Intraoral removal of stones in the proximal submandibular duct: usefulness of a surgical landmark for the hilum.

INTRODUCTION Sialolithiasis is the most common cause of salivary gland disease and about 80% to 90% of stones occur in the submandibular gland (SMG). Among them, 40% of the SMG stones are located in the distal submandibular duct near the punctum, and they are removed through the intraoral approach. The other 60% of the SMG stones are located in the proximal submandibular duct or in the submandibular gland, and they usually are removed by transcervical SMG resection. However, transcervical SMG resection has several disadvantages; hence, minimally invasive techniques are becoming increasingly important. The minimally invasive techniques include extracorporeal shockwave lithotripsy (ESWL), radiologically or endoscopically guided basket retrieval, and intraoral stone removal. In particular, intraoral stone removal has advantages, including patient tolerability and acceptance, a less time-consuming procedure, and the ability to be performed under both local and general anesthesia. However, intraoral stone removal has several disadvantages, including the risk of lingual nerve injury; a poor surgical field; and technical difficulty in approaching the hilar area, especially during the removal of larger and proximal submandibular stones. The purpose of this study was to identify a surgical landmark for a convenient approach to the proximal submandibular duct and hilar area of the SMG, and to evaluate the safety and effectiveness of the intraoral removal of stones in the proximal SMG. MATERIALS AND METHODS