title: Combined endoscopic and transcutaneous approach for parotid gland sialolithiasis: indications, technique, and results.
abstract: OBJECTIVE
  Despite all the advances of minimally invasive surgery, refractory stones remain in 10 to 20 percent of all cases of parotid gland sialolithiasis, and persistence of the symptoms makes removal of the gland inevitable. In some of these cases, however, it may be possible to conserve the gland using a combination of endoscopic and transcutaneous procedures.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  Nine patients treated with a combined endoscopic transcutaneous operation were evaluated. During this procedure, the stone is removed through a skin incision under endoscopic guidance. Indications were sialolithiasis refractory to treatment (n = 5), sialolithiasis with complications (n = 2), contraindications to primary minimally invasive surgery (n = 1), and primary treatment (n = 1). In seven cases, the stones were extracted. Simultaneous resection of a sialocele was carried out in one case, and simultaneous resection of a saliva-cutaneous fistula was carried out in another. A stent was inserted in 66.7 percent of the cases.
  
  
  RESULTS
  Treatment was successful in 88.9 percent of the patients. All of these patients were free of stones and symptoms, and glandular function was maintained both clinically and on ultrasound assessment. Complete parotidectomy had to be carried out in one case because it was not possible to reconstruct the duct system.
  
  
  CONCLUSIONS
  The combined operation offers a further option for gland-conserving treatment in cases with obstructive salivary gland disease, especially sialolithiasis. At present, it is indicated for cases that are resistant to treatment after sialendoscopy or extracorporeal shock wave lithotripsy. The gland resection rate can thus be further reduced.
authors.affiliation: Department of Otorhinolaryngology, University of Erlangen-Nuremberg, FAU Medical School, Erlangen, Germany. Michael.Koch@uk-erlangen.de
authors.forename: Michael
authors.initials: M
authors.lastname: Koch
authors.forename: Alessandro
authors.initials: A
authors.lastname: Bozzato
authors.forename: Heinrich
authors.initials: H
authors.lastname: Iro
authors.forename: Johannes
authors.initials: J
authors.lastname: Zenk
mesh_terms: D000368:Aged; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods; D010306:Parotid Gland / Q000601:surgery*; D015494:Salivary Gland Calculi / Q000601:surgery*; D012867:Skin