Die endoskopische und extrakorporale Stoßwellen-Lithotripsie von Speichelsteinen

Abstract

Shock wave lithotripsy of salivary gland stones has become more and more efficient in the treatment of sialolithiasis during the last years. We use two different methods in our hospital: Extracorporeal shock wave lithotripsy (ESWL) and endoscopically intracorporeal lithotripsy (EISL). The results of both therapies are compatible; 60-70% could be successfully treated. The indication is different due to the localisation of the salivary gland stone. Stones that are located in the glandula or very proximal in the duct should be fragmented by extracorporeal lithotripsy. Stones located in the duct and multiple intraductal stones should be treated by the intracorporeal method. Clinical experiments showed that some salivary stones do not fragment easily. The reason is still unknown. We examined the ability of fragmentation in relation to the physicochemical analysis of the stone. The stones were examined by infrared spectroscopy. This study revealed that pure carbonate apatite stones are more difficult to destroy than stones containing some protein.

Sialolithiasis Management

“…The remaining stone debris can be seen as the ideal nidus for further calcification and sialolithiasis recurrence. Success rates up to 75% for the parotid and up to 40% for the submandibular gland are reported [50][51][52][53][54] and are similar for external and intracannular lithotripsy. 50 Although sialendoscopy might be adapted as an adjuvant procedure to external lithotripsy to retrieve the fragments, we see little use in de novo investing in the ex- pensive equipment.…”

Die extrakorporale Stoßwellenlithotripsie in der Behandlung der Sialolithiasis der Kopfspeicheldrüsen

“…1). Während einige ihre Ergebnisse nach maximal drei [17,18,22], vier [23] oder fünf [24] Sitzungen bewerteten, gaben andere Mittelwerte an, die auf das gesamte [19,25] oder nur das erfolgreich behandelte Patientenkollektiv [20] bezogen waren. Unsere Ergebnisse zeigen, dass mehr als 5 Lithotripsie-Sitzungen zu keiner wesentlichen Erhöhung der Desintegrationsquote führen.…”

4 Laser in der Mundhöhle und im Oropharynx

“…Speichelsteine setzen sich aus organischem (Mukopolysacchariden) und anorganischem Material (Karbonatapatit) zusammen. Ursächlich für die Sialolithiasis wird die Bildung von Kalzium-Muzin-Komplexen gesehen, aus welcher sich Mikrolithen ausbilden [76].…”