Intraoral Removal Has Advantages over Submandibular Gland Resection

Are surgical outcomes better for intraoral removal of proximal submandibular stones or traditional submandibular gland (SMG) resection?

Background: Salivary stones, the most common cause of salivary ductal obstruction, usually occur in the SMG and its ductal system. About 40 percent are located distally in Wharton’s duct and can be easily removed through an intraoral procedure. Proximal and intraglandular stones, however, are difficult to remove transorally because of their positions deep in the mouth floor.

Study design: Prospective randomized study

Setting: Department of Otolaryngology-Head and Neck Surgery, Sungkyunkwan University School of Medicine, Changwon, South Korea; Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, South Korea

Synopsis: Proximal submandibular stones were diagnosed in 44 patients, all of whom were randomized to undergo stone removal either by an intraoral approach (IORS group) or through SMG resection (SMGR group). Stones in the IORS group were significantly smaller than those in the SMGR group and there was no significant difference in the distance of the stones from the hilum between groups. The mean operation time and the mean hospital stay in the IORS group was significantly shorter than the SMGR group. Additionally, IORS patients suffered significantly less pain than did SMGR patients. The limitations of the study included a small sample size and no objective evaluation for the function of the salivary gland after surgery.

Bottom line: Intraoral removal of proximal submandibular stones has several advantages over SMG resection in terms of hospital stay, mean operative time and postoperative pain.

Citation: Eun YG, Chung DH, Kwon KH. Advantages of intraoral removal over submandibular gland resection for proximal submandibular stones: a prospective randomized study. Laryngoscope. 2010;120(11):2189-2192.

—Reviewed by Sue Pondrom