View FLASH Surgery Presentation

Pictures of Stone in
Warthin's Duct
(Submandular Gland)

Pictures of Stone in
Stensen's Duct
(Parotid Gland)

Case Report #1
Large Submandibular
Calculus

Case Report #2
Large Submandibular
Calculus

Removal of the submandibular gland (also called the submaxillary gland) is a relatively uncommon operation which is done for the following reasons:

•   Treatment of a benign or malignant tumor.  Most tumors of the submandibular gland are benign with the most common being a pleomorphic adenoma.  The submandibular gland is the second most common location for a pleomorphic adenoma, the most common being the parotid gland.   Malignant tumors are rare and have a poor prognosis, the most common is an adenocystic carcinoma.  View Abstract

•   Chronic infection (sialadenitis).  Recurrent infection may be caused by a stone or stenosis of the duct.  When conservative treatment fails and infections continue to occur consideration should be given to removal of the gland. 

•   Removal of large salivary gland stones.  Salivary gland stones most commonly occur in the submandibular gland's duct (Warthin's Duct) because of its more mucoid secretion and uphill flow.   Large stones are usually removed surgically.  Either an external View Abstract or intraoral approach can be used.  In cases with marked inflammation, an external approach gives better exposure and aids in the preservation of nervous structures.   Small stones, less than 5 mm, can be extracted by dilation of the duct and the use of small microforceps.  View Abstract    Extracorporeal shock wave lithotripsy has been used to remove stones with a median size of 6.76 mm .  View Abstract    Iro, et al., found lithrotripsy most useful in the treatment of parotid stones less than 7 mm.  View Abstract    

Below is a FLASH presentation on the surgical technique of removal.  Usually this can be performed on an outpatient basis.  Complications include injury to the:

•   Mandibular branch of the Facial Nerve with resultant weakness or paralysis of the lower lip.

•   Lingual Nerve with numbness of the tongue (loss of sensation of touch).

•   Rarely, injury to the Hypoglossal Nerve with loss of motor function. 

 
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