Location Matters for Proximal Hilar Submandibular Stone Removal: Position Relative to the Mylohyoid

Area of Science:

• Otolaryngology
• Head and Neck Surgery
• Medical Imaging

Background:

• Sialolithiasis of the submandibular gland (SMG) can cause significant discomfort and obstruction.
• Proximal and hilar stones present unique challenges for minimally invasive removal.
• Sialendoscopy offers a gland-preserving approach but requires careful pre-operative assessment.

Purpose of the Study:

• To identify imaging predictors for successful sialendoscopy-assisted removal of proximal/hilar submandibular stones.
• To correlate CT imaging findings with sialendoscopy outcomes.
• To improve surgical planning for challenging SMG stones.

Main Methods:

• Retrospective cohort study of 76 patients with proximal/hilar SMG sialolithiasis.
• CT imaging analysis for stone size, number, location relative to the mylohyoid plane, and distance from the mandible.
• Correlation of imaging findings with sialendoscopy-assisted removal success rates.

Main Results:

• Successful sialendoscopy-assisted removal was achieved in 82.9% of cases.
• Stones located superior to or at the mylohyoid plane had higher success rates (100% and 84.6%) compared to inferior locations (60.0%).
• Larger stone diameter (8.0 mm vs. 5.4 mm) and shorter distance to the mandible were associated with successful removal (p<0.001).

Conclusions:

• Sialendoscopy-assisted transoral removal of proximal/hilar SMG stones often requires a combined approach (85.5%).
• Key imaging predictors for successful removal include stone position superior to/at the mylohyoid plane and larger stone size.
• CT imaging findings are crucial for effective surgical planning and patient selection for sialendoscopy.