Ultrasound Localization during Parotid Sialolithotomy

Objective 1) To describe a novel operative technique that has been demonstrated to be successful in stone localization and subsequent retrieval in patients with parotid sialolithiasis. 2) To demonstrate feasibility of the technique and discuss its indications. Method From August 2009 to January 2012, patients with symptomatic parotid sialolithiasis underwent ultrasound needle localization and open sialolithotomy in a tertiary‐level hospital setting. Outcomes included success of delivery, presence of infection, ductal stenosis, loss of glandular function, or facial nerve paralysis. Independent variables included size of and location of sialoliths. Results Five patients were treated using transcutaneous ultrasound‐guided needle placement and injection of methylene blue prior to external sialolithotomy in the operating room. Patients were chosen if they had failed prior sialendoscopic extraction. Postoperative outcomes and long‐term follow‐up results were obtained. Follow‐up ranged from 6 to 12 months. Mean operative time from skin incision to closure was 52 minutes (range, 43‐85 minutes). Five of 5 (100%) cases were successful for stone retrieval. Stents were placed in 4 of 5 cases. The average stone size was 5.3 mm. There were no complications of infection, ductal stenosis, loss of glandular function, or permanent buccal facial nerve paralysis. No patients had salvage parotidectomy. Conclusion After failing a purely endoscopic approach, sialoliths of the parotid gland pose a problem for precise localization and treatment. Ultrasound has been demonstrated to be reliable for identifying sialoliths. We propose a novel technique and assert that ultrasound‐guided needle localization is a reliable aid to effective external parotid sialolithotomy.