Clinical Efficacy of Sialendoscopy-Assisted Stone Removal for Non-Palpable Hilar and Intraglandular Submandibular Sialoliths

Abstract

Objectives: This study aimed to assess the efficacy of sialendoscopy in retrieving non-palpable submandibular stones located in the hilum or deeper parenchyma compared to traditional non-endoscopic transoral stone removal techniques.

Methods: Seventy patients with non-palpable submandibular hilar or intraparenchymal stones underwent sialendoscopy-assisted stone removal (SASR). Seventeen patients with hilar stones treated with non-endoscopic transoral stone removal (TOSR) were the control group. Parameters evaluated included stone characteristics (size, number, location, mobility, and accessibility) as well as outcomes (success rate, operation time, complications, recurrence, and functional recovery).

Results: The SASR group had four stones in the intraparenchymal glands, two of which were located inferior to the mylohyoid. Complete stone removal was achieved in 69 out of 70 patients (98.57%) in the SASR group. However, one patient had a sialolith measuring less than 2 mm in the intraparenchymal and inferior to mylohyoid that could not be removed. TOSR procedures were exclusively performed to remove hilar stones. Nevertheless, one patient in the TOSR group was unsuccessful in retrieving a 5-mm hilar stone, resulting in an overall success rate of 94.12%. The operation duration was much longer in the SASR group than in the TOSR group. However, the TOSR group had a significantly higher incidence of acute complications (41.18%), such as swelling, pain, or tongue numbness, compared to the SASR group (7.14%).

Conclusion: Sialendoscopy is a valuable adjunct to the transoral combined approach for retrieving non-palpable submandibular stones, especially those in the hilum or deeper parenchyma. A precise preoperative assessment of stone location is crucial for determining the appropriate surgical intervention.