What are the surgical options for sialolithiasis?

Updated: May 12, 2020
  • Author: Adi Yoskovitch, MD, MSc; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

In patients with calculi in proximity of the opening of the Wharton duct, the duct can be cannulated, dilated, and the stone removed via a transoral approach.

Patients with deep intraparenchymal stones or multiple stones should have their glands excised on an elective basis. Ultrasonic lithotripsy is rarely effective and is not offered at the authors' institution.

A study by Kopeć et al indicated that sialendoscopy and sialendoscopy-assisted surgery are effective treatments for lithiasis of the submandibular glands. The study found that of 175 patients with submandibular gland stones, complete stone removal was achieved in 149 of them, through either sialendoscopy alone (82 patients) or sialendoscopy with surgery (67 patients). The procedures were also effective in the treatment of lithiasis of the parotid glands. [15, 16]

Similarly, a prospective study by Aubin-Pouliot et al indicated that sialendoscopy-assisted salivary duct surgery is an effective treatment for chronic obstructive sialadenitis, especially that caused by sialolithiasis. In the study’s 40 patients (54 glands), the overall mean score on the Chronic Obstructive Sialadenitis Symptoms (COSS) questionnaire improved by 22.6 points, falling from 36.1 preoperatively to 13.5 at 3 months postoperatively. For submandibular gland patients specifically, the mean score fell from 38.1 preoperatively to 10.3, while for parotid gland patients the mean score fell from 32.6 to 19.0. The investigators found the greatest COSS score improvement in patients whose condition was caused by sialolithiasis, as opposed to those with radioactive iodine– or inflammatory-related sialolithiasis. [17]


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