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Salivary Ultrasound Sonopalpation for Stone Favorable for Transoral Removal

last modified on: Fri, 02/09/2018 - 15:02

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see also: Salivary UltrasoundSalivary Ultrasound Sonopalpation for StoneSialodochoplasty complex with duct scarringSubmandibular Stone and Bartholin's duct

Modified Ultrasound Note

Procedure: Diagnostic ultrasound of the upper neck and salivary glands

Preop Diagnosis: Submandibular sialoadenitis with sialolithiasis

Postop Diagnosis: Same

Surgeon: xxxx  Assistant: xxxx​

Description of Procedure: Following identification the patient informed consent and a brief timeout the Toshiba Aplio 500 ultrasound with the 14 MHz probe was used to image the upper anterior neck with unremarkable anterior bellies of digastric mylohyoid genioglossus and sublingual glands identified

The right submandibular gland is identified with dilated hilar region measuring 29.5 x 18.1 x 30.4 mm with a heterogeneous nature to the gland with careful inspection demonstrating sialolith overlying the mid- to posterior aspect of the mylohyoid muscle with which digital palpation was identified at the mid ductal area well distal to the gland measuring 7.9 mm for stone size

The right parotid gland was evaluated as hyperechoic and homogeneous with

The left submandibular gland measuring 37.4 mm x 12.4 mm x 29.2 mm and seem to be hyperechoic and homogeneous

The left parotid gland was unremarkable with a hyperechoic homogeneous nature

 

Video of dynamic movement of sludge in the dilated hilum of gland. Distal (toward the floor of mouth) stone not imaged on this video. Click to begin

Modified Open Stone Removal/Sialendoscopy Op Note

Preop Dx: Right submandibular sialolithiasis and sialadenitis

Postop Dx: Same

Procedure: Right submandibular sialodochoplasty (complex) with

                        Partial right sublingual gland resection

                        Open approach to duct with marsupialization with 6-0 maxon

                        Removal of 1 cm right submandibular sialolith

                        Instillation of 3 cc of kenalog 10 to duct and gland

                        Right submandibular sialendoscopy

Surgeon: xxx  Asst: xxx

Anesthesia: General OETT

Findings: large right posterior-mid ductal stone removed through open transoral floor of mouth approach) as per photos below

P: peridex oral rinses 4 x/day; augmentin x 10 days; medrol dose pak

​Modified Dilation In-Clinic Procedure Note

Procedure: Cannulation with dilation of right submandibular duct (7 French Cook dilator) with microscopic control followed by Kenalog-10 infusion 2 cc
 
Preop Diagnosis: Status post right submandibular duct stone resection and open floor of mouth ductoplasty with duct narrowing
 
Postop Diagnosis: Same
 
Surgeon: xxxx   
Anesthesia: Topical 2% viscous lidocaine applied;  premedication with oral ingestion of Augmentin 875 mg
 
Description of Procedure: Following identification the patient informed consent and a brief timeout in the clinic room with the microscope with her in the supine position and the above-mentioned anesthesia the microscope was used to image the duct opening with photography taken.  The 0.015 inch guidewire was placed over which by the Seldinger technique a 7 French Cook dilator was positioned and kept in place for 3-4 minutes removed photographs taken Kenalog-10 instilled and the procedure terminated.  She tolerated the procedure well