Name of the Procedure:

Sialolithotomy; Parotid, Extraoral or Complicated Intraoral

Summary

Sialolithotomy is a surgical procedure to remove stones from the salivary glands, specifically targeting the parotid gland either through an external (extraoral) incision or a complex internal (intraoral) approach. Salivary stones, or sialoliths, can block the flow of saliva and cause pain and swelling.

Purpose

The procedure aims to alleviate symptoms caused by the blockage of salivary flow, such as pain, swelling, and infection. By removing the stones, the goal is to restore normal salivary gland function and prevent further complications.

Indications

• Persistent pain or swelling in the salivary gland due to a blockage
• Recurrent infections or abscesses in the salivary gland
• Diagnosis of a salivary stone via imaging studies
• Ineffectiveness of non-surgical treatments for sialolithiasis

Preparation

• Fasting for a certain period before the procedure (usually 6-8 hours)
• Stopping certain medications as advised by the doctor
• Preoperative imaging studies such as an ultrasound, CT scan, or MRI to locate the stone

Procedure Description

1. Anesthesia: General anesthesia is typically administered.
2. Incision: An extraoral incision is made near the ear or an intraoral incision inside the mouth, depending on the stone's location.
3. Stone Removal: Specialized tools are used to locate and extract the stone from the parotid gland.
4. Closure: The incision is sutured closed, and the area may be irrigated to ensure no fragments remain.
5. Postoperative Care: Antibiotics and pain medication are given to prevent infection and manage discomfort.

Duration

The procedure usually takes about 1-2 hours, depending on the complexity and location of the stone.

Setting

This procedure is performed in a hospital or a surgical center.

Personnel

• Surgeon (usually an otolaryngologist or head and neck surgeon)
• Anesthesiologist
• Surgical nurses
• Possibly a radiologist if intraoperative imaging is required

Risks and Complications

• Infection
• Bleeding
• Nerve damage leading to numbness or weakness
• Scarring (especially in extraoral approach)
• Recurrence of stones

Benefits

• Relief from pain and swelling
• Restoration of normal salivary gland function
• Prevention of recurrent infections and potential abscess formation

Recovery

• Outpatient or short hospital stay
• Pain management through prescribed medications
• Soft diet and plenty of fluids
• Follow-up appointment to monitor healing
• Avoid strenuous activities for at least a week

Alternatives

• Conservative management (hydration, sour candies to stimulate saliva, massage)
• Non-invasive techniques (shock wave lithotripsy)
• Endoscopic procedures for smaller stones Pros of Sialolithotomy: Definitive removal of stones, high success rate. Cons of Sialolithotomy: Surgical risks, longer recovery compared to non-invasive methods.

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel pain. After surgery, there may be discomfort which can be managed with pain medications. Swelling and tenderness may last for several days, but most symptoms improve within a week.