Minimally-invasive surgery in the management of symptomatic parotid stones

Correlation of Complex Impacted Mandibular Teeth with Pericoronitis and Effect of Minimally Invasive Tooth Extraction on Patients' Long-term Outcome of Masticatory Ability

Objective

To explore the correlation of complex impacted mandibular teeth and pericoronitis, as well as the effect of minimally invasive tooth extraction on patients' long-term outcomes of masticatory ability.

Methods

A total of 101 patients with complex impacted teeth who were treated in our hospital from March 2019 to June 2021 were selected and divided into the control group (n = 55) and the observation group (n = 46) according to the different treatment methods. The patients in the control group were given conventional extraction treatment, and the patients in the observation group were given minimally invasive extraction treatment. The clinicopathological features of patients complicated by pericoronitis were observed and the relationship between complex impacted mandibular teeth and pericoronitis was discussed. Additionally, we made statistics on operative time (OT), intraoperative blood loss (IBL), dental socket integrity score, and adverse reactions (ARs) and compared the clinical efficacy between the observation group and control group. The Visual Analogue Scale (VAS) and Oral Health Impact Profile scale (OHIP-14) were utilized for pain assessment and oral health status evaluation, respectively. Bite force (BF) and masticatory efficiency were also measured.

Results

OG showed less OT and IBL than CG, with a higher dental socket integrity score (P < 0.05). In addition, OG outperformed CG with a higher overall response rate and a lower incidence of ARs (P < 0.05). The pretreatment VAS score, mouth-opening degree, and OHIP-14 score differed insignificantly between groups (P > 0.05). After treatment, the VAS score of OG decreased, while the mouth-opening degree and OHIP-14 score increased (P < 0.05). Finally, the mastication ability was higher in OG at 7 days postoperatively, but there was no difference between groups at 6 months postoperatively (P > 0.05).

Conclusion

Complex mandibular impacted teeth can easily induce pericoronitis, so clinicians should pay attention to the influencing factors of pericoronitis. Minimally invasive surgery for complex impacted mandibular teeth can effectively improve treatment outcomes, accelerate patient rehabilitation, and provide more effective protection for patients' oral health and masticatory ability, which is worth promoting in clinical use.

Treatment of Sialolithiasis: What Has Changed? An Update of the Treatment Algorithms and a Review of the Literature

Treatment for sialolithiasis has undergone significant changes since the 1990s. Following the development of new minimally invasive and gland-preserving treatment modalities, a 40–50% rate of gland resection was reduced to less than 5%. Extracorporeal shock-wave lithotripsy (ESWL), refinement and extension of methods of transoral duct surgery (TDS), and in particular diagnostic and interventional sialendoscopy (intSE) are substantial parts of the new treatment regimen. It has also become evident that combining the different treatment modalities further increases the effectiveness of therapy, as has been especially evident with the combined endoscopic–transcutaneous approach. In the wake of these remarkable developments, a treatment algorithm was published in 2009 including all the known relevant therapeutic tools. However, new developments have also taken place during the last 10 years. Intraductal shock-wave lithotripsy (ISWL) has led to remarkable improvements thanks to the introduction of new devices, instruments, materials, and techniques, after earlier applications had not been sufficiently effective. Techniques involving combined approaches have been refined and modified. TDS methods have been modified through the introduction of sialendoscopy-assisted TDS in submandibular stones and a retropapillary approach for distal parotid sialolithiasis. Recent trends have revealed a potential for significant changes in therapeutic strategies for both major salivary glands. For the submandibular gland, ISWL has replaced ESWL and TDS to some extent. For parotid stones, ISWL and modifications of TDS have led to reduced use of ESWL and the combined transcutaneous–sialendoscopic approach. To illustrate these changes, we are here providing an updated treatment algorithm, including tried and tested techniques as well as promising new treatment modalities. Prognostic factors (e.g., the size or location of the stones), which are well recognized as having a strong impact on the prognosis, are taken into account and supplemented by additional factors associated with the new applications (e.g., the visibility or accessibility of the stones relative to the anatomy of the duct system).

Bilateral parotid gland punctate calcifications in Sjögren's Syndrome: a case report

Sjögren's syndrome is a chronic autoimmune disorder characterized by mononuclear infiltration of exocrine glands, most commonly the lacrimal and salivary glands. While up to 34% of patients report bilateral parotid swelling, bilateral parotid sialolithiasis remains an exceptionally rare symptom. Here we present a patient who presents to the otolaryngology clinic with presentation of bilateral punctate parotid gland sialolithiasis prior to diagnosis of Sjögren's syndrome. Due to a wide array of clinical presentations frequently affecting the head and neck, otolaryngologists are often the initial providers for patients suffering from Sjögren's syndrome.

Sialendoscopy-assisted combined approach for parotid sialolithotomy: Our long-term experience

OBJECTIVES

To assess the long-term outcome of sialendoscopy-assisted combined approach for parotid sialolithotomy with gland preservation.

PATIENTS AND METHODS

A retrospective study of patients treated with a combined sialendoscopic and open approach was conducted between 2011 and 2020. Demographic data of patients such as operative technique, stone size, stone location, complications, and symptom relief were collected. Patients were followed up via clinical examination and questionnaires.

RESULTS

Seventy-four patients were included and underwent endoscopy-assisted combined operations for the removal of 98 parotid stones. Of the 98 stones, 92(94%) stones were completely removed and 6(6%) were partially removed. At a mean follow-up of 47.1 ± 35 months, 65 of 74 patients (88%) achieved long-term success. Patients with stone incomplete removal were significantly more often to develop the recurrence of obstructive symptoms (p = 0.000) There were no cases of facial nerve injury or fistula formation. Gland function was preserved in 73 of 74 patients (99%).

CONCLUSIONS

The combined approach for parotid stones is a safe and gland-preserving alternative to parotidectomy. The techniques described here show high success rates and good long-term results, and they avoided the need for gland resection in >95% of cases.

Wireless mobile ultrasonography-assisted parotid duct stone removal

Ultrasonography is highly sensitive for the diagnosis of sialoliths. Recently, wireless mobile ultrasonography was developed. We describe the case of a 49-year-old man who presented with painful postprandial left cheek swelling. Computed tomography detected a solitary 5-mm parotid duct stone with infection at the anterior portion of the left masseter muscle. Transoral stone removal was planned, although difficulty was expected in view of the surrounding infection. Surgery was performed under the guidance of mobile ultrasonography, and the stone was removed safely.

Sialendoscopy-assisted transfacial removal of parotid calculi

Superficial parotidectomy has significant morbidity, and minimally invasive techniques have therefore been developed, including those involving sialendoscopy, to remove sialoliths and preserve the gland along with its function. The size, mobility and location of the sialolith, alongside the presence of strictures, all dictate management. We outline basic treatment paradigms and describe two sialoendoscopyassisted surgical procedures developed for treating stones, one intraoral and one extraoral.