Transoral removal of submandibular stones

Objective: To assess transoral treatment of submandibular lithiasis. Design: Study of a series of patients with submandibular stones undergoing transoral removal of the sialoliths. Duration of follow-up: 6 months to 7 years. Setting: Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg, Erlangen, Germany, center for treatment of salivary stones. Patients: Two hundred thirty-one patients (127 females, 104 males) suffering from submandibular lithiasis had a mean age of 41.7 years (age range, 12-86 years). Stone location was distal to the edge of the mylohyoid muscle in 115 patients and proximal to the gland in 102 patients (mean size of sialoliths, 6.3 mm [range, 2-30 mml). Fourteen other patients had 2 separate stones, one within the hilum and a smaller more proximal one within the gland. Interventions: Transoral removal of the stones under local anesthesia and preservation of the submandibular gland. Main Outcome Measures: Complete removal of the stones, complications, and recurrence of the stones. Results: All 115 patients with distal stone location, 93 (91%) of 102 patients with stones of the perihilar region, and 9 (64%) of the 14 patients with 2 separate stones in the hilum and parenchyma were free of stones. Submandibulectomy had to be carried out in 4 patients (1.7%). Recurrence of lithiasis and damage to the lingual nerve remained below 1%. Conclusions: Transoral removal should be the treatment of choice in patients with submandibular stones that can be palpated bimanually and localized by ultrasound within the perihilar region of the gland.