Intra-oral parotid duct exploration and ductoplasty for large parotid duct stones: how we do it

Salivary duct stones are a common occurrence, most frequently found in the submandibular gland. A smaller proportion of stones can be found in the parotid system (5%–10%). Saliva drains from the parotid gland via Stensen's duct, which emerges from the anterior surface of the parotid gland, superficial to the masseter muscle. At the anterior border of the masseter muscle, it pierces the buccopharyngeal fascia and continues in the submucosa to enter the oral cavity at the papilla lateral to the second upper molar. It is approximately 4-cm long, with a diameter of 2–3 mm.

Sialoendoscopy has gained popularity over the past number of years to extract proximal duct stones, however, larger impacted stones may not be amendable to this approach and pose a clinical dilemma for surgeons. For these patients a trans-facial approach may be advocated, or even a parotidectomy can be required. Both of these approaches can be challenging and are significantly invasive, not least associated with cosmetically unsightly scars and also a risk of facial nerve injury.

This article demonstrates an alternative approach of intra-oral parotid duct exploration and ductoplasty technique for large impacted parotid duct stones. This technique is particularly suitable for difficult cases following unsuccessful sialoendoscopy, and as an alternative to the trans-facial approach.