Name of the Procedure:

Sialolithotomy: Submandibular (submaxillary), Sublingual, or Parotid, Uncomplicated, Intraoral

Summary

Sialolithotomy is a surgical procedure to remove salivary stones (sialoliths) from one of the major salivary glands: the submandibular, sublingual, or parotid gland. This procedure is performed internally through the mouth, minimizing external scarring.

Purpose

Sialolithotomy is used to treat obstructive sialadenitis caused by salivary stones or sialoliths. These stones can block the flow of saliva, leading to swelling, pain, and possible infection.

Indications

• Recurrent swelling and pain in the affected salivary gland.
• Persistent infection or inflammation of the salivary gland.
• Imaging studies (e.g., ultrasound, sialography) confirming the presence of a salivary stone.
• Failure of conservative treatments, such as hydration, massage, or sialogogues (substances that stimulate saliva flow).

Preparation

• Fasting for several hours before the procedure as instructed by the healthcare provider.
• Medication adjustments based on the doctor's advice.
• Preoperative imaging to locate the stone precisely.
• Routine blood tests and possibly a dental check-up.

Procedure Description

1. Anesthesia: Local anesthesia or mild sedation is administered.
2. Access: The surgeon makes a small incision inside the mouth to access the affected salivary gland.
3. Stone Removal: Using specialized instruments, the surgeon locates and carefully extracts the stone.
4. Closure: The incision site may be left open to heal naturally or sutured, depending on the size.
5. Irrigation: The duct may be irrigated to ensure no residual stones remain.

Duration

The procedure typically takes 30 minutes to 1 hour, depending on the number and size of the stones.

Setting

Sialolithotomy is usually performed in a hospital, outpatient clinic, or surgical center.

Personnel

• ENT (Ear, Nose, and Throat) surgeon or oral surgeon
• Surgical nurse
• Anesthesiologist (if sedation is required)

Risks and Complications

• Common Risks: Pain, swelling, minor bleeding
• Rare Risks: Infection, injury to the salivary duct or gland, recurrence of stones, nerve damage (leading to numbness or weakness in the affected area)

Benefits

• Relief from pain and swelling caused by the obstructed salivary gland
• Restoration of normal saliva flow
• Prevention of recurrent infections or chronic sialadenitis

Recovery

• Pain management with over-the-counter pain relievers
• Soft diet and plenty of fluids for the first few days
• Avoiding spicy and acidic foods
• Regular mouth rinses to maintain hygiene and prevent infection
• Follow-up appointment within 1-2 weeks to ensure proper healing

Alternatives

• Conservative Management: Hydration, gland massage, sour candies to stimulate saliva flow
• Minimally Invasive Techniques: Sialendoscopy, extracorporeal shock wave lithotripsy (ESWL)
• Each alternative varies in invasiveness, recovery time, and success rate depending on the stone's size and location.

Patient Experience

Patients may experience mild discomfort during the procedure due to the anesthesia. Post-operative pain and swelling are common but managed with medication and proper care. The intraoral approach minimizes visible scarring, and most patients resume normal activities within a few days, following post-operative instructions for a smooth recovery.