Transoral carbon dioxide laser sialolithectomy with topical anaesthesia. A simple, effective, and minimally invasive method.

Sialolithiasis frequently causes a variable degree of inflammation of the submandibular gland and stone removal can be a critical issue when incursion is deep, causing neck infection or abscess formation. The authors present their 6-year experience of performing sialolithectomy with CO(2) laser. Nineteen patients with stones in Wharton's duct were treated with CO(2) laser. Topical anaesthesia was applied by maintaining the patient in an upright position after spraying 10% lidocaine onto the oral cavity. The laser was set up in continuous mode at 4-6 W with a focusing spot. Locating the stone was accomplished by manual palpation or lacrimal probe insertion with or without the aid of radiological images. The success rate was 95%; only one procedure was unsuccessful, necessitating stone removal under general anaesthesia. Mean stone size was 0.37 cm. Only one patient developed ranula after laser surgery. The results suggest that transoral CO(2) laser sialolithectomy is simple and safe, with a low incidence of complications, and can be readily managed on an out-patient basis. This technique can be chosen for first-line treatment of sialolithiasis in cases where the stone is above the hilum of Wharton's duct.