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Contents

        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