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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Acta+Otorhinolaryngol+Ital
2017 ; 37
(2
): 122-127
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L?asportazione transorale scialoendoscopico-assistita dei calcoli
ilo-parenchimali sottomandibolari: risultati chirurgici e soggettivi
#MMPMID28516974
Capaccio P
; Gaffuri M
; Rossi V
; Pignataro L
Acta Otorhinolaryngol Ital
2017[Apr]; 37
(2
): 122-127
PMID28516974
show ga
It has been suggested that a conservative trans-oral approach to proximal and
hilo-parenchymal submandibular stones (HPSMS) is a valid alternative to the more
frequently used sialadenectomy. The aim of this study was to evaluate the
surgical, ultrasonographic and patients' subjective outcomes of results of the
trans-oral removal of HPSMS. Between January 2003 and September 2015,
sialendoscope-assisted trans-oral surgery was used to remove symptomatic, large
(> 7 mm), fixed and palpable HPSMS from 479 patients under general anaesthesia.
All patients were followed clinically and ultrasonographically to investigate
symptom relief and recurrence of stones, and were telephonically interviewed to
assess saliva-related subjective outcomes with a questionnaire. Stones were
successfully removed from 472 patients (98.5%); the seven failures (1.5%)
concerned pure parenchymal stones. One year after the procedure, 408 patients
(85.1%) were symptom free, 59 (12.3%) had recurrent obstructive symptoms and 12
(2.6%) had recurrent infections. Of the 54 patients who developed a recurrent
stone (11.2%), 52 underwent a second procedure: 29 interventional
sialendoscopies, two sialendoscope-assisted intra-corporeal pneumatic
lithotripsy, eight secondary transoral surgery to remove residual stones, six a
cycle of extra-corporeal lithotripsy and seven submandibular sialadenectomy. Most
patients (75.2%) reported mild surgery-related pain. The symptoms of 454 patients
(94.8%) improved after adjunctive treatment and, at the end of follow-up, the
affected gland was preserved in 98.5% of patients. A sialendoscope-assisted
trans-oral removal of large HPSMS is a safe, effective, conservative surgical
procedure, and functional preservation of the main duct and parenchyma of the
obstructed gland allows sialendoscopic access through the natural ostium in case
of recurrence. Combining a trans-oral approach with other minimally invasive,
conservative procedures ensures symptomatic relief and salivary duct system
clearance in the majority of patients.