Otolaryngologic Clinics of North America RSS feed: Current Issue. Otolaryngologic Clinics of North America updates you on the latest trends in patient management; keeps you up to date on the newest advances; and provides a sound basis for choosing treatment options. Each issue focuses on a single topic in otolaryngology and is presented under the direction of an experienced guest editor.http://www.oto.theclinics.com/?rss=yesElsevier Inc.en © 2009 Published by Elsevier Inc. All rights reserved. Otolaryngologic Clinics of North America0030-6665426December 2009 © 2009 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.oto.theclinics.com/article/PIIS0030666509001674/abstract?rss=yesContents10.1016/S0030-6665(09)00167-4Otolaryngologic Clinics of North America 42, 6 (2009)2009-12-01Otolaryngologic Clinics of North America2009-12-01426S0030-6665(09)X0006-Xvxihttp://www.oto.theclinics.com/article/PIIS0030666509001686/abstract?rss=yesForthcoming Issues10.1016/S0030-6665(09)00168-6Otolaryngologic Clinics of North America 42, 6 (2009)2009-12-01Otolaryngologic Clinics of North America2009-12-01426S0030-6665(09)X0006-Xxiixiihttp://www.oto.theclinics.com/article/PIIS0030666509001352/abstract?rss=yes The contributors to this issue are dedicated to a better understanding of salivary gland disease and the advancement of minimally-invasive means of diagnosis and treatment. They are at the forefront of knowledge and experience in the field of sialendoscopy and lithotripsy. By sharing their experiences in this book-sized collection of articles, a review of the present-day breadth of these fields can be gained from one source. From queries into the initiation of pathologic salivary processes to improved patient treatment techniques, knowledge that previously would have taken much time to garner is assembled in this issue for the readers.Preface: Salivary Endoscopy and LithotripsyMichael H. Fritsch10.1016/j.otc.2009.08.017Otolaryngologic Clinics of North America 42, 6 (2009)2009-12-01Otolaryngologic Clinics of North America2009-12-01426S0030-6665(09)X0006-Xxiiixivhttp://www.oto.theclinics.com/article/PIIS003066650900139X/abstract?rss=yesThis article presents a brief literature review of sialendoscopy and lithotripsy highlights from journal articles and presentations spanning from 1953 to 2009. Seventy-seven sources were reviewed for this article.Sialendoscopy and Lithotripsy: Literature ReviewMichael H. Fritsch10.1016/j.otc.2009.09.001Otolaryngologic Clinics of North America 42, 6 (2009)2009-12-01Otolaryngologic Clinics of North America2009-12-01426S0030-6665(09)X0006-X915926http://www.oto.theclinics.com/article/PIIS0030666509001170/abstract?rss=yesUncertainty about the causes and natural history of salivary stones (sialoliths) and other obstructions is being dispelled by clinical and experimental research. Sialoliths are now shown to be secondary to chronic obstructive sialadenitis. Microscopic stones (sialomicroliths) accumulate during secretory inactivity in normal salivary glands and produce atrophic foci by obstruction. Microbes ascend the main salivary duct during secretory inactivity and proliferate in atrophic foci and cause spreading inflammation, leading to inflammatory swelling and fibrosis that can compress large ducts. This leads to stagnation of secretory material rich in calcium that precipitates onto degenerating cellular membranes to form a sialolith.Causes, Natural History, and Incidence of Salivary Stones and ObstructionsJohn D. Harrison10.1016/j.otc.2009.08.012Otolaryngologic Clinics of North America 42, 6 (2009)2009-12-01Otolaryngologic Clinics of North America2009-12-01426S0030-6665(09)X0006-X927947http://www.oto.theclinics.com/article/PIIS0030666509001194/abstract?rss=yesThe advent of sialoendoscopy techniques presents new challenges in the diagnostic imaging of the salivary glands. This article reviews the different diagnostic imaging approaches for work-up of patients before sialoendoscopy. The relative advantages and disadvantages of each technique and guidelines for application of the different techniques are discussed.Diagnostic Radiographic Imaging for Salivary EndoscopyKristine M. Mosier10.1016/j.otc.2009.08.010Otolaryngologic Clinics of North America 42, 6 (2009)2009-12-01Otolaryngologic Clinics of North America2009-12-01426S0030-6665(09)X0006-X949972http://www.oto.theclinics.com/article/PIIS0030666509001200/abstract?rss=yesUltrasound investigation of the major salivary glands has been routinely used for the past 25 years. Ultrasound provides an immediate diagnosis in acute or chronic inflammatory salivary diseases and can visualize sialolithiasis as small as 0.4 mm. Ultrasound is also an important imaging modality for salivary gland tumors, guiding fine needle aspiration (FNA) for cytological diagnosis. It is particularly sensitive in detecting suspicious lymph nodes in the neck and helps to guide FNA. Ultrasound is a first-line tool for diagnosis of salivary pathology. It is simple to use, noninvasive, and well tolerated, even in children.Clinical Ultrasound of the Salivary GlandsPhilippe Katz, Dana M. Hartl, Agnès Guerre10.1016/j.otc.2009.08.009Otolaryngologic Clinics of North America 42, 6 (2009)2009-12-01Otolaryngologic Clinics of North America2009-12-01426S0030-6665(09)X0006-X9731000http://www.oto.theclinics.com/article/PIIS0030666509001212/abstract?rss=yesTechnical developments have taken place since the first endoscopes suitable for sialendoscopy appeared. Now, a variety of endoscopes are available. Ranging from rigid to flexible, each type has its own properties. Light sources, imaging, recording instrumentation, and other equipment used with the endoscopes facilitate or extend the range of their use. Experiences using different endoscopes in more than 300 endoscopies are discussed.Technology of SialendoscopyUrban W. Geisthoff10.1016/j.otc.2009.08.008Otolaryngologic Clinics of North America 42, 6 (2009)2009-12-01Otolaryngologic Clinics of North America2009-12-01426S0030-6665(09)X0006-X10011028http://www.oto.theclinics.com/article/PIIS003066650900125X/abstract?rss=yesWhen basic surgical principles are followed diagnostic salivary endoscopy is a relatively safe operative procedure. Therapeutic sialendoscopy uses such instrumentation as lasers, forceps, baskets, and balloons for endoductal fragmentation, retrieval, and dilatation. Based on experience acquired from more than 300 salivary endoscopy procedures and a review of the current literature, the most relevant operative techniques are presented.Basic Sialendoscopy TechniquesUrban W. Geisthoff10.1016/j.otc.2009.08.004Otolaryngologic Clinics of North America 42, 6 (2009)2009-12-01Otolaryngologic Clinics of North America2009-12-01426S0030-6665(09)X0006-X10291052http://www.oto.theclinics.com/article/PIIS0030666509001224/abstract?rss=yesThis article presents and discusses advanced minimally invasive sialoendoscopy and combined methods: endoscopy, endoscopic-assisted techniques, and external-lithotripsy combined procedures. It also presents rare situations and complications encountered during sialoendoscopic procedures. Sialoendoscopy is a relatively novel technique, which adds significant new dimensions to the surgeon's armamentarium for management of inflammatory salivary gland diseases. Because of the rapid development in minimally invasive surgical techniques, surgeons are capable of more facilely treating complicated inflammatory and obstructive conditions of the salivary glands.Advanced Sialoendoscopy Techniques, Rare Findings, and ComplicationsOded Nahlieli10.1016/j.otc.2009.08.007Otolaryngologic Clinics of North America 42, 6 (2009)2009-12-01Otolaryngologic Clinics of North America2009-12-01426S0030-6665(09)X0006-X10531072http://www.oto.theclinics.com/article/PIIS0030666509001182/abstract?rss=yesMinimally invasive alternatives for treatment of salivary duct obstruction are discussed. Radiologically- and endoscopically-guided interventions using wire baskets and dilating balloons, including cutting balloons, are covered as are combined endoscopic and open approaches.Alternatives for the Treatment of Salivary Duct ObstructionMark McGurk, Jackie Brown10.1016/j.otc.2009.08.011Otolaryngologic Clinics of North America 42, 6 (2009)2009-12-01Otolaryngologic Clinics of North America2009-12-01426S0030-6665(09)X0006-X10731085http://www.oto.theclinics.com/article/PIIS0030666509001406/abstract?rss=yesJuvenile recurrent parotitis (JRP) can be a debilitating illness in children. Knowing how to recognize and diagnose it for early treatment avoids recurrences that could lead to significant destruction of the glandular parenchyma. This article discusses the various therapeutic modalities proposed in the literature (medical treatment or sialendoscopy) and describes the authors' treatment of choice of combining antibiotics and iodinated oil sialography.Treatment of Juvenile Recurrent ParotitisPhilippe Katz, Dana M. Hartl, Agnès Guerre10.1016/j.otc.2009.09.002Otolaryngologic Clinics of North America 42, 6 (2009)2009-12-01Otolaryngologic Clinics of North America2009-12-01426S0030-6665(09)X0006-X10871091http://www.oto.theclinics.com/article/PIIS0030666509001236/abstract?rss=yesSalivary gland preservation during treatment for obstructive duct and gland problems is a goal worth pursuing. Difficult cases may seem to be candidates for sialadenectomy. However, progress in endoscopic and open-surgical procedures can help the physician to find solutions that overcome difficult problems without removing the gland. Broader application of these sialendoscopic and open preservation procedures may be especially useful for physicians without access to extracorporeal lithotriptors.Sialendoscopy Strategies for Difficult CasesMichael H. Fritsch10.1016/j.otc.2009.08.006Otolaryngologic Clinics of North America 42, 6 (2009)2009-12-01Otolaryngologic Clinics of North America2009-12-01426S0030-6665(09)X0006-X10931113http://www.oto.theclinics.com/article/PIIS0030666509001248/abstract?rss=yesThe traditional treatment for sialolithiasis was extirpation of the affected gland. It is now known, however, that salivary gland function can recover completely after stone extraction alone. Since the mid-1980s, much thought has been given to treating sialolithiasis with extracorporeal or intracorporeal shock waves in a manner similar to that used for urinary tract or biliary tract stones, and this has been implemented successfully. This article provides an overview of the various methods of extracorporeal and intracorporeal lithotripsy that have been used or proposed for salivary calculi to date, considering the advantages and disadvantages of each of the techniques.Extracorporeal and Intracorporeal Lithotripsy of Salivary Gland Stones: Basic InvestigationsJohannes Zenk, Michael Koch, Heinrich Iro10.1016/j.otc.2009.08.005Otolaryngologic Clinics of North America 42, 6 (2009)2009-12-01Otolaryngologic Clinics of North America2009-12-01426S0030-6665(09)X0006-X11151137http://www.oto.theclinics.com/article/PIIS0030666509001261/abstract?rss=yesOver the past 20 years, development of minimally invasive therapies has led to the use of extracorporeal shock wave lithotripsy (ESWL) to treat salivary stones. The two main energy sources are piezoelectric and electromagnetic extracorporeal lithotripsy. Both have the aim of fragmenting the stones. ESWL is considered the treatment of choice for all parotid calculi and submandibular perihilar or intraparenchymal stones of less than 7 mm. Continuous ultrasonographic monitoring during the procedure reduces the number of untoward effects. The main limitations are the need for multiple sessions and residual stone fragments inside the duct system.Extracorporeal Lithotripsy Techniques for Salivary StonesPasquale Capaccio, Sara Torretta, Lorenzo Pignataro10.1016/j.otc.2009.08.003Otolaryngologic Clinics of North America 42, 6 (2009)2009-12-01Otolaryngologic Clinics of North America2009-12-01426S0030-6665(09)X0006-X11391159http://www.oto.theclinics.com/article/PIIS0030666509001169/abstract?rss=yesSalivary gland ductal obstructions are common, being the most frequent nonneoplastic salivary disorders in adults. Salivary calculi are the main cause of obstruction. Traditional and invasive transcervical sialadenectomy is still the most widely used treatment for perihilar and intraparenchymal obstructive salivary diseases worldwide despite the well-known morbidity related to its functional, neurologic, and aesthetic sequelae. However, improved radiologic imaging, better optical systems and endoscopic devices, and the introduction of minimally invasive therapeutic options have allowed the development of conservative gland-preserving techniques for managing salivary gland obstructions, including extracorporeal shock wave lithotripsy, operative sialoendoscopy, video-assisted transoral and transcervical stone removal, and ductal rehabilitation through interventional radiology and sialoendoscopy. Through adopting a minimally invasive and multimodal policy, a significant number (74%–100%, technique dependent) of salivary calculi can be safely and successfully retrieved while leaving an intact and functional salivary gland system. Only 2% to 5% of patients require gland excision. However, long-term follow-up evaluations of obstructive symptom recurrence are needed before the ultimate benefits of a gland-preserving conservative approach and the residual role of adenectomy can be assessed.The Role of Adenectomy for Salivary Gland Obstructions in the Era of Sialendoscopy and LithotripsyPasquale Capaccio, Sara Torretta, Lorenzo Pignataro10.1016/j.otc.2009.08.013Otolaryngologic Clinics of North America 42, 6 (2009)2009-12-01Otolaryngologic Clinics of North America2009-12-01426S0030-6665(09)X0006-X11611171http://www.oto.theclinics.com/article/PIIS0030666509001273/abstract?rss=yesTreatment of obstructive diseases of the major salivary glands has undergone a dramatic change in the last 10 to 15 years. New minimally invasive techniques have been developed, covering all different entities that are included in the complex of salivary gland obstruction, and can help the physician to find the right diagnosis and an adequate treatment plan and to perform a gland-preserving form of therapy. Sialolithiasis or stenosis is the cause of about 90% of all obstructive salivary gland diseases. The development of radiologically or fluoroscopically controlled methods, but especially the introduction of sialendoscopy, has led to changes in the treatment protocol. Knowledge from the authors' experience and from a thorough investigation of the literature has been combined to elaborate algorithms for the treatment of the different obstructive diseases of the salivary glands. Sialoliths and stenoses can be successfully treated by radiologically or fluoroscopically controlled or sialendoscopically based methods in approximately 80% of cases. Extracorporeal shock-wave lithotripsy (ESWL) is successful in up to 50% of cases. Transoral duct slitting is an important method for extraparenchymal submandibular stones, with a success rate of 90%. Operative duct procedures and the combined endoscopic-transcutaneous approach complete the spectrum of treatment modalities of the parotid gland. Sialendoscopy plays a central role in the treatment of obstructive salivary gland diseases, but maximum success can only be attained by the reasonable combination of all these new minimally invasive techniques. Altogether, in well over 95% of cases, resection of the gland can be prevented, thus reducing morbidity and the surgical risks for patients.Algorithms for Treatment of Salivary Gland ObstructionsMichael Koch, Johannes Zenk, Heinrich Iro10.1016/j.otc.2009.08.002Otolaryngologic Clinics of North America 42, 6 (2009)2009-12-01Otolaryngologic Clinics of North America2009-12-01426S0030-6665(09)X0006-X11731192http://www.oto.theclinics.com/article/PIIS0030666509001285/abstract?rss=yesAlgorithms for treatment of salivary stones for physicians without access to an extracorporeal lithotriptor are proposed. Strategies for stones of different sizes and for salivary duct stenoses and strictures are discussed.Algorithms for Treatment of Salivary Gland Obstructions Without Access to Extracorporeal LithotripsyMichael H. Fritsch10.1016/j.otc.2009.08.001Otolaryngologic Clinics of North America 42, 6 (2009)2009-12-01Otolaryngologic Clinics of North America2009-12-01426S0030-6665(09)X0006-X11931197http://www.oto.theclinics.com/article/PIIS0030666509001388/abstract?rss=yesIncisionless Otoplasty surgery for lop (protuberant) ears has evolved through three major steps in technique since its inception in 1992. Improvement was seen with each progressive technical advance. The previously published 2.0 version of 2004 has undergone evolution to streamline placement of the percutaneous retention sutures. The new 3.0 version technique greatly reduces the number of operative steps required. In this article, technical instructions for the 3.0 version are explained, and multiple applications of the 3.0 procedure and the 2.0 are illustrated.Incisionless OtoplastyMichael H. Fritsch10.1016/j.otc.2009.09.003Otolaryngologic Clinics of North America 42, 6 (2009)2009-12-01Otolaryngologic Clinics of North America2009-12-01426S0030-6665(09)X0006-XBonus Article - Facial Plastic Surgery11991208http://www.oto.theclinics.com/article/PIIS0030666509001340/abstract?rss=yesEndoscopic surgery of the inner ear may be a useful, minimally invasive approach to remove pathologic lesions and yet retain inner ear function. Several different endoscopic inner ear surgical entry sites and strategies that may help to preserve otologic function are described. These endoscopic surgical method alternatives are based on temporal bone studies, prior literature, and clinical patient experiences. Endoscopic inner ear surgery is a challenging, but potentially very useful method to address inner ear problems.Endoscopy of the Inner EarMichael H. Fritsch10.1016/j.otc.2009.08.018Otolaryngologic Clinics of North America 42, 6 (2009)2009-12-01Otolaryngologic Clinics of North America2009-12-01426S0030-6665(09)X0006-XBonus Article - Otology - Neurotology Surgery12091222http://www.oto.theclinics.com/article/PIIS0030666509001698/abstract?rss=yesIndex10.1016/S0030-6665(09)00169-8Otolaryngologic Clinics of North America 42, 6 (2009)2009-12-01Otolaryngologic Clinics of North America2009-12-01426S0030-6665(09)X0006-X12231229