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



(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




monitor for restenosis, may require stent for 4-8 weeks


< 1.5 cm

resect segment and perform end-to-end closure, then stent for 4-8 weeks


>= 1.5 cm

resect segment and interpose a vein, then stent for 4-8 weeks



• 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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