Extracorporeal Shockwave Lithotripsy for Salivary Calculi in Pediatric Patients

Abstract

Salivary gland lithiasis is uncommon in pediatric patients. Color Doppler ultrasonography (US) enables an accurate diagnosis of lithiasis to be made without exposure to the radiation of traditional imaging techniques. The development of minimally invasive techniques in the ENT field has made salivary lithotripsy a feasible alternative to traditional invasive surgery. The safety and efficacy of shock wave lithotripsy for salivary calculi were evaluated 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 parotid glands (n = 3) underwent extracorporeal electromagnetic shock wave lithotripsy (EESWL). In four cases the stone was intraductal (two submandibular and two parotideal) and in the remaining three cases it was intraparenchymal (two submandibular and one parotideal). In one case sedative anesthesia was performed. The mean number of therapeutic sessions was five. Patients were followed up clinically and with US for 6-72 months (mean 32 months). Complete disintegration of the calculi was achieved in five cases while in two cases a residual fragment < 2 mm in diameter was observed. None of the patients had recurrence of calculi in the treated gland. Mild self-limited adverse effects (pain, swelling of the gland, self-limiting bleeding from the duct, cutaneous petechiae) were observed in four cases. Our data suggest that EESWL is effective, safe and well tolerated; the minimal invasiveness of the technique suggests that EESWL should be used as the primary approach to salivary calculi in pediatric patients. The continuous US monitoring enables the efficacy of EESWL to be evaluated during both treatment and follow-up, with only slight discomfort for the pediatric patient.

Modern management of paediatric obstructive salivary disorders: long-term clinical experience

“…Stone lithotripsy was required to treat 65% of stones (13/20): 12 patients underwent ESWL and one patient sialendoscopy-assisted laser lithotripsy. ESWL was mainly used during the first 10 years of our experience 27 , but the advent of sialendoscopy in 2001 allowed us to treat some patients with residual stone fragments after lithotripsy. Current technology is evolving towards intracorporeal laser or pneumatic fibre lithotripsy techniques, but only a few studies of intraductal laser and pneumatic lithotripsy have been published 7 28 29 and no final conclusion can be drawn, especially in the case of children.…”

Salivary gland diseases in children

“…Extracorporeal shockwave lithotripsy (ESWL) is an excellent method for disintegrating or destroying impacted parotid stones, irrespective of their site and size. The stone fragments may pass spontaneously or a repeated attempt can be made to remove the stone endoscopically [ 86 ], [ 87 ], [ 88 ]. ESWL is also suitable for use in children (Figure 4 (Fig.…”