Objectives:Sialendoscopy has become the standard treatment for sialolithiasis;however,larger submandibular calculi may require an incisional technique.This study describes and evaluates an intraoral microscopic-assist...Objectives:Sialendoscopy has become the standard treatment for sialolithiasis;however,larger submandibular calculi may require an incisional technique.This study describes and evaluates an intraoral microscopic-assisted sialolithotomy(IMAS)as a refined submandibular stone extraction technique.Methods:Retrospective case series of 64 submandibular IMAS procedures operated at a tertiary university center and private hospital from 2015 to 2021 were evaluated.Preoperative radiological assessment included noncontrast computed tomography scan±magnetic resonance sialography.Stone characteristics(side,number,size,and location),operative findings,complications,and postoperative follow-up were reviewed.Success was defined as successful intraoral stone extraction with no symptoms or stone recurrence for at least 12 months postoperatively.Results:The study included 43 males and 19 females,mean age 38±12 years.Two patients had bilateral stones.All but one operated gland had stones extracted(98.4%),however the true success was 93.8%(60/64)as three patients had recurrent/residual stones within a year.Biggest stone longest diameter was 9.8±4.6 mm(range,5-30 mm).Hilar and intraglandular stone locations were 73.4%and 6.3%,respectively.Median operative time was 55 min.Adjunctive sialendoscopy was performed in 42.2%.Its use is significantly correlated with having>3 stones(mean 3.4 vs.1.2 stones)[P<0.001,95%confidence interval:-3.19 to-1.25].Minor complications included temporary lingual paresthesia(7.8%)and postoperative ranula(1.6%).Conclusions:Submandibular IMAS is a highly effective safe technique for stones(≥5 mm).The improved microscopic visualization,illumination and magnification allows addressing all stone locations including intraglandular calculi and enables better lingual nerve identification and preservation.展开更多
文摘Objectives:Sialendoscopy has become the standard treatment for sialolithiasis;however,larger submandibular calculi may require an incisional technique.This study describes and evaluates an intraoral microscopic-assisted sialolithotomy(IMAS)as a refined submandibular stone extraction technique.Methods:Retrospective case series of 64 submandibular IMAS procedures operated at a tertiary university center and private hospital from 2015 to 2021 were evaluated.Preoperative radiological assessment included noncontrast computed tomography scan±magnetic resonance sialography.Stone characteristics(side,number,size,and location),operative findings,complications,and postoperative follow-up were reviewed.Success was defined as successful intraoral stone extraction with no symptoms or stone recurrence for at least 12 months postoperatively.Results:The study included 43 males and 19 females,mean age 38±12 years.Two patients had bilateral stones.All but one operated gland had stones extracted(98.4%),however the true success was 93.8%(60/64)as three patients had recurrent/residual stones within a year.Biggest stone longest diameter was 9.8±4.6 mm(range,5-30 mm).Hilar and intraglandular stone locations were 73.4%and 6.3%,respectively.Median operative time was 55 min.Adjunctive sialendoscopy was performed in 42.2%.Its use is significantly correlated with having>3 stones(mean 3.4 vs.1.2 stones)[P<0.001,95%confidence interval:-3.19 to-1.25].Minor complications included temporary lingual paresthesia(7.8%)and postoperative ranula(1.6%).Conclusions:Submandibular IMAS is a highly effective safe technique for stones(≥5 mm).The improved microscopic visualization,illumination and magnification allows addressing all stone locations including intraglandular calculi and enables better lingual nerve identification and preservation.
