This protocol addresses sialolithiasis of the sublingual gland in the specific setting of submandibular gland sialolithiasis where the calculus is located in the proximal to hilar duct system — a presentation where stone position and size within the duct determine the appropriate management pathway.
Sialolithiasis of the submandibular gland with the stone situated in the proximal to hilar duct system. Stone mobility, size, and depth within this segment of the duct are the primary factors shaping the choice of intervention.
Management centres on surgical and minimally invasive duct access procedures, with the specific technique determined by stone size and how deep the stone lies within the duct system. The structured protocol specifies which intervention applies in each sub-scenario — consult the full regimen for the complete decision pathway.
DOI: 10.3390/jcm11010231
Stones in the Proximal to Hilar Duct System
Immobile, impacted larger stones (<10 mm) are an indication for TDS, but can also be removed with mechanical fragmentation or ISWL followed by fragment extraction.
Extended TDS/sialendoscopy-assisted TDS is the first choice in large stones (>10 mm), as it is an effective and fast modality.
It can be performed if the stone can be visualized during sialendoscopy, is not located too far within the duct system (depth measured with the sialendoscope <6.5–7.0 cm), and is palpable.