Pull-through sialodochoplasty for Stensen's megaduct.

INTRODUCTION Obstructive parotid disease often causes significant discomfort and negative quality of life in patients who suffer from this condition. The disorder presents as intermittent, recurrent swelling and tenderness of the parotid gland made worse during meals. Salivary duct obstruction results in stagnation of saliva, often leading to recurrent bouts of parotitis. Although salivary stones are the most common cause of obstructive parotid disease, stenosis of Stensen’s duct is estimated to account for 15% to 25% of cases. Historically, treatment of Stenson’s duct stenoses has been difficult, with repeated blind dilation offering only temporary benefit. Many patients progressed to definitive management with parotidectomy. Currently, sialendoscopy allows better visualization of these stenoses and employs minimally invasive approaches to their management; however, parotidectomy continues to be offered in recurrent cases. In 2009, Koch et al. described three types of stenosis: inflammatory (type 1), fibrous with intraductal circular or web-like inclusions and moderate luminal narrowing (type 2), and fibrous with high-grade to complete obstruction (type 3). They also reported that due to a reservoir effect, type 2 stenoses have a tendency to form megaducts. Megaducts are defined as Stensen’s ducts with diameters exceeding 10 mm, often with thin walls that further contribute to the gland’s weak excretory force (Fig. 1). In addition to the obstructive symptoms, megaducts pose a cosmetic problem as they frequently appear as a bulge on the patient’s cheek, further reducing the patient’s quality of life. In a retrospective study conducted in 2014, Koch et al. found that patients with type 2 stenoses reported continued pain or other symptoms postsialendoscopy more frequently than patients with other types of stenosis, with an overall recurrence rate of 13.3%. The purpose of this report is to describe a novel approach to patients with symptomatic Stensen’s ductal stenosis with concurrent megaducts.