Extracorporeal lithotripsy (ECL) and interventional sialendoscopy are the classical treatments for Stensen's duct salivary stones, but some cases cannot be treated using these techniques. Another technique is now available, transoral Stensen's duct approach.
Transoral Stensen's duct approach can be performed under local anesthesia. The exact location of Stensen's duct is confirmed after introduction of a 0000 probe (Storz®) in the duct that is stopped by the impacted stone. This may be confirmed on preoperative noninjected CT-scan. During this approach, the surgeon passes the mucosa and buccinator muscle, tracts the buccal fat pad laterally, and then finds the duct. During this procedure one must avoid harming the superior buccal branch of the facial nerve by dissecting gently close to the duct. When the duct is found, the stone is easily removed with a ductal lateral incision or better 12 o'clock ductal incision.
Transoral approach of Stensen's duct salivary lithiasis is an easy, fast, and inexpensive technique that can be recommended in case sialendoscopy surgery fails. Morbidity for patients is much lower than that of classical parotidectomy.