Recent progress in endoscopic surgery has facilitated the non-surgical removal of sialoliths from the duct of the submandibular gland. 1 Drage N.A. Brown J.E. Escudier M.P. McGurk M. Interventional radiology in the removal of salivary calculi. Radiology. 2000; 214: 139-142 Crossref PubMed Scopus (53) Google Scholar , 2 Nahlieli O. Shacham R. Bar T. Eliav E. Endoscopic mechanical retrieval of sialoliths. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003; 95: 396-402 Abstract Full Text Full Text PDF PubMed Scopus (83) Google Scholar However, the limitations of endoscopic techniques are: adhesion of stones to the ductal walls, ducts that are too narrow; strictures; ducts with sharp angles; giant sialoliths, and intraparenchymal stones. 1 Drage N.A. Brown J.E. Escudier M.P. McGurk M. Interventional radiology in the removal of salivary calculi. Radiology. 2000; 214: 139-142 Crossref PubMed Scopus (53) Google Scholar , 2 Nahlieli O. Shacham R. Bar T. Eliav E. Endoscopic mechanical retrieval of sialoliths. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003; 95: 396-402 Abstract Full Text Full Text PDF PubMed Scopus (83) Google Scholar The conventional intraoral approach cannot help some of these cases because of the narrowness of the visual field, particularly when the stone is located in the gland hilus or intraparenchymally. 3 McGurk M. Makdissi J. Brown J.E. Intra-oral removal of stones from the hilum of the submandibular gland: report of technique and morbidity. Int J Oral Maxillofac Surg. 2004; 33: 683-686 Abstract Full Text Full Text PDF PubMed Scopus (54) Google Scholar , 4 Zenk J. Constantinidis J. Al-Kadah B. Iro H. Transoral removal of submandibular stones. Arch Otolaryngol Head Neck Surg. 2001; 127: 432-436 Crossref PubMed Scopus (107) Google Scholar The method is influenced by a number of factors that were pointed out by McGurk et al.: 3 McGurk M. Makdissi J. Brown J.E. Intra-oral removal of stones from the hilum of the submandibular gland: report of technique and morbidity. Int J Oral Maxillofac Surg. 2004; 33: 683-686 Abstract Full Text Full Text PDF PubMed Scopus (54) Google Scholar no limitation of mouth opening, a class II skeletal base where there is retroclination, over eruption of the lower incisors, and so on. For these cases, subsequent submandibular sialoadenectomy has usually been required. In an effort to preserve the submandibular gland, we have tried to remove sialoliths located at the hilus and to do a sialodochoplasty using a surgical microscope by an extraoral approach with a larger visual field as an alternative to submandibular sialoadenectomy.