Abstract
Objective: 1) To demonstrate the utility of ultrasound in the assessment of the submandibular gland after endoscopic-assisted or purely open sialolithotomy. 2) To discuss limitations of using ultrasound for assessment after submandibular sialolithotomy.
Method: From August 2009 to January 2012, 22 adult patients with symptomatic submandibular sialolithiasis underwent endoscopic-assisted or purely open sialolithotomy in a tertiary-level clinic setting. Pre- and immediate postprocedure ultrasound was performed. Examinations were analyzed for evidence of persistent obstruction.
Results: Twenty patients with symptomatic submandibular sialolithiasis underwent either endoscopic-assisted sialolithotomy or pure open sialolithotomy for proximally located stones. Three of 22 (13%) demonstrated residual stones on ultrasound characterized by acoustic shadowing immediately after sialolithotomy and were retreated in the same setting with success. Fifteen of 22 (68%) demonstrated proximal ductal dilatation after stone removal. Eighteen of 22 (81%) demonstrated trace hyperechogenic foci without shadowing indicating air bubbles or blood. At 2 weeks, all findings had resolved. There were no instances of infection, ductal stenosis, loss of glandular function, or permanent lingual nerve paralysis with follow-up ranging from 6 months to 1 year.
Conclusion: Ultrasound can be used to assess for residual obstruction immediately after submandibular sialolithotomy. Only the presence of posterior shadowing reliably predicted pathology. The presence of proximal ductal dilatation and hyperechogenic foci without shadowing take longer to resolve after sialolithotomy, and should not be used to influence treatment decisions during procedures.
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