NEW MODALITIES IN THE MANAGEMENT OF HUMAN SIALOLITHIASIS

Sialolithiasis 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 duri ng 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. U ntil now there has been no proof of a metabolic disorder which could b e responsible for coincidental stone development (6%) in the urinary t ract or the bile duct system. Concrements are diagnosed by B-scan ultr asonography in nearly 100% of all cases. After our basic in vitro and in vivo investigations two systems of shockwave treatment are useful f or clinical application: extracorporeal shockwave lithotripsy (piezoel ectric) and intracorporeal laser lithotripsy (Rhodamine-6G-dye-laser), both supported by auxiliary measures (slitting and widening of the du ct, dormia-basket extraction, sialagogues and gland massage). Due to o ur 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 tr eated by extracorporeal lithotripsy, if the stone is located in intrag landular parts or in the hilum. Stones of the hilum also can be treate d by laser lithotripsy. In the distal parts and near the orifice papil lotomy and stone extraction should be tried independent of the stone s ize. 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, submandibulectomy is necessary. Calculi of the parotid gland s hould only be treated by extracorporeal lithotripsy, regardless of the ir size and location. Because of severe duct stenosis papillotomy is n ot indicated. Parotidectomy should be carried out only in cases reluct ant to minimally-invasive measures.