Submandibular sialolithiasis treatment: a comparative pilot prospective study of holmium: YAG laser and pneumatic lithotripsy techniques.

Abstract

Objective: Sialendoscopy is a minimally invasive technique employed to diagnose and treat obstructions in the major salivary glands.Holmium: YAG Laser Lithotripsy (HLL) and Intraductal Pneumatic Lithotripsy (IPL) are increasingly utilized for stone fragmentation; however, comparative studies are still limited. This study aims to prospectively compare the outcomes of HLL and IPL in cases of submandibular sialolithiasis.

Materials and methods: Fifty patients diagnosed with submandibular sialolithiasis were randomly assigned to two groups for treatment with either HLL or IPL. Demographics, stone size and location, operative times, and complications were meticulously documented. Preoperative imaging with ultrasound and computed tomography identified stone parameters. Follow-up assessments occurred at 1 week, 3 months, and 6 months post-treatment, which included a 3-month ultrasound to evaluate for residual stones and assess ductal evaluation.

Results: No significant differences between the groups concerning demographics, stone size, or location (p > 0.05). However, the IPL group demonstrated shorter operative times for distal and mid-duct stones (p < 0.05). The stone-free rates were 92% in the HLL group and 96% in the IPL group. The HLL group exhibited higher rates of mucosal laceration and ductal perforation, while the IPL group showed a greater potential for stone migration. Postoperative symptom resolution was achieved in both groups. Additionally, quality of life (QOL) scores, assessed using the SF-36 questionnaire, showed significant improvement at 6 months postoperatively in both groups, with no statistically significant differences between them.

Conclusion: Both HLL and IPL are effective treatments for submandibular sialolithiasis. IPL is associated with shorter operative times, especially for distal and mid-duct stones, while the complication rates for both methods remain within acceptable limits.