How effective is ultrasound in localizing sialoliths during submandibular gland sialolithotomy?
Bottom Line: Ultrasound can be used effectively for precise sialolith localization intraoperatively, and can be repeated multiple times during any given procedure.
Explore This IssueDecember 2019
Background: Sialolithiasis is one of the most commonly diagnosed salivary gland diseases. Surgical stone removal is often necessary due to recurrent symptoms. Stone localization is essential in sialolithiasis diagnosis and treatment. Ultrasound confers benefits of portability, intraoperative accessibility, and cost-effectiveness, although it can be difficult to assess stones that are located at the duct ostium, those in the anterior floor of the mouth, or those that are smaller than 2 mm.
Study design: Retrospective case series utilizing data from a total of 164 patients, compiled from 2009 through 2016 in a tertiary academic center.
Setting: Division of Otolaryngology–Head and Neck Surgery, George Washington University, Washington, D.C.
Synopsis: The stone was successfully delivered in 147 cases; 119 were performed in the office, and 28 were performed in the operating room. The most common symptom that the patients experienced was general swelling, followed by post-/periprandial swelling and pain. Success was significantly associated with sialolith location. One hundred sialoliths were located proximally close to the hilum, and 64 were located distally. Stones located distally had a 98.4% success rate, whereas proximal stone location had an 87.3% success rate. Mean stone size was 7.5 ± 4.1 mm in successful cases and 11.8 ± 8.5 mm in non-successful cases. Successful stone delivery occurred in an average of 20.2 ± 8 minutes, while failed procedures took an average of 37.7 ± 10 minutes. One hundred forty-seven patients were symptom free at three months. Eight patients had complications during or after successful stone delivery: Five had stricture formation and three had ranula formation. There were five complications in unsuccessful cases: Two patients experienced severe bleeding and three experienced severe pain under local anesthesia. There were no cases of tongue numbness or motor dysfunction.
Citation: Romero NJ, Fuson A, Kieliszak CR, Joshi AS. Sonolocation during submandibular sialolithotomy. Laryngoscope. 2019:129:2716–2720