Extracorporeal Shock Wave Lithotripsy of Submandibular Stones: Evaluation after 10 Years

Abstract

The use of extracorporeal shock waves in the treatment of submandibular stones is a minimally invasive approach for the treatment of this disease. Its clinical significance has been determined in a long-term retrospective study, performed as follow-up to the short-term results. From 1989 to 1994, 197 patients (88 female, 109 male; age range, 8 to 83 years) with symptomatic, sonographically detectable concretions of the submandibular gland were treated with extracorporeal shock wave lithotripsy. The review analysis was completed retrospectively in 2002 and included 191 patients with complete data. The period under review ranged from 8 to 13 years, with an average of 10.5 years. Altogether, 67 of the 191 patients (35%) either were free of stones or had no more symptoms from the residual sialoliths. Another 15% had a significant improvement in their symptoms and required no further therapy. The remaining 95 patients (50%) had residual stones; they had no symptoms in the short review period, but have had symptoms since. The therapeutic success was not influenced by the stone size, but rather by the stone location within the gland. After therapy, no severe side effects were identified. Extracorporeal shock wave lithotripsy is a possible treatment for stones in the submandibular gland. In combination with other gland-preserving methods, it now forms part of a multitherapeutic approach that renders submandibulectomy unnecessary in the majority of cases.

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

“…2,9 In contrast others have found no relationship to stone size in a retrospective study. 5 In circumstances of partial success, where the stone was broken sufficiently to allow saliva to pass but remained in the ductal system, then the magnitude of the shockwave was important to the outcome for submandibular stones. It is not clear if composition might render some stones more resistant to shock waves than others, as has been shown for renal calculi, or whether the retention of calculi is due to the dynamics of duct salivary flow.…”

“…To date exogenous factors have been cited as being more important to outcome than the composition of the calculi 5 in view of the lower cure rates for submandibular when compared to parotid calculi. The rationale for this view is that the combination of the ascending duct and viscous (seromucous) saliva in the submandibular gland promote the impaction of the calculus in the duct wall.…”

Advantages of intraoral removal over submandibular gland resection for proximal submandibular stones

“…7 Recently, several conservative and minimally invasive techniques have been developed for salivary gland surgery, including extracorporeal lithotripsy, interventional radiology, and operative sialoendoscopy. [8][9][10][11][12] These techniques are based on many reports showing that useful recovery can be achieved even in severely damaged glands. 1,2,13 These new techniques have improved the diagnoses of various salivary diseases, but their success rates for stone removal are still variable and are worse for large stones than for smaller stones.…”

A different approach in removal of proximal Wharton's duct stone: Case report

“…Another disadvantage is unwanted skin incision scar (11). Recently minimal invasive methods were defined such as extracorporeal lithotripsy, interventional radiology and operative sialoendoscopy (12,13). Although these new techniques provide severe benefit to the diagnosis of large salivary gland stones, they may still remain insufficient especially for the treatment of large stones (14).…”