King Edward VII's Hospital, London

 

University College London Hospital (NHS base)

        

 

 

Researching, Developing & Teaching Minimally Invasive Head & Neck Surgery 

 

 

Salivary Gland Disorders

 

Salivary Gland Stones

 
 

Salivary Stones are uncommon. The incidence in the UK population is about 60 cases per million population each year. The majority (80%) form in the submandibular gland (SMG) and 20% in the Parotid. A myth has developed that once a stone forms, the gland becomes infected and never recovers. We have shown this is not the case but most surgical units will recommend gland removal. This is no longer necessary. Salivary stones can be reliably removed and the gland remains healthy.

 

The management of salivary stones was revolutionised by teams in London, Paris, Erlangen, Israel and Milan. We published the combined results from all these centres which totalled more than 4,600 patients with salivary stones. Less than 3% of patients required salivary gland removal with 82% of stones retrieved. The results of stone removal today (2017) are an improvement on this figure with over 90% of stones extracted by minimally invasive techniques.

 

Techniques available.

New miniature instruments have made minimally invasive salivary gland surgery possible. New micro-endoscopes are less than 1mm in diameter and allow excellent visualisation of the salivary duct system. Micro-instruments such as baskets, balloons, forceps and lithotripter wires can be passed through the endoscopes to target stones and strictures.

 

Salivary stone seen through the endoscope camera

 

Small stones

The salivary ducts are 2 to 3 mm wide. Small stones less than 4mm can be grasped and pulled down the duct. This can be done with tiny wire baskets either under direct vision through a micro-endoscope or under radiological control. The results are excellent with about 75% of small stones retrieved by this method alone.

 

Minimum sized stones

Stones measuring between 5 and 8 mm cannot be drawn down the duct. They have to be broken up first. A new lithotripter (stone breaker) is now available, it is hand-held and works by passing a thin wire down the working channel of the micro endoscope to touch the stone. A shock wave is passed down the wire and after approximately 50 shocks the stone will break and the fragments can be removed with a basket. (video bottom right) If cases are selected appropriately then in our experience about 75% of middle size stones can be successfully removed by this method. 

 

Parotid gland stones larger than 8mm

These larger stones can be removed more easily and efficiently by minimally invasive surgical procedures that leave the gland intact.

 

These stones are located with the endoscope light and camera and illuminated from the inside to guide surgery - video below.

 

We have published our results in over 100 cases with excellent rates of stone retrieval (95%+) and few serious complications.

 

An endoscope-mounted camera with light can accurately locate the stone within the duct and guide the surgery.

 

Video: Endoscopically assisted stone removal from parotid gland

 

Full Screen: Run the video and click bottom right corner. Double click or ESC key to return

 

Fixed submandibular stones larger than 8mm

These are also removed by an endoscope assisted surgical technique. Under day care general anaesthesia, an incision in made along the floor of the mouth, the submandibular duct is found and traced back into the gland with the help of the micro endoscope. The stone is found and released. The operation takes about 30-40min. Our results in over 300 cases show excellent results with stone retrieval rates of 97%

 

 

 

Above: Wire basket mounted on the endoscope.

Other available channels in the endoscope carry light, camera, fibre-optics and other devices

 

 

 

Endoscope

 

 

 

 

Video: Stone retrieval with endoscope-mounted wire basket

 

Full Screen: Run the video and click bottom right corner. Double click or ESC key to return

 

 

 

Micro forceps small enough to enter salivary duct and grasp small stones can also be operated through the endoscope.

 

 

 

Breaking stones with the lithotripter

These larger stones may be susceptible to being fragmented into smaller pieces using pneumatic lithotripsy using compressed air to deliver small repeated impacts to the stone. Fragments are then removed with wire baskets or micro-forceps

 

 

 

Video: Pneumatic lithotripsy: Breaking stones seen through the endoscope camera.

 

Full Screen: Run the video and click bottom right corner. Double click or ESC key to return

 

 

     

Please use our contact page for treatment enquiries and further information

 

 

____________________________________________________________________________________________________________________

 

 

 

 

 

HCA Healthcare UK, The Shard,  St Thomas' Street, London SE1 9BS 

Practice Secretary: Mrs Marzieh Sandi

tel  +44 (0)20 7403 3876  fax +44 (0)20 7357 6824 e: mark.mcgurk@salivary-gland.co.uk

Consulting Sessions: Monday PM, Thursday AM/PM at The Shard

 

 Contact  Form

 

 

 

Copyright   2017 Mark McGurk

 

Home Page        Tumours    Strictures      Stone       Ranulae    Other Developments     Events

 

website: Orchid Software Tuition, Jersey  44 (0) 7797 838252