Abstract
Multiple intraglandular sialolithiasis for stones deep in the glandular parenchyma may require submandibulectomies, especially if sialendoscopic facilities are unavailable. We describe a gland-sparing intraoral sialolithotomy approach for both hilar and intraparenchymal multiple sialoliths. Nine patients with obstructive sialadenitis resulting from multiple sialoliths in both the deep hilar region and the submandibular gland parenchyma were selected for this study. Ultrasonography and computer tomography (CT) scans were performed to determine the location, number and sizes of the calculi and the distance between hilar and intraparenchymal sialoliths. All sialoliths were removed via gland-sparing, intraoral sialolithotomy. In all, 27 stones were found in the 9 patients. The hilar and deeper sialoliths were 4.5–11 and 0.8–4.5 mm, respectively, in diameter. The largest distance between the hilar and intraparenchymal sialoliths was 28.3 mm. Sialoliths in the hilar region were excised through an intraoral incision before deeper intraparenchymal stones were eased out of the same incision site. Postoperative follow-up imaging verified complete sialolith removal. Therefore, submandibular gland multiple sialoliths in the hilum and parenchyma can be successfully removed via an intraoral sialolithotomy under general anesthesia, thereby preserving the gland and restoring its secretory function.
Highlights
Multiple intraglandular sialolithiasis for stones deep in the glandular parenchyma may require submandibulectomies, especially if sialendoscopic facilities are unavailable
We postulate that intraoral excision of palpable hilar stones could permit the passage of smaller intraparenchymal stones through the same incision site in tandem with extraoral gland massage when performed under general anesthesia, avoiding the need for submandibulectomies that are otherwise indicated in such instances
The results indicated that xerostomia and taste impairment are unspecific and atypical symptoms of obstructive salivary gland diseases
Summary
Multiple intraglandular sialolithiasis for stones deep in the glandular parenchyma may require submandibulectomies, especially if sialendoscopic facilities are unavailable. Nine patients with obstructive sialadenitis resulting from multiple sialoliths in both the deep hilar region and the submandibular gland parenchyma were selected for this study. Submandibular gland multiple sialoliths in the hilum and parenchyma can be successfully removed via an intraoral sialolithotomy under general anesthesia, thereby preserving the gland and restoring its secretory function. Koch et al reported that 34% of sialoliths are distributed in the distal duct (ductal stones), 57% within the hilum of the gland (hilar stones), and 9% in the gland parenchyma (intraparenchymal stones)[4]. Sialendoscopy and ESWL may not always be readily available due to the need for subspecialization training and the prohibitive costs of procurement and equipment maintenance Both treatment modalities could cause inadvertent fragmentation and retrograde displacement of ductal and hilar sialoliths deeper into the gland parenchyma. We postulate that intraoral excision of palpable hilar stones could permit the passage of smaller intraparenchymal stones through the same incision site in tandem with extraoral gland massage when performed under general anesthesia, avoiding the need for submandibulectomies that are otherwise indicated in such instances
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