← Back to List

Program Number: B308
Session Name: Poster Session

Decision Making and Outcomes in Trans-facial Approaches to Parotid Stones; a Multi-institutional Review

Aaliyah C Riccardi, MD¹; Nicole Kloosterman, MD²; Katherine L Garvey, MD³; Tazheh Kavoosi, MD⁴; Rohith Bhethanabotla, BS⁵; Christopher Rassekh, MD, FACS⁶; Jolie L Chang, MD⁵; William R Ryan, MD⁵; Mark Marzouk, MD⁴; Marion Boyd Gillespie, MD, MSc⁷; Alexandra Kejner, MD²; M. Allison Ogden, MD³; Barry Schaitkin, MD¹; Shaum Sridharan, MD¹; ¹Department of Otolaryngology, University of Pittsburgh Medical Center; ²Department of Otolaryngology, MUSC; ³Department of Otolaryngology Washington, University School of Medicine; ⁴Department of Otolaryngology-Head and Neck Surgery, Upstate Medical University; ⁵Otolaryngology-Head and Neck Surgery, University of California San Francisco; ⁶Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania; ⁷Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Science Center

Introduction: Parotid sialolithiasis is a common pathology that can cause frequently recurrent salivary swelling, pain, and even infection. There are various well described treatment modalities such as endoscopic retrieval, open surgery, and combined approaches. Pure endoscopic techniques are limited by stone size, location and mobility. Literature surrounding external approaches to parotid stones is limited especially in light of the diversity in approaches and varying utilization of facial nerve monitoring. This multi-institutional study aims to investigate trends and examine outcomes in external approach to parotid stones.

Methods: This is a retrospective multi-institutional case series evaluating external approaches for parotid stones performed at participating large academic institutions from 2010-2022. All adult patients 18 years or older with diagnosis of parotid stone were included, unless they were lost to follow up or had incomplete documentation. The study design was approved by the Institutional Review Board of University of Pittsburgh Medical Center (UPMCIRB-23070095).

Results: A total of 72 patients underwent an external approach for parotid stone extraction. The largest average dimensions of removed sialoliths was 8 ± 3.91 and the most common locations were the duct (54%) and intraglandular (30%). Endoscopy was used to localize the stone in 52% of cases. Intraoperatively, facial nerve monitoring was used in 51% of cases, and the most common incision design was a modified Blair (60%). Complete stone removal was achieved in 96% of the cohort. The rate of recurrent symptoms was 22% and the post-operative sialocele rate was 15%. Patients who received intra-operative Botox treatment had a 9% rate of sialocele compared to 16% in those who did not (p= .07). Intraoperative stenting was done in 36% of the cases. Interestingly, although on the stented patients had smaller sized stones on average, 7.5 mm compared to 8.3 mm, the stented patients were more likely to have recurrent symptoms, 34% of patients compared to 15% of the non-stented patients (p=.03). Only one patient was found to have a recurrent sialolith. There was one case of temporary facial weakness in a patient with intra operative monitoring. There was no permanent facial nerve weakness.

Conclusion: A transfacial approach to large parotid stones is a safe and effective method for the removal of parotid sialoliths, particularly in cases not amenable to extraction via sialdendoscopy.   No cases of permanent facial nerve weakness occurred with or without monitoring.  Sialocele was limited and all resolved without intervention.  

 

 

← Back to List