Algorithm changes in treatment of submandibular gland sialolithiasis

Abstract

Our research was conducted to determine the algorithm changes during the treatment of submandibular sialolithiasis. Two time periods were compared between 2004–2008 and 2009–2012. The turning point was December 2008, when sialendoscopy procedure was introduced. In the first period, 48 patients were treated: 31 outpatient duct incisions with stone evacuation and 17 surgical excision of submandibular gland. In the second period, 207 sialendoscopy procedures were performed on 197 patients. Out of this particular group, 158 patients were diagnosed with pathological obstruction of salivary glands and 64 of them were confirmed to have sialolithiasis of submandibular gland. Deposits of calcifications in 40 individuals (62.5 %) affected by sialolithiasis were removed endoscopically; however, in 21 patients, due to the increased circumference of the stone, the intimate association of deposits within the wall of the duct along with its presence inside the deep portions of the gland, double approach (incision of the floor of the mouth in hilar area and sialendoscopy) was performed. Three individuals had their salivary glands totally removed due to the presence of calcified deposits within the glandular parenchyma. Our results allow us to affirm that sialendoscopy is the current treatment of choice for submandibular glands affected by sialoliths. Indication for a complete removal of the gland is becoming uncommon as a first line treatment although still indispensable in chosen cases.

Sialendoscopy under local anaesthesia

“…There are no agreements or official recommendations concerning the anaesthetic methods for sialendoscopy. It appears that many centres in Europe use LA or LAS [4,11,12], whereas GA is generally favoured in the USA [5,13,14]. It seems logical that minor procedures in the head and neck region should be safer under LA, but we did not find comparative studies to support this.…”

Effectiveness and costs of sialendoscopy in pediatric patients with salivary gland disorders

“…Studies have shown variable rates of sensitivity and specificity with ultrasound, but there is consensus that, in experienced hands, ultrasound can identify stones down to 1.5 mm . The current gold standard for diagnosis of sialolithiasis remains the CT scan . Ultrasound and/or MRI have replaced sialography as imaging studies of choice for diagnosis of JRP .…”

Solitary parotid duct sialolith in a patient with Sjörgren’s syndrome: Report of a case

“…Once a diagnosis of sialolithiasis is made, effective treatment of the sialolith depends on the location of the stone, and is accomplished by extraoral or intraoral surgical removal of the sialolith (10)(11)(12). Removal of the affected salivary gland and its associated duct may also be necessary (10).Typically, calculi <2 mm in diameter can be treated without surgical intervention.…”

“…Removal of the affected salivary gland and its associated duct may also be necessary (10).Typically, calculi <2 mm in diameter can be treated without surgical intervention. Initial treatment options include oral analgesia (nonsteroidal antiinflammatory drugs or opiates in some cases), hydration, local heat, gland massage, sialogogues (ie, sour candy) to promote ductal secretions, and discontinuation of anticholinergic medications (11,12).…”