Transoral Sialolitectomy as an Alternative to Submaxilectomy in the Treatment of Submaxillary Sialolithiasis

Abstract

Introduction: Sialolithiasis is the most common pathology in the submaxillary gland. The introduction of minimally invasive techniques isolated or associated with sialoendoscopy is replacing glandular resection as a treatment. The conservation of the gland is justified by the recovery of function and a low recurrence rate. The rate of complications is lower in conservative techniques than in submandibular gland resection. Patients and Methods: Thirty-three patients with fixed stones in the hilum of the submaxillary gland were treated by transoral sialolitectomy between July 2015 and July 2018, demographic data of the patients such as the number of stones, size, time of hospital stay, complications, pre-and postoperative lingual nerve function, and lithiasis recurrence were collected. Results: The average volume of the stones was 1.02 cm. Complete removal of the stone was possible in 32 patients. All the patients were operated in the outpatient clinic. Seven (21%) patients reported some degree of alteration of the lingual nerve function, of which the only one presented a persistence of more than 4 weeks due to an inadvertent injury that required a microsurgical anastomosis. Conclusions: Transoral sialolitectomy is a reproducible technique with good results and lower complication rates than submandibular gland resection. Our results in the first 33 cases encourage us to maintain the combined techniques as standard in the treatment of submaxillary sialolithiasis. Current experience guides the definitive substitution of submandibular gland resection by conservative techniques in obstructive pathology.

Transoral Robotic Surgery in the Management of Submandibular Gland Sialoliths: A Systematic Review

“…Furthermore, according to our analysis, the mean sialolith size was greater than that reported in the literature regarding the sialolith excision via the non-robotic transoral technique [5,7,8,10,11,[32][33][34]. With the increase in the sialolith size, the necessity of tactile feedback diminishes, which facilitates the robotic removal of SMG stones.…”

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

“…With this research, we pretend to confirm that the hilar transoral submandibular sialolitectomy (TOSL) is the best treatment option for SHL [ 5 , 6 , 12 , 13 ]. To that end, precise information regarding status of glandular parenchyma, persistence of lithiasis, evaluation of duct recanalization and the impact on the patient's quality of life will be provided.…”

“…There have been a number of justifications for the removal of salivary gland, including the fact that COS invariably alters the glandular parenchyma's functionality and the potentially simple development of new calculi [ 5 ]. Furthermore, submandibular gland excision, which is a well-standardized technique, has no remarkable negative impact on patients' quality of life.…”

“…Despite ongoing debate, a transoral approach with or without sialendoscopy assistance is recommended to resolve symptomatic, impacted, and palpable SHL [ 5 – 13 ]. Additionally, it has been demonstrated to have high success rates, few side effects, and a low recurrence rate [ 5 , 7 , 8 , 14 ].…”

“…Most authors do not propose suturing the duct opening following stone removal [ 5 , 8 , 10 , 15 ], due to the risk of possible post-surgical stenosis; nor do they recommend performing a sialodochoplasty, which is a new salivary opening in the floor of the mouth [ 6 ]. However, others perform sialodochoplasty, or the marsupialization of the duct, with very good results [ 11 ].…”