Ultrasound Indicators of Persistent Obstruction after Submandibular Sialolithotomy

Abstract

Objective

To identify and describe the ultrasound indicators of persistent obstruction following transoral submandibular sialolithotomy and discuss the utility of ultrasound in the immediate postoperative period.

Study Design

We performed a prospective case series with planned data collection of patients who underwent treatment for symptomatic submandibular swelling.

Setting

A tertiary care center.

Subjects

Thirty-three patients of either sex with known submandibular gland sialoliths who failed endoscopic retrieval of calculi.

Methods

We performed in-office or operating room–based transoral submandibular gland sialolithotomy followed by immediate postprocedure ultrasound examination for the assessment of residual calculi. All patients underwent mandatory reexploration for suspicious findings.

Results

Only the appearance of hyperechogenic foci with posterior shadowing reliably predicted the presence of residual stones following transoral sialolithotomy (P < .0001). The presence of hyperechogenic foci without posterior shadowing (P = 1.00), ductal dilatation (P = .23), and intraglandular dilatation (P = 1.00) was not indicative of retained calculi.

Conclusion

The presence of hyperechogenic foci with posterior shadowing on immediate postprocedure ultrasound is an accurate indicator of residual stones following transoral submandibular sialolithotomy. Ultrasound examination can be reliably used to identify patients at risk of symptomatic recurrence of sialoliths.