Sialendoscopy and CT navigation assistance in the surgery of sialolithiasis
Background: Sialendoscopy-assisted combined approach is well established in the surgery of sialolithiasis. In proximal salivary stones, transcutaneous sialendoscopy-assisted extractions with parotid preservation and submandibular gland resection are gold-standard in numerous institutions. As submandibular stones are found most often, we believe preserving these glands is paramount, and in that sense, we perform transcutaneous procedures as well. Recently, we added CT navigation to improve the results of this challenging surgery.
Patients and methods: All the patients submitted to sialendoscopy and sialendoscopy-assisted procedures at our institution between January 2012 and October 2020 were included in the present study. From November 2019 we added CT navigation in cases with sialolithiasis and a presumably bad sialendoscopic visibility. We evaluated parameters of the disease, diagnostic procedures, sialendoscopic findings and outcomes, with or without optical surgical navigation.
Results: In 372 patients, we performed 178 successful salivary stone removals with 118 combined sialendoscopy-assisted approaches and among the last listed 16 transcutaneous proximal stone operations, 10 submandibular and 6 parotid. Surgical navigation was used in six patients, four times in submandibular and twice for parotid sialolithiasis. These were all non-palpable, sialendoscopically invisible or partially visible stones and we managed to preserve five of the six salivary glands.
Conclusion: The addition of surgical navigation to sialendoscopy-assisted procedures for non-palpable, sialendoscopically invisible and fixed stones represents a step forward in managing sialolithiasis. By consistently performing sialendoscopy and related preservation procedures also in submandibular sialolithiasis, we significantly reduced the need for sialoadenectomies.