title: The treatment of large sialoliths by sialendoscopic combined approach.
abstract: OBJECTIVE
  To investigate the advantages, disadvantages, and complications of the combined surgical technique for removing large sialoliths from the salivary glands.
  
  
  METHODS
  This retrospective study analyzed 37 patients with obstructive sialadenitis caused by sialolithiasis who could not undergo surgery using a purely sialendoscopic technique because of the stone size or because of a tight distal stricture obstructing the passage of stone removal by an endoscope.
  
  
  RESULTS
  Six patients had parotid gland obstruction, and the other 31 patients had submandibular gland obstruction. The calculi varied in size from 5 to 45 mm (average, 10.4 mm). Twenty-three stones were located at the hilar part of the gland or in the proximal part of the duct close to the hilum. The other 14 stones were located in the middle third of the duct. Thirty patients had no complications and were free of symptoms, with normal saliva secretion checked by milking the gland. Five patients developed minor complications that were treated under local anesthesia. Only 2 patients developed severe ductal restenosis and required further sialadenectomy.
  
  
  CONCLUSIONS
  The combined technique showed good results for removing large sialoliths or proximally located sialoliths that could not have been removed by sialendoscopy alone. The use of an endoscope enables further exploration of the remaining duct, allowing for the removal of further sialolith and reconstruction of the duct after sialolith removal. The technique is not limited to stone size or location along the duct.
authors.affiliation: Sialendoscopy and Minimal Invasive Surgery Service, Department of Oral and Maxillofacial Surgery, Rambam Health Care Campus, Haifa, Israel; Technion Faculty of Medicine, Haifa, Israel. Electronic address: dr.hilaklein@gmail.com.
authors.forename: Hila
authors.initials: H
authors.lastname: Klein
authors.affiliation: Sialendoscopy and Minimal Invasive Surgery Service, Department of Oral and Maxillofacial Surgery, Rambam Health Care Campus, Haifa, Israel; Technion Faculty of Medicine, Haifa, Israel.
authors.forename: Leon
authors.initials: L
authors.lastname: Ardekian
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003251:Constriction, Pathologic / Q000175:diagnosis; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010305:Parotid Diseases / Q000601:surgery; D011183:Postoperative Complications; D012189:Retrospective Studies; D012463:Saliva / Q000378:metabolism; D012465:Salivary Duct Calculi / Q000601:surgery; D015494:Salivary Gland Calculi / Q000601:surgery*; D013364:Submandibular Gland Diseases / Q000601:surgery