Is ductoplasty required following transoral sialolithotomy? - A case series

Abstract

Objective: This study aimed to determine if there was a difference in postoperative outcomes and complications between patients who underwent traditional two-layer closure (ductoplasty and floor of mouth) after Wharton's duct sialolithatomy during hybrid sialendoscopy compared to those who underwent single layer closure of only the floor of mouth.

Methods: Retrospective case series of a single surgeon's patients who underwent hybrid sialendoscopy at an urban tertiary care hospital. Demographic, preoperative, intraoperative, and postoperative information was collected from patients who underwent hybrid sialendoscopy with transoral sialolithotomy of Wharton's duct from 2020 to 2023. Data included salivary glands explored, intraoperative complications, ductal repair, postoperative complications, and recurrence of salivary symptoms.

Results: 32 patients underwent hybrid sialendoscopy. Of those, 28.1% (n = 9) underwent traditional two-layer closure, and in 71.9% (n = 23) had single layer closure. 2.6% (n = 1) had a postoperative infection. There were no immediate postoperative complications reported in those with single layer closure. There was no statistical difference in postoperative complications between the two groups (p = 0.10). In patients with follow up, 86.7% of (n = 13) patients had documented salivary flow through the natural papilla after one layer closure compared to 80% (n = 4) in the two-layer group. There was no significant difference between the groups (p = 0.72).

Conclusions: The results of this study support that single layer closure without ductoplasty after hybrid sialendoscopy allows for ductal recanalization and may produce the same postoperative outcomes as traditional two-layer closure while increasing operative efficiency.

Keywords: Ductoplasty; Salivary glands; Sialendoscopy; Sialolithiasis; Submandibular gland.