Sialoendoscopy and the management of pediatric sialolithiasis

Pediatric sialolithiasis can be managed effectively through both intraoral approaches, including sialoendoscopy, and extraoral approaches, such as gland removal. This study assesses factors in the evaluation and management of salivary stones in children.

A descriptive retrospective study of patients diagnosed with sialolithiasis and treated with sialoendoscopy at a tertiary care pediatric hospital from October 2008 to August 2022 was conducted. Presenting symptoms at the time of diagnosis, the distribution of stone locations, size, and the method of stone removal based on stone location were evaluated.

Seventeen patients were included in the final review. All patients had salivary gland stones diagnosed through imaging or visualized intraoperatively. The most common presenting complaint of sialolithiasis was facial swelling (82 %). Eighty-eight percent had submandibular duct stones, and 11 % had parotid duct stones. 50 % of stones were proximal, 22 % were distal, 6 % were at the hilum, and 11 % intraglandular. Forty-seven percent of patients underwent stone removal via sialoendoscopy and intraoral incision, 35 % through sialoendoscopy alone, and 18 % required gland removal. Chi-square testing was performed to evaluate differences in removal rates based on the location of the stone. Among patients with submandibular gland stones, distal stones (100 %) were more likely to be removed via sialoendoscopy with or without an intraoral incision compared to proximal (75 %), hilar (0 %), and intraglandular stones (0 %) (p = 0.005). Proximal (25 %), hilar (100 %), and intraglandular (100 %) submandibular stones were more likely to require gland removal than distal stones (0 %) (p = 0.026).

The findings in this review suggest that distal stones in the submandibular gland are more likely to be removed via sialoendoscopy with an intraoral incision as opposed to proximal, hilar, and glandular stones, which were more likely to necessitate gland excision.