Sialendoscopy‐assisted transfacial removal of parotid sialoliths: A systematic review and meta‐analysis

Abstract

Objective To review the literature and conduct a meta-analysis to determine the effectiveness and safety of the combined endoscopic-transfacial approach for parotid sialolith management. Data Sources PubMed 1946-, Embase 1947-, CINAHL, the Cochrane Database of Systematic Reviews, Cochrane Database of Abstracts of Review Effects (DARE), Cochrane Central Register of Controlled Trials (CENTRAL), clinicaltrials.gov, Proquest Dissertations and Theses, and FirstSearch Proceedings to March, 2015. Review Methods Published prospective or retrospective English-language studies with reported outcomes of more than one patient undergoing the combined endoscopic-transfacial procedure for parotid sialolithiasis were included. Two independent authors screened all eligible studies and reviewed and extracted data from relevant publications. Weighted pooled proportions for stone removal, symptom improvement, gland preservation, and complications were calculated. Results Ten studies, primarily retrospective single-institution studies, were included in the final analysis with a total of 184 patients. Overall, the procedure was noted to be successful with low risk; the weighted pooled proportions were 0.99 (95%CI 0.97 to 1.00) for stone removal, 0.97 (95%CI 0.93 to 0.99) for symptom improvement, 1 (95%CI 0.99 to 1.00) for gland preservation, and 0.06 (95%CI 0.01 to 0.15) for complications. Conclusion While our analysis is primarily based on retrospective data, the evidence shown here suggests that the combined endoscopic-transfacial technique is an effective treatment for parotid gland sialolithiasis not amenable to intraoral or purely endoscopic removal. This approach results in high rates of symptom improvement and gland preservation. The complication rates are low, further supporting the use of this technique.

Stellenwert der Sialendoskopie an deutschen HNO-Kliniken im Jahr 2016

“…Dafür könnte es zwei Erklärungen geben: Erstens werden neben der diagnostischen Sialendoskopie zunehmend komplexere interventionelle Sialendoskopien durchgeführt, die einer postoperativen intravenösen Entzündungs-, Schwellungs-und Schmerzprophylaxe bedürfen. Zu nennen sind in diesem Zusammenhang die intraduktale Lithotripsie und der kombinierte Zugangsweg [3,4,16]. Zweitens deckt lediglich die stationäre Behandlung die bei der Sialendoskopie anfallenden hohen Material-und Personalkosten ab.…”

A Pilot Study to Assess the Sialendoscopy-Assisted Transfacial Approach in Parotid Gland Sialolithiasis

“…Before the onset of sialendoscopy, the management of parotid gland lithiasis was limited to attempt its extraction using a transfacial or intraoral approach (according to the palpation or radiological image), a suprafacial parotidectomy (SP) or through conservative management waiting for the atrophy of the gland. 4 Today, those floating lithiases, smaller than 4 mm, can be handled mostly by sialendoscopy with excellent results. However, larger lithiasis (>7 mm) is usually fixed in sections of the ductal tree where the diameter is smaller than the stone, duct bifurcations, stenosis, or in the glandular parenchyma itself.…”

“…3 Sialendoscopy is a minimally invasive technique that has evolved significantly in the last 2 decades, reaching success rates above 80%. 4 These could be achieved only using the sialoendoscope when we find a completely visible and floating lithiasis, usually less than 4 mm. 3 However, when the stone is bigger, primary extraction is not possible, being necessary to use other techniques such as intraductal lithotripsy or combined techniques.…”

Combined Approaches in Sialolithiasis of Major Salivary Glands

“…Indications for this combined management are failure of interventional sialendoscopy to treat impacted calculi, stones larger than 8 mm, stones located behind a stenosis which cannot be dilated, and finally a non-successful extra-or intracorporeal lithotripsy [4][5][6][7][8].…”