Procedure allows for removal of salivary stones with minimal scarring

A new procedure is becoming rapidly popular with many to remove calcified masses in the salivary glands with minimal scarring.

For 32-year-old civil engineer Akhil Chauhan, planning and problem-solving for a variety of projects is all in a day's work. But one problem he never knew he had a problem, showed up on a dental visit.

"He took x-rays of my full mouth," said Chauhan, "and then he saw this calcified mass thing."

The calcified mass was a stone, the size of an olive, deep in Chauhan's salivary gland. Standard procedure was to remove the stone and the gland through an incision in his neck.

"I was worried about having a scar like after the surgery," said Chauhan.

Louisiana State University (LSU) head and neck surgeon doctor Rohan Walvekar offered him a much less invasive alternative. Walvekar is pioneered a procedure that merges miniaturized endoscopy with surgical robotics to remove even large, deeply-imbedded stones without open surgery.

"What we did is use salivary endoscopy to document and identify the location of the stone," said Walvekar. Then, we use the robot to do the dissection in the mouth."

Walvekar believes that the 3-D imaging, endoscopic magnification and the precision of the robotic arms help improve visibility and accuracy.

"My assistants can do a better job because they're seeing what I'm doing, and I get a three-dimensional view," said Walvekar.

Less than one year after Chauhan's salivary stone surgery, there's no visible sign he had surgery at all.

In recent years, endoscopy has become a more viable option for removal of small salivary stones. However, for very large stones or for those located deep in the salivary glands, accessing the stones, even with endoscopy, can be extremely difficult.

Thanks to its early success, Walvekar's new robotic approach is attracting patients and surgeons from all over the United States.

Research Summary:
Removing The Stone Growing In Your Mouth

Background: Salivary duct stones are a type of salivary gland disorder. The stones are crystallized minerals in the ducts that drain the salivary glands. The painful stones are caused when chemicals in the saliva crystallize into a stone that can block the salivary ducts. When saliva is unable to exit a blocked duct, it backs up into the gland and causes pain and swelling of the gland. Salivary stones most often affect the back of the mouth on both sides of the jaw, but they can also affect glands on the sides of the face.
(SOURCE: MedlinePlus)

Symptoms: Salivary stones can create extreme pain in the mouth. The symptoms can range from difficulty opening the mouth or swallowing to pain in the face and mouth to dry mouth. Some people will also experience facial or neck swelling. While the stones can cause a large amount of discomfort, they are not dangerous and can be removed with minimal discomfort.
(SOURCE: MedlinePlus)

Treatment: If a person experiences repeated stones or infections, the affected salivary gland may have to be surgically removed. Physicians and dentists can use a number of techniques to try and remove the stone. The dentist may be able to push the stone out, or the stone may be surgically cut out. Oftentimes, the stone can be flushed out just by increasing the flow of saliva. Doctors can stimulate the flow of saliva by giving the patient sour candy or citrus and combining it with fluids and a massage.

About the doctor: In November 2010, Dr. Rohan Walvekar, from LSU Health Sciences Center, reported the first use of a surgical robot guided by a miniature salivary endoscope to remove a salivary stone. Dr. Walvekar was able to remove a 20 mm salivary stone and repair the salivary duct. This new technique not only saves the salivary gland, but it also reduces blood loss, scarring, and hospital stay time.
Salivary endoscopes allow surgeons to remove the stone while preserving the gland. The endoscopes improve surgical view, exposure, and magnification of the surgical field using a two-dimensional view. The robotic units produce high-definition, three-dimensional images.
(SOURCE: LSU Health Sciences Center)

For more information, please contact:
*Leslie Capo, Media Relations
LSU Health Sciences Center
(504) 568-4806
LCapo@lsuhsc.edu


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