Glandular function after intraoral removal of salivary calculi from the hilum of the submandibular gland

Abstract

We studied 43 patients (25 women and 18 men) who had salivary calculi removed from the hilum of the submandibular gland. Preoperatively they had clinical and radiographic examinations, and glandular function was measured scintigraphically in 38 patients. Postoperative follow-up was based on history, clinical examination, structured questionnaire, and scintigraphy. Stone(s) were removed successfully in 42 patients (97%). During the follow-up of a mean of 24 months (range 4-47), 37 patients were symptom-free and 2 patients had mild obstructive symptoms that did not require intervention. The other 4 patients had repeated infections that necessitated removal of the gland under general anaesthesia. Preoperative and postoperative scintigraphic assessments were made in 37 patients (88%). There was a significant increase in the functional fraction and the excretion rate in the gland after removal of the calculus. We conclude that glandular function improves to varying degrees in most patients after the removal of a salivary calculus.

Transoral removal of hiloparenchymal submandibular calculi: a long-term clinical experience

“…Successful stone retrieval was achieved in all but one of the patients. This result is in line with other results [2,12,15,17,18]. The only failure was represented by intraparenchymal calculi, very adherent to gland tissue.…”

“…US and colour US were performed in patients with a minimum postoperative follow-up of 36 months: the restoration of the normal appearance of the ductal system and gland parenchyma was observed in most of the cases examined, conWrming the histopathological and scintigraphic assumption that obstructive sialadenitis is a reversible condition [15]. As US is unable to adequately evaluate microliths less than 1.5 mm [20] a postoperative videosialoendoscopic check of the treated gland should be done, but this is only sometimes possible due to patient, time and cost factors.…”

“…The treatment of choice for large or Wxed stones is endoscopic-assisted intra-oral removal of stones [12,13]. The follow-up of patients undergoing conservative treatment for submandibular gland calculi may be assessed clinically, scintigraphically [15], or by ultrasound [16]. The clinical outcome is diYcult to standardize as criteria vary in the literature.…”

“…The clinical outcome is diYcult to standardize as criteria vary in the literature. Scintigraphic examination has demonstrated a variable improvement in glandular function in most patients after stone removal [15]. Ultrasonography (US) is also an amenable and simple method of assessing duct and parenchymal architecture.…”

Submandibular giant sialoliths—2 case reports and review of the literature

“…The key question is whether or not a gland with such a stone has suffered irreparable functional damage. While experimental studies show extensive regeneration of the glandular parenchyma after prolonged ligation of the excretory duct of the submandibular gland [20], clinical studies have shown satisfactory return to normal functioning of the salivary glands in a vast majority of patients with transoral removal of the stone alone [21][22][23][24]. However, factors such as glandular infection, calculus diameter and patient's age can infl uence the recovery of function [25].…”