الفهرس 
ANATOMYOnly 14 pages are availabe for public view
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Abstract
Sialolithiasis is the most common disorder of salivary gland, accounting for 50% of major salivary gland diseases. While, 1% of autopsy reports documented sialolithiasis, annual clinically significant sialolithiasis is less common, with studies showing an incidence of 30 to 60 symptomatic cases requiring treatment per million individuals.
The introduction of salivary gland endoscopy is a major step forward in diagnosing and locating intra-ductal sialoliths and in allowing minimally invasive surgical treatment that can successfully manage to sialolithiasis. Now, using a combination of endoscopic techniques combined with trans-oral or external approaches, it provides a safe, effective, gland-preserving alternative.
Graspers, miniforceps, Dormia baskets and balloons are mainly used for the endoscopically-controlled retrieval of stones or their fracture into smaller pieces through the working channel or by pushing them forward in parallel to the endoscopic device. Intra-corporeal laser lithotripsy may be alternatively adopted to fragment the stone before using the graspers or baskets.
The only absolute contraindication is acute sialadenitis because the use of endoscope during inflammation increases the chance of ductal trauma. Microstomia and trismus are relative contraindications.
Management of submandibular sialolithiasis is based on sialolith size, orientation, and shapes. Marchal and Dulguerov suggested that the removal of submandibular stones smaller than 4 mm is amenable to sialendoscopy with basket or forceps retrieval, whereas larger stones may require the use of ancillary techniques such as fragmentation.
A combined procedure starts with endoscopic visualization and localization of the stone followed by a standard external or trans-oral approach to remove the stone without the need of gland removal followed by duct repair with stenting or marsupialization.
Various techniques of sialodochotomy are developed to minimize the risk of lingual nerve injury.
The more serious iatrogenic complication is avulsion of the duct. Other complications include recurrent sialadenitis because of restenosis or due to postoperative infections especially in cases of proximal sialoliths or retained sialoliths after an unsuccessful removal attempt. Other complications include transient lingual nerve paresthesia, ranula formation, hemorrhage and fistula in the floor of mouth and reduced salivary flow.