Extracorporeal shockwave lithotripsy for salivary calculi in pediatric patients

Salivary gland lithiasis is uncommon in pediatric patients. Color Doppler u ltrasonography (US) enables an accurate diagnosis of lithiasis to be made w ithout exposure to the radiation of traditional imaging techniques. The dev elopment of minimally invasive techniques in the ENT field has made salivar y lithotripsy a feasible alternative to traditional invasive surgery. The s afety and efficacy of shock wave lithotripsy for salivary calculi were eval uated in pediatric patients. Seven children (5 males; age 4-15 years) with single calculi (mean diameter 4.4 mm) of the submandibular (n = 4) and paro tid glands (n = 3) underwent extracorporeal electromagnetic shock wave lith otripsy (EESWL). In four cases the stone was intraductal (two submandibular and two parotideal) and in the remaining three cases it was intraparenchym al (two submandibular and one parotideal). In one case sedative anesthesia was performed. The mean number of therapeutic sessions was five. Patients w ere followed up clinically and with US for 6-72 months (mean 32 months). Co mplete disintegration of the calculi was achieved in five cases while in tw o cases a residual fragment < 2 mm in diameter was observed. None of the pa tients had recurrence of calculi in the treated gland. Mild self-limited ad verse effects (pain, swelling of the gland, self-limiting bleeding from the duct, cutaneous petechiae) were observed in four cases. Our data suggest t hat EESWL is effective, safe and well tolerated; the minimal invasiveness o f the technique suggests that EESWL should be used as the primary approach to salivary calculi in pediatric patients. The continuous US monitoring ena bles the efficacy of EESWL to be evaluated during both treatment and follow -up, with only slight discomfort for the pediatric patient.