Intraductal Pneumatic Lithotripsy after Extended Transoral Duct Surgery in Submandibular Sialolithiasis

Koch, Michael; Mantsopoulos, Konstantinos; Goncalves, Miguel; Iro, Heinrich

doi:10.1177/0194599818802224

Cited by 12 publications

(12 citation statements)

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“…Following our earlier experiences [49], relevant damage to the sialendoscopes was avoided by the application of a maximum of 3.2 W with the smaller sialendoscopes and by keeping a distance of at least 0.5 cm between the sialendoscope tip and stone surface. In most cases a varying degree of ductal maceration was observed, which—if too pronounced—was treated by prophylactic stent implantation.…”

Section: Resultsmentioning

confidence: 99%

Intraductal Lithotripsy in Sialolithiasis Using the Calculase III™ Ho:YAG Laser: First Experiences

2020

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Background and Objectives To report the first experiences with a newly available Ho:YAG laser system for the treatment of salivary stones. Study Design/Materials and Methods A retrospective study in a tertiary referral center was conducted. Patients diagnosed with sialolithiasis were treated in Erlangen using the Calculase III™ Ho:YAG laser (Karl Storz, Tuttlingen, Germany). Preset parameters had a frequency of 4 Hz and energy of 0.8–1.2 J, resulting in 3.2–4.8 W. Following total fragmentation, one to two serial sialendoscopies were performed to achieve complete fragment clearance. Results A total of 55 stones in 49 patients were treated; 17 stones in 15 submandibular glands and 38 in 34 parotids. In total, 61 laser lithotripsies (range 1–3 per stone) were performed using various modes (long, short, and burst) and with preset parameters of 4 Hz and energy of 0.8–1.2 J, resulting in effective power of 3.2–4.8 W. Complete fragmentation was achieved in all the accessible stones. Sialendoscopes, fibers, or the mode used had no significant influence on success rates. A multimodal therapy concept was employed to treat stones in 12.24% of the cases; 95.92% of the patients were ultimately stone‐free, and all became symptom‐free. All glands were preserved. Conclusions The new Calculase III™ Ho:YAG laser was effective in the treatment of sialolithiasis with no increased risk of complications in the patients or damage to the sialendoscopes. Clinical factors such as the type of gland involved, or the location and size of stones had a greater impact on success rates than the technical or preset parameters. Lasers Surg. Med. © 2020 Wiley Periodicals LLC

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Section: Resultsmentioning

confidence: 99%

Intraductal Lithotripsy in Sialolithiasis Using the Calculase III™ Ho:YAG Laser: First Experiences

2020

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“…Approximately 80% to 90% of sialolithiasis occurs in the submandibular gland (SMG), and the most frequent sites of SMG stones are the distal duct and hilum. [1][2][3] It is not a major surgical problem to remove stones situated in the distal or middle part of Wharton's duct, but extracting stones located in the proximal ducts, especially in the deep hilum or intraglandular ducts, is more challenging. 1 Since the introduction of endoscopy, the deeply located stones can be successfully removed in 80% to 90% of cases.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3] It is not a major surgical problem to remove stones situated in the distal or middle part of Wharton's duct, but extracting stones located in the proximal ducts, especially in the deep hilum or intraglandular ducts, is more challenging. 1 Since the introduction of endoscopy, the deeply located stones can be successfully removed in 80% to 90% of cases. 4,5 Notwithstanding, there still exists a small group of patients with deep hilum or intraparenchymal stones that need to undergo submandibulectomy, due to the considerable difficulties of surgery, poor gland function after stone removal, or postoperative complications.…”

Section: Introductionmentioning

confidence: 99%

Treatment strategy of hilar and intraglandular stones in wharton's duct: A 12‐year experience

Zhao

Zhang

et al. 2019

The Laryngoscope

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Objectives/Hypothesis To suggest a strategy for transoral removal of hilar and intraparenchymal submandibular stones. Study Design Retrospective case series. Methods Retrospective evaluation was performed for 514 consecutive patients with hilar and intraparenchymal submandibular stones treated via endoscopy‐assisted surgery from January 2006 to June 2018. Three patients had bilateral stones. The stones were classified as: hilar (type I), posthilar (type II), intraparenchymal (type III), and multiple stones (type IV). Results The affected glands included 311 with type I, 84 with type II, 65 with type III, and 57 with type IV stones. Stones were successfully removed in 478 glands (92.5%, 478/517). Main treatment techniques included hilum ductotomy in 311 glands, intraparenchymal ductotomy in 68, submandibulotomy in 14, intraductal retrieval in 74, and hilum ductotomy accompanied by intraductal retrieval in 11. At a mean 40‐months follow‐up of 478 successful cases, clinical outcomes were good in 425, fair in 27, and poor in 26 glands. Postoperative sialograms in 75 stone‐free patients were categorized as: type I, normal (n = 6); type II, ectasia or stenosis in the main duct and no persistent contrast on functional films (n = 44); type III, ectasia or stenosis in the main duct and mild contrast retention (n = 15); and type IV, poor shape of the main duct and evident contrast retention (n = 10). Postoperative sialometry of 32 patients revealed no significant differences of the gland function between the two sides. Conclusions Appropriate use of various endoscopy‐assisted approaches helps preserve the gland and facilitates recovery of gland function in patients with different depths of hilo‐parenchymal submandibular stones. Level of Evidence 4 Laryngoscope, 130:2360–2365, 2020

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“…Ultrasound imaging and sialendoscopy are preferentially employed to detect the concrements [ 11 , 12 , 13 , 14 ]. The latter often need to be removed by sialendoscopy-assisted interventions such as basket extractions, mechanical fragmentation, or transoral or endoscopic–transcutaneous surgical approaches [ 15 , 16 , 17 , 18 , 19 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

Neutrophil Extracellular Traps Promote the Development and Growth of Human Salivary Stones

Mantsopoulos

Koch

Weidner

et al. 2020

Cells

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Salivary gland stones, or sialoliths, are the most common cause of the obstruction of salivary glands. The mechanism behind the formation of sialoliths has been elusive. Symptomatic sialolithiasis has a prevalence of 0.45% in the general population, is characterized by recurrent painful periprandial swelling of the affected gland, and often results in sialadenitis with the need for surgical intervention. Here, we show by the use of immunohistochemistry, immunofluorescence, computed tomography (CT) scans and reconstructions, special dye techniques, bacterial genotyping, and enzyme activity analyses that neutrophil extracellular traps (NETs) initiate the formation and growth of sialoliths in humans. The deposition of neutrophil granulocyte extracellular DNA around small crystals results in the dense aggregation of the latter, and the subsequent mineralization creates alternating layers of dense mineral, which are predominantly calcium salt deposits and DNA. The further agglomeration and appositional growth of these structures promotes the development of macroscopic sialoliths that finally occlude the efferent ducts of the salivary glands, causing clinical symptoms and salivary gland dysfunction. These findings provide an entirely novel insight into the mechanism of sialolithogenesis, in which an immune system-mediated response essentially participates in the physicochemical process of concrement formation and growth.

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Intraductal Pneumatic Lithotripsy after Extended Transoral Duct Surgery in Submandibular Sialolithiasis

Abstract: No sponsorships or competing interests have been disclosed for this article.

Cited by 12 publications

References 44 publications

Intraductal Lithotripsy in Sialolithiasis Using the Calculase III™ Ho:YAG Laser: First Experiences

Intraductal Lithotripsy in Sialolithiasis Using the Calculase III™ Ho:YAG Laser: First Experiences

Treatment strategy of hilar and intraglandular stones in wharton's duct: A 12‐year experience

Neutrophil Extracellular Traps Promote the Development and Growth of Human Salivary Stones

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