Ultrasound-guided transfacial approach in the surgical management of impacted parotid stones: Beyond sialendoscopy.

Parotid lithiasis represent a frequent cause of salivary obstruction, especially complex when it involves the proximal third of Stensen's duct or when the stones are large than 7 mm. Although sialendoscopy have optimized its management, there are cases where these techniques fail or are unavailable. The ultrasound-guided transfacial approach emerges as a minimally invasive alternative. This retrospective study conducted between February 2024 and February 2025 aims to describe the technique and outcomes of ultrasound-guided transfacial surgery in a tertiary care centre. Adults with stones ≥7 mm, located in the proximal third of Stensen's duct, secondary branches, or glandular parenchyma, who underwent surgery in a tertiary care centre and had at least 6 months of follow-up, were included. A total of 9 procedures were performed in 8 patients (6 women, 2 men), with a mean age of 58 ± 13 years. The mean stone size was 9.22 ± 1.92 mm. Stones were mainly located in the main duct (6 cases), secondary branches (2 cases), and glandular parenchyma (1 case). The mean surgical time was 51 ± 14 min. No conversions to parotidectomy were required, and no facial nerve injuries were recorded. There was one case of salivary fistula, which resolved conservatively in 21 days. All patients preserved normal glandular function and reported aesthetic satisfaction. Our results suggests that the ultrasound-guided transfacial approach is safe, effective, and reproducible for treating large or proximal parotid stones, offering results comparable to combined techniques but without requiring complex equipment or radiation. It is a useful alternative in centres where sialendoscopy or lithotripsy is unavailable or has failed.