Name of the Procedure:

Sialolithotomy; Submandibular (Submaxillary), Complicated, Intraoral

Summary

A sialolithotomy is a surgical procedure to remove a stone (sialolith) from the submandibular gland. This specific type of surgery is performed through the inside of the mouth and is termed "complicated" due to the intricacy involved in accessing and removing the stone.

Purpose

This procedure addresses the presence of stones within the submandibular gland that cause blockage and lead to symptoms like pain, swelling, and infection. The goal is to eliminate these symptoms by removing the obstruction, allowing normal saliva flow.

Indications

• Recurrent pain and swelling in the submandibular region
• Chronic sialadenitis (inflammation of the salivary gland)
• Evidence of a stone in the gland identified via imaging studies
• Failure of conservative treatments (e.g., hydration, massage, or other non-invasive methods)

Preparation

• Patients may be asked to fast for several hours before the procedure.
• Adjustments to medications, such as blood thinners, may be required.
• Pre-operative imaging (e.g., ultrasound or CT scan) to locate the stone accurately.

Procedure Description

1. The patient is placed under local or general anesthesia for comfort.
2. An intraoral incision is made to access the floor of the mouth.
3. The tissues are carefully dissected to reach the duct of the submandibular gland.
4. The stone is meticulously extracted using specialized tools.
5. The duct and the surgical site are inspected for any residual stones.
6. The incision is closed with dissolvable stitches.

Duration

The procedure typically takes about 30 to 60 minutes, depending on the complexity.

Setting

Performed in a hospital or a surgical center with appropriate sterile conditions and equipment.

Personnel

• Surgeon specialized in oral and maxillofacial surgery or otolaryngology
• Anesthesiologist or nurse anesthetist
• Surgical nurse and operating room staff

Risks and Complications

• Infection
• Bleeding
• Temporary or permanent nerve damage causing numbness or difficulty moving parts of the mouth or tongue
• Recurrence of stone formation
• Swelling and bruising

Benefits

• Relief from pain and swelling caused by the stone
• Restoration of normal saliva flow
• Reduced risk of recurrent infection

Recovery

• Patients usually go home the same day.
• Pain and swelling management with prescribed medications.
• Instructions for oral hygiene to prevent infection.
• Soft diet recommended initially.
• Follow-up appointment to monitor healing and ensure no complications.

Alternatives

• Conservative treatments such as increasing fluid intake, sialogogues (substances that stimulate saliva flow), and massage.
• Non-invasive stone removal techniques like extracorporeal shock wave lithotripsy (limited to smaller stones).
• Sialendoscopy, a minimally invasive technique.

Patient Experience

During the procedure, patients will be under anesthesia and should feel no pain. Post-operatively, patients may experience discomfort, swelling, and mild pain which can be managed with medications. Adherence to post-operative instructions will facilitate smooth recovery.