Dr.K.O.Paulose FRCS DLO, Consultant ENT Surgeon, Jubilee Hospital, Trivandrum, Kerala, India
Â Surgical procedure
Removal of long standing salivary gland stone requires a delicate and careful handling to avoid unnecessary damage to the duct and adjacent structures.
Usually this is done under local anesthesia. But in the above shown case I was forced to do it under GA as many attempts failed by infiltration anesthesia causing lot of fibrosis.
The possibility to removal of the stone under local anesthesia was abandoned at patients request as he had 3 attempts from different doctors all failed. It will be embarrassing for me for one more trial if it fails.
Patient under GA, the tongue was retracted by a piece of gauze. The duct sutured loosely behind the stone to prevent its posterior dislodgment, about 2-cm mucosal incision was performed against the stone position in the longitudinal axis of the duct. Upon dissection to reach the stone sublingual salivary gland structure encountered, it was a little bit difficult to expose the stone after incising the duct lining because the fibrous adhesions resulting from recurrent inflammatory processes.
After its exposure, I grasped the stone gently by mosquito artery forceps, and the adhesions were relieved by excavator end of the surgical curette, which facilitated its removal. The size of the stone was about 1cm.
Copious irrigation and suction was done to ensure removal of possible minor stones posterior to the removed stone, and a clear mucous secretion was noticed through the wound incision. After ensuring homeostasis, Closure of mucosal wound was done with 3/0 catgut suture. Postoperative analgesic and antiseptic mouthwash were prescribed