Intraoral therapy for sialolithiasis in the submandibular gland or at the junction of the duct and the gland

We retrospectively analyzed the medical records of 28 patients who underwent surgical extraction of sialolithiasis in the submandibular gland or at the junction of the duct and gland at the Sano Kosei General Hospital Department of Otorhinolaryngology between April 2003 and March 2014. Glandular stones were observed in 7 patients and at the junction in 21. Twenty-two patients had 1 stone; 5 had 2 stones; and 1 had 3 stones. In 21 patients, the maximum diameters of the 25 stones as measured by computed tomography (CT) were <5 mm for 5 stones, 5 to <10 mm for 7, 10 to <15 mm for 9, and ≥15 mm for 4. Preoperative bidigital palpation detected palpable stones in 19 (palpable group) and non-palpable stones in 6 patients (non-palpable group), while stones in 3 patients could not be determined. Of these 28 patients, 24 chose intraoral surgical treatment, while 4 chose submandibular gland extraction. In 23 of these 24 patients who underwent intraoral treatment, the stones were extracted as planned; in the remaining case, the stone was excreted naturally post-operation. All patients showed favorable postoperative progress. The postoperative complications in the intraoral treatment included temporary submandibular swelling in 7 patients, persistent pain in 4, and transient glossal nerve paralysis in 3, but no permanent complications. However, the non-palpable group had significantly longer operative durations and a higher incidence of complications. Intraoral surgical treatment can be used as the first-line therapy for sialolithiasis in the submandibular gland or at the junction of the duct and gland. Although intraoral treatment is possible in the non-palpable group, patients should be adequately informed about the complications risks, and their wishes, sex, and social background should be considered before performing this method.