Comparative analysis of approaches to the Wharton's duct during surgery of the submandibular gland: A retrospective case-control study.

Publisher: Blackwell Scientific Publications Country of Publication: England NLM ID: 101247023 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1749-4486 (Electronic) Linking ISSN: 17494478 NLM ISO Abbreviation: Clin Otolaryngol Subsets: MEDLINE

Original Publication: Oxford : Blackwell Scientific Publications, c2005-

Salivary Gland Calculi*/surgery ; Salivary Ducts*/surgery ; Submandibular Gland*/surgery ; Postoperative Complications*/epidemiology; Humans ; Retrospective Studies ; Male ; Female ; Case-Control Studies ; Adult ; Middle Aged ; Aged ; Recurrence ; Endoscopy/methods ; Adolescent ; Submandibular Gland Diseases/surgery ; Child ; Aged, 80 and over

Introduction: We investigated complications and recurrence rates after surgical techniques for sialolith removal with intact and resected Wharton's duct of the submandibular gland.
Methods: The retrospective case-control analysis of a series analysed 271 surgical operations (2003-2022) for sialolithiasis performed at a hospital department of Otolaryngology-Head and Neck Surgery. The study compared two approaches: (1) pure endoscopic technique or pinpoint stone removal with Wharton's duct left intact and (2) transoral duct dissection or pinpoint stone removal technique, after which the duct was shortened. While choosing the surgical option, the size of the stone, the location of the stone, and the presence of multiple stones were taken into account. The rates of complications (lingual nerve paraesthesia, duct stenosis, drooling, and sialoadenitis), the incidence of foreign bodies, and the rate of recurrence during follow-up of ≥18 months were compared.
Results: 323 sialoliths were removed from 271 patients. Of these 323 calculi, 150 were removed by the first approach and 173 by the second approach. The calculi varied in diameter from 2 to 38 mm with an average diameter of 8.2 mm. For all 271 patients, the rate of recurrence was 4.8%, but 11 recurrent cases (8.7%) appeared after the first approach surgeries and 2 cases (1.4%) after the second approach surgeries (p = .03). Other variables did not show statistically significant differences.
Conclusions: Surgical removal of the submandibular calculi, ending with shortening of Wharton's duct, reduces the recurrence rate for sialolithiasis but does not affect the rate of postsurgical complications.
(© 2024 John Wiley & Sons Ltd.)

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Keywords: Wharton's duct; calculi; surgery; the submandibular gland

Date Created: 20240503 Date Completed: 20240613 Latest Revision: 20240613

20240613

10.1111/coa.14176

38699810