Efficacy, Risks, and Limits of Extracorporeal Shock Wave Lithotripsy for Salivary Gland Stones

Abstract

Stones of the salivary glands may cause recurrent swelling, ascending inflammation, and colic-like pain. Previously, in order to get rid of these stones, the gland usually had to be removed surgically in spite of the associated risks to adjacent structures, especially the facial nerve. We treated 104 salivary gland stones in patients 14 to 78 years old using the Storz Modulith SL 10 lithotripter. Each session (average 3.6 per patient) consisted of 1000 impulses at 2 Hz and 16 to 18 kV. No anesthesia was required. Earplugs were applied to patients being treated for parotid gland stones. With the aid of SWL and drug-induced salivation, 17 (59%) of the patients with parotid gland stones and 42 (56%) of those with submandibular gland stones obtained either total stone clearance or sufficient fragmentation to permit spontaneous passage. Four patients required surgery. The remaining patients are still being treated. The noninvasive SWL for salivary gland stones is noninvasive and painless and has a considerable success rate. It can be performed on an outpatient basis.

Extracorporeal Shockwave Lithotripsy for Salivary Calculi in Pediatric Patients

“…The low rate of adverse effects observed in this study con rms the results of previous reports (20,21) in which this method, which was well tolerated by both children and adults, was associated with a low morbidity in contrast to surgical procedures. Moreover, this new miniaturized lithotripter usually obviates the use of anesthesia or sedation, in contrast to the reports of other authors (21).…”

Factors influencing the outcome of extracorporeal shock wave lithotripsy in the management of salivary calculi

“…[2][3][4][5][6][7] In this study an acute exacerbation of the infection occurred in 6.3% (9/142) cases.…”

Salivary lithotripsy in the era of sialendoscopy

“…Currently, laser and pneumatic lithotripsy are most often used and many experiences have been reported after application of a holmium:YAG laser 13 15 43 45 - 47 49 51 53 - 61 65 . For the 10-20% of stones that cannot be accessed using a sialendoscope or any other surgical method, ESWL is the treatment of choice and can be successful in up to 80% of cases, particularly under ultrasound guidance 6 23 25 30 - 36 41 57 65 . It should finally be mentioned that a combination of extra-corporeal and intra-ductal fragmentation may further increase success rates 20 23 64 65 .…”

“…Although it is sometimes difficult to make direct comparisons of published studies because of the different outcomes considered (e.g. symptomatic recovery, ultrasonographic stone clearance or detection of stone fragments no larger than 2 mm), when evaluated as the rate of complete stone clearance, the effectiveness of electromagnetic ESWL is 26-69% and that of piezoelectric ESWL is 29-81% (Table I) 8 - 10 18 19 25 - 35 ; the success rate is higher in the case of parotid gland stones (electromagnetic ESWL 39-69% vs 26-42%; piezoelectric ESWL 33-81% vs. 29-40%) (Table I) 8 - 10 18 19 25 - 35 .…”