Sialoendoscopy and the management of pediatric sialolithiasis.

Advantages of submandibular gland preservation surgery over submandibular gland resection for proximal submandibular stones

ABSTRACT: The Salivary stones and strictures are the most common cause of unilateral parotid or submandibular gland swelling. Traditionally, these patients treated by open surgery submandibular stones are still the most common cause of submandibular gland resection parotid gland resection is less frequent as it is major surgical procedure with postoperative complication like facial nerve paresis. The common cause of stone formation is obstruction, stricture formation leading to stasis of saliva, dehydration, change in salivary pH associated with oropharngeal sepsis. Over the last two decades, increasing awareness for minimally invasive treatment and with development of interventional radiological procedures for the management of obstructive sialadenitis has led to avoid surgical removal of gland and complications associated with surgery The interventional sialographic procedures can be used to remove salivary duct stones and is treatment of first choice in salivary duct strictures. For stone removal and stricture dilatation local anesthesia, I/V cannulas of different sizes, balloon dilators and wire baskets are used under fluoroscopy. The wire guided sialographic technique (1) is used for sialography and the I/V cannula used for sialography is used as access for interventional sialography. The stones in the intraglandular ducts, large stones and distal stones near the hilum of the gland are difficult to remove and the small size mobile stones can be easily removed. KEYWORDS: Salivary gland, Salivary stone, Salivary duct stricture, Salivary fistula, obstructive sialoadenitis, Interventional Sialography.

The submandibular gland is the second largest major salivary gland, which secretes 40% of the total daily saliva. Owing to its anatomic characteristics as well as the high viscosity and basicity of the saliva, sialolithiasis is found most commonly in the submandibular gland. Sia lolithiasis that cannot be treated by conservative treatment is conventionally removed by an excision of the submandibular gland. Generally, an excision o f the submandibular gland is performed via an extra-oral approach but the disadvantages of this treatment include a risk of injuring the facial ner ve and scar formation. Case reports have revealed an even less invasive intraoral surgical technique for the removal of sialolith that does not affect the submandibular gland function. The functional recovery of the gland, complications and recurrence rates after surgery with this conservative intraor al procedure were all successful. We report 5 patients from the department of Oral and Maxillofacial Surgery at Dental Hospital, Yonsei University, who had under gone a resection of the sialolith though the intraoral approach with successful results.

Anatomical study of the submandibular gland duct after removal of a distal stone without sialodochoplasty: a sialographic evaluation of a clinical phase II trial

Minimally invasive surgery of sialolithiasis using sialendoscopy.

Relevance. Mandibular hypoplasia in adolescents poses significant functional and aesthetic challenges. Mandibular distraction osteogenesis (DO) enables gradual bone lengthening with new bone formation and remains an effective treatment modality with low relapse rates. However, the choice of surgical approach for distractor placement—intraoral versus extraoral–remains a subject of debate. Each approach entails distinct anatomical, surgical, and aesthetic considerations. The intraoral approach avoids visible scarring, which is especially important for adolescents, whereas the extraoral approach is technically straightforward in severe deformities and permits greater distraction length.Objective. To compare intraoral and extraoral mandibular distraction in adolescents by analyzing anatomical landmarks, surgical techniques, complication rates, and aesthetic out-comes, and to develop clinical recommendations for selecting the optimal approach.Materials and methods. A literature review was conducted using relevant sources from the PubMed, Scopus, Web of Science, and Google Scholar databases published within the past 10 years, focusing on mandibular distraction osteogenesis in children and adolescents. The following key parameters were compared: surgical approach, distraction vector and magnitude, treatment duration, complication rates, and aesthetic outcomes. Two summary tables are presented: (1) a comparative analysis of intraoral and extraoral approaches, and (2) an overview of distraction protocols and outcomes reported in various studies.Results. Intraoral distractors are placed through an intraoral incision and typically feature curvilinear activation, allowing simultaneous vertical and horizontal mandibular lengthening with concealed hardware and no visible external scars. This approach is associated with fewer postoperative complications (~10% vs. 30–40%) and infrequent neurosensory disturbances, although it generally achieves a slightly smaller mean elongation (approximately 10–15 mm) compared to extraoral systems. Extraoral distractors require a submandibular incision and external activation units, enabling greater distraction length (~15–20 mm or more) and precise vector control. However, they are associated with higher risks of hypertrophic scarring, pin-site infections, and transient facial nerve paresis. Adolescent patients tend to tolerate intraoral distractors better due to improved comfort and aesthetics. Recent studies have shown no significant differences in treatment success or airway improvement between approaches when distraction parameters remain within device capabilities; however, intraoral systems demonstrate higher reliability (fewer mechanical failures) and a lower overall scar burden.Conclusion. Mandibular distraction osteogenesis is a reliable treatment modality for mandibular hypoplasia in children and adolescents with incomplete facial skeletal growth. The intraoral approach is preferable for moderate deformities, providing superior aesthetic outcomes and fewer complications. The extraoral approach remains justified for severe deficiencies requiring maximal elongation or complex vector adjustment, particularly in cases with limited mouth opening. Clinical recommendations are proposed to individualize surgical access selection based on deformity severity, anatomical constraints, and aesthetic considerations.

Trans-oral robotic surgery for Hilo-parenchymal submandibular stones

There are many different management strategies for salivary calculi within the parotid ducts. Commonly, the stones can be extracted via an intra-oral approach. Stones that are farther from the papillae require more complex management. This article describes a technique for extra-oral excision of palpable salivary calculi using known external facial landmarks and dissection. Two cases are discussed and illustrations shown, and a brief discussion of other techniques for the management of salivary stones is included.

The purpose of this study is to evaluate the benefits of the intraoral approach for removal of the submandibular gland (SMG) by comparing it with the usual method of the transcervical approach. Sixteen patients who required SMG resection for benign disorders were divided into two surgical groups who underwent surgery via the intraoral (n = 8) or transcervical (n = 8) approach. The intraoral approach (IOA) consisted of an incision on the floor of mouth from the caruncle of Wharton's duct to the retromolar trigone while the transcervical approach (TCA) consisted of an incision along the natural skin crease overlying the gland. The operation time, hospital stay, complications, and cosmetic appearance were compared between groups. The mean operation time of the IOA group was significantly longer than that of the TCA group, but decreased gradually with surgical experience. The mean hospital stay of the IOA group was significantly shorter than that of the TCA group. Most patients (88 %) of the IOA group experienced sensory defects of the lingual nerve, but these symptoms were temporary. No lasting complications were noted in the IOA group; however, one patient of the TCA group had permanent paralysis of the marginal mandibular branch of the facial nerve. The incision scars were invisible owing to the location on the mouth floor in the IOA group, whereas they were apparent even on the natural skin crease of the neck in the TCA group. In conclusion, the SMG can be removed safely and effectively by IOA with the avoidance of an external scar and of injury to the marginal mandibular nerve. We suggest that the IOA be substituted for the TCA as the primary procedure for removal of the SMG in suitably selected patients.

To compare surgical outcomes after intraoral removal of proximal submandibular stones versus traditional submandibular gland (SMG) resection. : A prospective randomized study. Forty-four consecutive patients were diagnosed with proximal submandibular stones in the hilum of the submandibular gland by ultrasonography or computed tomography. All of the patients were randomized to undergo removal of the stones either by an intraoral approach (IORS group, 22 patients) or through SMG resection (SMGR group, 22 patients). We then compared the surgical outcomes between these two groups. Stones in the IORS group were significantly smaller than those in the SMGR group. There was no significant difference in the distance of the stones from the hilum between groups. The mean operation time in the IORS group was significantly shorter than that of the SMGR group. The mean hospital stay of the IORS group was also significantly shorter than that of the SMGR group, and IORS patients felt significantly less pain than did SMGR patients. No patient experienced any complication after surgery with the exception of a single patient who experienced transient and mild neck swelling. Intraoral removal of proximal submandibular stones has several advantages over SMG resection. Based on our results, we suggest that our intraoral removal method be selected as the primary procedure for the removal of proximal submandibular stones rather than SMG resection.

This article presents clinical observations related to large salivary stones that occur in the submandibular salivary gland in salivary stone disease. The author describes several clinical cases in which salivary concretions of unusually large sizes were discovered and studied. The article presents data on the localization of stones, sizes, as well as complications resulting from their presence. The analysis of the presented clinical observations allows us to draw conclusions about the unusual and rare nature of this type of salivary stone disease. A detailed description of clinical cases, including the results of multispiral tomography and orthopantomogram, allows us to better understand the features of the formation and development of large salivary stones in the submandibular salivary gland. This article has practical value for dentists and medical specialists involved in the diagnosis and treatment of salivary stone disease. It provides additional knowledge about possible complications associated with large salivary stones, and also emphasizes the importance of timely detection and removal of such stones to prevent possible complications and improve the quality of life of patients.

Mandibular Reconstruction Using a Tray With Particulate Cancellous Bone and Marrow and Platelet-Rich Plasma by an Intraoral Approach

Mass on the Floor of the Mouth in a Teenager.

A 68-year-old woman presented to the emergency department (ED) with rapidly progressing left submandibular swelling and inability to tolerate secretions. Her physical examination showed the left submandibular gland was markedly enlarged, firm, and exquisitely tender to palpation. Laboratory tests were remarkable for a white blood cell count of 16.22 k/μL with a neutrophil predominance (81.3%). Computed tomography of the neck was performed and showed markedly dilated, enhancing left submandibular duct that mimicked an abscess, measuring over 1.0 cm in diameter (normal 1–3 mm)1 without visualized obstructing calculus (Figures 1 and 2). Numerous sialoliths were noted within both submandibular glands (Figure 3). In the ED, the patient had rapid worsening of the oral cavity and submandibular edema, and her airway was secured via nasotracheal intubation. She was admitted to the intensive care unit and received intravenous antibiotics and steroids, with resolution of her symptoms within 3 days. She was extubated and discharged home. Sialolithiasis, or salivary stones, may form in any of the salivary glands, but the submandibular gland is the most common site (80%) and forms the largest stones.2 Submandibular stones can be diagnosed on physical examination by palpating the floor of the mouth and pushing the tongue upward and backward to put tension on the papilla.3 Imaging may be necessary if stones are unable to be seen or palpated. Management is usually conservative and includes applying heat packs, massaging the gland, and use of sialagogues to promote saliva production. Anti-staphylococcal antibiotics are administered if there are signs of infection.

A calcified structure blocking the flow of saliva into the mouth is a major cause of salivary dysfunction. If a stone is detected, the goal of treatment would be to remove it. Furthermore, the fundamental treatment for preventing recurrence, although depending on the location and size of the stone, is salivary gland resection. The submandibular gland duct and hilum stone is usually removed by transoral approach. If there are multiple stones in the submandibular gland and the duct, it would be necessary to carry out resection of submandibular gland, using the intra-oral approach. We recently experienced a case of multiple stone in the submandibular gland and the duct in a 73-year-old man, who presented with the right submandibular area swelling after meals. We removed the submandibular gland and duct stone without intra-oral approach and present this case with a review of the literature. Key words: Sialolithiasis ㆍ Submandibular gland ㆍ Whartons duct