Salivary Stone Disease (Sialolithiasis): Surgical Therapy

Oral and maxillofacial surgery.

The therapy of sialolithiasis depends on the location, size, and mobility of the sialolith. Today, minimally invasive surgical procedures that preserve glands are increasingly being performed.

  • For intraductal stone location (in the excretory duct):
    • Glandular massage – massaging out very small stones (“grits”) near the papillae.
    • Interventional sialoendoscopy
      • Endoscopic removal of small stones up to 5 mm
      • In combination with intraductal lithotripsy (stone disintegration) with the help of laser fibers ( e.g. Ho:YAG laser) and microdrills also removal of initially larger calculi.
      • In combination with extraoral (“outside the oral cavity“) surgical removal of a stone in the ductus parotideus (parotid duct), if endoscopic removal is not possible.
    • Sialolithotomy – ductal incision with stone removal.
      • In case of stone in Wharton’s duct (common excretory duct of submandibular gland and sublingual gland).
      • In the case of stone in the Stenon’s duct from extraoral due to risk of stenosis (risk of narrowing) in enoral (“within the oral cavity“) procedure.
  • Gland extirpation (synonyms: sialectomy; sialadenectomy; extirpation of a salivary gland; surgical removal of a salivary gland).
    • In case of failure of minimally invasive procedures
      • Extirpation of the submandibular gland
      • Partial parotidectomy (partial surgical removal of the parotid gland).
  • EWSL – Extracorporeal shock wave lithotripsy.
    • In case of intraglandular (“inside the gland”) location.
    • Preferable to partial parotidectomy, especially in the case of parotid stones
    • Several sessions required
    • The sandy fragments are flushed out in the following days in the best case, assisted by the administration of sialogoga (drugs that promote salivation) and glandular massage.
    • If spontaneous removal of the fragments is not possible, but only their transport into the ductal system is achieved: Combination with endoscopic removal or duct slitting.
    • Contraindications:
      • Acute purulent sialadenitis
      • Stenosis (narrowing) of the excretory ducts