Minimally invasive surgery for submandibular hilar stones or stones in the deep portion of the Wharton duct of children and young adults

DOI
  • Funakoshi Urara
    Department of Otorhinolaryngology, Chiba Children’s Hospital
  • Ohtsuka Yuichiro
    Department of Otorhinolaryngology, Chiba Municipal Kaihin Hospital
  • Yonekura Syuji
    Department of Otorhinolaryngology—Head and Neck Surgery, Chiba University
  • Okamoto Yoshitaka
    Department of Otorhinolaryngology—Head and Neck Surgery, Chiba University Chiba Rosai Hospital

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Other Title
  • 小児・若年者のワルトン管深部・移行部唾石に対する低侵襲手術の取り組み

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Abstract

<p>Generally, removal of the submandibular gland has been performed to treat submandibular hilar stones or stones in the deep portion of the Wharton duct. Minimally invasive surgery, such as sialendoscopic or transoral surgery, has recently been adopted. Because the salivary stones of children are relatively small and there is a strong demand for minimally invasive surgery from parents, there is a good indication for minimally invasive surgery in children. Sialendoscopic surgery does not require an incision or carry the risk of nerve paralysis, but salivary stones >5 mm in size are difficult to extract if not decimated by laser. Many stones are difficult to extract, such as cases in which it is difficult to secure a field of view or when the salivary stone cannot be grasped with a basket forceps. With transoral surgery, if it is possible to palpate stones at the bottom of the mouth, it is possible to remove the stones at the transition and deep parts; however, with this method, small stones which cannot be palpated cannot be removed and there is a risk of lingual nerve paralysis. For this reason, a combined approach involving sialendoscopic and transoral surgery has been reported. First, surgery is carried out using a sialendoscope, and in cases in which it is impossible to extract stones, a surgical procedure is continued with transoral surgery. Therefore, we examined the merits and disadvantages of the surgical procedure, the selection of the procedure, and the post-operative course for each minimally invasive surgical procedure for deep submandibular and transitional salivary glands of children and young adults treated in our hospital.</p>

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