Modern therapeutic strategies for submandibular lithiasis

Most salivary gland stones involve the submandibular gland, which often cause recurrent swelling and pain of the glands after meals, and used to be the main reasons for the gland removals. With the trend of minimally invasive treatment, gland preservation and functional recovery in the diagnosis and the treatment of submandibular lithiasis have been paid more and more attention. New equipment and technologies such as CBCT and sialendoscopy, which are widely used in clinical practice, have contributed a lot to the accurate orientation and minimally invasive treatment of stones, and enriched the managements of submandibular lithiasis. Based on our experience and the review of relevant literature, this paper attempts to summarize the treatment strategies for submandibular stones distributed in different parts of the duct: ① emphasizing on the integrity and functions of the organ; ② endoscopy and minimal invasiveness come first; ③ scientific classifications and personal managements. Appropriate treatment options should be selected according to the features of the stones: endoscopic lithotomy helps a lot in removing those located in the anterior or middle part of the duct; endoscopic lithotomy or/and sialolithotomy are needed according to the features of hilar stones; the regular follow-up is required for the intraglandular stones. Meanwhile, the evaluation of the gland function is also important. After the removals of sunmandibular stones, the functions of the glands should be promoted to restore as far as possible.