Learning Progression in the Use of Sialendoscopy for Sialolithiasis

Abstract

Objective Evaluate how learning progression affects outcomes for the use of sialendoscopy for sialolithiasis. Study Design Case series with chart review. Setting Academic tertiary care center. Subjects and Methods A retrospective chart review was conducted on 81 patients presenting with sialolithiasis between 2008 and 2012 who underwent surgical intervention on 85 salivary glands. Outcomes compared between the first 43 and subsequent 42 consecutive glands included successful removal, surgical method, and need for further intervention. Results For the first 43 patients (group A), mean age was 47.3 years (range, 15-77), and 44.2% were male. For the second 38 patients (group B), mean age was 49.9 (range, 23-76), and 50% were male. Mean stone size was similar in both groups; 8.3 versus 7.6 mm, respectively. In cases of stone visualization and removal, complete removal without gland excision was accomplished in 78.4% of cases in group A versus 94.3% in group B ( P = .04). Endoscopic removal occurred in 24.3% of patients in group A, versus 45.8% in group B. A combined approach was used in 54.1% of patients in group A versus 48.6% in group B. In group A, 18.9% underwent gland removal as part of initial intervention versus 0% in group B ( P = .007). Overall gland preservation was 81.4% in group A versus 97.6% in group B ( P = .015). Conclusion This study documents the effect of learning curve on sialendoscopy for the management of sialolithiasis. With experience, the success of sialendoscopy increases with a significant decrease in the number of gland excisions.