Introduction: Transsphenoidal surgeries imply the risk of intraoperative lesions to the neurovascular structures surrounding the sphenoid sinus (SS). Aim of the present study is to assess the metrical and morphologic relationships existing between SS and sella turcica (ST). Materials and Methods: Two hundred computed tomography-scans of patients were selected. For each patient volumes of SS were calculated from their 3-dimensional models segmented through ITK-SNAP program. Variants of SS in pneumatisation and sellar diameters [antero-posterior (AP) diameter, depth, and length] were evaluated on each computed tomography-scan. Correlations among different measurements were assessed through Spearman test (P<0.01), whereas associations between sellar parameters and presence of pneumatisation variants were assessed through Mann-Whitney test (P<0.01). Results: In males, pneumatization of the greater wings was related to smaller AP diameter (P<0.01) and depth of ST (P<0.01), whereas in females lower values of depth were found in patients with pneumatization of the pterygoid processes (P<0.01). In both sexes, a positive correlation was found between AP diameter and, respectively, length and depth of ST (P<0.01), together with a negative correlation between volume of SS and depth of ST (P<0.01). Lastly, in females a positive correlation was found between age and, respectively, length and depth of ST (P<0.01). Conclusions: The present study highlighted new metrical and morphologic relationships between volume and pneumatisation of SS and diameters of ST. Knowledge of these correlations allows to understand more clearly, in the preoperative setting, the surgical working space. Further studies are needed, especially for what concerns the relationship between sellar measurements and age in females.

The recent diffusion of transoral robotic surgery has prompted its application not only in the oropharyngeal and hypopharyngeal-laryngeal fields, which are the anatomical sites of major use of the method, but also in the oral floor for the removal of tumours and other diseases affecting the salivary glands, such as sialothiasis. This study aims to assess the safety and efficacy profiles of transoral robotic surgery compared to traditional transoral procedures for the treatment of submandibular stones. PubMed, Embase, and Web of Science were searched for studies reporting on traditional or robotic transoral surgery for submandibular stones. As recommended by the PRISMA guidelines, proportion meta-analysis was performed on a random-effects model. The present review was registered on PROSPERO (CRD42024522199). A total of 2520 participants from 23 studies were included. The selected patients had a mean age of 44 years (range 5-87), with 48 % of them being female. Transoral robotic surgery had a success rate of 95.7 % (95 % CI 90.9-99.0), higher than traditional transoral approaches (success rate 92.6 %; 95 % CI 89.3-95.4). Transient stupor of the lingual nerve was observed more frequently in robotic surgeries (15.8 % vs 8.1 %). However, no reports of permanent injury to the lingual nerve were found. Transoral robotic surgery is a valid treatment option for submandibular stones. Due to the high costs of the procedure, strict patient selection is mandatory.

Dysfunction of the masseter muscle may cause pathological kinking of the parotid duct leading to parotitis; MR sialography is a non-invasive radiological examination that allows to evaluate dynamically the ductal system of the parotid glands. In the present study we aimed to assess the relationships between Stensen’s duct and masseter muscle and their implications in the aetiopathogenesis of recurrent parotitis secondary to masseter muscle dysfunction. Forty-one patients with recurrent unilateral parotitis and nine with bilateral recurrent parotitis, all with a clinical suspicious of masseter muscle hypertrophy due to bruxism were enrolled. They underwent ultrasonography as a first line examination and then MR sialography and sialendoscopy. Different anatomical features were studied. Involved parotid glands had a wider duct compared to contralateral unaffected parotid glands of patients with recurrent parotitis (p = 0.00134); male subjects with parotitis had a longer duct compared to the salivary glands of healthy patients (p = 0.00943 for affected glands and p = 0.00629 for the contralateral). A concordance between the evidence of an acute duct angle during sialendoscopy and a wider duct in patients with parotitis was observed although not statistically significant. These initial findings suggest that the masticatory muscle dysfunction related to bruxism seems to condition alteration of parotid duct course and anatomy thus favouring the occurrence of recurrent parotitis. A specific diagnostic iter based on clinical evaluation, dynamic ultrasonography and MR sialography, is therefore, mandatory to confirm the relationship between masseter muscle anatomy and parotid duct anomalies; this is the premise for an adequate therapeutic approach to underlying masticatory muscle disorder.

Background/Objectives: The failure rate of minimally invasive surgical approaches to parotid stones is about 10%, primarily due to the presence of large, impacted, or unpalpable deep stones. When stones are palpable and exceed 7 mm in size, a combined transfacial and sialendoscopic approach offers a safe and effective surgical option, while unpalpable and impacted stones located in the parenchyma, not visible or accessible through sialendoscopy, can be treated with a CT-guided transfacial approach. Methods: Twenty-two patients (three females, mean age 53 years, range 32–73 years) underwent CT navigation-assisted transfacial removal of unpalpable and impacted parotid stones at the Department of Otolaryngology and Head and Neck Surgery of Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico of Milan between 2017 and 2024. Results: The mean size of the stones was 7.4 mm (range 4–14 mm), while the mean depth of stones, calculated as the distance from the skin surface, was 8.7 mm (range 4–14 mm). Stones were removed successfully in all but five patients (77% success rate). Failure of the procedure was significantly associated (p < 0.05) with the depth of the stone (>12 mm); in all these cases, patients were treated immediately by means of traditional parotidectomy. Conclusions: The CT-navigation-assisted transfacial approach can be considered a safe, reliable, and efficacious option for the treatment of difficult unpalpable parotid stones, impacted and deeply located in the gland parenchyma. Stones deeper than 10 mm can be more effectively treated by means of traditional parotidectomy if extracorporeal lithotripsy is not available.

Objectives: Sublingual ranulas present diagnostic and therapeutic challenges due to their heterogenous clinical presentations. This systematic review and meta-analysis aims to synthesise treatment outcomes and proposes a new classification for this condition.Methods: Following PRISMA guidelines, a thorough literature search identified studies on patients with sublingual ranulas receiving medical or surgical treatment. Proportion meta-analysis compared success rates among studies using a random-effects model.Results: Forty-two studies were included, covering 686 endoral ranulas, 429 plunging ranulas, and 16 ranulas extending into the parapharyngeal space. Sublingual sialoadenectomy with or without pseudocyst wall excision showed low heterogeneity and the highest success rates. Consequently, a new classification system is proposed categorising ranulas by intraoral (Type 1), cervical (Type 2) or parapharyngeal space (Type 3) extension.Conclusion: This study confirms the role of sublingual gland resection as standard of care and highlights the need for a revised classification to improve patient outcomes.