A comparison of parotid imaging characteristics and sialendoscopic findings in obstructive salivary disorders.

OBJECTIVES/HYPOTHESIS To examine how preoperative imaging characteristics correlate with sialendoscopic findings and operative outcomes in patients with obstructive parotid symptoms. STUDY DESIGN Retrospective review. METHODS We identified 112 consecutive patients who underwent 134 unilateral or bilateral parotid gland sialendoscopies between December 2005 and August 2013. We reviewed clinical history, radiographic imaging and reports, operative reports, and clinical outcomes. Available preoperative computed tomography (CT) or magnetic resonance imaging (MRI) were analyzed for parotid stone size and location relative to the masseter muscle. RESULTS For patients with parotid stone on preoperative imaging, at least one stone was found on sialendoscopy in 63% of cases. In contrast, for all cases with preoperative imaging negative for stone, no stone was found on sialendoscopy suggesting that parotid stones are not radiolucent on CT imaging. Furthermore, stones located anterior to the masseter were more successfully visualized on sialendoscopy compared to stones located posterior to the masseter. Anteriorly located stones were also more accessible for endoscopic management, whereas posterior stones required combined approaches for management. CONCLUSIONS Preoperative imaging characteristics such as stone presence, size, and location provide essential information that can guide surgical planning and clinical outcome expectations for obstructive parotid disease management. All parotid CT scans that failed to demonstrate stones on imaging had no stone found on sialendoscopy. Stones posterior to the masseter muscle are the most difficult to access with sialendoscopy, and in these cases, patients should be counseled about the potential need for a transfacial approach to remove symptomatic stones. LEVEL OF EVIDENCE 2b.