[Submandibular sialoliths. Stone removal with organ preservation].

BACKGROUND: Sialolithiasis as a cause of sialadenitis within Wharton's duct accounts for more than 80% of all cases. In the past extirpation of the gland was carried out in nearly all cases. Gland-preserving therapies such as transoral removal have so far been seldom examined. PATIENTS AND METHODS: In 683 patients suffering from submandibular lithiasis with a mean age of 45 years (8-87 years) transoral removal of the stones were carried out. The follow-up period was 1-7 years. The stone location was distal to the edge of the mylohyoid muscle in 283 cases and more proximal to the gland within the hilum in 296 patients (single concrements). Fifty-nine patients had two separate stones, one within the area of the hilum and other smaller ones proximal within the gland.
RESULTS: All patients with distal stone location, 89% of patients with single stones of the perihilar region, and 63% of the patients with two separate stones in the hilum and parenchyma were free of stones. Another 8 and 23%, respectively, had small residual concrements without any complaints. Recurrence of lithiasis or damage of the lingual nerve remained below 1%.
CONCLUSION: Transoral removal in palpable sialoliths should be considered as the treatment of choice in patients suffering from submandibular stones located within the floor of the mouth or within the perihilar region of the gland. Ultrasound imaging is important for exact location of the stones.