Management of giant sialoliths: Review of the literature and preliminary experience with interventional sialendoscopy

Abstract

Our review reflects current treatment recommendations for giant stones, i.e., transoral sialolithotomy for ductal stones and gland resection for hilar glandular stones. Our preliminary experience with CA for giant stones suggests improved gland preservation rates (86% vs. 57%) independent of stone location and with preservation of salivary function.

Diagnostic and interventional sialendoscopy: A preliminary experience

“…We present a retrospective observational study of 33 patients who were treated at our institution. 6 Our goal was to report our initial experience and challenges faced with diagnostic and interventional sialendoscopy.…”

Robotic Surgery for Salivary Gland Disease

“…Larger (C8 mm) submandibular and parotid stones can be removed using the combined approach technique, which pairs stone localization by sialendoscopy with transoral or external removal of stone(s) [26, 27 •• , 28]. The combined approach technique has been shown to have a gland preservation rate of 86 % [23]. However, transoral removal of large submandibular stones can be complicated by hilar-glandular location of the stone, limited exposure of the proximal floor of the mouth due to reduced mouth opening, large teeth and obesity.…”

Submandibular Megalith: Case Report

“…Sialoliths are larger than 15 mm in length and 1 g in weight are called "Giant Stones" or "Megaliths" and have been rarely reported (7.6%) in the medical literature. 1,4,7,8 A salivary calculus develops by continuous deposition at a rate of approximately 1 to 1.5 mm per year, and it could be hypothesized that it could take at least 10 years to obtain a stone classified as megalith. 7,9 The ability of a calculus to grow and become a giant sialolith depends mainly on the affected duct's reaction.…”

“…1,4,7,8 A salivary calculus develops by continuous deposition at a rate of approximately 1 to 1.5 mm per year, and it could be hypothesized that it could take at least 10 years to obtain a stone classified as megalith. 7,9 The ability of a calculus to grow and become a giant sialolith depends mainly on the affected duct's reaction. When the sialolith is located in a duct able to dilate and to allow a normal secretion of salivary flow around the stone the sialolith might increase in size becoming a giant calculus and remain asymptomatic for a long period.…”