Ultrasound Assessment after Parotid Sialolithotomy

Abstract

Objective: 1) To demonstrate the utility of ultrasound in the assessment of residual parotid sialoliths or fragments after endoscopic-assisted or purely open sialolithotomy. 2) To discuss limitations of using ultrasound for detection of sialolithiasis of the parotid glands.

Method: From August 2009 to January 2012, 5 adult patients with symptomatic parotid sialolithiasis underwent endoscopic-assisted or purely external sialolithotomy in a tertiary-level hospital setting. Pre-and intraoperative post-sialolithotomy ultrasound was performed. Outcomes included presence of residual stones/fragments and proximal ductal dilatation.

Results: Five patients with symptomatic parotid sialolithiasis refractory to sialendoscopic extraction underwent either endoscopic-assisted sialolithotomy or pure open sialolithotomy. Four of 5 patients demonstrated proximal ductal dilatation on ultrasound. One of 5 (20%) demonstrated residual sialolithiasis on ultrasound immediately after sialolithotomy. That patient underwent re-exploration at the time of the procedure and was demonstrated to have residual sialolithiasis with successful delivery of the fragments. There were no instances of infection, ductal stenosis, loss of glandular function, or permanent buccal facial nerve paralysis, with follow-up ranging from 6 months to 1 year.

Conclusion: After cases of endoscopic-assisted or purely external parotid sialolithotomy, there is no widely used method to assess for residual stones. As a first, and in this small cohort of patients, we propose that ultrasound is effective and should be considered for the assessment of residual stones after external parotid sialolithotomy.