Submandibulectomy for Lithiasic Submandibular Sialadenitis: A Case Series of 23 Patients in the Drâa-Tafilalet Region of Southeastern Morocco.

BACKGROUND AND OBJECTIVE: Submandibular sialolithiasis is the most frequent cause of salivary gland obstruction. Although gland-preserving procedures are increasingly used, submandibulectomy remains indicated in advanced, intra-glandular, recurrent, or complicated lithiasic sialadenitis. It is a safe, effective, and definitive therapeutic option in patients with advanced lithiasic submandibular sialadenitis. In resource-limited, geographically remote settings such as the Drâa-Tafilalet region of southeastern Morocco, patients often present at an advanced stage due to limited access to specialized care, rendering conservative or endoscopic approaches unfeasible. This study describes our surgical experience and underscores the necessity of early diagnosis and routine histopathological examination. The primary objective of this study was to describe the clinical profile, surgical management, post-operative outcomes, and histopathological findings of consecutive patients undergoing submandibulectomy for lithiasic submandibular sialadenitis in the Drâa-Tafilalet region. Secondary objectives were to describe the regional healthcare factors associated with delayed presentation and to emphasize the value of routine histopathological examination of all excised glands. Given the descriptive design and limited sample size, the study was not intended to determine the incidence of occult malignancy or establish causal relationships between regional factors and disease occurrence. METHODS: We conducted a retrospective descriptive study over a two-year period (January 2024-December 2025) in the Department of Otolaryngology - Head and Neck Surgery at Al Amir Sultan Hospital, Errachidia, Morocco. A total of 23 patients who underwent submandibulectomy for lithiasic submandibular sialadenitis were included. Epidemiological, clinical, radiological, therapeutic, and histopathological data were collected and analyzed. RESULTS: All 23 patients (male-to-female sex ratio of 13:10; mean age 51.1 years) underwent submandibulectomy. Mean symptom duration was 24.2 months. Histopathological examination revealed chronic sialadenitis in 21 (91.3%) cases and unexpected malignancy in two (8.7%) cases as follows: one low-grade mucoepidermoid carcinoma and one adenoid cystic carcinoma. CONCLUSION: In Drâa-Tafilalet, lithiasic submandibular sialadenitis may reach late stages before specialist management. Submandibulectomy provided definitive disease control with acceptable morbidity in our series of 23 patients. Despite advances in gland-preserving approaches, it remains an important therapeutic option for advanced lithiasic disease in low-resource settings.