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.
Specialty: Otolaryngology
ICD-10: ,