Transoral removal of submandibular hilar lithiasis: results on the salivary duct system, glandular parenchyma, and quality-of-life recovery

Abstract

Objective(s) To confirm that hilar transoral submandibular sialolitectomy (TOSL) is the first treatment option for submandibular hilar lithiasis (SHL) in terms of glandular parenchyma recovery, salivary system restoration, and patient quality of life (QoL) improvement. Methods Depending on whether the stone was easily palpable, TOSL was carried out with or without sialendoscopy. For the first time in the literature, Magnetic Resonance Sialography (MR-Si) was performed before and after TOSL, to evaluate stone characteristics, glandular parenchyma status, hilum dilation and main duct recanalization. Radiological data was examined independently by two radiologists. COSQ, a recently validated and specific questionnaire, was used to assess associated QoL. Results Between 2017 and 2022, 29 TOSL patients were examined. With a high interobserver correlation, MR-Si was confirmed as a very useful radiological test in the pre- and post-surgical evaluation of SHL. The salivary main duct was completely recanalized in all cases. The presence of lithiasis was found in 4 patients (13.8%). After surgery, the majority of patients (79.31%) had hilum dilation. There was a statistically significant improvement in parenchyma status, but no significant progression to glandular atrophy. After surgery, COSQ mean values always improved (22.5 to 4.5). Conclusions TOSL is the ideal surgical technique for the management of SHL, resulting in improved parenchymal inflammatory changes, recanalization of Wharton’s duct, and enhancement patients’ QoL. As a result, before removing the submandibular gland, TOSL should be considered as the first treatment option for SHL.

In‐office Transoral Hilar Sialolithotomy: A Cost‐Effective and Patient‐Centered Procedure

“…Hilar or intraglandular submandibular stones have traditionally been excised under general anesthesia either via sialendoscopy, transoral sialolithotomy, or even sialoadenectomy. [1][2][3] We describe a variation of in-office transoral technique to accomplish the same result with lesser cost and minimal recovery time. A key aspect of this procedure is the identification of the lingual nerve, which is moved medially to avoid injury while delivering the stone.…”

“…1 Management of sialolithiasis via transoral sialolithotomy has been shown to result in improved parenchymal changes, recanalization of Wharton's duct, and improvements in quality of life. [1][2][3] There have been increasing efforts across otolaryngology to perform in-office procedures with local anesthesia. Benefits include reduction of the time and economic costs imposed on patients as well as the inherent risks of undergoing general anesthesia.…”

“…4,5 For distal or mid-ductal stones, transoral sialolithotomy under local anesthesia is routinely performed; however, hilar or intraglandular stones have traditionally required general anesthesia for removal. [1][2][3] This case series aims to showcase the efficacy and efficiency of in-office transoral submandibular sialolithotomy for hilar and intraglandular stones. This novel practice, unique to the senior author (A.J.…”