Algorithms for treatment of salivary gland obstructions

Treatment of obstructive diseases of the major salivary glands has undergone a dramatic change in the last 10 to 15 years. New minimally invasive techniques have been developed, covering all different entities that are included in the complex of salivary gland obstruction, and can help the physician to find the right diagnosis and an adequate treatment plan and to perform a gland-preserving form of therapy. Sialolithiasis or stenosis is the cause of about 90% of all obstructive salivary gland diseases. The development of radiologically or fluoroscopically controlled methods, but especially the introduction of sialendoscopy, has led to changes in the treatment protocol. Knowledge from the authors' experience and from a thorough investigation of the literature has been combined to elaborate algorithms for the treatment of the different obstructive diseases of the salivary glands. Sialoliths and stenoses can be successfully treated by radiologically or fluoroscopically controlled or sialendoscopically based methods in approximately 80% of cases. Extracorporeal shock-wave lithotripsy (ESWL) is successful in up to 50% of cases. Transoral duct slitting is an important method for extraparenchymal submandibular stones, with a success rate of 90%. Operative duct procedures and the combined endoscopic-transcutaneous approach complete the spectrum of treatment modalities of the parotid gland. Sialendoscopy plays a central role in the treatment of obstructive salivary gland diseases, but maximum success can only be attained by the reasonable combination of all these new minimally invasive techniques. Altogether, in well over 95% of cases, resection of the gland can be prevented, thus reducing morbidity and the surgical risks for patients.