Transoral removal of submandibular hilar lithiasis: results on the salivary duct system, glandular parenchyma, and quality¿of¿life recovery

Abstract

Objective(s) To confrm that hilar transoral submandibular sialolitectomy (TOSL) is the frst treatment option for subman dibular hilar lithiasis (SHL) in terms of glandular parenchyma recovery, salivary system restoration, and patient quality of life (QoL) improvement. Methods Depending on whether the stone was easily palpable, TOSL was carried out with or without sialendoscopy. For the frst time in the literature, Magnetic Resonance Sialography (MR-Si) was performed before and after TOSL, to evaluate stone characteristics, glandular parenchyma status, hilum dilation and main duct recanalization. Radiological data was examined independently by two radiologists. COSQ, a recently validated and specifc questionnaire, was used to assess associated QoL. Results Between 2017 and 2022, 29 TOSL patients were examined. With a high interobserver correlation, MR-Si was confrmed as a very useful radiological test in the pre- and post-surgical evaluation of SHL. The salivary main duct was completely recanalized in all cases. The presence of lithiasis was found in 4 patients (13.8%). After surgery, the majority of patients (79.31%) had hilum dilation. There was a statistically signifcant improvement in parenchyma status, but no signif cant progression to glandular atrophy. After surgery, COSQ mean values always improved (22.5 to 4.5). Conclusions TOSL is the ideal surgical technique for the management of SHL, resulting in improved parenchymal infam matory changes, recanalization of Wharton¿s duct, and enhancement patients¿ QoL. As a result, before removing the sub mandibular gland, TOSL should be considered as the frst treatment option for SHL. Keywords Hilar · Stone · Transoral · Ductal recovery · Quality-of-life