A gland-sparing, intraoral sialolithotomy approach for hilar and intraparenchymal multiple stones in the submandibular gland

Abstract

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.

Treatment of Sialolithiasis: What Has Changed? An Update of the Treatment Algorithms and a Review of the Literature

“…After this, further developments took place that refined and combined the successful techniques. Very good results were reported after the application of TDS [ 30 , 31 , 32 , 33 , 34 , 35 , 36 ] and sialendoscopy-assisted TDS [ 37 , 38 , 39 , 40 , 41 ]. Several groups reported transoral robot-assisted extraction of deeply located and large submandibular sialoliths [ 42 , 43 , 44 ], also in combination with sialendoscopic assistance [ 45 , 46 ].…”

Concurrent giant sialoliths within the submandibular gland parenchyma and distal segment of Wharton’s duct: Novel case report

“…Anatomically, 53% of salivary stones of the submandibular gland complex have been found in the hilar/proximal region of Wharton's duct, 37% in the distal aspect of the duct and 10% within the gland parenchyma. 10 Multiple sialoliths of the submandibular gland typically cluster within the same subsection, and there are only a limited number of cases of concomitant sialolithiasis within the hilar/proximal duct and the intraglandular region 11,12 or ipsilateral distal and proximal segments of Wharton's duct. 13 To the best of our knowledge, the featured patient represents the first recorded account of coexistent giant sialoliths within the ipsilateral submandibular gland parenchyma and distal region of Wharton's duct.…”

“…Use of computed tomography and CBCT scans, sialoendoscopy, magnetic resonance imaging and high-resolution ultrasonography may be helpful for localisation of the site of the sialolith, diagnostic corroboration and optimal selection of the surgical approach. 11,25 Sialoliths have an estimated growth rate of 1-1.5 mm/year. 26 With regard to the patient in this report, it appears that the parenchymal sialolith had increased in size by about 45% within 3 years, averaging 2.4 mm per year.…”

Tratamento cirúrgico de sialolito intraglandular: relato de caso

“…Os sialolitos são facilmente palpáveis nas porções periféricas dos ductos salivares e comumente expelidos, de forma espontânea, por meio da pressão exercida pela saliva retida, caso o volume e/ou textura do cálculo seja favorável. Como se tratava de uma lesão intraglandular, a excreção espontânea da lesão não poderia ocorrer, sendo necessário um planejamento cirúrgico mais invasivo 12 .…”