Four cases of sialolithiasis over submandibular gland were treated in two different surgical approaches, depending on the location of the sialoliths. The intra-oral surgical approach has some limitations; it requires the location of the sialolith to be in front of the transverse line between the mandibular first molars and the sialolith to be palpable by hand. The extra-oral surgical approach provides a more favorable surgical field; however, it results in a clear scar over the transcervical area. Under some conditions such as intraglandular sialoliths, recurrent sialoadenitis, persistent symptoms, and salivary tumor, the sialoliths and submandibular gland must be removed together.