Soliman Ola K, Sitton Matthew S, Lambert Elton M
Baylor College of Medicine, School of Medicine, Houston, TX, USA.
Division of Otolaryngology, Department of Surgery, Texas Children's Hospital, Houston, TX, USA; Department of Otolaryngology, Baylor College of Medicine, Houston, TX, USA.
Int J Pediatr Otorhinolaryngol. 2025 Oct;197:112526. doi: 10.1016/j.ijporl.2025.112526. Epub 2025 Aug 18.
Pediatric sialolithiasis can be managed effectively through both intraoral approaches, including sialoendoscopy, and extraoral approaches, such as gland removal. This study assesses factors in the evaluation and management of salivary stones in children.
A descriptive retrospective study of patients diagnosed with sialolithiasis and treated with sialoendoscopy at a tertiary care pediatric hospital from October 2008 to August 2022 was conducted. Presenting symptoms at the time of diagnosis, the distribution of stone locations, size, and the method of stone removal based on stone location were evaluated.
Seventeen patients were included in the final review. All patients had salivary gland stones diagnosed through imaging or visualized intraoperatively. The most common presenting complaint of sialolithiasis was facial swelling (82 %). Eighty-eight percent had submandibular duct stones, and 11 % had parotid duct stones. 50 % of stones were proximal, 22 % were distal, 6 % were at the hilum, and 11 % intraglandular. Forty-seven percent of patients underwent stone removal via sialoendoscopy and intraoral incision, 35 % through sialoendoscopy alone, and 18 % required gland removal. Chi-square testing was performed to evaluate differences in removal rates based on the location of the stone. Among patients with submandibular gland stones, distal stones (100 %) were more likely to be removed via sialoendoscopy with or without an intraoral incision compared to proximal (75 %), hilar (0 %), and intraglandular stones (0 %) (p = 0.005). Proximal (25 %), hilar (100 %), and intraglandular (100 %) submandibular stones were more likely to require gland removal than distal stones (0 %) (p = 0.026).
The findings in this review suggest that distal stones in the submandibular gland are more likely to be removed via sialoendoscopy with an intraoral incision as opposed to proximal, hilar, and glandular stones, which were more likely to necessitate gland excision.
小儿涎石病可通过包括唾液腺内镜检查在内的口内方法以及诸如腺体切除等口外方法有效治疗。本研究评估儿童唾液腺结石评估和治疗中的相关因素。
对2008年10月至2022年8月在一家三级儿科医院被诊断为涎石病并接受唾液腺内镜检查治疗的患者进行描述性回顾性研究。评估诊断时的症状表现、结石位置分布、大小以及基于结石位置的取石方法。
最终纳入17例患者。所有患者均通过影像学检查或术中可视化确诊为唾液腺结石。涎石病最常见的症状表现是面部肿胀（82%）。88%的患者有下颌下腺导管结石，11%有腮腺导管结石。50%的结石位于近端，22%位于远端，6%位于腺门，11%位于腺体内。47%的患者通过唾液腺内镜检查和口内切口取石，35%仅通过唾液腺内镜检查取石，18%需要切除腺体。进行卡方检验以评估基于结石位置的取石率差异。在下颌下腺结石患者中，与近端（75%）、腺门（0%）和腺体内结石（0%）相比，远端结石（100%）更有可能通过唾液腺内镜检查联合或不联合口内切口取出（p = 0.005）。与远端结石（0%）相比，近端（25%）、腺门（100%）和腺体内（100%）的下颌下结石更有可能需要切除腺体（p = 0.026）。
本综述结果表明，下颌下腺远端结石比近端、腺门和腺体内结石更有可能通过唾液腺内镜检查联合口内切口取出，而后三者更有可能需要腺体切除。
