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. 2025 Mar 28;14(7):2338.
doi: 10.3390/jcm14072338.

CT Navigation-Assisted Transfacial Removal of Parotid Stones: Does It Work?

Michele Gaffuri  1   2 , Ludovica Battilocchi  1   2 , Matteo Lazzeroni  3   4 , Lorenzo Pignataro  1   2 , Pasquale Capaccio  3   4
Affiliations

CT Navigation-Assisted Transfacial Removal of Parotid Stones: Does It Work?

Michele Gaffuri et al. J Clin Med. .

Abstract

Background/Objectives: The failure rate of minimally invasive surgical approaches to parotid stones is about 10%, primarily due to the presence of large, impacted, or unpalpable deep stones. When stones are palpable and exceed 7 mm in size, a combined transfacial and sialendoscopic approach offers a safe and effective surgical option, while unpalpable and impacted stones located in the parenchyma, not visible or accessible through sialendoscopy, can be treated with a CT-guided transfacial approach. Methods: Twenty-two patients (three females, mean age 53 years, range 32-73 years) underwent CT navigation-assisted transfacial removal of unpalpable and impacted parotid stones at the Department of Otolaryngology and Head and Neck Surgery of Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico of Milan between 2017 and 2024. Results: The mean size of the stones was 7.4 mm (range 4-14 mm), while the mean depth of stones, calculated as the distance from the skin surface, was 8.7 mm (range 4-14 mm). Stones were removed successfully in all but five patients (77% success rate). Failure of the procedure was significantly associated (p < 0.05) with the depth of the stone (>12 mm); in all these cases, patients were treated immediately by means of traditional parotidectomy. Conclusions: The CT-navigation-assisted transfacial approach can be considered a safe, reliable, and efficacious option for the treatment of difficult unpalpable parotid stones, impacted and deeply located in the gland parenchyma. Stones deeper than 10 mm can be more effectively treated by means of traditional parotidectomy if extracorporeal lithotripsy is not available.

Keywords: CT navigation assisted; endoscopy assisted; minimally invasive technique; parotid stones; sialolithiasis.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Before surgery, DICOMs were imported on iPlan CMF software (Brainlab, Munich, Germany) to set up the optical-based navigation system of the operating room.
Figure 2
Figure 2
Optical-based navigation was used to locate the stone in the gland parenchyma (a–c).
Figure 3
Figure 3
Stone position was marked on the skin surface.
Figure 4
Figure 4
A blunt dissection, guided by the navigation system, allowed the exposure of the parotid gland and the subsequent exact localization of the stone as visualized on the display.
Figure 5
Figure 5
The duct was then incised and opened under navigation guidance and the stone removed.
See this image and copyright information in PMC

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References

    1. Koch M., Schapher M., Mantsopoulos K., von Scotti F., Goncalves M., Iro H. Multimodal treatment in difficult sialolithiasis: Role of extracorporeal shock-wave lithotripsy and intraductal pneumatic lithotripsy. Laryngoscope. 2018;128:E332–E338. - PubMed
    1. Overton A., Combes J., McGurk M. Outcome after endoscopically assisted surgical retrieval of symptomatic parotid stones. Int. J. Oral Maxillofac. Surg. 2012;41:248–251. doi: 10.1016/j.ijom.2011.10.010. - DOI - PubMed
    1. McGurk M., MacBean A.D., Fan K.F., Sproat C., Darwish C. Endoscopically assisted operative retrieval of parotid stones. Br. J. Oral Maxillofac. Surg. 2006;44:157–160. doi: 10.1016/j.bjoms.2005.03.026. - DOI - PubMed
    1. Nahlieli O., London D., Zagury A., Eliav E. Combined approach to impacted parotid stones. J. Oral Maxillofac. Surg. 2002;60:1418–1423. - PubMed
    1. Baurmash H., Dechiara S.C. Extraoral parotid sialolithotomy. J. Oral Maxillofac. Surg. 1991;49:127–132. doi: 10.1016/0278-2391(91)90098-7. - DOI - PubMed