Impact of Submandibular Sialolith Characteristics on Successful Sialendoscopy-Assisted Removal

Abstract Objective To evaluate sialolith characteristics associated with reduced success of sialendoscopy-assisted treatment in submandibular gland lithiasis and to assess postoperative patient-reported outcomes. Methods A retrospective analysis was conducted of patients undergoing sialendoscopy for obstructive submandibular gland disease between 2010 and 2023. Stone size, location, mobility, and quantity were recorded. Treatment success was defined as complete stone extraction. Patient-reported symptom improvement and the need for subsequent submandibulectomy were evaluated during follow-up. Results Among 215 patients with submandibular sialolithiasis, complete stone extraction was achieved in 69.3%. Floating stones and fixed stones located in the distal duct demonstrated high success rates (87.2% and 90.0%, respectively). In contrast, fixed stones located in the proximal duct or hilum showed significantly lower success (41.4%; p < 0.001). Stones ≤ 4 mm were associated with significantly higher extraction success compared with larger stones ( p = 0.001). Stone number did not significantly affect outcomes. Complete stone removal was strongly associated with significant or complete symptom improvement and a lower rate of subsequent submandibulectomy ( p < 0.001). Conclusion Stone size greater than 4 mm and fixed proximal or hilar localization are factors associated with reduced success of sialendoscopy-assisted treatment. Recognition of these factors may improve patient selection and guide the use of alternative or combined treatment approaches.