Intraoral removal of proximal submandibular stones--an alternative to sialadenectomy?

Submandibular salivary stones account for most symptomatic sialoliths and most are treated by adenectomy. Transoral removal of proximal or hilar stones is an alternative approach that preserves the functioning gland. Between 1999 and 2006, 186 consecutive patients had transoral removal of 186 stones in the proximal third or hilum of the submandibular gland. Both patient and treatment details were recorded prospectively and outcome assessed by a structured questionnaire. Stone removal was achieved in 99% (185/186) of cases treated. Morbidity was low and there were no intra-operative complications. At median follow up of 28 months (range 4-62 months) 4% (7/186) had subsequently undergone sialadenectomy for persisting symptoms. 105/186 responded to a questionnaire, 76% (80/105) were symptom-free and in a further 17% (18/105) symptoms were mild. No patient had lingual nerve anaesthesia but 6% (6/105) reported a mild tingling. 93% (97/105) were pleased to have had the operation. Submandibular stones can be reliably retrieved from the proximal portion of the duct or hilum with minimal morbidity. Evolving review data suggests that the incidence of recurrent disease is low at 2 years, suggesting that this technique may be a viable alternative to adenectomy.