Fritsch reported an algorithm for managing a patient with a stenosis of the parotid duct when extracorporeal lithotripsy is not available. The author is from Indiana University Medical Center in Indianapolis.
Patient selection: stenosis or stricture of the parotid (Stensen's) duct
Situation: extracorporeal lithotripsy not available
Factors affecting the success rate of endoscopic dilatation:
(1) extent of fibrosis and/or calcification
(2) ability to pass the dilator into the stenotic segment
Parameters:
(1) endoscopic dilatation of duct stenosis (with laser, guidewire, balloon)
(2) length of the stenotic segment
Endoscopic Dilatation of Duct Stenosis
Length of the Stenotic Segment
Management
successful
NA
monitor for restenosis, may require stent for 4-8 weeks
unsuccessful
< 1.5 cm
resect segment and perform end-to-end closure, then stent for 4-8 weeks
unsuccessful
>= 1.5 cm
resect segment and interpose a vein, then stent for 4-8 weeks
where:
• Stenting is performed to prevent restenosis during the healing phase.
• Vein for interposition may come from a dorsal hand vein or saphenous malleolar ankle branch.
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