Stones in the anterior two-thirds of the submandibular duct in the floor of the mouth are removed by ductal dilation and massage. A suture is placed around the duct behind the stone so as to lift the duct upwards and prevent the stone from falling back out of reach. The stone is lifted out after making a longitudinal incision in the duct. The incision is left open to facilitate drainage. The patient should be warned that there is a 20% recurrence rate.
Stones in the hilum of the submandibular gland require excision of the gland because of their inaccessibility and the postoperative tendency for simple stone removal to result in stricture. Care must be taken to avoid damage to the mandibular branch of the facial nerve.
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