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Sialendoscopy and CT navigation assistance in the surgery of sialolithiasis Cover

Sialendoscopy and CT navigation assistance in the surgery of sialolithiasis

Open Access
|Aug 2021

Figures & Tables

Figure 1

Patient, prepared for surgery. With fiducial markers attached to the skin and navigational star on the patient’s forehead (BrainLab, Munchen, Germany).

Figure 2

After identifying the skin’s reference point with the stone being visible in the three-axis, the surgical trajectory is checked by the navigation.

Figure 3

In case the stone is at least partially sialendoscopically visible, it can represent a backup guidance in a challenging final combined approach.

Figure 4

All stones were removed following the navigational trajectory with a transcutaneous or transoral approach.

Patients and sialendoscopic operations at the Department of Otorhinolaryngology and Cervicofacial Surgery, University Clinical Center Ljubljana, Slovenia, January 2012 – November 2020

All operations 415 (100%)
Operated salivary ductalSubmandibular273 (66%)
systemParotid142 (34%)
Local302 (72.8%)
AnesthesiaGeneral113 (27.2%)
All372
Male193 (51.8%)
Patients
Female179 (48.1%)
Age (average, span − in years)48 (4−84)
Ultrasound372 (100%)
Mandibular occlusal radiography17 (4.6%)
Radiology diagnosticsCT143 (38.4%)
MR sialography8 (2.2%)
X-ray sialography2 (0.5 %)
All247
The type of interventionalSalivary stone extraction178
procedureStricture dilatation69
Stent insertion (after stricture dilatation or stone extraction)145

Sialendoscopy-assisted transcutaneous salivary stone extractions with or without the use of navigation at the Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Slovenia

Gland / Stone extraction outcomeParotid glandSubmandibular glandTotal
Successful4610
Successful (with navigation)235
Successful last attempt wire basket retrieval (transcutaneous approach failed) 11
Total61016

Sialendoscopy and navigation-assisted combined approach procedures at the Department of Otorhinolaryngology and Cervicofacial Surgery November 2019 – November 2020

Patient(years) AgeSexHistorySiteStone palpabilityStone locationStone visibilityFixationApproachStone size (millimeters)Final depth reached with sialendoscope (millimeters)Follow-up
167FAcute abscess formationLeft parotidNoWithin the abscess cavityNot visible-Transcutaneous sialendoscopy- assisted5 (SPH)72Without complaints 14 months
246MAdvanced sialolithiasisRight submandibularNo55 millimetres depthPartially visibleFixedTranscutaneous sialendoscopy- assisted10 (SPH)60Without complaints 12 months
360FPersisting swellingRight parotidNo45 millimetres depthPartially visibleFixedTranscutaneous sialendoscopy- assisted7 x 4 x 365Without complaints 11 months
470MAdvanced sialolithiasisLeft submandibularNo64 millimetres depthNon visibleFixedTranscutaneous sialendoscopy- assisted10 (SPH)75Without complaints 11 months
521MPersistent swellingLeft submandibularNo100 millimetres depthNot visibleFixedTranscutaneous sialendoscopy- assisted3 (intraglandular, found after gland resection)90resection After gland without complaints 7 months
634MFloor of the mouth phlegmonaLeft submandibularNo28** milimetres depthNot visibleFixedsialendoscopy- Transoral assisted6 x 4 x 362Without compaints 14 months

Inclusion criteria for the use of CT navigation (if three or more criteria were met)

Non-palpable stone
Difficult or impossible sialendoscopic visualization of the stone
Far proximal stone
Presumably fixed stone
Extraluminal stone (in an abscess or deeply embedded)
Salvage procedure with previously failed sialendoscopy or sialendoscopy-assisted procedure
DOI: https://doi.org/10.2478/raon-2021-0015 | Journal eISSN: 1581-3207 | Journal ISSN: 1318-2099
Language: English
Page range: 284 - 291
Submitted on: Feb 8, 2021
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Accepted on: Feb 25, 2021
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Published on: Aug 10, 2021
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year

© 2021 Aleksandar Anicin, Jure Urbancic, published by Association of Radiology and Oncology
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.