1. Open Parotid Approaches Lab Preparation Missouri Sialendoscopy Course Columbia, Missouri April 17, 2015 Henry Hoffman MD MS 3,000+ page handout with videos/photos: search for “Iowa Protocols” search: “Sialendoscopy Course LSU 2015”

2. H Hoffman --- Disclosures -- Consultant to COOK Medical -- research in laryngology, surgical management of salivary disorders and other ENT applications -- The University of Iowa Research Foundation (UIRF)and Dr. Hoffman filed a provisional patent application April 11 2013 “Transilluminating Obturator” UIK-04301 -- The University of Iowa Research Foundation and Dr. Hoffman filed a patent application March 25 2009 (US Patent) and March 19 2010 (International Patent: CT/US2010/027995) “Arytenoid Repositioning Device” Portions of possible future profits from devices associated with these patents will be disbursed through the UIRF with Henry Hoffman listed as one of the recipients Missouri Sialendoscopy Course Columbia, Missouri April 16, 2015 Henry Hoffman MD MS

4. Future of Sialendoscopy in the Management of Salivary Disorders Sialendoscopy as an adjunct Improved Equipment

6. Gonzalez RD, Whiting BM, and Canales BK: The History of Kidney Stone Dissolution Therapy: 50 Years of Optimism and Frustration with Ranacidin J Endourol. Feb 2012;26(2):110-118 “In the future, it is likely that irrigations of the urinary tract with various solutions designed to dissolve stones will be an important part of the practice of urology. Arthur R. Israel, 1981 “Any urologist who treats stone disease should be familiar with the fundamentals of chemolysis and its potential role in the management of urinary calculi” Arthur D. Smith 2000 Adjuvant medical therapy: Radioiodine sialadenitis: pre-treatment sialendoscopy with duct dilation and instillation of amifostine/steroids/pilocarpine Sjogren’s syndrome: sialendoscopy for dilation with instillation of steroid/immune modulators Stone debulking and dissolution – citrates/magnesium; maintenance programs after removal

7. Adjuvant treatment - High degree of elemental similarity between sialoliths and nephroliths – ‘whether prescription drugs used in the conservative management of sialolithiasis should be investigated -oral prescription of magnesium and citrate supplements could be simple and convenient medical management for preventing recurrence after removal of sialoliths by minimally-invasive surgery, such as sialendoscopy23 or extracorporeal shockwave lithotripsy.5 Oral Biosciences Ultrastructural and elemental analysis of sialoliths and their Comparison with nephroliths Nagaraju Rakesh, Yashoda Devi Bhoomareddy Kantharaj, Manjushree Agarwal& Kunal Agarwal Journal of Investigative and Clinical Dentistry(2014),5, 32–37

8. Sialendoscopy as an adjunct Sialendoscopy used to identify and preserve the submandibular duct in resection of plunging ranula

9. Sialendoscopy as an adjunct Sialendoscopy used to ensure no retained ductal stones after sialadenectomy

10. Sialendoscopy as an adjunct Sialendoscopy used to identify and preserve the parotid duct in resection of accessory lobe

11. Future of Sialendoscopy Improved Equipment Smaller Durable Better optics Better baskets (one wire loop) Better dilators (smaller) Scissors (MERS, other) Stents New operations (restore valve – pneumoparotitis) Combined imaging with treatment (fluoroscopy) More working channels (urologic scopes with two working channels)

12. Open Approaches to Parotid Stones Iowa Protocols Easy: “Combined Open” https://wiki.uiowa.edu/pages/viewpage.action?pageId=9 1508369 Hard: https://wiki.uiowa.edu/display/protocols/Parotid+stone+ and+polyp+removal+through+open+approach Complication: https://wiki.uiowa.edu/display/protocols/Complication+f rom+open+(transfacial)+approach+to+parotid+stone+re moval?src=search

13. Lab Cadaver Dissection Parotid duct (Stensen’s duct) cannulation dilation, sialendoscopy Identify duct through open approach (preauruicular) identify buccal branches of VII and duct open duct (retrograde, actually antegrade sialendo) Intraoral incision for ductoplasty follow duct as far through buccal space as possible