Transoral Sialolithotomy Research Articles

An interesting case of asymptomatic giant submandibular sialolithiasis: a case report

Sialolithiasis is the most common disease of salivary glands. On the other hand, giant submandibular sialoliths or megaliths are quite rare. Our case report is of an unusually large submandibular sialolith called a giant sialolith as dimensions exceed 15 mm in size. Patient was asymptomatic on presentation and had preserved gland function. A firm mass was detected on the left floor of mouth and on transoral sialolithotomy a single large calculus of 40 mm, in greatest dimension, was removed in toto. Though submandibular gland sialoliths are generally asymptomatic in nature, giant calculi usually present with symptoms including pain and swelling of the involved gland caused by the accumulation of saliva, due to blockage of the lumen of Wharton’s duct by the calculus. This is a rare case report of an asymptomatic giant submandibular sialoithiasis, its diagnosis and management.

Enormous Asymptomatic Intraoral Sialolithiasis: A Case Report.

Sialolithiasis is one of the most common diseases of salivary glands. More than 80% of the sialoliths occur in the submandibular gland. While most of the calculi are less than 10 mm in size, 7.6% are larger than 15 mm and are classified as giant sialoliths. We demonstrate a rare case of asymptomatic giant sialolith in the left Wharton's duct with a total atrophy of the left submandibular salivary gland. A 48-year-old female patient presented with lumping sensation for 1 month. A left mouth floor mass was found accidentally during examination and was later revealed to be a painless sialolithiasis. Image study revealed a giant sialolith in the left Wharton's duct with duct dilatation and left submandibular gland total atrophy. She underwent transoral sialolithotomy with removal of a huge stone, measuring 3.5 × 1.4 cm in size. Sialolithiasis usually presents with typical symptoms of the involved salivary gland, and the size of calculi is usually less than 20 mm. This is a rare case report of an asymptomatic giant sialolith in the Wharton's duct, causing left submandibular salivary gland total atrophy, and its diagnosis and management.

Hybrid Exoscopic and Robotic Transoral Removal of a Bilateral Hilar Submandibular Stone: Technical Note and Review of the Literature

Submandibular gland sialolithiasis can be addressed by gland removal or by stone removal. Intraoral stone removal has now become the go-to technique to minimize aesthetic and functional sequelae (e.g., marginalis mandibulae injury, visible surgery scar) and, although traditional techniques were first experimented with (intraoral ducotomy), newer techniques drew the interest of the scientific community: sialoendoscopy, TORS-S (TransOral Robotic Surgery Assisted–Sialolithotomy) and VITOM-guided sialolithotomy. In this article, we compare the two newest transoral techniques for transoral sialolithotomy, TORS-S and 3D-4K VITOM-guided sialolithotomy, used to treat bilateral hilar submandibular gland sialolithiasis in the same patient, one technique for each side. Using these techniques, a faster recovery is achievable with almost no anatomical and/or functional sequelae, since they both allow better visualization and manipulation of soft tissues and noble structures (e.g., lingual nerve and Wharton’s duct) and make surgery easier and safer. Moreover, OR staff can better perceive surgical steps and be involved in the procedure, thus showing the high educational and training potential of these technologies.

Modified Marionette Technique for Unassisted In-Office Access to the Submandibular Duct.

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Removal of stones from the superficial lobe of the submandibular gland (SMG) via an intraoral endoscopy-assisted sialolithotomy.

Sialolithiasis is the most common cause of chronic sialadenitis of the submandibular gland (SMG). Symptomatic superficial lobe stones are often treated by submandibulectomy. A gland preserving operation allows for transoral stone removal through endoscopically assisted sialolithotomy. Herein, we provide clinical and sonographical follow-up data in patients who underwent sialolithotomy under general anesthesia. Sixty patients treated at the Department of Oral and Maxillofacial Surgery at Düsseldorf University Hospital for superficial lobe sialolithiasis of SMG were included in this study. All received transoral sialolithotomy under general anesthesia. Follow-up was conducted via standardized patient questionnaires, clinical examination, and B-mode and color Doppler sonography. Mean patient age was 48.9years. 56.6% of right and 43.4% of left SMG were affected. Mean follow-up was 45months. Fifty-five of 59 detected stones could be removed. Mean operation time was 71min. 3.3% of patients reported recurrent episodes of postoperative pain and 10% felt recurrent episodes of gland swelling. Persistent postoperative lingual nerve hypesthesia was described in one patient. No facial nerve damages occurred. Salivary flow rates remained reduced in most of the affected glands upon stone removal. Sonographical follow-up data of the previously affected SMG after intraoral endoscopy-assisted sialolithotomy showed a regular gland size in 70.8% of cases, a parenchyma free of inflammation in 93.8%, and without signs of fibrosis in 72.9% of cases. 68.7% of patients showed a regular structure of Wharton's duct at time of follow-up. In total, 89.6% of patients were diagnosed stone-free within both glands on follow-up. No case required subsequent submandibulectomy. Sialolithotomy of Wharton's duct for removal of stones from the SMG's superficial lobe is a promising alternative to submandibulectomy. Reduction of postoperative morbidity through endoscopically assisted sialolithotomy for removal of superficial lobe stones from SMG. Ethics Committee of Heinrich-Heine-University Düsseldorf (no. 5586).

Sonolocation during submandibular sialolithotomy.

Ultrasound is a proven tool for diagnostic and therapeutic purposes for treatment of salivary gland pathology. It is also useful for localization of calculi during submandibular gland transoral sialolithotomy when calculi cannot easily be palpated. Our objective was to determine the efficacy of sialolith localization using ultrasound during submandibular gland sialolithotomy. Retrospective case series. A study performed utilizing data compiled from 2009 through 2016 in a tertiary academic center. Treatment was completed in 164 patients with sialadenitis and sialolithiasis by submandibular gland transoral sialolithotomy in either the office (81%) or the operating room (19%). Ultrasound was used for localization of sialoliths during submandibular gland sialolithotomy. Main treatment outcomes studied were success of the procedure, complications, and follow-up. Successful sialolithotomy was performed in (147 patients) 90% of cases. Complications were minimal and included stricture formation, which occurred in 3% (five patients) of cases, followed by ranula formation in 1.8% (three patients) of cases. There were no incidences of lingual nerve injury. Ultrasound can be used effectively for precise sialolith localization intraoperatively. 4 Laryngoscope, 129:2716-2720, 2019.

Ultrasound Indicators of Persistent Obstruction after Submandibular Sialolithotomy

To identify and describe the ultrasound indicators of persistent obstruction following transoral submandibular sialolithotomy and discuss the utility of ultrasound in the immediate postoperative period. We performed a prospective case series with planned data collection of patients who underwent treatment for symptomatic submandibular swelling. A tertiary care center. Thirty-three patients of either sex with known submandibular gland sialoliths who failed endoscopic retrieval of calculi. We performed in-office or operating room-based transoral submandibular gland sialolithotomy followed by immediate postprocedure ultrasound examination for the assessment of residual calculi. All patients underwent mandatory reexploration for suspicious findings. Only the appearance of hyperechogenic foci with posterior shadowing reliably predicted the presence of residual stones following transoral sialolithotomy (P < .0001). The presence of hyperechogenic foci without posterior shadowing (P = 1.00), ductal dilatation (P = .23), and intraglandular dilatation (P = 1.00) was not indicative of retained calculi. The presence of hyperechogenic foci with posterior shadowing on immediate postprocedure ultrasound is an accurate indicator of residual stones following transoral submandibular sialolithotomy. Ultrasound examination can be reliably used to identify patients at risk of symptomatic recurrence of sialoliths.

Surgeon-performed ultrasound and transfacial sialoendoscopy for complete parotid duct stenosis

A 57-year-old man presented with a 16-month history of right parotid swelling since undergoing a transoral sialolithotomy of the parotid duct. An ultrasound and a computed tomography scan showed a 6 cm-long dilated parotid duct without evidence of sialolithiasis or tumor mass. The complete Stensen's duct stenosis that was found was managed by a surgeon-performed ultrasound-guided transfacial needle catheterization of the dilated parotid duct, anterograde sialoendoscopy, recanalization of the duct, and stent placement. At 15 month follow-up, the patient reported no recurrent facial swelling or discomfort. Surgeon-performed ultrasound, combined with sialoendoscopy, can provide unique advantages for managing parotid duct stenosis and obstructive sialadenitis.

Ultrasound Localization during Submandibular Sialolithotomy

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.

Asymptomatic large sialolith of Wharton's duct: a case report

Sialoliths are responsible for the obstruction of the secretion of saliva. They are rarely larger than 15 mm. More than 80% of the salivary gland calculi appear in the submandibular gland, but they can also be located in the glandular parenchyma and more frequently in the excretory duct. We report an asymptomatic large sialolith case in Wharton's duct of a 58-year-old man and its diagnostic imaging, surgical management and outcomes. For these reasons, we considered useful to report our case in the managing of a sialolith 35 mm in length and weighing 6.45 g located inside Wharton's duct and his treatment was by transoral sialolithotomy with preservation of the submandibular gland.

Robotic‐assisted transoral removal of a submandibular megalith

The majority of salivary stones are less than 8 mm in size and most frequently occur in the submandibular gland. Traditional management of larger stones involves gland resection. Sialendoscopy combined with an external or a transoral sialolithotomy, also called the combined approach technique, permits stone removal and gland preservation. A 31-year-old male presented to our service with a 20-mm megalith in the left submandibular gland. Here we report the first description of a combined approach using the da Vinci Si Surgical System to facilitate transoral stone removal and salivary duct repair.

Management of giant sialoliths: Review of the literature and preliminary experience with interventional sialendoscopy

To report our experience with management of giant salivary stones via a combined approach technique using salivary endoscopy (CA) and results of a review of current literature related to giant salivary stones. Retrospective case series. An institutional review board-approved chart review was performed on patients managed with a CA to treat giant salivary stones (≥15 mm). In addition, we reviewed the English literature from 1942 to 2009. Table 1 consists of 54 stones; 47 of which were identified during the review of literature and 7 from our case series. Of those 47 stones, 23 were hilar in location, 23 were glandular in location, and 1 stone was missing data. The gland preservation rate in the 47 reported stones was 57% (17/30). Among patients where gland resection was reported, the majority of the patients (12/13) had hilar glandular stones. Only one patient with a ductal stone had a gland resection. In our series, CA enabled a gland preservation rate of 86% (6/7). Among these patients, stone location was hilar glandular in six (86%) and ductal in one (14%). The mean size of stones from the literature review was 35 mm and from our series was 19 mm. Our review reflects current treatment recommendations for giant stones, i.e., transoral sialolithotomy for ductal stones and gland resection for hilar glandular stones. Our preliminary experience with CA for giant stones suggests improved gland preservation rates (86% vs. 57%) independent of stone location and with preservation of salivary function.

Surgical Treatment of a Giant Sialolith of the Wharton Duct

Sialoliths are responsible for the obstruction of the secretion of saliva. They are rarely larger than 15 mm. A 48-year-old man was referred for the assessment of swelling and pain in the submandibular right region during meals. A hard mass was palpable along the right Wharton duct. A panoramic radiograph showed a single, elongated, radiopaque, 22-mm-long mass in the right submandibular region. A diagnosis of giant sialolith in the right Wharton duct was made. Removal of the giant sialolith and sialodochoplasty were performed via an intraoral approach. Six months after the intervention, salivary flow was normal. Diagnosis and management of sialoliths of a remarkable size are challenging for the clinician. Conservative methods of treatment should be considered as an alternative for surgical excision, in particular for little calculi, but for giant sialoliths, transoral sialolithotomy with sialadenectomy or sialodochoplasty still remains the mainstay of management.

O.203 Reconstruction of complex defects of the parotid region

Four patients with chronic submandibular sialadenitis and sialolithiasis were successfully managed with sialadenectomy and transoral sialolithotomy. The use of sialograms, usual treatment procedures, and surgical anatomy is discussed.

Giant salivary gland calculi: Diagnostic imaging and surgical management

Giant salivary gland calculi (GSGC; >15 mm) are considered rare. Only 14 well-documented cases have been reported in the literature since 1942. The purpose of this study was to evaluate the imaging modality and treatment outcome of patients with GSGC. Six personally observed subjects with GSGC were evaluated and treated. Occlusal film, panoramic radiograph, axial computed tomographic (CT) scan, and scintigraphy were used for imaging. Stone location, shape, and size were estimated on occlusal film, panoramic radiograph, and CT scans. Stones were removed with transoral sialolithotomy, and size was measured directly on the surgical specimen. Treatment outcome was evaluated with scintigraphy 2 months after surgery. The mean age of the patients (all male) was 48 years (range, 25 to 61 years). Five subjects had stone in the submandibular gland, and 1 in the parotid gland. The mean stone size was 30 x 15.8 mm, as measured directly on the surgical specimen. The preoperative estimation of the stone size with occlusal film was limited to those located in the anterior portion of the duct. Panoramic radiograph was precise and comparable with the estimation with CT scan for all stones. In 5 of the 6 subjects, a nearly normal function of the glands was seen 2 months after surgery. GSGC of the submandibular or parotid glands is a disease that affects the middle-aged male patient. An occlusal film is a suitable imaging modality for stones, but estimation of size is limited to stones in the anterior duct portion. Panoramic radiograph and CT scan were comparable in precise preoperative estimation of stone size, regardless of stone location. Removal of the GSGC with the minimally invasive method, via the transoral sialolithotomy, is the treatment of choice, with reasonable results.

Surgical management of submandibular sialadenitis and sialolithiasis

Four patients with chronic submandibular sialadenitis and sialolithiasis were successfully managed with sialadenectomy and transoral sialolithotomy. The use of sialograms, usual treatment procedures, and surgical anatomy is discussed.