Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Objective: To evaluate long-term outcomes of submandibular sialolithiasis treatment, focusing on xerostomia, by comparing gland-preserving procedures to gland resection.
Study Design/Methods: Thirty-six patients were evaluated with follow-up (via phone, email, postal mail) more than five years after surgery for submandibular sialolithiasis to compare sialendoscopy-assisted gland-preserving surgery with submandibular gland resection. Patients were identified through review of a single surgeon’s log at an academic institution, encompassing procedures conducted between 2013 and 2018. Clinical parameters, including radiographic imaging and procedural details, were reviewed. Long-term follow-up focused on the resolution of initial salivary symptoms of pain and swelling, with ‘success’ defined as symptom resolution without new salivary symptoms or need for additional treatment on the same submandibular gland after the initial course of treatment. Xerostomia was evaluated separately employing the validated Xerostomia Questionnaire (XQ). Additional follow-up inquired about stone recurrence, the need for further treatments, and the presence of facial numbness, tongue numbness or weakness, or bothersome scar.
Results: Review identified 82 patients receiving 89 procedures directed to sialolithiasis resulting in 36 responses (median follow-up of 97.4 months). Gland resection was the first surgery in 11 patients (30.6%) with an additional 3 (8.3%) treated with gland removal after failing gland-preserving surgery due to persistent pain and swelling. 22 patients (61.1%) retained their glands after undergoing a sialendoscopy-assisted transoral procedure, with one requiring a second such procedure. Resolution of pain and swelling following the first surgical procedure was identified in all 11 (100%) who underwent gland resection and in 18 of 25 (72%) who underwent sialendoscopy-assisted gland-preserving procedures. Among the 7 (28%) who failed the primary endoscopic treatment, long term follow-up identified resolution of symptoms in 3 treated with gland resection, 1 with repeat endoscopic procedure, and 1 reporting spontaneous resolution of long-term symptoms. Two patients treated endoscopically had persistent symptoms at time of long-term follow-up. Among the 22 patients with preserved glands, 6 (27.3%) reported dry mouth, with an average XQ score of 8.0 at long-term follow-up. Dry mouth was reported by 4 of the 14 patients (28.6%) with gland removal with an average XQ score of 3.4. There were four patients with autoimmune diseases. One (multiple sclerosis) had their gland removed and reported no dry mouth, while 3 (rheumatoid arthritis, Grave’s disease, ulcerative colitis) preserved their glands and reported long-term xerostomia. Facial numbness about the incision (2 patients) was associated with ‘a bothersome scar’ in one and was limited to the gland resection group (N=14). No reports of facial or tongue weakness were noted (N=36). 20 out of 22 patients (90.9%) with gland preservation (one requiring two endoscopic procedures) and all 14 with gland removal were ultimately deemed ‘successful’ at long-term follow-up.
Conclusion: Degree of xerostomia, as subjectively reported and graded by XQ score, was similar at long-term follow-up among patients treated with gland preservation when compared to those who underwent gland removal. Avoidance of gland resection through transoral stone removal is associated with a higher likelihood of persistent salivary symptoms that may require additional treatment.