Combined Endoscopic-Transcutaneous Approach for Management of Large Parotid Stones.

INTRODUCTION:The aim of this paper is to present our experience with combined endoscopic-transcutaneous approach in terms of effectiveness and safety in patients with large or impacted parotid stones. MATERIALS AND METHODS:This is a prospective study carried out from August, 2012 to February, 2017 analyzing 21 patients with parotid sialolithiasis. The indication of combined approach was either failed attempt to remove the stone endoscopically, large size (>4mm), or impacted stone. The exact location of the stone was pointed out by endoscopic transillumination and the stone was removed via transcutaneous incision which could be linear incision or a preauricular incision followed by stenting for 3 weeks. RESULTS:We were successfully able to remove the stone in all 21 cases using modified Blair's incision in 18 cases, while a linear incision was used in remaining 3 cases. Two patients developed stricture in the post-operative period at 5 and 3 months, respectively. The strictures were successfully dilated endoscopically and the patients are asymptomatic ever since. CONCLUSION:Combined endoscopic-transcutaneous approach is a highly successful approach with few complications for removal of parotid stones and thus resulting in high gland preservation rates in patients of parotid sialolithiasis.