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).
- In case of failure of minimally invasive procedures
- 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