TORS safe and effective modality for sialolithotomy with high success rate

This study aimed to systematically review the literature to determine the efficacy and safety of transoral robotic surgery (TORS) in the management of submandibular gland (SMG) sialolithiasis. PubMed, Embase, and Cochrane were searched for English-language articles evaluating TORS in the management of SMG stones published up to 12 September 2022.

Sialolithiasis represents the most common cause of obstructive salivary gland disorders [1]. While postmortem studies indicate a 0.115% prevalence of sialoliths in the general population, their clinical (symptomatic) prevalence amounts to 0.45% [1,2,3]. Most salivary stones (as high as 80–90% of cases) affect the submandibular gland (SMG), with a preferential location in the distal third of the Wharton’s duct, at the hilum or in the hilo-parenchymal area of the SMG

Nine studies with a total of 99 patients were included. Eight patients underwent TORS followed by sialendoscopy (TS); 11 patients underwent sialendoscopy followed by TORS and sialendoscopy (STS); 4 patients underwent sialendoscopy followed by TORS only (ST); and 4 patients underwent TORS without sialendoscopy (T). The mean operative time amounted to 90.97 min. The mean procedure success rate reached 94.97%, with the highest for ST (100%) and T (100%), followed by the TS (95.04%) and STS (90.91%) variants. The mean follow-up time was 6.81 months. Transient lingual nerve injury occurred in 28 patients (28.3%) and was resolved in all of them within the mean of 1.25 months. No permanent lingual nerve injury was reported. TORS is a safe and effective management modality for hilar and intraparenchymal SMG sialoliths, with high procedural success in terms of successful sialolith removal, SMG preservation, and reduced risk of permanent postoperative lingual nerve damage.

Reference:

Rogalska M, Antkowiak L, Kasperczuk A, Scierski W, Misiolek M. Transoral Robotic Surgery in the Management of Submandibular Gland Sialoliths: A Systematic Review. Journal of Clinical Medicine. 2023; 12(8):3007. https://doi.org/10.3390/jcm12083007

Keywords:

TORS, safe, effective, modality, sialolithotomy, high success rate, Rogalska M, Antkowiak L, Kasperczuk A, Scierski W, Misiolek M, sialolithotomy; sialendoscopy; robot-assisted; sialolithiasis; submandibular stones; lingual nerve