ENDOSCOPIC MANAGEMENT OF SUBMANDIBULAR SIALOLITHIASIS

Background: Transoral removal and sialoadenectomy remain the main method of treatment for submandibular stone. However, missed ductal stone and risk of lingual nerve or hypoglossal nerve injury is not uncommon. We attempt to avoid the above complications by an innovative method.Methods: There were 6 females and 5 males, age ranged from 19 to 89 years. The procedures were performed under general anaesthesia, CO2 laser papillotomy of the submandibular orifice was done and a 3.1 mm rigid scope was inserted under vision with normal saline irrigation. Stones were either broken down by laser or retrieved by Dormia‐basket or forcep.Results: A total of 11 patients underwent the procedure. Therapeutic procedure was performed in 9 patients as the stones were identified and removed. Another two patients underwent diagnostic procedure only and no stone was found. One stone was identified and clearance achieved in 7 patients. More than 3 stones were removed in each of the other two patients. Pain and swelling of the submandibular gland subsided in 9 patients within 4 weeks after the procedure. There was persistent swelling more than 6 months after the procedure in one patient but no residual stone was revealed by CT scan of submandibular gland. One patient has residual stone demonstrated by sialogram which was performed because of persistent symptoms.No lingual nerve or hypoglossal nerve injury was detected in any patient.None of the patient need submandibular sialoadenectomy for stone removal.Conclusion: CO2 laser papillotomy and sialodoscopy is a new and efficacious treatment for submandibular ductal stone. It reduces the incidence of missed stone, nerve injury and chance of sialoadenectomy.