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Resumen Introduccion No existen modelos de entrenamiento previamente descritos para aprender o ensenar como extraer litiasis de los conductos salivales. Es por ello que presentamos un novedoso modelo de simulacion que nos permite representar fielmente el proceso de extraccion endoscopica de litiasis mediante sialoendoscopia. Materiales y metodos Se desarrollo un modelo de simulacion utilizando la cabeza de un cerdo, se utilizaron esferas de omeprazol para simular la existencia de litiasis en los diversos conductos de cada glandula salival y se utilizo una cesta Dormia para entrenar la extraccion del modelo de litiasis. Resultados Veintisiete residentes en formacion y/o jovenes especialistas han entrenado con exito esta tecnica utilizando este modelo. Veintiseis (96,3%) consideraron util el modelo para entrenar el uso de cestas, siendo todos ellos capaces de capturar la esfera de omeprazol en el conducto salival. Se obtuvo un porcentaje de satisfaccion mediante una encuesta anonima de 92,25 sobre 100 puntos. Conclusion Describimos un novedoso modelo de simulacion mediante esferas de omeprazol, que permite al cirujano practicar como realizar el diagnostico y tratamiento de la enfermedad obstructiva de glandulas salivales en un entorno libre de riesgos, garantizando la reproducibilidad de la tecnica en condiciones similares a las de la practica habitual.

Resumen Introduccion La lesion del nervio facial continua siendo la complicacion mas grave de la cirugia de la glandula parotida. Debido a la creciente evidencia sobre las ventajas del uso de la monitorizacion intraoperatoria del nervio facial, se distribuyo una encuesta entre los miembros de la Sociedad Espanola de Otorrinolaringologia y Cirugia de Cabeza y Cuello con el objetivo de determinar los patrones de uso en nuestro medio. Material y metodos Se distribuyo un cuestionario que incluia 12 preguntas separadas en 3 secciones en formato e-mail a traves del correo oficial de la Sociedad Espanola de Otorrinolaringologia y Cirugia de Cabeza y Cuello. La primera seccion de preguntas evaluaba las caracteristicas demograficas, la segunda seccion estaba relacionada con el patron de uso de los sistemas de monitorizacion intraoperatoria del nervio facial y la tercera seccion se referia a los litigios relacionados con la paralisis facial. Resultados Se enviaron un total 1.544 cuestionarios anonimos. Recibimos un total de 255 encuestas, para una tasa de respuesta global del 16,5%. De estos, 233 (91,3%) realizaban cirugia de glandula parotida y 94% usaban monitorizacion intraoperatoria del nervio facial. Un 94% de los encuestado usaba la monitorizacion intraoperatoria del nervio facial si realizaba menos de 10 parotidectomias por ano y un 93,8% si realizaban mas de 10 parotidectomias por ano (OR, 1,02; IC del 95%, 0,68-1,45; p = 0,991). Conclusion Nuestros datos demuestran que la mayoria de los otorrinolaringologos y cirujanos de cabeza y cuello en Espana estan empleando la monitorizacion del nervio facial durante la cirugia de la glandula parotida. Casi todos coinciden en que esto busca mejorar las medidas de seguridad quirurgica y consideran que la monitorizacion del nervio facial es util para prevenir lesiones inadvertidas.

Introduction Facial nerve injury remains the most severe complication of parotid gland surgery. Due to the increasing evidence about the advantage of the use of intraoperative facial nerve monitoring, a survey was distributed among members of the Spanish Society of Otorhinolaryngology-Head and Neck Surgery with the objective of determining patterns of its use. Material and methods A questionnaire which included 12 separate questions in 3 sections was distributed via email through the official email of the Spanish Society of Otorhinolaryngology-Head and Neck Surgery. The first section of questions was in relation to demographic characteristics, the second section was related to the pattern of monitoring use and the third section referred to litigation related to facial palsy. Results 1544 anonymous questionnaires were emailed. 255 surveys were returned, giving an overall response rate of 16.5%. From these, 233 (91.3%) respondents perform parotid gland surgery. Two-hundred nineteen (94%) respondents use intraoperative facial nerve monitoring. Of the respondents,94% used intraoperative facial nerve monitoring if in their current practice they performed fewer than 10 parotidectomies per year and 93.8% if they performed more than 10 (OR, 1.02; 95% CI, 0.68−1.45; p = .991). With regard to lawsuits, just 3 (1.2%) of the respondents had a history of a parotid gland surgery–associated lawsuit and in just one case the facial nerve monitor was not used. Conclusion Our data demonstrate that most otolaryngologists in Spain use intraoperative facial nerve monitoring during parotid gland surgery. Almost all of them use it to improve patient safety and consider that facial nerve monitoring should be helpful preventing inadvertent injury.

Antecedentes y objetivo: En la infección por SARS-CoV-2 la pérdida repentina del olfato y/o gusto han sido descritas como síntomas iniciales. El objetivo principal de este estudio es conocer la prevalencia de estos síntomas en España. Materiales y métodos: Estudio prospectivo de pacientes con COVID-19 confirmado mediante RT-PCR en España. Se utilizaron los cuestionarios traducidos y validados. Resultados: Un total de 1043 pacientes COVID-19 leve. Edad media de 39 ± 12 años. 826 pacientes (79,2%) refirieron algún grado de alteración del olfato, 662 (63,4%) pérdida total y 164 (15,7%) parcial. 718 pacientes (68,8%) notaron alteración del gusto. Hubo una asociación significativa entre ambos trastornos (p

There are no previously described training models for learning or teaching how to remove lithiasis from the salivary ducts. Therefore, we present a new simulation model to enable us to faithfully represent the process of endoscopic lithiasis extraction by sialoendoscopy.A simulation model was developed using a pig's head, omeprazole spheres were used to simulate lithiasis in the various ducts of each salivary gland and a Dormia basket was used to train in extraction of the lithiasis model.Twenty-seven residents in training and/or young specialists were successfully trained in this technique using this model. Twenty-six (96.3%) considered the model useful for training in the use of baskets; all of them were able to capture the omeprazole sphere in the salivary duct. A satisfaction rate of 92.25 out of 100 points was obtained through an anonymous survey.We describe a novel simulation model using omeprazole spheres, which allows the surgeon to practice how to diagnose and treat obstructive pathology of the salivary glands in a risk-free environment guaranteeing the reproducibility of the technique in conditions similar to those of normal practice.

Introduction:Sialolithiasis is the most common cause of symptomatic obstructive sialadenitis. Sialendoscopy represent a minimally invasive technique that has evolved significantly in the last 2 decades, with high success rates in managing sialolithiasis and allowing gland preservation. Lithotripsy assisted or not by laser represents the fragmentation of stone or lithiasis within the salivary duct followed immediately by removal of the fragmented pieces. Material and Methods: A systematic review investigating the role of laser-assisted lithotripsy with sialendoscopy (LAS) in the treatment of sialolithiasis was performed.Results:Sixteen papers meet inclusion criteria. The mean maximum diameter of lithiasis was 7.11 mm (min: 2 mm/max: 17 mm; standard deviation [SD]: 2.33; 95% CI = 1.573-4.463). Success rate described ranging from 71% to 100% with a mean of 87.3% (SD: 7.21; 95% CI: 5.326-11.158) and the gland preservation rate was 97%. Considering only “non retrievable–non floating stones” studies that include both parotid and submandibular stones: Eight clinical retrospectives, nonrandomized studies and 1 prospective, nonrandomized study report results from parotid and submandibular gland lithiasis. According to this, the most common gland involved was the submandibular gland (n = 153; 65.1%), in comparison to the parotid gland (n = 82; 34.8%).Conclusion:The current evidence supports LAS as a conservative, efficient, safe, and gland-preserving alternative technique, in experienced hands, for management of mid-size sialolith removal from major salivary glands, when the indication is appropriate.

Although lithiasis represents more than 60% of all cases of salivary gland obstruction, only 20% occurs in the Stensen´s duct. Nonetheless, the potential complications related to parotid gland surgery due to facial nerve injury, makes the development of minimally invasive techniques highly relevant. A pilot study was conducted to assess results of patients treated by sialendoscopy-assisted trans-oral approach to treat Stensen´s duct lithiasis. Eight patients were included; all of them operated satisfactorily. Six of them were male, and 2 were female. The mean size of the stones was 9.6 mm (Min: 6 mm/Max: 16 mm). Regarding to lithiasis location: it was anterior to the masseter line in the distal third of the Stensen’s duct in seven patients and in another patient was immediately below the buccinator muscle. During the follow-up, all patients presented a healthy functioning of the gland after the compressive massage. Regarding complications, one patient presented a Stensen’s duct stenosis, which required reintervention. The transoral Stensen´s duct approach represents a safe technique for lithiasis bigger than 3 mm in the distal portion of the Stensen´s duct, anterior to the Masseter Muscle line and when other minimal invasive techniques fail.

Introduction: Twenty percent of the total lithiasis that affect a major salivary gland will be found in the parotid gland. An exclusive sialoendoscopic approach has achieved success rates close to 80%. In a significant percentage of these remaining cases, combined transfacial approaches assisted by sialendoscopy are presented as an option to be taken into account. Patients and Methods: A prospective analysis of cases treated by combined transfacial approach assisted by sialendoscopy for lithiasis of the parotid gland and the impact of the facial nerve stimulator used during surgery. Results: Five patients were included; all of them operated satisfactorily. In 4 of them, the approach proposed by McGurk and modified by Capaccio was used, and in 1 of them, the approach proposed by Nahlieli was used. We suffered a complication in just case due to the appearance of postoperative sialocele. Conclusion: According to our results and those previously published, the transfacial approach assisted by sialendoscopy can be considered a useful technique. Proper planning ensures an optimal result in the treatment of parotid gland lithiasis. The use of facial nerve stimulator guarantees extra security when working near to a branch of the facial nerve is suspected.

Introduction: Sialolithiasis is the most common pathology in the submaxillary gland. The introduction of minimally invasive techniques isolated or associated with sialoendoscopy is replacing glandular resection as a treatment. The conservation of the gland is justified by the recovery of function and a low recurrence rate. The rate of complications is lower in conservative techniques than in submandibular gland resection. Patients and Methods: Thirty-three patients with fixed stones in the hilum of the submaxillary gland were treated by transoral sialolitectomy between July 2015 and July 2018, demographic data of the patients such as the number of stones, size, time of hospital stay, complications, pre- and postoperative lingual nerve function, and lithiasis recurrence were collected. Results: The average volume of the stones was 1.02 cm. Complete removal of the stone was possible in 32 patients. All the patients were operated in the outpatient clinic. Seven (21%) patients reported some degree of alteration of the lingual nerve function, of which the only one presented a persistence of more than 4 weeks due to an inadvertent injury that required a microsurgical anastomosis. Conclusions: Transoral sialolitectomy is a reproducible technique with good results and lower complication rates than submandibular gland resection. Our results in the first 33 cases encourage us to maintain the combined techniques as standard in the treatment of submaxillary sialolithiasis. Current experience guides the definitive substitution of submandibular gland resection by conservative techniques in obstructive pathology.

Introduction The treatment of salivary obstructive pathology by minimally invasive techniques has been an object of assessment by different studies for decades. Lithiasis at the level of the salivary duct will be the most frequent cause of obstruction, representing more than 50% of the pathology of the major salivary glands and almost 80% of these affecting the Wharton duct. Material and methods A Prospective study comparing the results of combined transoral sialolitectomy and open submaxillectomy techniques by cervicotomy in 2 groups of patients treated by lithiasis at the level of the hilum of the submaxillary gland. Results 22 patients were included in the study 16 (72.7%) were men and 6 (27.3%) were women, the average age was 54.41 years ± 12.75 (Min: 30/Max: 77). Regarding the variables associated with the disease: average lithiasis, size of the stone, hospital stay, lingual nerve alteration or complications for both techniques, differences were not found between both groups. There were only statistically significant differences in the average stay in favor of the STA (P = .001). Conclusion The minimally invasive approaches to the salivary ductal system, associated or not with sialoendoscopy, can be efficacy and can be associated with lower number of complications. The natural tendency should be aimed to gradually replacing open sialoadenectomy techniques, reserving its indication for the treatment of tumor pathology.