Patient Outcomes After Unsuccessful Endoscopic Sialolith Extraction

Area of Science:

• Otolaryngology
• Endoscopic Surgery
• Salivary Gland Disorders

Background:

• Sialendoscopy is a minimally invasive technique for salivary stone removal.
• Failure to extract salivary calculi via sialendoscopy can lead to residual sialolithiasis.
• Understanding outcomes after failed sialendoscopy is crucial for patient management.

Purpose of the Study:

• To evaluate clinical outcomes after failed endoscopic extraction of salivary calculi.
• To determine the relationship between clinical outcomes and stone characteristics (location, number, size, mobility).
• To assess the need for further surgical intervention following unsuccessful sialendoscopy.

Main Methods:

• Prospective observational study of endoscopic sialolithiasis procedures.
• Analysis of 465 sialendoscopy procedures performed between 2010 and 2020.
• Evaluation of recurrent symptoms and need for additional surgery after failed stone extraction.

Main Results:

• 154 of 465 procedures (33.1%) were for obstructive sialolithiasis, with 30 (19.4%) experiencing unsuccessful stone extraction.
• Re-operation was performed in 52% of failed submandibular cases and 66.7% of failed parotid cases.
• Perihilar stone location increased the likelihood of a failed procedure by 5 times (P=.001), and intraglandular location by 8.5 times (P=.005).
• Intraglandular stones increased the likelihood of requiring revision procedures by almost 11 times (P=.004).
• Stone size, mobility, multiplicity, and concurrent stenosis did not correlate with the need for further surgery.

Conclusions:

• A significant portion of "failed" sialendoscopies do not necessitate further intervention.
• Salivary stone location is a key predictor of both sialendoscopy failure and the need for re-intervention.
• These findings aid in counseling patients and planning management after endoscopic procedures for sialolithiasis.