Sialolithiasis is defined as calcified stone(s) in the salivary duct or glands. Submandibular gland
sialolithiasis is the most common (80 to 90%), followed by parotid gland
sialolithiasis (5 to 15%). The typical clinical presentation is salivary gland swelling after eating. As the swelling persists, symptoms owing to local
inflammation, such as
pain and
trismus, emerge. In severe cases,
cellulitis and even
abscess formation occur and subsequently lead to salivary gland
atrophy or
fistula formation if the
sialolithiasis remains untreated. The most common treatment is complete excision of the affected gland together with the stone(s). In some cases, intraoral sialolithotomy is performed when the stone is solitary and easily palpable through the oral cavity. Sialendoscopy is increasingly performed because of its minimal invasiveness. The major limitation of endoscopic
laser lithotripsy of the salivary glands is the size of the stone. Often, for a stone larger than 4 mm, multiple fragmentations of the stone into small pieces is necessary before the pieces can be removed by wire basket or grasping
forceps. Recently, the
holmium:YAG laser has been reported as quite effective in removing larger
salivary gland stones. However, sialoendoscopic
laser lithotripsy is a very time-consuming procedure and in most cases, when there are multiple large stones in a single gland, entire gland excision is recommended. This report describes a male patient diagnosed with multiple large stones in his left submandibular gland who was successfully treated under sialendoscopy with
holmium:YAG laser lithotripsy.