Intraoral microscopic-assisted sialolithotomy for management of medium-large submandibular sialolithiasis: A refined technique

Objectives: Sialendoscopy has become the standard treatment for sialolithiasis; however, larger submandibular calculi may require an incisional technique. This study describes and evaluates an intraoral microscopic-assisted sialolithotomy (IMAS) as a refined submandibular stone extraction technique.

Methods: Retrospective case series of 64 submandibular IMAS procedures operated at a tertiary university center and private hospital from 2015 to 2021 were evaluated. Preoperative radiological assessment included noncontrast computed tomography scan ± magnetic resonance sialography. Stone characteristics (side, number, size, and location), operative findings, complications, and postoperative follow-up were reviewed. Success was defined as successful intraoral stone extraction with no symptoms or stone recurrence for at least 12 months postoperatively.

Results: The study included 43 males and 19 females, mean age 38 ± 12 years. Two patients had bilateral stones. All but one operated gland had stones extracted (98.4%), however the true success was 93.8% (60/64) as three patients had recurrent/residual stones within a year. Biggest stone longest diameter was 9.8 ± 4.6 mm (range, 5-30 mm). Hilar and intraglandular stone locations were 73.4% and 6.3%, respectively. Median operative time was 55 min. Adjunctive sialendoscopy was performed in 42.2%. Its use is significantly correlated with having ˃3 stones (mean 3.4 vs. 1.2 stones) [P < 0.001, 95% confidence interval: -3.19 to -1.25]. Minor complications included temporary lingual paresthesia (7.8%) and postoperative ranula (1.6%).

Conclusions: Submandibular IMAS is a highly effective safe technique for stones (≥5 mm). The improved microscopic visualization, illumination and magnification allows addressing all stone locations including intraglandular calculi and enables better lingual nerve identification and preservation.