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

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Abstract

Objectives

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.

Materials and methods

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.

Results

Mean patient age was 48.9 years. 56.6% of right and 43.4% of left SMG were affected. Mean follow-up was 45 months. Fifty-five of 59 detected stones could be removed. Mean operation time was 71 min. 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.

Conclusions

Sialolithotomy of Wharton’s duct for removal of stones from the SMG’s superficial lobe is a promising alternative to submandibulectomy.

Clinical relevance

Reduction of postoperative morbidity through endoscopically assisted sialolithotomy for removal of superficial lobe stones from SMG.

Trial registration

Ethics Committee of Heinrich-Heine-University Düsseldorf (no. 5586)

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Abbreviations

SMG:

Submandibular gland

CBCT:

Cone-beam computed tomography

dSGE:

Diagnostic sialendoscopy

iSGE:

Interventional sialendoscopy

ESWL:

Extracorporeal shock wave lithotripsy

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Authors and Affiliations

  1. Department of Oral and Maxillofacial Surgery, Heinrich-Heine-University, Moorenstraße 5, 40225, Düsseldorf, Germany

    Christoph Sproll, Henrik Holtmann, Norbert R. Kübler, Daman Deep Singh, Majeed Rana & Julian Lommen

  2. MKG Brühl, Uhlstraße 95-97, 50321, Brühl, Germany

    Christian Naujoks

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  1. Christoph Sproll
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Contributions

CS and JL worked out the concept and wrote the manuscript. JL carried out the follow-up examinations. JL and CS conducted follow-up sonographies. CS, CN, and DS carried out the operational procedures. JL assisted the operations. NK, HH, MR, and CN gave critical scientific input for the study design and engaged in manuscript creation.

Corresponding author

Correspondence to Julian Lommen.

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Competing interests

The authors declare that they have no competing interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Ethics approval was granted by the Ethics Committee of the Heinrich-Heine-University of Düsseldorf and given the reference number 5586.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Consent for publication

Patients gave their written consent to take part in the study. The forms can be obtained from the corresponding author in German language..

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Sproll, C., Naujoks, C., Holtmann, H. et al. Removal of stones from the superficial lobe of the submandibular gland (SMG) via an intraoral endoscopy-assisted sialolithotomy. Clin Oral Invest 23, 4145–4156 (2019). https://doi.org/10.1007/s00784-019-02853-9

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