Ultrasound Localization during Submandibular Sialolithotomy

Abstract

Objective: 1) To describe a novel office-based operative technique that has been demonstrated to be successful in stone localization and retrieval of proximally located submandibular sialoliths. 2) To demonstrate the feasibility of the technique and discuss its indications. Method: From August 2009 to January 2012, patients with symptomatic submandibular sialolithiasis underwent ultrasound needle localization and open sialolithotomy in a tertiary-level clinic setting. Outcomes included success of delivery, presence of infection, ductal stenosis, loss of glandular function, or lingual nerve paralysis. Independent variables included size and location of sialoliths. Results: Sixteen in-office cases of ultrasound-guided needle localization and open sialolithotomy were performed for patients who had failed sialendoscopy and stone extraction. Follow-up ranged from 6 months to 1 year. Sixteen of 16 (100%) were successful. The average size of sialoliths was 6.7 mm (range, 5-11 mm). Mean procedure time was 24 minutes (range, 18-42 minutes) from needle localization. There were no complications of infection, ductal stenosis, loss of glandular function, presence of additional sialoliths, or permanent lingual nerve paralysis. No patients had salvage submandibular sialadenectomy. Conclusion: After failing a purely endoscopic approach, proximally located sialoliths of the submandibular gland pose a problem for precise localization and treatment. Ultrasound has been demonstrated to be reliable for identifying sialoliths. We propose a novel technique and assert that ultrasound-guided needle localization is a reliable aid to effective transoral sialolithotomy.