Removal of submandibular hilar stones using a sialendoscope and a high-definition endoscope: Our experience and...

Sialendoscopy is a minimally invasive approach that enables better visualisation of the salivary ductal system, as well as treatment of salivary stones. A high-definition endoscope (HDE) is excellent for observing deep areas of the oral cavity. We have used these two types of endoscopes for the treatment of submandibular hilar stones. The aim of this study was to review the treatment outcomes of sialendoscopy with/without an HDE for submandibular hilar stones in our patient population.

We conducted a retrospective review of 74 cases of submandibular hilar stones that were treated at our hospital. The following factors were investigated in these cases: age, gender, stone size, removal method, success rates, postoperative complications, and rate of improvement in symptoms postoperatively. Regarding the removal method, stone retrieval via the Wharton's duct using the sialendoscope was classified as sialendoscopy alone, while endoscopic stone removal using a transoral approach with the assistance of the sialendoscope was classified as the combined approach.

Median patient age was 35.5 years. There were 30 males and 44 females. Stone size ranged from 1 to 18 mm, with a median size of 6 mm. The stones were successfully removed transorally in 71 (96 %) of the 74 patients. Stone retrieval was performed by sialendoscopy alone in 10 cases, while a combined approach was required in the remaining 61 cases. Of these 61 cases, the stone location could be identified under a magnified view with HDE in 46 cases. In the remaining 15 cases, the stone location was identified by the simultaneous use of a sialendoscope and HDE. Regarding postoperative complications, ranula, transient lingual nerve paralysis and neck abscess were observed in three (4 %), two (2.7 %) and one (1.3 %) patient, respectively. In terms of the rate of symptom improvement, 67 of the 71 cases (94 %) in whom transoral stone removal was successful showed complete resolution of symptoms, while four cases (6 %) exhibited mild symptoms of obstruction.

Sialendoscopy is an effective method for removing submandibular hilar stones, with a low incidence of postoperative complications. Using an HDE during transoral surgery enhances its efficacy by aiding precise localisation of the stone, facilitating its removal and detecting residual fragments or stones.