Management of parotid sialolithiasis

We reviewed the data of 10 patients with parotid gland sialolithiasis who were treated at our hospitals over the last 7 years(four patients were treated surgically, the stones discharged spontaneously after conservative therapy in three patients, and the stones remained in the parotid gland or Stensen's duct in three patients). One patient with bilateral punctate multiple sialoliths in the parotid glands was diagnosed as having Sjögren's syndrome. All the stones that discharged spontaneously, within two months of conservative therapy by parotid gland massage, were <2mm in diameter. Surgery included extraction of the sialoliths by sialendoscopy alone in two patients, a sialendoscopy-assisted transfacial approach in one, and a transfacial approach without sialendoscopy in one. For one patient undergoing sialendoscopy, we used supplemental ultrasound during the operation to locate the sialolith and evaluate the stone residual. For one patient in whom assessment of the stone by sialendoscopy was difficult, we switched to the transfacial approach, in which we initially inserted a lacrimal bougie that was thinner than the sialendoscope into the Stensen's duct via the oral cavity into the hilar region, and identified the duct by palpating the bougie from the transfacial surgical field. Then, the sialendoscope was inserted through the small slit of the Stensen's duct made in the hilar region. Although sialendoscopy is a useful tool for visualizing and extracting stones, in some cases stones are difficult to reach by sialendoscopy. Therefore, we believe that patients should be informed preoperatively about the potential need for a transfacial approach even for favorable sialoliths.