(0670) Is Ductal Repair Required Following Transoral Sialolithotomy: A Case Series

Introduction: When performing transoral sialolithotomy, traditionally the submandibular duct and the overlying mucosa are closed in two layers. Closure of only one layer, the oral mucosa, could improve surgical efficiency. This study aims to determine whether omitting direct ductal closure significantly affects patient outcomes after transoral sialolithotomy.

Methods: This single surgeon retrospective cohort study at a tertiary care institution looked at demographic, preoperative, intraoperative, and postoperative information of patients who underwent hybrid submandibular sialendoscopy with transoral sialolithotomy from 2020-2023. Data collected included salivary glands explored, need for conversion to open sialolithotomy, if ductal repair was performed, intra and postoperative complications, and recurrence of salivary symptoms.

Results: Out of 165 cases, 23.1% (n = 38) converted to hybrid transoral sialolithomy. Of those, 36.8% (n = 14) underwent traditional two layer closure of the duct and oral mucosa, and in 63.2% (n = 24) only the oral mucosa was closed. Postop complications within the first two weeks were reported for 2.6% (n = 1); 1 patient developed an infection. All patients who had complications had two layer closure intraoperatively. There were no immediate postop complications reported in those with only closure of the oral mucosa. There was no statistical difference in postop complications between the two groups (p = 0.1845). Some patients (13.2% (n = 5)) experienced recurrence of salivary symptoms in the first 2-4 weeks. In the single layer closure group, 12 of 16 patients with postoperative follow up had normal saliva expression through the natural papilla.

Conclusions: Our findings indicate that single layer mucosal closure after transoral sialolithotomy is sufficient to maintain adequate salivary flow and have limited morbidity. Therefore, the single layer closure after hybrid salivary stone removal can increase operative efficiency in many cases.