title: Ultrasound indicators of persistent obstruction after submandibular sialolithotomy.
abstract: OBJECTIVE
  To identify and describe the ultrasound indicators of persistent obstruction following transoral submandibular sialolithotomy and discuss the utility of ultrasound in the immediate postoperative period.
  
  
  METHODS
  We performed a prospective case series with planned data collection of patients who underwent treatment for symptomatic submandibular swelling.
  
  
  METHODS
  A tertiary care center.
  
  
  METHODS
  Thirty-three patients of either sex with known submandibular gland sialoliths who failed endoscopic retrieval of calculi.
  
  
  METHODS
  We performed in-office or operating room-based transoral submandibular gland sialolithotomy followed by immediate postprocedure ultrasound examination for the assessment of residual calculi. All patients underwent mandatory reexploration for suspicious findings.
  
  
  RESULTS
  Only the appearance of hyperechogenic foci with posterior shadowing reliably predicted the presence of residual stones following transoral sialolithotomy (P < .0001). The presence of hyperechogenic foci without posterior shadowing (P = 1.00), ductal dilatation (P = .23), and intraglandular dilatation (P = 1.00) was not indicative of retained calculi.
  
  
  CONCLUSIONS
  The presence of hyperechogenic foci with posterior shadowing on immediate postprocedure ultrasound is an accurate indicator of residual stones following transoral submandibular sialolithotomy. Ultrasound examination can be reliably used to identify patients at risk of symptomatic recurrence of sialoliths.
authors.affiliation: The George Washington University, Division of Otolaryngology-Head and Neck Surgery, Washington, DC, USA.
authors.forename: Arjun S
authors.initials: AS
authors.lastname: Joshi
authors.forename: Shivangi
authors.initials: S
authors.lastname: Lohia
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012008:Recurrence; D012086:Reoperation; D015494:Salivary Gland Calculi / Q000000981:diagnostic imaging* / Q000601:surgery*; D012680:Sensitivity and Specificity; D013022:South Carolina; D013364:Submandibular Gland Diseases / Q000000981:diagnostic imaging* / Q000601:surgery*; D016896:Treatment Outcome; D014463:Ultrasonography / Q000379:methods
keywords: postoperative imaging; recurrence; sialolithiasis; submandibular gland; transoral sialolithotomy; ultrasound examination