Transoral submandibulotomy plus duct marsupialization; an appropriate approach for the treatment of proximal submandibular sialolithiasis; a long-term follow-up study

Abstract

BACKGROUND: Sialolithiasis is the most common salivary gland-related disease worldwide, leading to sialadenitis. Although there is no serious problem with surgical removal of stones at the middle and distal parts of the Wharton's duct, the approach for treating proximal stones located near to hilum and its adjacent parenchyma is a challenge. The current study has aimed to evaluate the outcome of transoral submandibulotomy for submandibular gland stone treatment. METHODS: This study was conducted on 63 patients with proximal (or deep hilar) submandibular sialolithiasis treated with transoral submandibulotomy and duct marsupialization from January 2011 to April 2019 in Pars hospital. Complications of the old fashion surgery (transcervical submandibulectomy) were assessed in this method (number and size of the stone(s), relapse of sialolithiasis-related obstructive symptoms, partial or complete removal of the stone(s), sialolithiasis recurrence, postoperative surgical or nonsurgical intervention, foreign body sensation, and taste sensation quality). RESULTS: The stone(s) was located at the proximal of the duct in 68 of the cases, while 32 of the stones were located at the deep hilar region. The mean size of the stones was 1.28+/-0.51 cm. Postoperative inflammation, postoperative pain, sialolithiasis recurrence, obstructive symptoms, postoperative nonsurgical intervention, postoperative surgical intervention, reduced taste sensation, and foreign body sensation were presented in 24, 29, 29, 44, 14, 6, 11, and 10 respectively. Eighty-nine percent of recurrences were healed spontaneously. CONCLUSION: Considering the cosmetic advantage due to the lack of cervical surgery scar (which is mandatory in old fashion transcervical method), long-term follow-up of transoral submandibulotomy showed successful outcomes regarding neurological impairment, postoperative pain and inflammation and incredibly complete stone removal that was found in all of the patients. In addition, submandibular duct marsupialization is recommended based on our study.