MINIMALLY INVASIVE THERAPY OF SIALOLITHIA SIS BY EXTRACORPOREAL SHOCKWAVES

Background: In the past, management of sialolithiasis required surgica l extirpation of the afflicted gland, in case the concrements could no t be removed by dilatation or dissection of the glandular duct. The ai m 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 ex tracorporeal piezoelectric shockwave treatment. The concrements had a median diameter of 8 (4-18) mm and were located in the submandibular g land (69%) and in the parotid gland (31%). A total number of 72 shockw ave treatments (maximum 3 treatments per patient) were performed under continuous sonographic monitoring. Results: In 45 patients (88%) comp lete fragmentation of the concrements was achieved. Piezoelectric shoc kwave therapy was tolerated without any need for anesthesia, nor admin istration of sedatives or analgesics. The only untoward effects result ing from therapy were individual localized petechial hemorrhages after 10 out of 72 treatments (13%) and transient swelling of the gland imm ediately 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%) we re significantly higher than those of patients with stones of the subm andibular gland (40%, p < 0.01). Auxiliary measures such as dilatation or dissection of the salivary duct were required only in patients suf fering from concrements of the submandibular gland (20%). No long-term damage to the treated salivary gland nor to adjacent tissue structure s were noted during the median follow-up period of 9 (124) months. Con clusion: Extracorporeal piezoelectric shockwave therapy promises to be come a safe, comfortable and effective minimal-invasive, non-surgical treatment of salivary stones.