Transoral removal of submandibular stones.

OBJECTIVE To assess transoral treatment of submandibular lithiasis. DESIGN Study of a series of patients with submandibular stones undergoing transoral removal of the sialoliths. Duration of follow-up: 6 months to 7 years. SETTING Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg, Erlangen, Germany, center for treatment of salivary stones. PATIENTS Two hundred thirty-one patients (127 females, 104 males) suffering from submandibular lithiasis had a mean age of 41.7 years (age range, 12-86 years). Stone location was distal to the edge of the mylohyoid muscle in 115 patients and proximal to the gland in 102 patients (mean size of sialoliths, 6.3 mm [range, 2-30 mm]). Fourteen other patients had 2 separate stones, one within the hilum and a smaller more proximal one within the gland. INTERVENTIONS Transoral removal of the stones under local anesthesia and preservation of the submandibular gland. MAIN OUTCOME MEASURES Complete removal of the stones, complications, and recurrence of the stones. RESULTS All 115 patients with distal stone location, 93 (91%) of 102 patients with stones of the perihilar region, and 9 (64%) of the 14 patients with 2 separate stones in the hilum and parenchyma were free of stones. Submandibulectomy had to be carried out in 4 patients (1.7%). Recurrence of lithiasis and damage to the lingual nerve remained below 1%. CONCLUSIONS Transoral removal should be the treatment of choice in patients with submandibular stones that can be palpated bimanually and localized by ultrasound within the perihilar region of the gland.