Intraductal Fragmentation in Sialolithiasis Using Pneumatic Lithotripsy: Initial Experience and Results

Abstract

Objective To report initial experience in using a pneumatic lithotripter to treat salivary stones. Study Design Level IV retrospective study. Setting University hospital and tertiary referral center. Methods A pneumatic lithotripter was used to treat salivary stones after these were diagnosed. Probes with diameters of 0.7 mm were used. Total fragmentation was intended in all stones. Stone fragments were removed using several instruments in serial sialendoscopies to achieve complete stone clearance. Results A total of 62 patients with 77 stones were treated. Forty-three submandibular stones were treated in 34 patients, and 34 parotid stones were treated in 28 patients. An operating pressure of 2.5 bar and a single frequency mode were used. Complete fragmentation was achieved in all but one of the treated stones in both glands (98.7%). Among the patients, 90.32% became stone free and 100% symptom free. Multiple stones were treated in 24.19% of the patients, and multimodal therapy was also carried out in 24.19%. All of the glands were preserved. Conclusions The pneumatic lithotripter proved to be effective in the treatment of sialolithiasis. Stone size, location, and the gland involved were important clinical factors. The device was sufficient to achieve success without any increased risk for complications in the patients or damage to the sialendoscopes.

Treatment of Sialolithiasis: What Has Changed? An Update of the Treatment Algorithms and a Review of the Literature

“…Pneumatic lithotripsy was applied and investigated in three studies, with good results of over 80% or 90% being reported [ 105 , 106 , 107 ]. In another study, IPL and intraductal laser lithotripsy (ILL) were compared in patients with submandibular gland sialolithiasis, both showing success rates > 90% [ 108 ].…”

“…The primary indication for ISWL is with stones in which gland-preserving treatment is not possible using the well-established techniques. All stones that are accessible with the sialendoscope but not treatable with conventional intSE in the parotid gland, and all stones that cannot be treated with conventional intSE or TDS in the submandibular gland, are recognized indications for ISWL [ 97 , 98 , 99 , 100 , 101 , 103 , 104 , 105 , 106 , 107 ].…”

“…Since ISWL requires the insertion of interventional sialendoscopes with a working channel diameter of at least 0.4 mm for ILL and 0.65 mm for IPL [ 97 , 98 , 99 , 100 , 101 , 103 , 104 , 105 , 106 , 107 ], the options for performing ISWL are substantially dependent on the anatomical preconditions in the duct system. If the duct system is too narrow or there are duct variations, it may prohibit successful ISWL.…”

“…A combination of ISWL and TDS has also been reported in cases of difficult sialolithiasis in the SMG. Stones that are not removable with TDS (persistent sialolithiasis), residual stones in patients with multiple sialolithiasis, and recurrent stones after TDS in posthilar to intraparenchymal locations are important new indications for ISWL, as has been shown in recent publications [ 103 , 104 , 105 , 107 , 110 ]. The topic was addressed specifically in one of these papers, in which persistent, residual, and recurrent stones after TDS were treated with ISWL, with a success rate of 97% [ 110 ].…”

La recidiva della patologia ostruttiva salivare dopo scialoendoscopia. Una revisione narrativa della letteratura

“…This difference in the way of approaching salivary stones is often related to the need of balancing therapeutic efficacy with the desire of the patient to avoid facial nerve damage. The recent clinical experience with sialendoscopy-assisted laser and pneumatic intracorporeal lithotripsy (ISWL), has contributed to pursuing the minimal invasive therapeutic pathway 11 .…”