Successful Intraductal Sialolithiasis Removal Using Sialendoscopy: A Case Report and Surgical Video Tips

Abstract

Introduction: Sialolithiasis is major cause of the obstructive salivary gland disease, accounting for ~60% of all cases. Other etiologies include strictures, mucoid debris, anatomic ductal abnormalities, and scar tissue.1 About 80% to 95% of sialolithiasis cases occur in the submandibular gland, 5% to 20% in the parotid gland, and only 1% to 2% in the remaining glands. The treatment of the obstructive salivary gland has evolved in the past 25 years with the introduction of thin semiflexible endoscopes and microinstruments such as forceps, baskets, wires, lasers, and balloons. These advancements allow for sialendoscopy and other intraductal manipulations including stone removal, dilatation of strictures, and cleansing of mucus plugs.2 In addition, these procedures can be used in combination with minimally invasive external approaches.3 Sialendoscopy is the main option for effectively treating these obstructive conditions, leading to improvements in overall quality of life.4 The objective of the surgical video is to clarify the basic steps involved in effectively removing intraductal sialolithiasis. Materials and Methods: A 36-year-old man presented with complaints of pain, swelling, and difficulty swallowing during meals, in the right submandibular salivary gland area. The symptoms had been present for the past 2 years and had worsened progressively, with no improvements with analgesics. The patient had a history of drinking less water during the past 10 years, but otherwise had no remarkable medical history. During the neck clinical examination, the right submandibular gland was found to be smaller than the contralateral gland, and no atypical lymph nodes were detected. Intraoral examination revealed a palpable 8 mm sialolith in the right floor of the mouth, which caused a discharge of milky saliva on manipulation. The remaining mucosa appeared normal. A CT scan revealed a 9 mm elliptical sialolith in the middle third of the right submandibular duct, consistent with the clinical examination and suspicion of obstructive sialolithiasis. Laboratory tests were normal. As treatment, sialendoscopy was indicated. The procedure was conducted following the standards set by Marchal et al.5 The intervention was performed for both diagnostic and therapeutic interventions, using a semirigid modular sialendoscope (Karl Storz, Tuttlingen, Germany) with a diameter of 1.7 mm, along with working channel, salivary probes, conic dilatators, bougies, baskets for stones, dilatator balloons, and silastic stents to the main duct to maintain papilla patency.6 The sialolith was completely removed without any adverse events. Results: The patient recovered uneventfully postoperatively and was discharged the next day. Conclusion: Our findings support the use of sialendoscopy for obstructive sialolithiasis. Patients usually obtain a complete resolution of their clinical symptoms and the technology has a high success rate when performed by an experienced team. The patient who agreed to participate in the study has written and signed the informed consent statement. No competing financial interests exist. No funding was received for this article. Runtime of video: 4 mins 49 secs