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[Combined approach of parotid lithiasis. A technical note]
A Louvrier1, J-M Foletti2, L Guyot2
1Service de chirurgie maxillo-faciale et stomatologie, centre hospitalier La Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France; Service de chirurgie maxillo-faciale, de stomatologie et d'odontologie hospitalière, centre hospitalier universitaire de Besançon, boulevard Fleming, 25030 Besançon cedex, France.
The combined approach effectively removes large parotid stones resistant to standard treatments. This minimally invasive technique offers good outcomes for posterior duct stones, avoiding parotidectomy and reducing facial nerve risks.
Area of Science:
- Otolaryngology
- Surgical Innovation
Context:
- Traditional treatments for parotid lithiasis (sialendoscopy, extracorporeal lithotripsy, transoral removal) have limitations.
- Large calculi or those in the middle/posterior parotid duct often resist these methods.
- A combined surgical approach has been developed to address these challenges.
Purpose:
- To describe a combined surgical technique for treating difficult parotid lithiasis.
- To present a novel approach for stone removal when conservative methods fail.
Summary:
- The combined approach involves preoperative imaging (ultrasound/CT), general anesthesia, and sialendoscopy for localization.
- A facelift incision provides access to the parotid duct, where a window is created for stone extraction.
- Post-removal, ductal patency is confirmed with sialendoscopy, followed by layered closure and drainage.
Impact:
- This technique is indicated for parotid stones unresponsive to conservative treatments, particularly those in the posterior duct.
- It achieves good stone removal rates with low morbidity, potentially avoiding parotidectomy.
- The approach minimizes the risk of facial nerve injury and offers an alternative to more invasive procedures.
