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Objective: Sialendoscopy has remained the standard of treatment for sialolithiasis; however, large stones impacted in the submandibular gland hilum often require an intra‐oral combined approach. Methods: Patients treated for submandibular hilar sialolithiasis from 2015 to 2021 at two tertiary centers were stratified into two groups based on the surgical technique: Intraoral Microscopic‐Assisted Sialolithotomy (IMAS) versus Robot‐Assisted Sialolithotomy and Sialendoscopy (RASS). We compared the characteristics of retrieved stones, surgical success rate, operative time, and post‐operative complications in both techniques. True surgical success was defined as successful stone extraction without reoccurrence within 12 months. Results: The RASS technique was attempted in 60 patients and successful in 56 (93.3%) cases whereas the IMAS technique was performed in 52 patients and successful in 48 (92.3%) cases. The longest dimension of the predominant retrieved calculi was 9.6 ± 3.1 mm (range, 5–18 mm) for the robotic technique and 10 ± 4.8 mm (range, 5–30 mm) for the microscopic technique. The operative time for the robotic technique excluding robot setup time was 70.6 ± 24.8 min compared to 61.9 ± 42.4 min for microscopic technique (p = 0.018). No major adverse outcomes were reported; however, temporary lingual paresthesia was found in ten robotic (16.7%) and five microscopic (9.6%) cases. Conclusion: The two techniques were comparable in terms of efficacy and safety for large stones. The robot has the advantage of intraoral high dynamic maneuverability and improved surgeon posture while the microscopic technique has the advantage of intraoral tactile feedback. The procedure was significantly shorter in duration with the microscope. Level of Evidence: 3 Laryngoscope, 134:2170–2176, 2024 [ABSTRACT FROM AUTHOR]

This article explores the practice of in-office transoral sialolithotomy, a procedure used to remove salivary stones. The procedure, which is done with local anesthesia, is primarily used for distal submandibular stones but can also be used for other types of stones. The article emphasizes the benefits of in-office procedures, such as reduced time and costs for patients, as well as potential improvements in outcomes and quality of life. A study conducted by the senior author found similar rates of complications and stone recurrence compared to removal under general anesthesia. The article discusses the effectiveness and advantages of in-office transoral sialolithotomy for submandibular hilar and intraglandular stones, with a success rate of 90% and a low complication rate of 5%. It offers benefits for both patients and physicians, including reduced costs and anesthesia exposure. However, it is important to note that the study is limited to the experience of a single surgeon, and there may be subjective factors that influence the decision to abort the procedure or classify stones. Overall, in-office transoral sialolithotomy is a viable option for treating submandibular sialoliths. [Extracted from the article]

This study aimed to systematically review the literature to determine the efficacy and safety of transoral robotic surgery (TORS) in the management of submandibular gland (SMG) sialolithiasis. PubMed, Embase, and Cochrane were searched for English-language articles evaluating TORS in the management of SMG stones published up to 12 September 2022. Nine studies with a total of 99 patients were included. Eight patients underwent TORS followed by sialendoscopy (TS); 11 patients underwent sialendoscopy followed by TORS and sialendoscopy (STS); 4 patients underwent sialendoscopy followed by TORS only (ST); and 4 patients underwent TORS without sialendoscopy (T). The mean operative time amounted to 90.97 min. The mean procedure success rate reached 94.97%, with the highest for ST (100%) and T (100%), followed by the TS (95.04%) and STS (90.91%) variants. The mean follow-up time was 6.81 months. Transient lingual nerve injury occurred in 28 patients (28.3%) and was resolved in all of them within the mean of 1.25 months. No permanent lingual nerve injury was reported. TORS is a safe and effective management modality for hilar and intraparenchymal SMG sialoliths, with high procedural success in terms of successful sialolith removal, SMG preservation, and reduced risk of permanent postoperative lingual nerve damage. [ABSTRACT FROM AUTHOR]

Obstructive parotitis usually occurs as a painful, unilateral swelling of the cheek with a decreased salivary flow and pus discharge, when secondarily infected. The known causes for this condition include commonly, sialoliths, strictures, and/or stenosis of the duct. Imaging in patients with obstructive parotitis has multifactorial benefits ranging from diagnosis to localisation thus, enabling preoperative planning. A 43-year-old female patient presented with features suggestive of obstructive parotitis with secondary infection. The diagnosis was confirmed by Ultrasonography (USG) and a Radiovisiograph (RVG) was performed to localise the sialolith. The patient was admitted and treated with supportive therapy in the form of intravenous antibiotics, milking of the gland, and adequate hydration. Sialolithotomy was scheduled following the resolution of the acute phase of infection. Repeat USG and RVGRVGRVG were performed on the day of surgery to confirm the position of the sialolith but the sialolith could not be located. A panoramic radiograph was performed to confirm the absence of the sialolith. The planned procedure was cancelled, and the patient was continued on systemic antibiotic therapy and anti-inflammatory medication for three more days. On follow-up, copious serous saliva could be expressed from the duct. This highlights the importance of repeating preoperative imaging in patients who have received supportive therapy including gland massage.

Abstract Background Conventionally, indirect radiography has been used to diagnose salivary gland diseases. However, with the development of sialendoscopy, diagnosis and treatment of salivary gland diseases have become more effective. Herein, we report a case of sialolithotomy treated with sialendoscopy and compare it with the existing methods through a literature review. Case presentation Two patients with a foreign body sensation under the tongue and dry mouth visited the Anam Hospital, Korea University. Radiographic examination revealed salivary stones inside the right Wharton duct, and the patients underwent sialolithotomy under local or general anaesthesia. The stones were totally removed, and there were no postoperative complications such as bleeding or pain. Conclusion The development of sialendoscopy has enabled better definitive diagnosis of salivary gland diseases compared with the conventional methods; better treatment outcomes can be obtained when sialendoscopy is used in appropriate cases.

One of the most common disorders of the salivary glands is sialolithiasis. A history of pain or/and swelling in the salivary glands, especially during meal suggests this diagnosis. For small and accessible stones conservative therapies like milking of ducts with palliative therapy can produce satisfactory results. Surgical management should be considered when the stone/stones are inaccessible or large in size as conservative therapies turned out to be unsatisfactory. In this paper, we present three cases of sialolithiasis in the submandibular gland along with a review of existing literature. The purpose of this paper is to add three more cases to the literature and review the theories of etiology, clinical features, available diagnostic and treatment procedures.

Objectives/hypothesis: 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.Study Design: Retrospective case series.Methods: 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.Results: 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.Conclusions: Ultrasound can be used effectively for precise sialolith localization intraoperatively.Level Of Evidence: 4 Laryngoscope, 129:2716-2720, 2019. [ABSTRACT FROM AUTHOR]

Background: Sialoendoscopy is the standard treatment for sialolithiasis; however, some patients may be unlikely to benefit from an endoscopic approach. This study assesses predictors of failure in the endoscopic management of sialoliths. Methods: Patients treated for sialolithiasis from 2012 to 2017 at two centers were stratified into 3 groups: successful interventional sialendoscopy, incisional sialolithotomy, and gland excision. Patient, disease, and surgical factors were compared. Results: Interventional sialendoscopy was attempted in 156 of 206 cases and successful for 42 (27%). Endoscopically retrieved calculi were smaller (4.96 mm) compared to incisional sialolithotomy (7.90 mm). Nonendoscopic approaches were required more often in submandibular cases 87% (P ≤ .005). Palpable stones were present in 74% of incisional sialolithotomies (P < .001). Submandibular location (OR 3.50, 1.53‐7.98), palpability (OR 2.74, 1.21‐6.18), CT localization (OR 3.05, 1.32‐7.10, P = .010), and increased diameter (OR 1.25, 1.09‐1.44) were predictive of incisional management. Conclusion: Stone size/location, CT‐localization, and palpability were predictive of calculi that require an incisional approach. If these factors are recognized, the surgeon can consider proceeding directly to incisional sialolithotomy. Level of evidence: III [ABSTRACT FROM AUTHOR]

Contrast-enhanced ultrasound (CE-US)-derived intensity-time gradients (ITGs) can be used for noninvasive monitoring of extracorporeal shock wave sialolithotripsy effects in chronic sialolithiasis-related sialadenitis. Aim of this trial was to further validate CE-US as an independent and quantitative diagnostic tool for sialolithotomy efficacy. In this prospective clinical phase II evidence level c study perfusion in patients ( n = 10) with unilateral sialolithiasis of the submandibular gland was quantitatively analyzed by CEUS before and after sialolithotomy comparing with the contralateral disease-free gland. A visual analog scale (VAS) scoring clinical complaints was correlated with CE-US-derived ITGs. Furthermore, ITG ratios reflecting values from the contralateral side and the diseased side were calculated. VAS documented significantly reduced clinical complaints after sialolithotomy indicative of a successful treatment. VAS data significantly correlated with CE-US-derived ITGs. In addition, ITG ratios were significantly increased after sialolithotomy. In conclusion, CE-US-derived ITGs and ITG ratios appear as independent and valid quantitative parameters of sialolithotomy efficacy. [ABSTRACT FROM AUTHOR]

In this report we present a patient with a large sialolith of the submandibular gland and its treatment by sialolithotomy. Sialoadenectomy vs. sialolithotomy for treatment of large submandibular gland calculi has been discussed. A 49 year-old male administered to our clinic with an ultrasonography report specifying submandibular gland calculi. An orthopantomograph was obtained and a large radio opaque lesion was detected just below the left mandibular border, in alignment with the second molar tooth. Computerized tomography examination was made and the calculus was designated to be in the posterior part of the gland. The sialolith was removed under general anesthesia, sialoadenectomy was not performed. At 3 months, 6 months and 1-year follow-up patient did not have any complaints. We are in the opinion that sialolithotomy should be preferred primarily for large submandibular sialoliths and sialoadenectomy should be considered only if symptoms occur. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Sialoendoscopy is a valuable technique for a variety of obstructive and nonobstructive disorders of the major salivary glands. However, the utility of sialoscopes is limited for salivary stones, which frequently required open removal. Transoral sialolithotomy without scopes is an efficient, low-cost alternative with excellent outcomes available for most of the submandibular stones., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2021 Elsevier Inc. All rights reserved.)

One of the most common disorders of the salivary glands is sialolithiasis. A history of pain or/and swelling in the salivary glands, especially during meal suggests this diagnosis. For small and accessible stones conservative therapies like milking of ducts with palliative therapy can produce satisfactory results. Surgical management should be considered when the stone/stones are inaccessible or large in size as conservative therapies turned out to be unsatisfactory. In this paper, we present three cases of sialolithiasis in the submandibular gland along with a review of existing literature. The purpose of this paper is to add three more cases to the literature and review the theories of etiology, clinical features, available diagnostic and treatment procedures., Competing Interests: Conflict of interest: the authors declare no potential conflict of interest.