Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Center Ljubljana, Ljubljana, Slovenia.
Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
Radiol Oncol. 2021 Aug 10;55(3):284-291. doi: 10.2478/raon-2021-0015.
A sialendoscopy-assisted combined approach is well established in the surgery of sialolithiasis. In cases of proximal salivary stones, transcutaneous sialendoscopy-assisted extractions with parotid and submandibular gland preservation is the primary intention of treatment. We recently added computer tomography (CT) navigation to improve the results of this challenging surgery equally in both localizations.
Al l the patients who submitted to sialendoscopy and sialendoscopy-assisted procedures at the tertiary institution between January 2012 and October 2020 were included in the present study. From November 2019, CT navigation was added in cases with sialolithiasis and a presumably poor sialendoscopic visibility. We evaluated the parameters of the disease, diagnostic procedures, sialendoscopic findings and outcomes, with or without optical surgical navigation.
We performed 178 successful salivary stone removals in 372 patients, of which 118 were combined sialendos-copy-assisted approaches, including 16 transcutaneous proximal, 10 submandibular and 6 parotid stone operations. Surgical navigation was used in six patients, four times for submandibular and twice for parotid sialolithiasis. These were all non-palpable, sialendoscopically invisible or partially visible stones, and we managed to preserve five of the six salivary glands.
The addition of CT navigation to sialendoscopy-assisted procedures for non-palpable, sialendoscopically invisible and fixed stones is a significant advantage in managing sialolithiasis. By consistently performing sialendoscopy and related preservation procedures, we significantly reduced the need for sialoadenectomies in patients with obstructive salivary gland disease.
唾液腺镜辅助联合治疗在涎石病的治疗中已得到广泛应用。对于近端涎石，保留腮腺和颌下腺的经皮唾液腺镜辅助提取术是治疗的主要目的。我们最近将计算机断层扫描（CT）导航技术应用于该具有挑战性的手术中，以同等程度地提高这两种位置的治疗效果。
本研究纳入了 2012 年 1 月至 2020 年 10 月期间在三级医疗机构接受唾液腺镜和唾液腺镜辅助治疗的所有患者。自 2019 年 11 月起，对于有涎石症且预计唾液腺镜可视性较差的患者，我们在手术中增加了 CT 导航。我们评估了疾病的参数、诊断程序、唾液腺镜的发现和结果，包括有无光学手术导航。
我们对 372 例患者进行了 178 次成功的唾液结石清除术，其中 118 例为联合唾液腺镜辅助治疗，包括 16 例经皮近端、10 例颌下腺和 6 例腮腺结石手术。6 例患者使用了手术导航，其中 4 例用于颌下腺涎石症，2 例用于腮腺涎石症。这些都是无法触及、唾液腺镜下不可见或部分可见的结石，我们成功保留了 6 个唾液腺中的 5 个。
将 CT 导航技术应用于无法触及、唾液腺镜下不可见和固定的结石的唾液腺镜辅助治疗是管理涎石病的重要优势。通过持续进行唾液腺镜检查和相关的保留手术，我们显著减少了因阻塞性唾液腺疾病而需要进行唾液腺切除术的患者数量。
