried out in 2 stages using a FiberLase U2 thulium laser in Popcorning, Dusting and Fragmentation modes. For each stage, 12 sialoliths of equal diameter were selected and 2 experimental models were created in which the concretions were crushed alternately. With the help of the first installation, the effect of retropulsion was evaluated, with the help of the second model and a thermocouple, the temperature change during irrigation and the time required for crushing the concretion to particles of size ≤1 mm were investigated. Results: Fragmenting sialoliths to pieces of the required size is a success in all three modes. At the maximum values of the pulse, the crushing process occurred much faster and ranged from 7 to 10 minutes, while accompanied by an increase in the temperature of the irrigation solution to 48°C. Crushing at the minimum values of the laser pulse was characterized by a lower temperature rise in all three modes, however, it took much longer and in the Popcorning mode was 57 minutes. . It was possible to crush the sialoliths to the required size in all three modes. According to the study, Dusting and Popcorning were safe and effective modes. An experimental study has shown that it is possible to conduct the next stage — research in a clinical setting.
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... 6,8,10,12---14,16 The population evaluated in different studies significantly varied. Of the nine studies in adult populations, four studies included only lithiasic OSGDs, 1,7,13,15 one study included OSGD with underlying Sjogren syndrome, 14 one 10 and three studies included both lithiasic and alithiasic OSGDs. 6,9,16 Of the 4 studies in children and adolescents, two included only lithiasic OSGDs 9,11 and two included juvenile recurrent parotitis. ...
Sialendoscopy for treatment of major salivary glands diseases: a comprehensive analysis of published systematic reviews and meta-analyses
Article
Full-text available
  • Jul 2023
  • Braz J Otorhinolaryngol
Objectives: Sialendoscopy is a minimally invasive procedure used to diagnose and treat obstructive salivary gland diseases. Previous studies in the topic have shown mixed results. The present study aimed to evaluate the efficacy and safety of sialendoscopy through previous systematic reviews for different outcomes of several diseases. We also aimed to assess studies' methodological quality and heterogeneity. Methods: We conducted a comprehensive systematic literature search of Pubmed, Embase, Lilacs and Cochrane Library. We included systematic reviews and meta-analyses that used sialendoscopy to treat both lithiasic and alithiasic salivary glands diseases. Data extraction included studies' characteristics and results. We assessed studies' methodological quality using the AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews 2) tool. Results: 13 studies were included in the review, being 9 in adult populations and 4 in pediatric populations. Sialendoscopy proved to be effective at the treatment of different lithiasic and other obstructive diseases, but with important heterogeneity. The technique was also considered highly safe in most studies. However, studies had a critically low quality of evidence. Conclusions: Most studies demonstrated high efficacy and safety of sialendoscopy, but with critically low quality of evidence. We still lack randomized studies in this field, and future systematic reviews on the topic should follow current guidelines to improve conduction and reporting.
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Sialolithiasis
Chapter
  • Jun 2024
Sialolithiasis, or salivary stones is defined as the formation of calcific concretions within the ductal system of a salivary gland (SG). The submandibular salivary gland is most frequently involved. The presence of stones is less common in the parotid gland, while its occurrence in the sublingual and minor salivary glands is infrequent. Salivary stasis in the presence of a nidus favors salt precipitation and sialolith formation. The stone’s obstruction to salivary flow favors the development of objective and subjective symptomatology, pain and swelling, primarily associated with periods of increased salivary demand. Inevitably in time, an acute suppurative sialadenitis will develop secondary to the occurrence of an ascending duct invasion by oral bacteria. Therapeutic intervention to remove the offending sialolith is required. Sialolithectomy is usually rewarded by salivary gland recovery.
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Experimental study of the effects of laser sialolithotripsy
Article
Full-text available
  • Nov 2023
Relevance: The effectiveness of removing concretions using sialoendoscopy depends on the size and location of the concretion in the salivary gland. According to the results of the researchers, the predominant intracorporeal lithotriptor is the holmium YAG laser in the crushing of urolites and sialolites. However, to date, in comparative studies of lasers of different types in urology, the thule laser FiberLase U2 demonstrates high efficiency. The research of urologist surgeons served as the basis for conducting an experiment on the possibility of crushing sialolites. The aim is to evaluate the safety and time of crushing of sialolites with a thulium laser FiberLase U2 in vitro. Materials and methods: 12 round-shaped sialolites with a diameter of 5-6mm were selected for the study. We have developed a model simulating the duct of the gland. The fiber of the FiberLase U2 laser was fed through the proximal end of the model and a series of lithotripsies were carried out sequentially in three modes of the device at maximum and minimum values of energy and pulse frequency, fixing the temperature rise during irrigation and the resulting effects during crushing. Results: crushing of sialolites to fragments with a size of 1 mm is possible in all three laser modes. Operation at the maximum values of the pulse energy and frequency proceeded faster, while the maximum temperature rise varied from 45 C to 48 C, depending on the mode. Crushing was accompanied by pronounced cavitation, frequent sparks when the laser pulse was applied. Fragmentation at the minimum parameters of the pulse energy and frequency proceeded much slower, however, the maximum temperature rise remained in the range from 33 C to 40 C, the listed effects were observed to a lesser extent in all three modes. Conclusion: the use of a thule laser for crushing concretions in all three modes at the maximum values of the pulse energy and frequency is inefficient and unsafe, work in the minimum values of the Dusting and Popcorning modes has shown the best results, however, further study of crushing with this laser is necessary.
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Outcomes of the salivary-oral health impact profile (S-OHIP) for chronic salivary disorders
Article
  • Jul 2023
Purpose: The Oral Health Impact Profile (OHIP) is a previously validated, concise, patient-friendly questionnaire used to determine the impact of oral diseases on patient quality of life. The present study seeks to examine the outcomes of a modified Salivary-OHIP (S-OHIP) survey in patients with chronic salivary disorders. Materials and methods: A prospective cohort of 67 patients with chronic salivary disorders and a control group of 16 patients undergoing septoplasty were surveyed using the modified Salivary-OHIP (S-OHIP) before surgery and six weeks following operative intervention. Additional factors analyzed included age, gender, etiology of salivary disease, general quality of life using the EQ-5D-5L, and general salivary symptoms. Results: There was no difference between treatment and control groups with respect to age or gender. There was a significant difference between the groups regarding change in S-OHIP scores before and after surgery (p < 0.01). Salivary patients had a significant decrease in S-OHIP scores indicating improved salivary quality of life (p < 0.01), with a mean decrease in score of 9.5. The control group showed no change in S-OHIP score (p = 0.47). Conclusion: The S-OHIP allows for a specific, targeted survey of salivary symptoms and is a useful, patient-friendly tool to quantify symptomatic changes in patients with chronic salivary disorders. Level of evidence: Level III.
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Success rate of sialendoscopy. A systematic review and meta-analysis
Article
  • Jul 2023
  • ORAL DIS
Objective: To perform a systematic review and meta-analysis on the efficacy and safety of sialendoscopy in the treatment of obstructive diseases of the major salivary glands. Materials and methods: We searched four databases for literature. The primary outcome assessed was the success rate. Secondary outcomes included the use of supportive devices, number of sialadenectomies and complications. Risk of bias was assessed. Meta-analyses with subgroup analysis were performed. Results: In total, 91 studies were included, comprising 8218 patients undergoing 9043 sialendoscopic procedures. The majority of studies had a medium or high risk of bias. The incidence of sialadenectomy varied from 0% to 14%. No major complications were reported. Meta-analysis revealed a weighted pooled success rate of 80.9%. Subgroup analyses showed the weighted pooled success rate in patients with sialoliths (89.6%), stenoses (56.3%), submandibular glands (88.3%), parotid glands (81.2%), patients treated by an endoscopic-assisted transoral removal of a sialolith (86.3%), patients treated by a combined approach of the parotid gland (78.2%), patients with JRP (67.0%) and with RAIS (45.8%). Conclusion: The success rate of sialendoscopy did not considerably change in the last 9 years. Sialendoscopy is an efficient and safe procedure for the treatment of major salivary gland obstructive disease.
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Suture Stenting After Sialendoscopy: A Novel Technique That Reduces Risk of Recurrent Parotitis
Article
  • Jun 2023
  • LARYNGOSCOPE
Objective: Chronic sialadenitis is associated with decreased quality of life and recurrent infections. While sialendoscopy with stenting is effective in relieving symptoms of sialadenitis, currently available stents are rigid and poorly tolerated by patients, leading to early removal and potential for adverse scarring. This study examines whether sutures can be used as a stenting material to improve patient comfort and reduce recurrence risk. Methods: This is a retrospective cohort study of a consecutive series of adult patients with chronic sialadenitis undergoing sialendoscopy with or without suture stenting. Data were collected between 2014 and 2018 with a 3-year follow-up period ending in 2021. The primary outcome measure was recurrence of sialadenitis within 3 years of surgery. Secondary outcomes were stent dislodgement and patient-reported discomfort. Results: We included 63 patients with parotid sialadenitis of whom 28 underwent suture stenting and 35 did not receive stenting after sialendoscopy. Stents were well tolerated, with a mean duration of 34.5 days, and only 2 of 28 stents (7.1%) accidentally dislodged within the first week. Suture stenting significantly reduced symptom recurrence after sialendoscopy (OR = 0.09, 95% CI 0.02-0.45, p = 0.003; 3-year sialadenitis recurrence rate: 7.1% vs. 45.7%, p = 0.005). Cox multivariate regression for clinicodemographic variables showed an HR of 0.04 (95% CI 0.01-0.19, p < 0.001) for the risk of symptom recurrence. Conclusions and relevance: Suture stenting after sialendoscopy is low cost, available across all institutions, well-tolerated by patients, and highly efficacious in reducing risk of recurrent sialadenitis after sialendoscopy. Level of evidence: 3 Laryngoscope, 2023.
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Sialoendoscopy, sialography, and ultrasound: A comparison of diagnostic methods
Article
Full-text available
  • Nov 2016
Objective To compare the accuracy of ultrasound, sialography, and sialendoscopy for examining benign salivary gland obstructions. Methods In this prospective study, patients with symptoms of obstruction of the major salivary gland duct system presenting at the ENT Clinic University Hospital, Ostrava, from June 2010 to December 2013 were included. All patients (n=76) underwent ultrasound, sialography, and sialoendoscopy. The signs of sialolithiasis, ductal stenosis, or normal findings were recorded after the examinations. Statistical analysis of the sensitivity and specificity of all the methods was performed, as well as a comparison of the accuracy of each method for different kinds of pathology (sialolithiasis or stenosis). Results The sensitivity of ultrasound, sialography, and sialoendoscopy for sialolithiasis findings were 71.9%, 86.7 %, and 100%, respectively. The sensitivity of sialography and sialoendoscopy for stenosis of the duct was 69.0%, and 100%, respectively. The study showed impossibility of ultrasonic diagnostics of ductal stenosis. The sensitivity of sialoendoscopy for both pathologies was significantly higher than that from ultrasound or sialography (p<0.05). The specificity of sialoendoscopy was significantly higher than that from by ultrasound or sialography (p<0.05). Conclusion Sialoendoscopy was the most accurate method for examination ductal pathology, with significantly higher sensitivity and specificity than by ultrasound or sialography.
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Sialoendoscopy and combined approach for the management of salivary gland stones
Article
Full-text available
  • Aug 2012
  • Eur Arch Oto Rhino Laryngol
Unlabelled: The introduction of minimally invasive surgical procedures has significantly reduced the rate of major salivary gland removal due to sialolithiasis. The aim of this study is to assess the effectiveness of sialoendoscopy, rate of salivary fistula or natural ostium stenosis in parotid sialolithiasis treatment. The endpoint was to analyse the efficiency of a combined transcutaneous and endoscopic approach in the removal of refractory and impacted stones in most difficult cases. Study design: prospective study, tertiary university centre, between XII 2008 and XI 2011, 185 sialendoscopies (SE) were performed in 162 patients. Within the group of 29 patients with parotid sialolithiasis endoscopy was the definite treatment in 15 cases (53 %), in 9 cases lithotripsy (ESWL) was necessary and in 5 patients who failed SE and lithotripsy, a combined approach was performed. This approach comprised both SE and open surgery. We observed no salivary fistula formation after the incision of the duct. Stenosis of the natural ostium thanks to the insertion of stent was observed only in one case. Sialoendoscopy is the method of choice with a high rate of success and gland preservation in small and medium stones. The combined transcutaneous and endoscopic approach is indicated for large stones, for complications after and contraindications in using minimally invasive procedures. Short and medium term follow up shows that surgery can be performed with a high rate of success.
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Intraductal Laser Fiber Tip Fracture and Retrieval During Sialendoscopic Laser-Assisted Lithotripsy
Article
  • Sep 2017
Fragmentation of flexible laser fiber tips has been reported to occur during therapeutic bronchoscopy and urologic stone treatment. We report fragmentation of 200-µm single-use silica-based fibers during sialendoscopy-controlled Holmium:YAG laser treatment of a parotid and a submandibular stone. The technique employed to successfully retrieve the fiber tips is described in the context of identifying this potential complication from endoscopic management of sialolithiasis.
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Intraductal Pneumatic Lithotripsy for Salivary Stones With the StoneBreaker: Preliminary Experience
Article
  • Feb 2016
  • LARYNGOSCOPE
Objectives/hypothesis: To test the effectiveness of a newly approved pneumatic lithotripter for fragmentation of salivary stones. Study design: Retrospective study in a tertiary referral center. Methods: In 44 patients, 49 stones were primarily treated with direct endoscopic guidance using the StoneBreaker. Twenty-three stones were located in the parotid gland and 26 in the submandibular gland. Results: Complete fragmentation was achieved combined extracorporeal in 97.7% of the stones. All of the patients became symptom free, and 97.7% were stone free. Three patients underwent lithotripsy procedures. Altogether additional treatment was necessary in five cases to achieve stone clearance. The reason for residual sialolithiasis was intraparenchymal repulsion of a residual fragment (n = 1). The glands were preserved in all cases. Conclusions: Endoscopically guided intraductal pneumatic lithotripsy using the StoneBreaker is an effective and promising procedure for the treatment of sialolithiasis. Level of evidence: 4 Laryngoscope, 2016.
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Sialoendoscopy as a diagnostic and therapeutic option for obstructive diseases of the large salivary glands-a retrospective analysis
Article
  • Sep 2015
  • CLIN ORAL INVEST
Objectives The diagnosis and therapy of obstructive inflammatory disorders of the salivary glands have changed in the past decades following the introduction of sialoendoscopy. The aims of the present study were to analyze the relevance of sialoendoscopy using our own data and to compare the results to those of other studies. Patients and methods A retrospective analysis of 70 patients was performed, who were treated for obstructive disorders of the parotid and/or submandibular gland in whom sialoendoscopy was indicated. Two categories of interventions were considered: diagnostic interventional sialoendoscopy and endoscope-assisted interventions. Interventional sialoendoscopy procedures requiring extirpation of the gland were included in the analysis, as were abnormal intraductal processes that were detected during endoscopy. Results Treatment was successful in 58 of 67 (86.6 %) procedures (sialoendoscopy without surgical intervention n = 59; endoscope-assisted surgical intervention n = 8). Based on the underlying disease, the success rate was 88.6 % (n = 39) in patients with obstructive sialadenitis without sialolithiasis and 86.6 % (n = 19) in patients with sialolithiasis. It was not possible to draw definitive conclusions on the underlying disease from the observed pathological intraductal changes. Conclusions Sialoendoscopy is an effective and safe diagnostic and therapeutic option with low complication rate. However, limiting factors such as the size or the position of potentially removable obstacles must be taken into consideration. Clinical relevance The rate of gland extirpations can be reduced using sialoendoscopy.
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Complications of Sialendoscopy: Personal Experience, Literature Analysis, and Suggestions
Article
  • Jul 2014
  • J ORAL MAXIL SURG
Objective The current article describes our experience, combined with analysis of the emerging literature, presenting suggestions of how to avoid the complications that may arise during or follow endoscopic or endoscopy-assisted surgery of the salivary glands. Methods In a retrospective study, the surgical data of 498 consecutive patients that were operated upon for calculi removal from the parotid, submandibular and the sublingual glands from 2010 to 2012 were collected and analyzed. The analysis was concentrated on specific complications of endoscopic or endoscopy-assisted surgeries. Results The patients were operated upon by various sialendoscopy-involved techniques that included intraductal endoscopy, and endoscopy-assisted extraductal approach. The total number of complications associated with endoscopy was 3.23% (n=17). In one case (0.2%) (submandibular gland surgery), severe bleeding occurred that required immediate gland resection. Conclusion Up-to-date sialendoscopic and endoscopy-assisted techniques produce a minimal number of postsurgical endoscopy-related complications, but are not complication-free surgeries. Strictures, ranulas, and lingual nerve paresthesias are the most frequent of these complications. Further reduction of the number of complications is possible with careful pre-procedural imaging analysis and correct endoscopic techniques.
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Outcomes of Holmium Laser-Assisted Lithotripsy with Sialendoscopy in Treatment of Sialolithiasis
Article
  • Mar 2014
  • OTOLARYNG HEAD NECK
The purpose of the current study was to compare outcomes and complication rates of sialolithiasis treated with intracorporeal holmium laser lithotripsy in conjunction with salivary endoscopy with those treated with simple basket retrieval or a combined endoscopic/open procedure. Case-comparison study. Tertiary hospital. Review of prospectively collected data of patients who underwent treatment for sialolithiasis by the senior author during 2011 to 2013. Patient demographics, operative techniques, surgical findings, clinical outcomes, and complications were recorded. Additional information regarding symptoms and satisfaction with treatment was obtained via standardized telephone questionnaire at the time of the data analysis. Thirty-one patients were treated for sialolithiasis. Sialoliths averaged 5.9 mm in size (range, 2-20 mm) and were comparable between both groups. Sixty-eight percent were in the submandibular gland (n = 21), with the remaining 32% in the parotid gland (n = 10). Fifty-two percent of patients (n = 16) were treated endoscopically with intracorporeal holmium laser lithotripsy, while the remaining 48% (n = 15) were treated with salivary endoscopy techniques other than laser lithotripsy. Successful stone removal without additional maneuvers occurred in 81% of the laser cases and 93% of the nonlaser group. Patients in the laser group reported an average improvement of symptoms of 95% compared with 90% of the nonlaser group when adjusted for outliers. Complications in all patients included ductal stenosis (n = 2) and salivary fistula (n = 1). The results of our series show favorable results with the use of intracorporeal holmium laser lithotripsy for the endoscopic management of sialolithiasis with minimal adverse events.
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Sialoendoscopy with and without holmium:YAG laser-assisted lithotripsy in the management of obstructive sialadenitis of major salivary glands
Article
  • Nov 2013
Obstructive sialadenitis is a major cause of dysfunction of the salivary glands, and increasingly sialoendoscopy is used in both diagnosis and treatment. At present the limit of the endoscopic approach is the size of the stone as only stones of less than 4mm can be removed. Endoscopic laser lithotripsy has the potential to treat many stones larger than this with minimal complications and preservation of a functional salivary gland. The holmium:YAG laser has been widely and safely used in urology, and its use has been recently proposed in salivary lithotripsy for the removal of bigger stones. We describe our experience with sialoendoscopy for stones in the parotid and submandibular glands and assess the feasibility and the efficacy of holmium:YAG laser lithotripsy. We have used the procedure 50 times for 43 patients with obstructive sialadenitis; 31 patients had sialolithiasis, 15 of whom (48%) had stones with diameters between 4 and 15mm (mean 7). Total extraction after fragmentation was possible in 14 of the 15 patients without complications. Intraductal holmium:YAG laser lithotripsy is effective and safe, and allows the treatment of large stones in Stensen's and Wharton's ducts.
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Lithotripsy for salivary stones with prospective US assessment on our first 25 consecutive patients
Article
  • Sep 2013
To evaluate the predictive value of sonographic fragmentation in the successful treatment of sialolithiasis. The main objective was to streamline the management by treating the patients with three sessions of ultrasonic lithotripsy, and to compare the success rate and complications with data from the literature. A second objective was to analyse the predictive value of data from the post procedure and follow-up sonography related to therapeutic success with regard to size, site and location of stones. Prospective follow-up of 25 patients (mean age of 43 ± 17.2 years old 11-68; 13 women, 10 men) over a period of 31 months (October 2009-April 2012) with one or more salivary calculi (19 parotid, submandibular 6) treated with extracorporeal lithotripsy (electromagnetic MINILITH SL 1, Storz Medical, Switzerland). No anaesthesia or analgesia was used. Each session of lithotripsy lasted on average 30 min. Minor complications were collected on an anonymised sheet. Complete success (absence of clinical symptoms 3 months after the end of treatment (or the last session) and residual stones <2 mm) was observed in 36% of patients, partial success (persistence of symptoms least 3 months (lower intensity and lower frequency) or size of residual stones>2 mm) in 48% and failure (persistence of same or increased symptoms at 3 months or no change in size of the calculi) in 17% of patients. Sonographic fragmentation of the stone (p = 0.004), total energy delivered (p = 0.008) and the total number of shock waves (n = 0.045) are predictive factors of complete success. Size, salivary topography, ductal topography, mobilization of the stones, occurrence of minor side effects and total duration of treatment had no predictive value of complete success (p > 0.05). There was no significant difference between the first 5 and the last 20 patients (p = 0.367). In agreement with the literature data, the efficacy of treatment was greater for parotid than submandibular calculi. Extracorporeal lithotripsy is an alternative to conventional surgery with no major complications. Sonographic fragmentation of calculi, total energy and total number of shock waves are predictive factors of successful treatment.
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Thulium-YAG laser sialendoscopy for parotid and submandibular sialolithiasis
Article
  • Dec 2012
  • LASER SURG MED
To evaluate the efficacy and safety of thulium-YAG laser in sialendoscopic fragmentation of salivary lithiasis. Retrospective, interventional case series. Sixty-three patients treated by interventional sialendoscopy with thulium-Yag laser fragmentation between 2003 and 2010 at Edouard Herriot Hospital were included in the study. The laser was used for non-floating or large lithiasis (>4 mm). The sialendoscopic thulium fiber laser was used in a pulsed mode with an average power output of 2–8 W to fragment and facilitate extraction of salivary stones. Several variables were studied: success rate, total number of procedures, total energy per procedure, size and number of salivary stones removed, and complications. Our series of 63 cases includes 40 cases of parotid lithiasis and 23 cases of submandibular lithiasis. In nine cases, two sessions of laser were performed. Stone size was evaluated pre-operatively by ultrasound and varied between 2 and 18 mm. Laser fragmentation was possible in every case. Complete extraction of the lithiasis was possible in 51 cases (73.9%) and partial extraction in eight cases (12.6%). Extraction failed in four cases (6.3%). Mean stone size was 5.4 mm (5.7 mm for parotid glands and 5.0 mm for sub-mandibular glands) and mean energy per procedure was 1,450 J (range: 1,400–1,800 J). Ductal perforations were observed in 12.7% of the cases. 65.1% of patients were free of symptoms with a mean follow-up of 18 months. Thulium-YAG laser appears to be an effective and safe technique in the treatment of salivary lithiasis. Lasers Surg. Med. 44: 783–786, 2012.
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