Salivary calculi removal by minimally invasive techniques: A decision-tree based on the diameter of the calculi, and their position in the excretory duct.

Publication date: Available online 14 June 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Jean Marc Foletti, Nicolas Graillon, Simon Avignon, Laurent Guyot, C. Chossegros
IntroductionThe authors of this article suggest a decision tree for the choice of the best minimally invasive technique for treating submandibular and parotid calculi, according to the diameter of the calculi, and their position in the excretory duct.Materials and MethodsSubmandibular and parotid ducts can be both divided into three thirds, delineated by easily recognizable landmarks. The diameter of calculi is schematically classified into 1 of these 3 categories: floating, slightly impacted or largely impacted.ResultsUsing three criteria, the type of gland involved (G), the topography (T) of the calculus and its diameter (D), a GTD 3-stage classification of calculi is established. Then, the best indication of each available minimally invasive technique (sialendoscopy, transmucosal approach, a combined approach, intra or extracorporeal stone fragmentation) is discussed for each stage of calculi.DiscussionMinimally invasive treatment options mentioned here are numerous and have replaced invasive resection surgeries (submandibulectomy and parotidectomy) in the management of salivary calculi, improving significantly the prognosis of these diseases. The authors emphasize the need for flexibility in surgical indications, and challenge the dogma of an "all endoscopic" management of salivary calculi.



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