Ultrasound-Guided Needle Localization during Open Parotid Sialolithotomy

Abstract

Objectives

Our objective is to describe a novel operative technique for localization of parotid sialolithiasis, demonstrate the feasibility of the technique, and discuss its indications.

Study Design

Prospective study.

Setting

Tertiary-level academic center.

Subjects and Methods

Patients with symptomatic parotid sialolithiasis who had failed prior sialendoscopic extraction underwent ultrasound needle localization and open sialolithotomy. Data were prospectively collected. Independent variables included size of and location of sialoliths.

Results

Eleven patients were treated using transcutaneous ultrasound-guided needle placement and injection of methylene blue prior to external sialolithotomy. Follow-up ranged from 6 to 12 months. Ten (91.9%) patients had stones within the proximal one-third of the ductal lumen, and 1 (9.1%) had stones present within both the proximal one-third and middle one-third of the ductal lumen. The average surgical time was 53 ± 10.8 minutes. The average sialolith length was 7.6 ± 2 mm. The average sialolith width was 6 ± 1.9 mm. All 11 (100%) cases were successful for stone retrieval. Ten (91%) patients had complete symptom resolution, and 1 (9.1%) patient had partial resolution of symptoms. No patients had major complications. Three (27.3%) patients had minor complications.

Conclusion

After failing a purely endoscopic approach, sialoliths of the parotid gland pose a problem for precise localization and treatment. Ultrasound has been demonstrated to be reliable for identifying sialoliths. We propose a novel technique and assert that ultrasound-guided needle localization is a reliable aid to effective external parotid sialolithotomy, especially for larger stones >4 mm that are not amenable to sialendoscopic retrieval.