06/05/2025
Removal of Salivary Stones in the Anterior Floor of the Mouth via Marsupialization and Duct Drainage or Duct Catheterization
The management of sialolithiasis, particularly in the anterior floor of the mouth, often involves minimally invasive techniques aimed at preserving gland function while effectively removing obstructions. Salivary stones (sialoliths) located in the anterior portion of the submandibular duct (Wharton’s duct) can frequently be accessed and treated using marsupialization combined with ductal drainage or catheterization.
Marsupialization is a surgical technique in which the duct or cystic structure is incised and sutured open to create a permanent stoma. In cases of anterior duct stones, this method allows direct access to the obstructive calculus, enabling its removal with minimal trauma to surrounding tissues. After excision of the stone, the ductal opening is often maintained either through careful suturing techniques or by temporary placement of a ductal stent or catheter. This ensures continued drainage of saliva, prevents ductal stenosis, and promotes proper healing.
Duct catheterization, when employed, serves both diagnostic and therapeutic purposes. A catheter can be used to irrigate the duct, remove smaller fragments, and keep the duct patent during the postoperative period. In some protocols, the catheter remains in situ for several days to weeks, depending on the severity of the initial obstruction and the surgeon’s preference.
This combined approach of marsupialization and duct drainage or catheterization is generally well-tolerated by patients and is associated with a high success rate in preserving gland function and preventing recurrence. Postoperative care typically includes maintaining good oral hygiene, stimulating salivary flow, and monitoring for signs of infection or re-obstruction.
