title: Combined approach sialendoscopy for management of submandibular gland sialolithiasis.
abstract: OBJECTIVE
  Sialolithiasis is the primary cause of obstructive sialadenitis, affecting the submandibular gland in 80-90% of cases. Sialendoscopy has dramatically changed the diagnosis and management of salivary gland diseases. However, in cases in which endoluminal removal via sialendoscopy is not successful, a combined approach using a limited intraoral incision under guidance of sialendoscopy can facilitate stone removal. We reviewed our institution's experience with combined approach sialendoscopy and evaluated its role in managing sialolithiasis of the submandibular gland.
  
  
  METHODS
  Retrospective study of the treatment of sialolithiasis in the submandibular gland via combined approach sialendoscopy from January 2010 through March 2014. Demographics, clinical data, intraoperative findings and post-operative course were reviewed.
  
  
  RESULTS
  Most sialoliths (56.5%) were over 10 mm in size and were in the hilus of the gland (56%). The success rate of the combined approach was 87%. No significant complications were documented. Symptoms resolved in 75.7% of patients; however, this did not correlate with placement of an intraductal stent (p=0.7) or steroid irrigation (p=0.1). An overall gland preservation rate of 94.9% was achieved.
  
  
  CONCLUSIONS
  Combined approach sialendoscopy offers a minimally invasive technique for treating refractory sialolithiasis not amenable to removal via sialendoscopy alone. The procedure is well-tolerated, performed under local anesthesia with low morbidity and a high success rate.
authors.affiliation: Department of Otolaryngology, Meir Hospital, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: nofrat@gmail.com.
authors.forename: Nofrat
authors.initials: N
authors.lastname: Schwartz
authors.affiliation: Department of Otolaryngology, Meir Hospital, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Inbal
authors.initials: I
authors.lastname: Hazkani
authors.affiliation: Department of Otolaryngology, Meir Hospital, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Sivan
authors.initials: S
authors.lastname: Goshen
mesh_terms: D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D015494:Salivary Gland Calculi / Q000175:diagnosis / Q000601:surgery*; D013364:Submandibular Gland Diseases / Q000601:surgery*; D016896:Treatment Outcome