City hospital performs challenging oral surgery

Doctors at a city hospital have performed a "challenging" hi-tech surgery during which seven stones in a patient's oral region were removed without leaving any scar.
"Satyender Khatri, had complaints of recurrent swelling and pain below the left jaw area on food intake since many years. He had been diagnosed to have stones in the left submandibular duct (one of the salivary excretory ducts) region which kept on recurring.
"On CT scan he was found to have a large stone mid-way in the submandibular duct of size 7 mm and multiple small stones present in the junction of gland and duct with the largest being 4 mm in size," a senior official of the Sir Ganga Ram Hospital said, adding, the surgery was done recently.

The hospital has been performing such surgeries (sialendoscopy) in the past, but this one, he said, was "very challenging" as the patient had multiple stones and doctors also had to save his glands, which is difficult in such surgeries.
"When we saw the patient in our OPD we found that the left submandibular gland had swollen to twice its size and the ultrasound showed the presence of the stone in the duct situated in the floor of mouth and just a widened duct behind the stone.
"The normal size of the duct is just 3 to 5 mm in diameter and a 7 mm size stone had stretched the ductal wall causing extreme blockage leading to his problems.

"In this case, the larger stone was first brought to the opening of the duct and then removed. Then the smaller stones present in the back of the duct were addressed and the 4 mm stones was removed using microforceps, he said.

"Check endoscopy revealed five other smaller stones along with a lot of debris present in the part of the duct, which was almost inside the gland. These stones were also removed using a completely endoscopic approach and the duct was flushed of all debris," he added.
Dr Varun Rai, Associate Consultant at the hospital, said, "The procedure is relatively simple in experienced hands and with the sialendoscope we are now able to address the smaller stones at the back of the duct which would have inevitably led to them becoming larger with time and causing recurrence.

"This procedure of sialendoscopy is a relatively new technique in a developing country such as ours, with very few centres even offering it at present."
The incidence in our country is about 0.5 per cent, so in our country of 1.2 billion, we have an estimated 6 million people having stones in the salivary gland duct, the hospital said.