This protocol addresses submandibular sialolithiasis where the calculus is not accessible by bimanual palpation — when the stone is in the anterior region, or in the posterior region with a diameter of 4 mm or smaller.

Clinical Scenario

The calculus is not bimanually palpable. The stone is either located anteriorly, or posteriorly at a diameter at or below 4 mm. These characteristics determine which management pathway applies and inform the imaging and procedural considerations for this presentation.

Management Approach

The protocol for this presentation involves a surgical approach at the level of the submandibular gland. The full indications, decision criteria, and procedural pathway are detailed in the complete protocol.

References

DOI: 10.1051/mbcb/2018039

Sialendoscopy is mainly intended for small stones (less than 4 mm diameter) but can remove stones regardless of their position under local or general anesthesia.

This technique is indicated when the computed tomography does not show a calculus and when a minimally invasive technique should be favoured.

In case of multiple recurrence, failure of non-invasive and invasive treatments or complete loss of salivary gland function, submandibulectomy can be discussed with the patient.

View source ↗

Submandibular Sialolithiasis with Stone Not Bimanually Palpable

Clinical Scenario

Management Approach

References