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

Abstract

Traditional management of hiloparenchymal submandibular calculi is based on sialadenectomy. Recently, different minimally invasive and conservative techniques have been developed for the treatment of the submandibular calculi. We aimed to investigate the effectiveness of transoral surgical removal of large hiloparenchymal calculi by monitoring the trend for recurrence with clinical and ultrasonographic follow-up. A consecutive series of 84 patients with large (>7 mm) hilar or hiloparenchymal submandibular calculi underwent the transoral surgical removal under general anaesthesia. A video-assisted endoscopic procedure was performed in eight patients. All the patients underwent diagnostic ultrasonography and colour Doppler ultrasonography and clinical evaluation to define the exact location (hilar vs. parenchymal) and the diameter of the stone. The surgical procedure was successful in all but one of the patients. Stone recurrence was observed in 16 patients but obstructive symptoms were observed in only 12 patients during a median follow-up time of 52 months. The risk for recurrence was higher in patients who previously underwent extracorporeal shockwave lithotripsy. Conservative transoral removal of large hiloparenchymal submandibular calculi is a safe and effective surgical procedure. Future studies with longer follow-up will confirm the risk for recurrence of calculi.

Minimally invasive surgery of sialolithiasis using sialendoscopy

“…Sialolithiasis is one of the most common causes of major salivary gland inflammation [4,5]. Stones most frequently form in the submandibular gland (80%), with 20% occurring in the parotid gland [6,7].…”

Management of obstructive salivary disorders by sialendoscopy: a systematic review

“…McGurk, 200 6 Nahlieli, 200 7 Liu, 2009Walvekar, 20 09 Karavidas , 20 10 Koch, 201 0 Nahlieli, 201 0 Serbetci, 2010 Wall ace, 2010 Capaccio, 2011a Zenk, 20 12 Kopec, 201 3 Kopec, 2013a Ianovsk i, 2014 Phillips, 20 14 in the submandibular processes it is important to take this into account because the swelling may compromise the airway. Consequently, when bilateral procedures are done on the submandibular glands it is important to examine the gland and the oral cavity after the procedure on the first side to make sure that it is safe to operate on the other gland.…”

Sialendoscope-assisted transoral removal of hilo-parenchymal sub-mandibular stones: surgical results and subjective scores

“…It has been shown that trans-oral removal of large (> 7 mm) and deeply located submandibular stones 10 11 , the spread of which has been favoured by the development of interventional sialendoscopy, is safe and effective 11 , and highly successful in terms of stone removal and symptom relief 6 11 . A sialendoscope-assisted procedure is useful because the brightness can help in detecting any residual intraparenchymal stones after removal of the main HPSMS 12 , thus ensuring the complete clearance of the ductal system and eliminating symptoms of mealtime syndrome. On the basis of our previous findings 11 , it can be expected that only a small percentage of patients experience (often asymptomatic) stone recurrence, especially those previously treated by extra-corporeal shock wave lithotripsy (ESWL) in whom the parenchymal spread of micro-debris may not be detected by US or during surgical exploration through the oral hilo-parenchymal opening of the submandibular gland 13 14 .…”