Ultrasound-Guided Sialendoscopy with Holmium: Yttrium Aluminum Garnet (YAG) Laser Treatment of Parotid Sialolithiasis

Patient: Male, 38-year-old Final Diagnosis: Parotid sialolithiasis Symptoms: Painful • swelling Medication: — Clinical Procedure: — Specialty: Surgery OBJECTIVE: Unusual setting of medical care BACKGROUND: At present, promptly diagnosing sialolithiasis is easy with the assistance of various noninvasive diagnostic procedures. However, the treatment of parotid sialolithiasis remains inadequate. An immense challenge for oral maxillofacial practitioners is the treatment of large radiolucent stones, especially of those that are located in a hard-to-approach positions in the salivary ducts. This case report aims to propose the protocol of a new technique to improve the management of parotid salivary stones. In 2017, our hospital was the first medical center in Vietnam to implement this technique in the treatment of parotid sialolithiasis. CASE REPORT: A 38-year-old man was diagnosed with parotid sialolithiasis based on ultrasound and computed tomography (CT) scanning results. He underwent ultrasound-guided sialendoscopy with holmium: yttrium aluminum garnet (YAG) laser lithotripsy. The stone was large (22×12 mm) and in an unfavorable position. A narrow strip of fibrous tissue in front of the stone was also noted. However, 1 week after surgery the patient had local swelling of the parotid gland and no manifestation of inflammation, facial paralysis, or obstructed saliva through the drainage ducts. The patient was examined for clinical symptoms and glandular ultrasound at 3 months and 6 months after the procedure. The follow-up examination results showed normal parotid gland function, no complications or recurrence of stones, and no narrowing of the gland duct. CONCLUSIONS: Ultrasound-guided sialendoscopy with holmium: YAG laser is safe and effective for treating parotid salivary gland stones.