The authors describe a small case series (n=8) of patients with obstructive symptoms from sialolithiasis of the parotid gland. A combined endoscopic and transcutaneous approach was used. The position of the stone in Stensen’s duct was identified by endoscopic transillumination. The stone was subsequently removed through either an incision made directly over the duct itself for distal stones, or a traditional S-shaped parotidectomy flap was raised and the duct dissected out from the parenchyma of the gland. Facial nerve monitoring was used as there is a theoretical risk of injury to the buccal branch of the facial nerve. The procedure was performed as a day case and 75% of patients were symptom free afterwards. Salivary fistulae have not been reported, although one case of post operative infection was noted. One patient went on to have a superficial parotidectomy for multiple stones. The authors recommend the combined approach for patients with large stones (>5-6mm), or where the stones are in an unfavourable position for endoscopic removal (e.g. hilum of the gland). This applies to 10-15% of parotid salivary stones. This approach is most useful for single large stones where lithotripsy or sialoendoscopy have failed. The patient can be spared a superficial parotidectomy and risk of injury to the facial nerve is minimal. The patient group that would benefit from the combined approach is well defined in this study. However, support from some one experienced in sialoendoscopy is essential and joint cases may not be feasible in all centres.
Combined endoscopic and transcutaneous approach for removal of parotid stones
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