Intraoral microscopic-assisted sialolithotomy for management of medium-large submandibular sialolithiasis: A refined...

Sialendoscopy has become the standard treatment for sialolithiasis; however, larger submandibular calculi may require an incisional technique. This study describes and evaluates an intraoral microscopic-assisted sialolithotomy (IMAS) as a refined submandibular stone extraction technique.

Retrospective case series of 64 submandibular IMAS procedures operated at a tertiary university center and private hospital from 2015 to 2021 were evaluated. Preoperative radiological assessment included noncontrast computed tomography scan ± magnetic resonance sialography. Stone characteristics (side, number, size, and location), operative findings, complications, and postoperative follow-up were reviewed. Success was defined as successful intraoral stone extraction with no symptoms or stone recurrence for at least 12 months postoperatively.

The study included 43 males and 19 females, mean age 38 ± 12 years. Two patients had bilateral stones. All but one operated gland had stones extracted (98.4%), however the true success was 93.8% (60/64) as three patients had recurrent/residual stones within a year. Biggest stone longest diameter was 9.8 ± 4.6 mm (range, 5-30 mm). Hilar and intraglandular stone locations were 73.4% and 6.3%, respectively. Median operative time was 55 min. Adjunctive sialendoscopy was performed in 42.2%. Its use is significantly correlated with having ˃3 stones (mean 3.4 vs. 1.2 stones) [P < 0.001, 95% confidence interval: -3.19 to -1.25]. Minor complications included temporary lingual paresthesia (7.8%) and postoperative ranula (1.6%).

Submandibular IMAS is a highly effective safe technique for stones (≥5 mm). The improved microscopic visualization, illumination and magnification allows addressing all stone locations including intraglandular calculi and enables better lingual nerve identification and preservation.