New modalities in the management of human sialolithiasis

Abstract

SummarySialolithiasis is the most common disease of the great salivary glands with an incidence of 1.2%. New minimal-invasive methods like extracor-poreal Shockwave application or intracorporeal laser lithotripsy have changed the established ways of treatment of human sialolithiasis during the last years. Twenty per cent of our patients (n = 402) suffered from parotid duct stones and 80% from submandibular duct calculi. The typical symptoms were post-prandial pain and swelling of the glands. Until now there has been no proof of a metabolic disorder which could be responsible for coincidental stone development (6%) in the urinary tract or the bile duct system. Concrements are diagnosed by B-scan ultrasonography in nearly 100% of all cases. After our basic in vitro and in vivo investigations two systems of Shockwave treatment are useful for clinical application: extracorporeal Shockwave lithotripsy (piezoelectric) and intracorporeal laser lithotripsy (Rhodamine-6G-dye-laser), both supported by auxiliary measures (slitting and widening of the duct, dormia-basket extraction, sialagogues and gland massage). Due to our experiences with these minimally-invasive methods a new management of sialolithiasis is recommended depending on the localization of the calculi and their maximal diameters. Submandibular stones should be treated by extracorporeal lithotripsy, if the stone is located in intraglandular parts or in the hilum. Stones of the hilum also can be treated by laser lithotripsy. In the distal parts and near the orifice papillotomy and stone extraction should be tried independent of the stone size. If the maximum diameter is more than 12 mm and the concrement is detected in the intraglandular parts of the duct system or deep in the hilum, sub-mandibulectomy is necessary. Calculi of the parotid gland should only be treated by extracorporeal lithotripsy, regardless of their size and location. Because of severe duct stenosis papillotomy is not indicated. Parotidectomy should be carried out only in cases reluctant to minimally-invasive measures.