1196 Sonographic Assessment Versus Direct Clinical Measurement of Sialolith Size and Its Influence on Modality of Endoscopic Removal

Aim

The aim of this retrospective case series was to investigate the influence of sialolith size on the potential for endoscopic stone removal.

Method

The records of 52 patients who underwent salivary endoscopy between September 2018 and February 2020 were reviewed. Included cases presented with at least one symptomatic major salivary gland, and sonographic or radiographic evidence of stone disease.

Results

A total of 25 patients (48%) and 27 stones were identified. These patients had a mean age of 45.2 years (range 16–72); 52% were female. Most cases (19/25) involved the submandibular gland, with a virtually even division between left and right sides. The overall success rate of sialendoscopic retrieval was 23/27 (85%), with 17/27 stones removed intact and 6/27 undergoing fragmentation with an intraoral salivary pneumatic lithotripter (Cook Medical). Median (sonographic) stone size in the largest dimension for those stones removed intact was 4mm (range 3-12mm), while for those undergoing fragmentation it was 7mm (range 3-11mm). Ultrasound provided an accurate assessment of stone size in most cases, but underestimated diameter by an average of 1mm in 6/27 cases, and overestimated size by 1mm in a single case.

Conclusions

Sialendoscopic stone retrieval is a minimally invasive and effective treatment for sialolithiasis. It is possible to remove most stones using a basket, with intraoral lithotripsy employed for larger stones. Ultrasound is a reliable diagnostic tool for predicting stone size but may underestimate size in a small proportion of cases.

1203 Sialendoscopy In Non-Stone Sialadenitis Is an Effective Therapeutic Approach

Introduction

The aim of this retrospective case series was to investigate the therapeutic effectiveness of salivary endoscopy for non-stone related sialadenitis and obstructive symptoms.

Method

The records of 46 patients who underwent salivary endoscopy between September 2018 and December 2019 were reviewed. Included cases presented with at least one symptomatic major salivary gland, with no history or evidence of stone disease on clinical or radiologic examinations.

Results

A total of 22 patients (48%) and 26 glands were identified. These patients had a mean age of 50.8 years (range 27–74) and 73% were female. Most cases (19/26) involved the parotid gland. The primary imaging modality used was ultrasound, with sialography reserved for suspected strictures. The most common sonographic finding was ductal dilation (50%). Dexamethasone was instilled at completion of sialendoscopy in 23/26 cases. Outcomes included symptomatic improvement in 15/18 patients (4 patients have follow-up pending) with 5/15 experiencing complete symptom resolution. 2/18 patients did not have any symptomatic improvement, and 1/18 experienced acute infection that was treated with antibiotics. No patients required gland excision.

Conclusions

Salivary endoscopy is a minimally invasive and effective treatment for patients with non-stone sialadenitis that is refractory to conservative measures. Our review demonstrated 83% therapeutic benefit with gland preservation in all patients.

1341 Outcomes of Sialendoscopic Stone Retrieval Under Local Anaesthesia in The Outpatient Setting- A Single Surgeon’s Experience

Aim

The aim of this retrospective case series was to investigate the success rate of sialendoscopic stone retrieval under local anaesthetic.

Method

The records of 52 patients who underwent salivary endoscopy between September 2018 and February 2020 were reviewed. Included cases presented with at least one symptomatic major salivary gland, and sonographic or radiographic evidence of stone disease.

Results

A total of 25 patients (48%) and 27 stones were identified. Most cases (19/25) involved the submandibular gland, with a virtually even division between left and right sides. 19/25 patients underwent stone retrieval under local anaesthetic (LA) in the first instance (two of these patients had two stones). 6/25 patients underwent stone retrieval under general anaesthetic (GA) in the first instance, and this was successful in 5/6 cases. The overall success rate of LA sialendoscopic stone retrieval was 18/21 (86%), with 14/21 stones (66%) being successfully removed at the first treatment session and a further four at the subsequent treatment session. Under LA, 13/18 stones were removed intact, while the remaining 5 underwent fragmentation with an intraoral salivary pneumatic lithotripter (Cook Medical).

Conclusions

Sialendoscopic stone retrieval is a minimally invasive and effective treatment for both submandibular and parotid duct stones. It is possible to remove most stones under local anaesthetic at the first treatment session, using intraoral lithotripsy as an adjunct when indicated. This treatment modality provides therapeutic benefit with 86% success of stone retrieval under local anaesthetic with gland preservation in the vast majority of patients.

Electric scooters: convenient transport or ED headache?

Electric scooters (e-scooters) provide a potentially attractive means of private transportation in the pandemic era, during which use of public transport is discouraged. E-scooter use has become widespread recently, and we have noticed a concomitant rise in related craniomaxillofacial injuries, often associated with alcohol consumption and lack of protective equipment. We present here the first-published UK data on electric scooter injuries which, in the post-lockdown period, included facial lacerations, mandibular and midface fractures, avulsed teeth, and cervical spine injury. We urge that forthcoming legislation make e-scooters subject to at least the same requirements in lighting, helmet wear, and sobriety as bicycles and that, in this way, their benefits can be enjoyed while reducing associated morbidity and mortality.

A blacksmith's tale: use of a rare earth magnet to facilitate safe removal of a metallic fragment from the face

A 48-year-old blacksmith presented to A&E after sustaining facial injuries while operating a metal punch press. Radiographs revealed the presence of a metallic foreign body within the cheek, but this was clinically impalpable. By using a neodymium rare earth magnet extraorally, it was possible to identify the position of the fragment several centimetres lateral to the entry wound. Triangulation of the fragment's position allowed retrieval under local anaesthetic through the original penetration wound, without need for cross sectional imaging or extensive exploration under general anaesthetic. This case highlights an application for magnets in detection and removal of impalpable metallic foreign bodies embedded in superficial soft tissues.

Normal chest radiography in pulmonary tuberculosis: implications for obtaining respiratory specimen cultures

SETTING

Urban tuberculosis (TB) clinic, Nashville, Tennessee, USA.

OBJECTIVE

Chest radiographs (CXRs) help in the diagnosis of pulmonary TB, but may be normal. Mycobacterium tuberculosis in culture is diagnostic of TB, but cultures are not routinely obtained in resource-poor settings. We examined rates and risk factors for pulmonary TB associated with normal CXR.

DESIGN

An observational cohort study was performed among all respiratory culture-positive TB cases referred to the Nashville Health Department from October 1992 to July 2003. Clinical factors, demographics and underlying medical conditions were assessed.

RESULTS

Of 601 study patients, 53 (9%) had normal CXRs: 31/138 (22%) were human immunodeficiency virus (HIV) infected and 22/463 (5%) were non-HIV-infected/unknown (P<0.001). Among HIV-infected patients, normal CXR was more likely in persons with renal failure (13% vs. 3%, P=0.048). Among non-HIV-infected/unknown patients, normal CXR was more likely in those who were asymptomatic at presentation (32% vs. 13%, P=0.022). In multivariable logistic regression analysis, HIV infection was associated with an increased risk of normal CXR (odds ratio [OR] 6.61, P<0.0001); factors associated with reduced risk were dyspnea (OR 0.24, P=0.026), positive sputum smear (OR 0.45, P=0.028) and cough (OR 0.48, P=0.038).

CONCLUSIONS

The rate of normal CXR among persons with culture-confirmed pulmonary TB was high. Respiratory specimen cultures should be obtained in TB suspects with a normal CXR, particularly HIV-infected persons.