Artikel
Gland-preserving treatment of huge sialoliths of the submandibular glands
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Veröffentlicht: | 30. Juli 2013 |
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Introduction: Sialolithiasis is nowadays preferably treated with gland-preserving techniques like sialendoscopy, lithotripsy, or transoral stone removal. The question arises whether huge stones (“megaliths” of more than 15 mm) can be treated effectively in this way.
Methods: Retrospective analysis of patients treated between January 2003 and June 2009 at our department for a sialolithiasis of the submandibular glands.
Results: In 73 of 732 cases the diameter of the stone was 15mm or more (“megalithiasis”). In 70 cases the stone was removed transorally by duct slitting, ESWL was performed in one single case only, and two patients underwent primary submandibuletcomy. Duct slitting resulted in complete stone removal in 77%, in 23% a stone fragment remained. However, persisting complaints were recorded in only one case with a remaining fragment.
After a mean follow-up period of three years, 56 patients could be contacted 23% of which reported an occasional recurring of complaints (swelling or pain) since the treatment. In 9 cases (16%) a recurrent sialolithiasis was diagnosed.
Conclusions: In case of huge sialoliths of the submandibular gland, transoral stone removal by duct slitting is the gland-preserving procedure of choice. It is an effective technique regarding the patient’s symptoms; however, a complete stone removal is not always possible. The risk of a recurrent sialolithiasis is increased compared to cases with smaller stones. The patient should be informed appropriately about possibilities and limitations in these cases.