Long-Term Outcomes of Surgical Management for Submandibular Sialolithiasis: Gland Resection Versus Preservation

Describe long-term outcomes of submandibular sialolithiasis treatment, comparing gland-preserving procedures to gland resection.

This retrospective cohort study with prospective patient-reported outcome assessment study included all patients who underwent initial surgical management of submandibular sialolithiasis by a single surgeon from 2013 to 2018. Patients were contacted in 2024 and surveyed regarding treatment response. The primary outcome was xerostomia at long-term follow-up, measured using the Xerostomia Questionnaire (XQ). Secondary outcomes included stone recurrence, postoperative complications, and "ultimate surgical success," defined as resolution of salivary symptoms without additional interventions during the 5-to-10-year interval following the initial series of procedures. Eighty-two patients were identified; 36 (43.9%) completed follow-up.

Of 36 respondents (median follow-up 97.4 months), 11 (30.6%) underwent initial gland resection and 25 (69.4%) underwent initial gland-preserving, sialendoscopy-assisted procedures. Among the preservation group, 1 patient required a second gland-preserving procedure, and 3 ultimately underwent gland removal due to persistent symptoms. Resolution of symptoms after the first procedure occurred in all resection patients (100%) and 18 of 25 (72%) in the preservation group. Among those with preserved glands at follow-up (n = 22), 6 (27.3%) reported xerostomia (mean XQ 8.0) compared to 4 of 14 (28.6%) in the resection group (mean XQ 3.4). Ultimate surgical success was achieved in 90.9% of the preservation group and 100% of the resection group.

Both surgical approaches offer durable outcomes, though gland preservation may carry a higher risk of persistent symptoms and potential need for additional intervention. Xerostomia rates were comparable, suggesting gland preservation does not necessarily reduce long-term xerostomia risk.

OCEBM Level 4.