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[Minimally invasive treatment of sialolithiasis using extracorporeal shock waves]
1Klinik- und Poliklinik für Hals-Nasen-Ohrenkranke, Universität Erlangen-Nürnberg.
Background:
In the past, management of sialolithiasis required surgical extirpation of the afflicted gland, in case the concrements could not be removed by dilatation or dissection of the glandular duct. The aim of the present study was to investigate the safety and efficiency of extracorporeal shockwave lithotripsy of salivary gland stones in men.
Patients And Methods:
51 patients with symptomatic solitary salivary stones which could not be removed by conservative measures received extracorporeal piezoelectric shockwave treatment. The concrements had a median diameter of 8 (4-18) mm and were located in the submandibular gland (69%) and in the parotid gland (31%). A total number of 72 shockwave treatments (maximum 3 treatments per patient) were performed under continuous sonographic monitoring.
Results:
In 45 patients (88%) complete fragmentation of the concrements was achieved. Piezoelectric shockwave therapy was tolerated without any need for anesthesia, nor administration of sedatives or analgesics. The only untoward effects resulting from therapy were individual localized petechial hemorrhages after 10 out of 72 treatments (13%) and transient swelling of the gland immediately after shockwave application (2/72, (3%)). Twenty weeks after initial treatment 90% of the patients (46/51) were free of discomfort, and 53% of the patients (27/51) were stone free. The stone clearance rates of patients exhibiting concrements of the parotid gland (81%) were significantly higher than those of patients with stones of the submandibular gland (40%, p < 0.01). Auxiliary measures such as dilatation or dissection of the salivary duct were required only in patients suffering from concrements of the submandibular gland (20%). No long-term damage to the treated salivary gland nor to adjacent tissue structures were noted during the median follow-up period of 9 (1-24) months.
Conclusion:
Extracorporeal piezoelectric shockwave therapy promises to become a safe, comfortable and effective minimal-invasive, non-surgical treatment of salivary stones.