title: [Combined approach of parotid lithiasis. A technical note].
abstract: BACKGROUND
  Sialendoscopy, extracorporeal lithotripsy and transoral removal are the usual treatments for parotid lithiasis. These techniques cannot treat all the patients. In fact, removal of lithiasis bigger than the ductal diameter and situated in the middle or posterior third of the duct may fail with such techniques. For this reason the combined approach has been developed. Our technical note describes this procedure.
  
  
  METHODS
  Preoperative check-up needs an ultrasound or a CT scan of the parotid region. The procedure is conducted under general anesthesia. It begins with the localization of the lithiasis with help of the sialendoscope light visible through the skin. A face lift approach is performed giving access to the SMAS that is opened over the lithiasis and the transilluminated area. A window is opened on the duct and the lithiasis is removed. Proximal duct permeability is assessed with the sialendoscope. The different layers are sutured and a suction drainage is left in place.
  
  
  CONCLUSIONS
  Combined approach is indicated in case of failure of conservative techniques. It provides good results in removal of lithiasis located in the posterior or middle thirds of the duct. Its morbidity is low. It can avoid performing a parotidectomy and lowers the risk of facial palsy. In case of failure, botulinum toxin injection may be indicated.
authors.affiliation: Service de chirurgie maxillo-faciale et stomatologie, centre hospitalier La Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France; Service de chirurgie maxillo-faciale, de stomatologie et d'odontologie hospitalière, centre hospitalier universitaire de Besançon, boulevard Fleming, 25030 Besançon cedex, France. Electronic address: au.louvrier@gmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Louvrier
authors.affiliation: Service de chirurgie maxillo-faciale et plastique de la face, CHU Nord, chemin des Bourrely, 13015 Marseille, France; Aix-Marseille université, 13284 Marseille, France.
authors.forename: J-M
authors.initials: JM
authors.lastname: Foletti
authors.affiliation: Service de chirurgie maxillo-faciale et plastique de la face, CHU Nord, chemin des Bourrely, 13015 Marseille, France; Aix-Marseille université, 13284 Marseille, France.
authors.forename: L
authors.initials: L
authors.lastname: Guyot
authors.affiliation: Service de chirurgie maxillo-faciale et stomatologie, centre hospitalier La Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France; Aix-Marseille université, 13284 Marseille, France.
authors.forename: C
authors.initials: C
authors.lastname: Chossegros
mesh_terms: D000368:Aged; D003131:Combined Modality Therapy / Q000379:methods; D004724:Endoscopy / Q000379:methods; D005260:Female; D006801:Humans; D020347:Lithiasis / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D008096:Lithotripsy / Q000379:methods; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D019647:Oral Surgical Procedures / Q000379:methods*; D010305:Parotid Diseases / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies
keywords: Chirurgie; Endoscopie; Endoscopy; Lithiase; Lithiasis; Parotid; Parotide; Surgery