Endoscopic litectomy: optimizing the management of sialolithiasis

Sialolithiasis of the salivary glandular complex appears with high frequency in the major salivary glands. The most affected salivary gland is the submandibular gland, followed by the parotid and sublingual glands. The treatment of this disease by endoscopic litectomy has reduced the need of adenectomy.

We reviewed retrospectively a series of 77 patients who had salivary gland stones between January 2020 and January 2024. Inclusion criteria for endoscopic treatment was lithiasis smaller than 8 mm. Follow-up was performed at a week, one month and three months after the surgery by clinical examination with a mean follow-up of 17 months and CT in selected cases.

Treatment was successful in 69 cases, while in 8 patients the treatment failed, with a successful extraction of the stone in 89.61% of patients. A total of 74 stones were removed from 69 patients. The mean stone size was 6.68 mm (range 3 to 8 mm), located mainly in hilum (n=61, 75.60%), median duct (n=14, 17.07%) and retrocaruncular (n=6, 7.31%). Adenectomy, due to failure of the procedure, was performed in 10 patients, 7 in patients due to lack of recovery of the sialolith and in 3 patients due to postoperative stenosis after removal of the sialolith. Complications involved 6 patients with the presence of stenosis after the lithectomy procedure, in 3 patients it was resolved with endoscopic dilation and in the other 3 an adenectomy was necessary.

Minimally invasive intraoral surgery has high success rate, contributes to reduce the need for glandular radical surgery with a low rate of severe complications.