Jean Marc Foletti1, Nicolas Graillon2, Simon Avignon3, Laurent Guyot4, Cyrille Chossegros5. 1. Attending Surgeon, Aix-Marseille University, Laboratory of Applied Biomechanics, French Institute of Science and Technology for Transport, Spatial Planning, Development, and Networks (IFSTTAR), Marseille, France; and Department of Maxillofacial Surgery, Public Assistance Hospital of Marseille, University Hospital Center Nord, Marseille, France. Electronic address: jmfoletti@ap-hm.fr. 2. Attending Surgeon, Department of Maxillofacial Surgery, Public Assistance Hospital of Marseille, University Hospital Center Nord, Marseille, France; and Department of Maxillofacial Surgery, Public Assistance Hospital, University Hospital Center Conception, Pôle Plastic, Reconstructive, ORL and Maxillofacial Departement, Marseille, France. 3. Resident, Aix-Marseille University, Laboratory of Applied Biomechanics, French Institute of Science and Technology for Transport, Spatial Planning, Development, and Networks (IFSTTAR), Marseille, France; and Department of Maxillofacial Surgery, Public Assistance Hospital, University Hospital Center Conception, Pôle Plastic, Reconstructive, ORL and Maxillofacial Departement, Marseille, France. 4. Professor, Department of Maxillofacial Surgery, Public Assistance Hospital of Marseille, University Hospital Center Nord, Marseille, France. 5. Professor and Department Head, Department of Maxillofacial Surgery, Public Assistance Hospital, University Hospital Center Conception, Pôle Plastic, Reconstructive, ORL and Maxillofacial Departement, Marseille, France; and Aix-Marseille University, Speech and Language Laboratory, National Center for Scientific Research, Aix-en-Provence, France.
Abstract
PURPOSE: To suggest a decision tree for the choice of the best minimally invasive technique to treat submandibular and parotid calculi, according to the diameter of the calculi and their position in the excretory duct. MATERIALS AND METHODS: Submandibular and parotid ducts can both be divided into 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. RESULTS: Using 3 criteria, the type of gland involved (G), the topography (T) of the calculus and its diameter (D), a 3-stage GTD classification of calculi was established. Next, the best indication for each available minimally invasive technique (sialendoscopy, transmucosal approach, a combined approach, intra- or extracorporeal stone fragmentation) was determined for each calculus stage. CONCLUSIONS: The minimally invasive treatment options are numerous and have replaced invasive resection surgical approaches (submandibulectomy and parotidectomy) in the management of salivary calculi, significantly improving the prognosis of these diseases. We emphasize the need for flexibility in the surgical indications and challenge the dogma of "all endoscopic" management of salivary calculi.
PURPOSE: To suggest a decision tree for the choice of the best minimally invasive technique to treat submandibular and parotid calculi, according to the diameter of the calculi and their position in the excretory duct. MATERIALS AND METHODS: Submandibular and parotid ducts can both be divided into 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. RESULTS: Using 3 criteria, the type of gland involved (G), the topography (T) of the calculus and its diameter (D), a 3-stage GTD classification of calculi was established. Next, the best indication for each available minimally invasive technique (sialendoscopy, transmucosal approach, a combined approach, intra- or extracorporeal stone fragmentation) was determined for each calculus stage. CONCLUSIONS: The minimally invasive treatment options are numerous and have replaced invasive resection surgical approaches (submandibulectomy and parotidectomy) in the management of salivary calculi, significantly improving the prognosis of these diseases. We emphasize the need for flexibility in the surgical indications and challenge the dogma of "all endoscopic" management of salivary calculi.