Transfacial Ultrasound-Guided Gland-Preserving Resection of Parotid Sialoliths

Objective. Review surgical techniques and outcomes of ultrasound-guided, transfacial, gland-preserving removal of difficult parotid stones. Study Design. Case series with chart review. Setting. Two academic tertiary care centers. Methods. Patients who underwent ultrasound-guided, combined transfacial-endoscopic operation for symptomatic parotid sialolithiasis from June 2010 through June 2012 at 2 tertiary care university hospitals were evaluated. Outcome measurements included stone size, stone location, complications, symptom relief, and gland preservation rate. Results. A total of 14 patients underwent ultrasound-guided, transfacial operation for symptomatic parotid sialolithiasis. Ten of 14 patients (71%) had completely successful therapy defined by no symptoms postoperatively with a preserved, functional gland. Three of the 4 patients without complete symptom resolution did endorse symptom improvement, whereas the fourth patient eventually underwent parotidectomy. Needle localization was used to aid in transfacial stone retrieval in 57% of cases. Conclusion. Ultrasound-guided, combined transfacial-endoscopic removal of certain parotid stones is an alternative to parotidectomy for patients in whom endoscopy or shock wave therapy for stone retrieval is ineffective, unavailable, or contraindicated. Needle localization is a useful adjunct in stone retrieval.