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Retained Submandibular Stone After Submandibular Gland Resection with neck fistula - Clinical case example

last modified on: Mon, 10/23/2023 - 08:26

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see also: Instructions to patients submandibular salivary stonesCase Example 2 Retrograde Sialendoscopy to Prevent Retained Ductal Stone with Submandibular Gland Resection

return to: Submandibular Gland Resection or Sialolithiasis

Case Example

History: onset of left neck drainage beginning 2 1/2 months after left submandibular gland resection done for sialolithiasis

Modified Operative Note

Preop Dx: Retained left ductal stone s/p left submandibular gland resection
Postop Dx: Same
Procedure: Left submandibular sialodochoplasty (complex) with stone removal employing sialendoscopy
Left sublingual gland resection (subtotal)
Culture (tranoral) of submandibular site
Anesthesia: General OETT
Duct readily canulated and then infused with 1% lidocaine
Serial dilation of duct orifice followed by sialendoscopy (diagnostic scope) to 4 cm from duct orifice where scarring of duct precluded clear view of stone (?stone vs scarring imaged)
Duct opened with microscopic dissection with gradual removal of sublingual gland in course of marsupializing duct (sutured with 5-0 vicryl) -suturing done to ensure adequate intraoral drainage of site from which duct removed - in continuity with now opened duct with two large segments of stone removed. Copious irrigation - bipolar cautery followed by application of tannic acid. Specimens to path.