Fritsch reported an algorithm for managing a patient with a stone associated with the parotid gland or its duct (Stensen's duct) when extracorporeal lithotripsy is not available. The author is from Indiana University Medical Center in Indianapolis.
Situation: extracorporeal lithotripsy not available
Factors affecting stone removal:
(1) size of the stone
(2) changes in duct wall secondary to acute and chronic inflammation
(3) deposits on the outside of the stone causing adherence to the duct wall
Parameters:
(1) location of the stone
(2) diameter of the stone
|
Location of the Stone |
Diameter of the Stone |
Intervention |
|
distal duct |
NA |
papillotomy with or without stent; segmental-open procedure may be needed if stone large |
|
mid to proximal duct |
< 2 mm |
removal by endoscopic forceps or basket |
|
|
2 to 8 mm |
interventional endoscopy with laser lithotripsy, C-arm fluoroscopy, balloon dilation, basket removal. Followed by stent with or without papillotomy |
|
|
8 to 12 mm |
interventional endoscopy with laser lithotripsy, either staged lithotripsy OR endoscopic-open OR endoscopic segmental-open, followed by stent for 4 weeks |
|
|
> 12 mm |
consult specialist |
|
intraparenchymal |
< 5 mm |
NA |
|
|
5 to 12 mm |
endoscopic-open OR endoscopic segmental-open |
|
|
> 12 mm |
consult specialist |
where:
• Stent placement is needed after removal of a large stone to reduce the chance of duct stenosis during the healing.
• Endoscopic-Open: endoscopic surgery using a preauricular approach to the parotid gland with dissection down to the stone.
• Endoscopic Segmental-Open: an endoscopic-open procedure with wedge resection of diseased parotid gland.
• Endoscopic Segmental-Open: selected if the duct obstruction is severe with ectasias and/or multiple stenoses.
Specialty: Otolaryngology
ICD-10: ,
