Transoral Surgical Management of Sialolithiasis

Sialolithiasis is the main cause of obstructive salivary diseases, being involved in 66% of cases and accounting for about 50% of major salivary gland diseases. Post-mortem studies have shown a 1.2% prevalence of salivary calculi in the general population.
Traditional management of submandibular stones was based on sialolithectomy for distal duct stones and sialadenectomy for proximal and intraparenchymal submandibular stones.
The last two decades marked by a shift to minimally invasive, organ preserving, endoscopic management of salivary glands obstruction and sialolithiasis, that revolutionized the standard of care in those pathologies. Today, success of minimally invasive management of salivary glands calculi is reported at over 80%.
To date, based on the newer published studies, regardless of the location of the stone in the submandibular gland, endoscopic assisted transoral removal of stones seems to be the preferred approach. While distal parotid stones may be managed by a transoral approach, the distal and intraparenchymal stones not amenable for endoscopic retrieval are managed by a combined extraoral approach.
The main factor to take into consideration is the size of the stone, and it is widely accepted that stones up to 4 millimeters can be managed by Sialendoscopy alone, Stones 5 millimeters and greater are managed by combined intraoral approach or purely by a transoral surgical technique.