Introduction xi
Rui P. Fernandes
Preface xiii
Michael D. Turner and Maria J. Troulis
Surgical Armamentarium for Sialendoscopy 85
Michael D. Turner
Introduction 85
Sialendoscope segments 85
Basic structures of a fiberoptic endoscope 85
White balance 85
Sialendoscopes 85
Surgical Techniques for the Management of Parotid Salivary Duct Strictures 93
Erica M. Jackson and Rohan R. Walvekar
Anatomy 93
Stenosis type and classification 93
Patient selection 94
Diagnostic studies 94
Treatment 95
Medical and conservative therapy 95
Contraindications 95
Intervention based on clinical findings 95
Scenario I: papilla not visible 95
Scenario II: ductal stenosis in the distal parotid duct; papilla visible 95
Scenario III: ductal stenosis in the mid-parotid duct 97
Scenario IV: hilar and intraductal stenosis 97
Complications 97
Surgical Techniques for the Management of Submandibular Salivary Duct Strictures 99
Justine Moe and Joseph I. Helman
Local anatomy: floor of the mouth and Wharton duct 99
Pathogenesis 99
Signs and symptoms 99
Diagnosis 100
Treatment 100
Sialendoscopy 100
Step 1: duct identification and dilatation 101
Step 2: stricture management 101
Step 3: catheter/stent placement 102
Outcomes 102
Summary 103
Surgical Retrieval of Parotid Stones 105
Fernando Pozzi Semeghini Guastaldi, Jose Sandro Pereira da Silva, Maria J. Troulis, and Edward Lahey
Statement of the problem 105
Diagnostic methods 105
Surgical technique 105
Step 1: patient positioning 106
Step 2: identification and dilatation of Stensen duct 106
Step 3: duct navigation 107
Step 4: stone identification 107
Step 5: stone removal 109
Step 6: duct catheterization 109
Step 7: postoperative care 109
Complications 109
Pearls and pitfalls 109
Summary 110
Surgical Retrieval of Submandibular Stones 111
Joseph P. McCain and Jose Montero
Introduction: nature of the problem 111
Surgical technique 111
Preoperative planning 111
Surgical approach 111
Diagnostic sialendoscopy 111
Sialendoscopy sialolithectomy 111
Diagnostic sialendoscopy 112
Operative sialendoscopy 113
Potential complications 115
Pearls and pitfalls 115
Rehabilitation and recovery 117
Summary 117
Ultrasound-Guided Salivary Gland Techniques and Interpretations 119
Henry T. Hoffman and Nitin A. Pagedar
Introduction 119
Technique 119
Preparation: indications 119
Preparation: informed consent 120
Standard diagnostic approach 120
Generating a report 120
Diagnostic ultrasound imaging 122
Nonsalivary facial swelling 122
Sialolithiasis 122
Salivary duct stricture without stone 124
Chronic sialadenitis 125
Sjögren's syndrome 126
Ultrasound-directed salivary procedures 127
Ultrasound-guided percutaneous to antegrade sialendoscopy 127
Ultrasound-guided ductal stricture dilation 127
Ultrasound-guided Botox injection to salivary glands fine needle aspiration 128
Future directions 128
Shear-wave elastography 128
Contrast agents 128
Summary 131
Combined Parotid Techniques 133
M. Boyd Gillespie
Introduction 133
Patient evaluation 133
Part 1: getting started 134
Equipment 134
Operating room setup 134
Ostial dilation 134
Scope insertion 135
Part 2: obstructions distal to anterior border of masseter muscle (<2 cm from ostium) 136
Distal stones with normal ostium: method of Foletti 136
Distal (ostial) stricture with or without mega-duct: method of Marchal 137
Part 3: obstructions proximal to anterior border of masseter muscle (≥2 cm from ostium) 138
External preauricular approach 138
External transfacial approach 140
Complications of combined parotid techniques 140
Failure to improve (10%–15%) 141
Ductal stenosis (10%–15%) 141
Periauricular anesthesia (5%–10%) 141
Hypertrophic scar (3%–5%) 141
Salivary fistula/sialocele (1%–2%) 141
Facial nerve weakness (<0.5%) 142
Combined Surgical Approaches for the Removal of Submandibular Gland Sialoliths 145
Michael D. Turner
Techniques 145
Access to the duct orifice 145
Papillotomy technique 145
Anterior duct approach 146
Posterior duct approach 148
Slit duct approach 149
Hilum approach 150
Robot-Assisted Glandular Surgery 153
Mark F. Marzouk
Introduction 153
Robot-assisted sialolithotomy and sialendoscopy 154
Surgical technique 154
Complications 154
Postoperative care 155
Robot-assisted submandibular gland excision 155
Retroauricular 155
Transoral 155
Transcervical 155
Extracorporeal Lithotripsy 159
Oded Nahlieli
Introduction: nature of the problem 159
Surgical technique 159
The tool #1: extracorporeal shock wave lithotripters 159
The tool #2: sialoendoscope 160
Extracorporeal shock wave lithotripsy: techniques 160
Preoperative planning 160
Traditional extracorporeal shock wave lithotripsy approach 161
The Nahlieli low-energy shock waves technique 163
Potential complications 164
“Pearls and pitfalls” 164
Clinical results in the literature 165
Summary 166
Intracorporeal Lithotripsy 169
Jack Kolenda
Introduction: nature of the problem 169
Surgical technique 169
Preoperative planning 169
Preparation and patient positioning 169
Surgical approach 171
Potential complications 172
Pearls and pitfalls 172
Immediate postoperative care 172
Rehabilitation and recovery 173
Discussion 173
Pneumatic lithotripsy 173
Laser lithotripsy 173
Summary 174
