title: Combined approach to impacted parotid stones.
abstract: OBJECTIVE
  This article describes the use of combined endoscopic and ultrasound approach to locate and to extract impacted parotid stones, which cannot be retrieved by intraoral approach alone.
  
  
  METHODS
  A total of 12 parotid glands from 7 women and 5 men (age range, 35 to 62 years) with parotid sialoliths were treated with the combined method. Eleven of 12 of the procedures were performed under local anesthesia in an outpatient clinic. The identification of the calculi was done in 5 patients with 1.3-mm sialoendoscope (Nahlieli Sialoendoscope; Karl Storz, Tuttlingen, Germany) in 6 patients with the aid of high-resolution ultrasound, and in 1 patient the location was combined endoscopy and ultrasound. The removal of the calculi was performed extraorally via minimal incision. The indications for the combined approach were 1) calculus in the posterior third of the Stensen's duct with too narrow duct anterior to it, 2) obstruction of the posterior or middle third of the Stensen's ducts leading to the calculus, 3) large (>5-mm) stones in the middle or posterior part of the duct that cannot be dilated for intraductal removal, and 4) intraparenchymal stones.
  
  
  RESULTS
  Of the 12 patients, 9 had complete removal (75%); in 1 case with 3 sialoliths, we removed 2 and the gland remained asymptomatic. In 7 cases, the glands returned to function, 3 glands became atrophic with no function, but the gland remained asymptomatic. The aesthetic results were satisfactory in all cases, no major complications were noted.
  
  
  CONCLUSIONS
  Combined endoscopic ultrasound approach is another minimal invasive technique for identification and removal of impacted parotid sialolithiasis.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Barzilai Medical Center, Ashkelon, Israel. nahlieli@yahoo.com
authors.forename: Oded
authors.initials: O
authors.lastname: Nahlieli
authors.forename: Daniel
authors.initials: D
authors.lastname: London
authors.forename: Ami
authors.initials: A
authors.lastname: Zagury
authors.forename: Eli
authors.initials: E
authors.lastname: Eliav
mesh_terms: D000328:Adult; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010305:Parotid Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D012465:Salivary Duct Calculi / Q000000981:diagnostic imaging / Q000601:surgery*; D014463:Ultrasonography