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Multiple intraglandular sialolithiasis for stones deep in the glandular parenchyma may require submandibulectomies, especially if sialendoscopic facilities are unavailable. We describe a gland-sparing intraoral sialolithotomy approach for both hilar and intraparenchymal multiple sialoliths. Nine patients with obstructive sialadenitis resulting from multiple sialoliths in both the deep hilar region and the submandibular gland parenchyma were selected for this study. Ultrasonography and computer tomography (CT) scans were performed to determine the location, number and sizes of the calculi and the distance between hilar and intraparenchymal sialoliths. All sialoliths were removed via gland-sparing, intraoral sialolithotomy. In all, 27 stones were found in the 9 patients. The hilar and deeper sialoliths were 4.5–11 and 0.8–4.5 mm, respectively, in diameter. The largest distance between the hilar and intraparenchymal sialoliths was 28.3 mm. Sialoliths in the hilar region were excised through an intraoral incision before deeper intraparenchymal stones were eased out of the same incision site. Postoperative follow-up imaging verified complete sialolith removal. Therefore, submandibular gland multiple sialoliths in the hilum and parenchyma can be successfully removed via an intraoral sialolithotomy under general anesthesia, thereby preserving the gland and restoring its secretory function.

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We conclude that although an intact periosteum is ideal for the osteointegration of the DID fixture, adequate stability can still be achieved due to the sufficient anchorage accorded by the base screws in the apical cortex.

Purpose: This study investigated the stability and quality of life (QoL) outcomes of patients who received mandibular reconstructions with the anterolateral thigh perforator flap (ALTF) following tumor resection. Methods: Thirty-five patients with oral tumors that were resected and reconstructed with ALTF were included in this study. Volumetric analyses of each ALTF were performed at 6 to 18 months postoperatively. A QoL survey was also conducted 2 years postoperatively and compared by means of an independent-sample t test with 28 patients who had mandibular reconstructions with free fibula flap. Results: There were no significant volumetric changes in the ALTF or the QoL results of either group. Conclusions: Patients with advanced oral cancers have a higher risk of recurrence that mandates closer radiographic surveillance. This may be impaired by artifacts from metallic implants required in free fibula flap reconstructions. Anterolateral thigh perforator flap may be a viable alternative because it is easier for secondary resection, amenable for direct repairs, has volumetric stability, has a lower cost and results in a comparable QoL outcome.

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