Materiały źródłowe

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

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8746135/

  Treatment for sialolithiasis has undergone significant changes since the 1990s. Following the development of new minimally invasive and gland-preserving treatment modalities, a 40-50% rate of gland resection was reduced to less than 5%. Extracorporeal shock-wave lithotripsy (ESWL), refinement and extension of methods of transoral duct surgery (TDS), and in particular diagnostic and interventional sialendoscopy (intSE) are substantial parts of the new treatment regimen. […] It has also become evident that combining the different treatment modalities further increases the effectiveness of therapy, as has been especially evident with the combined endoscopic-transcutaneous approach. […] Intraductal shock-wave lithotripsy (ISWL) has led to remarkable improvements thanks to the introduction of new devices, instruments, materials, and techniques, after earlier applications had not been sufficiently effective.

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

  https://www.mdpi.com/2077-0383/11/1/231

  Treatment for sialolithiasis has undergone significant changes since the 1990s. Following the development of new minimally invasive and gland-preserving treatment modalities, a 40–50% rate of gland resection was reduced to less than 5%. Extracorporeal shock-wave lithotripsy (ESWL), refinement and extension of methods of transoral duct surgery (TDS), and in particular diagnostic and interventional sialendoscopy (intSE) are substantial parts of the new treatment regimen. […] It has also become evident that combining the different treatment modalities further increases the effectiveness of therapy, as has been especially evident with the combined endoscopic–transcutaneous approach. […] Recent trends have revealed a potential for significant changes in therapeutic strategies for both major salivary glands. For the submandibular gland, ISWL has replaced ESWL and TDS to some extent. For parotid stones, ISWL and modifications of TDS have led to reduced use of ESWL and the combined transcutaneous–sialendoscopic approach.

• #3 Salivary Stones: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/24344-sialolithiasis

  Sialolithiasis treatments include massage, heat application and, sometimes, surgery. […] Sialolithiasis treatment depends on the size and location of the stone. Treatments may include home remedies, antibiotics, in-office stone removal or, in some cases, surgery. […] Most of the time, salivary gland stones go away on their own with conservative treatment. You might be able to push the stone out of your salivary duct by drinking lots of water, applying heat or massaging the area. […] If you’ve developed an infection as a result of a salivary gland stone, your healthcare provider will probably prescribe antibiotics. […] If home remedies aren’t successful, your healthcare provider may try to remove the stone by gently probing the area with a blunt instrument. […] Larger salivary gland stones may require surgery. During this procedure, a surgeon inserts an endoscope into your salivary duct to locate the stone.

• #4 Salivary stones: symptoms, aetiology, biochemical composition and treatment | British Dental Journal

  https://www.nature.com/articles/sj.bdj.2014.1054

  Salivary stones, also known as sialoliths, are calcified concrements in the salivary glands. The management of salivary stones depends on the size and location of the stone. The management of salivary stones is focused on removing the salivary stones and preservation of salivary gland function which depends on the size and location of the stone. Conservative management of salivary stones consists of salivary gland massage and the use of sialogogues. Other therapeutic options include removal of the stone or in some cases surgical removal of the whole salivary gland. The primary objective in the treatment of sialolithiasis should be preservation of gland function in combination with a low level of complications and discomfort for the patient. Non-invasive conservative management of sialolithiasis consists of gland massage, in combination with use of sialogogues and irrigation. This treatment has the highest success rate when stones are small and located in the duct. When an infection is suspected, antibiotics should be prescribed. Nearly all intraductal submandibular and parotid stones can be removed by a relatively simple intraoral approach under local anaesthesia. After stone removal, it is recommended that salivary gland massage is carried out several times a day, combined with a sour diet and sialogogues to stimulate the salivary flow. Invasive management of sialolithiasis may consist of extracorporeal shock-wave lithotripsy, sialoendoscopy or surgical removal. Most patients experience no complaints or discomfort, but a normal functioning gland, after sialolith therapy that does not include surgical removal of the gland. Recurrence of sialoliths is rather uncommon, and is estimated to occur in 1-10% of the patients.

• #5 Salivary Gland Stones Rare but Not Unheard of in Children – Mayo Clinic News Network

  https://newsnetwork.mayoclinic.org/discussion/salivary-gland-stones-rare-but-not-unheard-of-in-children/

  Particularly if your daughter’s pain occurs when she’s eating, she might have one or more salivary gland stones. […] If salivary duct stones are confirmed, treatment options include: […] Increasing saliva production: Drinking more water and other steps to increase saliva production may help minimize symptoms. Sucking on lemon drops or chewing sugarless gum can help increase saliva production and possibly wash out the stone. […] Medication: If an infection is present, an antibiotic will reduce pain and swelling. […] Stone removal: During a sialoscopy procedure, a doctor uses a specialized scope to look into the salivary duct. In some cases, tools can be used to grab and remove the stone, or crush it and flush out the pieces. In children, this minimally invasive procedure requires general anesthesia, but is typically done on an outpatient basis. If the stone can’t be retrieved or crushed via the scope, it can be removed through other surgical procedures. […] It is important that you work with a doctor to confirm the diagnosis and develop a treatment plan. A salivary gland stone that doesn’t become dislodged will continue to cause pain and swelling when eating.

• #6 Salivary Gland Stones (Salivary Calculi) | Health

  https://patient.info/ears-nose-throat-mouth/salivary-gland-disorders-leaflet/salivary-gland-stones-salivary-calculi

  Salivary gland stones sometimes form in one of the salivary glands. These stones are small and form from chemicals in the saliva. A stone can cause a blockage of the flow of spit (saliva), which can lead to pain and swelling of the affected salivary gland. […] However, a small procedure may be needed to remove the stone. […] Most salivary gland stones that cause symptoms will not go away unless they come out or are removed. Sometimes a small stone comes out into the mouth by itself. […] If a salivary gland stone does not fall out by itself, medical advice may be needed. Possible treatment options and procedures include the following: […] Gentle probing into the tube (duct) from inside the mouth with a thin blunt instrument can sometimes free a stone which then falls into the mouth. This is done by a doctor. […] Therapeutic sialendoscopy. This is a similar procedure to that described above. It also uses a very thin tube (endoscope) with a camera and light at the tip. The tube is pushed into the duct. If a stone is seen, then a tiny basket or pair of grabbers attached to the tube is used to grab the stone and pull it out. This technique can successfully remove about 17 in 20 stones. Local anaesthetic is usually injected into the duct first to make this procedure painless. In some cases, where the stone is rather large, the stone is broken up first and the fragments are then pulled out. […] A small operation to cut out the stone is the traditional treatment but is done less and less, as therapeutic sialendoscopy has become available. It may still be needed if therapeutic sialendoscopy is not an available option, or if it fails. […] Shock wave treatment (lithotripsy) may be an option. This uses ultrasound waves to break up stones. The broken fragments then pass out along the duct. This is a relatively new treatment for salivary stones (although it has been used for many years to treat kidney stones). However, it is not done commonly. Sometimes shock waves are used to break up a large stone when therapeutic sialendoscopy is done to make smaller fragments which can be more easily removed.

• #7 Salivary Stones: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/24344-sialolithiasis

  Sialolithiasis treatments include massage, heat application and, sometimes, surgery. […] Sialolithiasis treatment depends on the size and location of the stone. Treatments may include home remedies, antibiotics, in-office stone removal or, in some cases, surgery. […] Most of the time, salivary gland stones go away on their own with conservative treatment. You might be able to push the stone out of your salivary duct by drinking lots of water, applying heat or massaging the area. […] If you’ve developed an infection as a result of a salivary gland stone, your healthcare provider will probably prescribe antibiotics. […] If home remedies aren’t successful, your healthcare provider may try to remove the stone by gently probing the area with a blunt instrument. […] Larger salivary gland stones may require surgery. During this procedure, a surgeon inserts an endoscope into your salivary duct to locate the stone.

• #8 Salivary Stones: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/24344-sialolithiasis

  In rare instances, you may need to have your salivary gland surgically removed. Healthcare providers reserve this treatment for people with severe, recurring (returning) symptoms, or if the stone is in a location that isn’t amendable to removal by conservative means. […] In many cases, sialolithiasis goes away on its own or with conservative, at-home treatments, such as heat application, gentle massage and sucking on sour candy.

• #9 Salivary stones: symptoms, aetiology, biochemical composition and treatment | British Dental Journal

  https://www.nature.com/articles/sj.bdj.2014.1054

  Salivary stones, also known as sialoliths, are calcified concrements in the salivary glands. The management of salivary stones depends on the size and location of the stone. The management of salivary stones is focused on removing the salivary stones and preservation of salivary gland function which depends on the size and location of the stone. Conservative management of salivary stones consists of salivary gland massage and the use of sialogogues. Other therapeutic options include removal of the stone or in some cases surgical removal of the whole salivary gland. The primary objective in the treatment of sialolithiasis should be preservation of gland function in combination with a low level of complications and discomfort for the patient. Non-invasive conservative management of sialolithiasis consists of gland massage, in combination with use of sialogogues and irrigation. This treatment has the highest success rate when stones are small and located in the duct. When an infection is suspected, antibiotics should be prescribed. Nearly all intraductal submandibular and parotid stones can be removed by a relatively simple intraoral approach under local anaesthesia. After stone removal, it is recommended that salivary gland massage is carried out several times a day, combined with a sour diet and sialogogues to stimulate the salivary flow. Invasive management of sialolithiasis may consist of extracorporeal shock-wave lithotripsy, sialoendoscopy or surgical removal. Most patients experience no complaints or discomfort, but a normal functioning gland, after sialolith therapy that does not include surgical removal of the gland. Recurrence of sialoliths is rather uncommon, and is estimated to occur in 1-10% of the patients.

• #10 Salivary duct stones Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/salivary-duct-stones

  Salivary duct stones are deposits of minerals in the ducts that drain the salivary glands. Salivary stones most often affect the submandibular glands. They can also affect the parotid glands. […] The goal is to remove the stone. […] Steps you can take at home include: Drinking lots of water, Using sugar-free lemon drops to increase the amount of saliva. […] Other ways to remove the stone are: Massaging the gland with heat — The provider or dentist may be able to push the stone out of the duct. In some cases, you may need surgery to cut out the stone. A newer treatment that uses shock waves to break the stone into small pieces is another option. A technique called sialendoscopy, can diagnose and treat stones in the salivary gland duct using very small cameras and instruments. If stones become infected or come back often, you may need surgery to remove the salivary gland.

• #11 Salivary duct stones: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/001039.htm

  The goal is to remove the stone. […] Steps you can take at home include: […] Drinking lots of water […] Using sugar-free lemon drops to increase the amount of saliva […] Other ways to remove the stone are: […] Massaging the gland with heat — The provider or dentist may be able to push the stone out of the duct. […] In some cases, you may need surgery to cut out the stone. […] A newer treatment that uses shock waves to break the stone into small pieces is another option. […] A technique called sialendoscopy, can diagnose and treat stones in the salivary gland duct using very small cameras and instruments. […] If stones become infected or come back often, you may need surgery to remove the salivary gland.

• #12 Salivary Gland Stones: Symptoms, Causes, and Treatment

  https://www.webmd.com/oral-health/salivary-gland-stones-symptoms-causes-treatments

  If a stone is detected, the goal of treatment is to remove it. For small stones, stimulating saliva flow by sucking on a lemon or sour candies may cause the stone to pass spontaneously. […] For larger, harder-to-remove stones, doctors usually make a small incision in the mouth to remove the stone. […] More and more, doctors are using a newer and less invasive technique called sialendoscopy to remove salivary gland stones. […] For people with recurrent stones or irreversible damage to the salivary gland, surgical removal of the gland may be necessary. […] In addition, antibiotics are prescribed if salivary stones have caused infection.

• #13 Salivary gland stones | nidirect

  https://www.nidirect.gov.uk/conditions/salivary-gland-stones

  You should see your GP if: […] Your GP may try to gently remove the stone. […] If that’s not possible, you may need to have the stone removed in hospital.

• #14 Salivary Duct Stones: Causes, Symptoms, and Diagnosis

  https://www.healthline.com/health/salivary-duct-stones

  There are several different treatments for salivary duct stones: […] Treatment for salivary duct stones involves activities to get rid of the stones. Your doctor or dentist may suggest sucking on sugar-free lemon drops and drinking a lot of water. The goal is to increase saliva production and force the stone out of your duct. You may also be able move the stone by applying heat and gently massaging the affected area. […] If you cant get the stone out at home, your doctor or dentist can try to push it out by pressing on both sides of the duct. Stones that are large or located deep within your duct may need to be surgically removed. […] In some cases, your doctor may suggest using shock waves to break the stone into smaller pieces. This is called extracorporeal shock wave lithotripsy (ESWL) and allows the smaller pieces to pass through the duct. During this procedure, high-energy sound waves are directed at the stone. You will likely be sedated or under general anesthesia during this process. ESWL is more commonly used to break up other types of stones in the body, such as those in the kidney or bladder.

• #15 Salivary Duct Stones: Causes, Symptoms, and Diagnosis

  https://www.healthline.com/health/salivary-duct-stones

  There are several different treatments for salivary duct stones: […] Treatment for salivary duct stones involves activities to get rid of the stones. Your doctor or dentist may suggest sucking on sugar-free lemon drops and drinking a lot of water. The goal is to increase saliva production and force the stone out of your duct. You may also be able move the stone by applying heat and gently massaging the affected area. […] If you cant get the stone out at home, your doctor or dentist can try to push it out by pressing on both sides of the duct. Stones that are large or located deep within your duct may need to be surgically removed. […] In some cases, your doctor may suggest using shock waves to break the stone into smaller pieces. This is called extracorporeal shock wave lithotripsy (ESWL) and allows the smaller pieces to pass through the duct. During this procedure, high-energy sound waves are directed at the stone. You will likely be sedated or under general anesthesia during this process. ESWL is more commonly used to break up other types of stones in the body, such as those in the kidney or bladder.

• #16 Salivary gland stones

  https://www2.hse.ie/conditions/salivary-gland-stones/

  You can try to remove the stone by doing things to increase saliva production, such as sucking on a lemon or lemon drops, drinking plenty of water, or massaging around the stone. […] If you have pain and swelling, take paracetamol or ibuprofen, or suck ice cubes or ice lollies. […] A GP may attempt to remove the stone with a thin, blunt instrument. […] If that’s not possible, you may need to have the stone removed in hospital.

• #17 Ear Nose and Throat – Salivary Stones: Causes, Symptoms and Treatment – Ear Nose and Throat Doctors

  https://www.entlubbock.com/blog/salivary-stones/

  You can take several steps at home to help you find relief from the pain and swelling. […] Hydration is extremely important if you have a salivary stone. On top of all the other benefits of water consumption, staying hydrated can increase your saliva production, which may help flush out the stone. […] Applying a warm compress such as a wet washcloth or a heating pad to the affected area could also help ease a little of the discomfort. […] Any type of swelling in the neck requires prompt medical attention. Though salivary stones are uncommon, they can become infected and lead to abscesses. […] Medical care for salivary stones can vary, and may include any of the following: […] Imaging can help guide your provider in deciding on the best medical care for your situation. […] Sometimes massaging can help to work the salivary stone loose from the opening of the duct.

• #18 Sialadenitis (Salivary Gland Infection): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/15749-sialadenitis-swollen-salivary-gland

  Antibiotics are usually the first line of sialadenitis treatment. The most common antibiotics for sialadenitis include dicloxacillin, cephalosporin or clindamycin. […] There are several ways to manage sialadenitis, including: Antibiotics, Home remedies, Nonsurgical treatments, Surgery. […] If sialadenitis doesn’t respond to other treatments, your healthcare provider may recommend surgery. If you’ve developed an abscess (a pocket of pus), they’ll drain the infection and remove any stones or other blockages. They may also use an endoscope to examine your salivary gland. Healthcare providers call this procedure a sialendoscopy. […] In most cases, salivary gland infections resolve after one week with conservative treatment. […] Infected or swollen salivary glands often go away on their own or with conservative treatment. But if you have lingering symptoms, such as swelling, pain, fever or difficulty swallowing, call your healthcare provider right away. You may need emergency treatment.

• #19 Management of anterior submandibular sialolithiasis | Journal of Oral Medicine and Oral Surgery

  https://www.jomos.org/articles/mbcb/full_html/2019/02/mbcb180053/mbcb180053.html

  Sialolithiasis is a common salivary gland disorder. The treatment of sialolithiasis must be early and remains mainly surgical. […] The therapeutic strategy will be based on the topography, the size and number of stones, the functional state of the gland, the degree of superinfection and the surgeon’s technical equipment. […] Medical treatment is indicated in case of infection, whereas post-operative medications usually consists of the following: Antibiotic, Amoxicillin 500mg (Clamoxyl 500), 2g/day for 6 days; Antispasmodic, phloroglucinol 80mg (Spasfon LYOC 80), 2 tablets/day for 6 days; Pain reliever, paracetamol 1000mg (Doliprane1000), 1 tablet/6h for 48h; Chlorxhexidine mouthwash, 3 times per day during 7 days. […] Non-invasive conservative management of salivary stones consists of gland massage after each meal, daily intake of 1.5 L of water and administration of sialogogues.

• #20 Salivary gland stones

  https://www2.hse.ie/conditions/salivary-gland-stones/

  You can try to remove the stone by doing things to increase saliva production, such as sucking on a lemon or lemon drops, drinking plenty of water, or massaging around the stone. […] If you have pain and swelling, take paracetamol or ibuprofen, or suck ice cubes or ice lollies. […] A GP may attempt to remove the stone with a thin, blunt instrument. […] If that’s not possible, you may need to have the stone removed in hospital.

• #21 Management of anterior submandibular sialolithiasis | Journal of Oral Medicine and Oral Surgery

  https://www.jomos.org/articles/mbcb/full_html/2019/02/mbcb180053/mbcb180053.html

  Sialolithiasis is a common salivary gland disorder. The treatment of sialolithiasis must be early and remains mainly surgical. […] The therapeutic strategy will be based on the topography, the size and number of stones, the functional state of the gland, the degree of superinfection and the surgeon’s technical equipment. […] Medical treatment is indicated in case of infection, whereas post-operative medications usually consists of the following: Antibiotic, Amoxicillin 500mg (Clamoxyl 500), 2g/day for 6 days; Antispasmodic, phloroglucinol 80mg (Spasfon LYOC 80), 2 tablets/day for 6 days; Pain reliever, paracetamol 1000mg (Doliprane1000), 1 tablet/6h for 48h; Chlorxhexidine mouthwash, 3 times per day during 7 days. […] Non-invasive conservative management of salivary stones consists of gland massage after each meal, daily intake of 1.5 L of water and administration of sialogogues.

• #22 Management of anterior submandibular sialolithiasis | Journal of Oral Medicine and Oral Surgery

  https://www.jomos.org/articles/mbcb/full_html/2019/02/mbcb180053/mbcb180053.html

  Sialolithiasis is a common salivary gland disorder. The treatment of sialolithiasis must be early and remains mainly surgical. […] The therapeutic strategy will be based on the topography, the size and number of stones, the functional state of the gland, the degree of superinfection and the surgeon’s technical equipment. […] Medical treatment is indicated in case of infection, whereas post-operative medications usually consists of the following: Antibiotic, Amoxicillin 500mg (Clamoxyl 500), 2g/day for 6 days; Antispasmodic, phloroglucinol 80mg (Spasfon LYOC 80), 2 tablets/day for 6 days; Pain reliever, paracetamol 1000mg (Doliprane1000), 1 tablet/6h for 48h; Chlorxhexidine mouthwash, 3 times per day during 7 days. […] Non-invasive conservative management of salivary stones consists of gland massage after each meal, daily intake of 1.5 L of water and administration of sialogogues.

• #23 Sialolithiasis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK549845/

  Sialolithiasis is the most frequent cause of salivary gland swelling, affecting the major salivary glands: parotid, submandibular, and sublingual glands. […] Initial management is conservative, with various minimally invasive surgical options available for persistent cases. […] A variety of treatment options exist for sialolithiasis, including sialogogues, direct massage of distal stones out of the duct, and other procedures including interventional sialography, lithotripsy, sialoendoscopy, and surgery. […] Management of sialolithiasis should begin with conservative measures, including massaging the salivary gland, nonsteroidal anti-inflammatory drugs, and sialogogues. […] Further treatment is dictated based on the sialolith’s size, number, and location if conservative management is unsuccessful.

• #24 Salivary Stones: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/24344-sialolithiasis

  Sialolithiasis treatments include massage, heat application and, sometimes, surgery. […] Sialolithiasis treatment depends on the size and location of the stone. Treatments may include home remedies, antibiotics, in-office stone removal or, in some cases, surgery. […] Most of the time, salivary gland stones go away on their own with conservative treatment. You might be able to push the stone out of your salivary duct by drinking lots of water, applying heat or massaging the area. […] If you’ve developed an infection as a result of a salivary gland stone, your healthcare provider will probably prescribe antibiotics. […] If home remedies aren’t successful, your healthcare provider may try to remove the stone by gently probing the area with a blunt instrument. […] Larger salivary gland stones may require surgery. During this procedure, a surgeon inserts an endoscope into your salivary duct to locate the stone.

• #25 Salivary gland stones

  https://www.nhs.uk/conditions/salivary-gland-stones/

  Salivary gland stones may cause: […] If you have pain and swelling, you can: […] The symptoms will not go away until the stone has been removed. […] Do not use anything sharp to try to remove a salivary gland stone because it could cause injury and infection. […] Treatments for salivary gland stones […] A GP may attempt to gently remove the stone with a thin, blunt instrument. […] If that’s not possible, you may need to have the stone removed in hospital.

• #26 ENT Doctor | Head and Neck Cancer Specialist | Yarah Haidar, MD – Salivary Gland Stones

  https://yarahhaidarmd.com/salivary-gland-stones/

  Salivary gland stones may be formed with calcium phosphate and calcium carbonate and range in size from a few millimeters to more than two centimeters. […] Patients may treat the stone by sucking on sugar-free lemon drops or ice cubes and drinking water. This will help increase saliva production and may force the stone out of the salivary glands. […] The physician may prescribe an antibiotic to treat the infection or ibuprofen to alleviate pain and swelling. […] If the stone is not very big, the dentist or physician may press on both sides of the gland to try and push it out. Large stones may need to be surgically removed. […] Sialoendoscopy is a minimally invasive procedure performed to remove a salivary gland tumor. During the procedure, the physician makes a small incision inside the mouth near the affected gland and inserts a slender tube called a sialoendoscope. Various instruments are inserted through this tube to capture and remove the stone. The patient will be under local or general anesthesia during a sialoendoscopy.

• #27 I Have Salivary Stones. Do I Need Surgery?

  https://www.parotidsurgerymd.com/about-us/articles/i-have-salivary-stones-do-i-need-surgery/

  Salivary gland stones, called sialolithiasis, are small calcium deposits that block the flow of saliva in the salivary glands. […] Conservative treatments are most often used to remove a salivary gland stone; however, stones deep in the salivary duct or chronic stones may require surgical removal. […] A salivary gland stone that is close to the exterior portion of the salivary duct can usually be massaged and squeezed out by a specialist. Sucking on citrus fruit can also remove stones that are small and close to the opening of the duct because of extra saliva that is produced. However, stones that are larger or located deep in the salivary duct may require minimally invasive sialendoscopy, or even salivary gland removal. […] Sialendoscopy is a minimally invasive surgery technique used to remove salivary gland stones that are either too large or too deep in the salivary duct to be removed using more conservative methods.

• #28 Salivary Gland Stones (Salivary Calculi) | Health

  https://patient.info/ears-nose-throat-mouth/salivary-gland-disorders-leaflet/salivary-gland-stones-salivary-calculi

  Salivary gland stones sometimes form in one of the salivary glands. These stones are small and form from chemicals in the saliva. A stone can cause a blockage of the flow of spit (saliva), which can lead to pain and swelling of the affected salivary gland. […] However, a small procedure may be needed to remove the stone. […] Most salivary gland stones that cause symptoms will not go away unless they come out or are removed. Sometimes a small stone comes out into the mouth by itself. […] If a salivary gland stone does not fall out by itself, medical advice may be needed. Possible treatment options and procedures include the following: […] Gentle probing into the tube (duct) from inside the mouth with a thin blunt instrument can sometimes free a stone which then falls into the mouth. This is done by a doctor. […] Therapeutic sialendoscopy. This is a similar procedure to that described above. It also uses a very thin tube (endoscope) with a camera and light at the tip. The tube is pushed into the duct. If a stone is seen, then a tiny basket or pair of grabbers attached to the tube is used to grab the stone and pull it out. This technique can successfully remove about 17 in 20 stones. Local anaesthetic is usually injected into the duct first to make this procedure painless. In some cases, where the stone is rather large, the stone is broken up first and the fragments are then pulled out. […] A small operation to cut out the stone is the traditional treatment but is done less and less, as therapeutic sialendoscopy has become available. It may still be needed if therapeutic sialendoscopy is not an available option, or if it fails. […] Shock wave treatment (lithotripsy) may be an option. This uses ultrasound waves to break up stones. The broken fragments then pass out along the duct. This is a relatively new treatment for salivary stones (although it has been used for many years to treat kidney stones). However, it is not done commonly. Sometimes shock waves are used to break up a large stone when therapeutic sialendoscopy is done to make smaller fragments which can be more easily removed.

• #29 Salivary duct stones Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/salivary-duct-stones

  Salivary duct stones are deposits of minerals in the ducts that drain the salivary glands. Salivary stones most often affect the submandibular glands. They can also affect the parotid glands. […] The goal is to remove the stone. […] Steps you can take at home include: Drinking lots of water, Using sugar-free lemon drops to increase the amount of saliva. […] Other ways to remove the stone are: Massaging the gland with heat — The provider or dentist may be able to push the stone out of the duct. In some cases, you may need surgery to cut out the stone. A newer treatment that uses shock waves to break the stone into small pieces is another option. A technique called sialendoscopy, can diagnose and treat stones in the salivary gland duct using very small cameras and instruments. If stones become infected or come back often, you may need surgery to remove the salivary gland.

• #30 Salivary Endoscopy | Stony Brook Medicine

  https://www.stonybrookmedicine.edu/patientcare/surgery/patient-care/clinical/ent-surgery/services/salivary-endoscopy

  Salivary endoscopy is a minimally invasive technique that allows for salivary gland surgery in a safe and effective way, and is done on an outpatient basis. […] The current standard in most institutions for treating salivary duct stones has been surgical removal of the gland that entails an incision in the neck and an overnight stay in the hospital. […] Salivary endoscopy spares the gland without risk to adjacent vital structures such as the tongue and facial nerves, and patients can go home the same day. […] The success rate of salivary endoscopy is over 90%, as reported in the current literature, with less than 5% recurrence. Recovery time is much faster than with an open technique, and patients may return to a normal diet the same day. […] Salivary endoscopy with steroid injection is now giving new hope to patients suffering with post-radiation sialadenitis.

• #31 Pain-Free Procedure Gives Patient Relief from Salivary Stones

  https://www.entorlando.com/blog/1057317-pain-free-procedure-gives-patient-relief-from-salivary-stones

  This innovative, minimally invasive technique allows for benefits such as: No external scarring, Preservation of the salivary gland, Less traumatic procedure compared to complete removal of the affected salivary gland, Improved quality of life, Decreased risk of facial nerve injury compared to open neck surgery, Quicker recovery patients are discharged on the same day as the procedure and can resume normal activity and work the following day, Lower morbidity especially for older patients with co-occurring disorders. […] After his successful salivary endoscopy, Rodney is grateful for finally being free from the long-lasting restrictions in his mouth and throat.

• #32 Salivary Endoscopy | Stony Brook Medicine

  https://www.stonybrookmedicine.edu/patientcare/surgery/patient-care/clinical/ent-surgery/services/salivary-endoscopy

  Salivary endoscopy is a minimally invasive technique that allows for salivary gland surgery in a safe and effective way, and is done on an outpatient basis. […] The current standard in most institutions for treating salivary duct stones has been surgical removal of the gland that entails an incision in the neck and an overnight stay in the hospital. […] Salivary endoscopy spares the gland without risk to adjacent vital structures such as the tongue and facial nerves, and patients can go home the same day. […] The success rate of salivary endoscopy is over 90%, as reported in the current literature, with less than 5% recurrence. Recovery time is much faster than with an open technique, and patients may return to a normal diet the same day. […] Salivary endoscopy with steroid injection is now giving new hope to patients suffering with post-radiation sialadenitis.

• #33 ENT Doctor | Head and Neck Cancer Specialist | Yarah Haidar, MD – Salivary Gland Stones

  https://yarahhaidarmd.com/salivary-gland-stones/

  Salivary gland stones may be formed with calcium phosphate and calcium carbonate and range in size from a few millimeters to more than two centimeters. […] Patients may treat the stone by sucking on sugar-free lemon drops or ice cubes and drinking water. This will help increase saliva production and may force the stone out of the salivary glands. […] The physician may prescribe an antibiotic to treat the infection or ibuprofen to alleviate pain and swelling. […] If the stone is not very big, the dentist or physician may press on both sides of the gland to try and push it out. Large stones may need to be surgically removed. […] Sialoendoscopy is a minimally invasive procedure performed to remove a salivary gland tumor. During the procedure, the physician makes a small incision inside the mouth near the affected gland and inserts a slender tube called a sialoendoscope. Various instruments are inserted through this tube to capture and remove the stone. The patient will be under local or general anesthesia during a sialoendoscopy.

• #34 ENT Doctor | Head and Neck Cancer Specialist | Yarah Haidar, MD – Salivary Gland Stones

  https://yarahhaidarmd.com/salivary-gland-stones/

  Some patients may need extracorporeal shock wave lithotripsy (ESWL). This treatment uses shock waves to break the stone into smaller pieces and allow them to pass through the gland. Patients will typically be sedated or under general anesthesia during the procedure. […] Most salivary gland stones are removed without complications. However, if patients continue to develop salivary gland stones, the physician may recommend surgically removing the affected gland.

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

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8746135/

  Techniques involving combined approaches have been refined and modified. […] Recent trends have revealed a potential for significant changes in therapeutic strategies for both major salivary glands. For the submandibular gland, ISWL has replaced ESWL and TDS to some extent. For parotid stones, ISWL and modifications of TDS have led to reduced use of ESWL and the combined transcutaneous-sialendoscopic approach. […] The primary indication for ISWL is with stones in which gland-preserving treatment is not possible using the well-established techniques. […] ISWL has been used for difficult sialolithiasis as a single-mode treatment, and also in combination with other techniques. […] Although ISWL may replace ESWL in some indications, particularly with parotid stones, ESWL has a place in treatment regimens if it is available.

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

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8746135/

  Treatment for sialolithiasis has undergone significant changes since the 1990s. Following the development of new minimally invasive and gland-preserving treatment modalities, a 40-50% rate of gland resection was reduced to less than 5%. Extracorporeal shock-wave lithotripsy (ESWL), refinement and extension of methods of transoral duct surgery (TDS), and in particular diagnostic and interventional sialendoscopy (intSE) are substantial parts of the new treatment regimen. […] It has also become evident that combining the different treatment modalities further increases the effectiveness of therapy, as has been especially evident with the combined endoscopic-transcutaneous approach. […] Intraductal shock-wave lithotripsy (ISWL) has led to remarkable improvements thanks to the introduction of new devices, instruments, materials, and techniques, after earlier applications had not been sufficiently effective.

• #37 ENT Doctor | Head and Neck Cancer Specialist | Yarah Haidar, MD – Salivary Gland Stones

  https://yarahhaidarmd.com/salivary-gland-stones/

  Some patients may need extracorporeal shock wave lithotripsy (ESWL). This treatment uses shock waves to break the stone into smaller pieces and allow them to pass through the gland. Patients will typically be sedated or under general anesthesia during the procedure. […] Most salivary gland stones are removed without complications. However, if patients continue to develop salivary gland stones, the physician may recommend surgically removing the affected gland.

• #38 Salivary Duct Stones: Causes, Symptoms, and Diagnosis

  https://www.healthline.com/health/salivary-duct-stones

  There are several different treatments for salivary duct stones: […] Treatment for salivary duct stones involves activities to get rid of the stones. Your doctor or dentist may suggest sucking on sugar-free lemon drops and drinking a lot of water. The goal is to increase saliva production and force the stone out of your duct. You may also be able move the stone by applying heat and gently massaging the affected area. […] If you cant get the stone out at home, your doctor or dentist can try to push it out by pressing on both sides of the duct. Stones that are large or located deep within your duct may need to be surgically removed. […] In some cases, your doctor may suggest using shock waves to break the stone into smaller pieces. This is called extracorporeal shock wave lithotripsy (ESWL) and allows the smaller pieces to pass through the duct. During this procedure, high-energy sound waves are directed at the stone. You will likely be sedated or under general anesthesia during this process. ESWL is more commonly used to break up other types of stones in the body, such as those in the kidney or bladder.

• #39 Salivary Stone Release – Exodontia

  https://exodontia.info/salivary-stone-release/

  Almost half of the Submandibular Calculi lie in the distal third of the duct and are amenable to simple surgical release through an incision (cut) directly onto the stone. […] If the Submandibular Gland has been damaged by recurrent infection and fibrosis or calculi have formed within the gland, the gland may require removal. […] Alternative methods of treatment have emerged such as the use of Extracorporeal Shock Wave Lithotripsy (ESWL) and more recently the use of Endoscopic Intracorporeal Shockwave Lithotripsy (EISWL), in which shockwaves are delivered directly to the surface of the stone lodged within the duct without damaging adjacent tissue (piezoelectric principle). […] Submandibular Gland Removal may be indicated following failure of lithotripsy or if the size of an intra-glandular stone is 12 mm as the success of lithotripsy may be 20% in such cases. […] In the case of small calculi, the treatment of choice should be medical, instead of surgical. […] Surgical removal of the calculus (or even of the whole gland) has traditionally been used as an alternative to medical therapy, whenever the latter was not possible or when it proved ineffective.

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

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8746135/

  Techniques involving combined approaches have been refined and modified. […] Recent trends have revealed a potential for significant changes in therapeutic strategies for both major salivary glands. For the submandibular gland, ISWL has replaced ESWL and TDS to some extent. For parotid stones, ISWL and modifications of TDS have led to reduced use of ESWL and the combined transcutaneous-sialendoscopic approach. […] The primary indication for ISWL is with stones in which gland-preserving treatment is not possible using the well-established techniques. […] ISWL has been used for difficult sialolithiasis as a single-mode treatment, and also in combination with other techniques. […] Although ISWL may replace ESWL in some indications, particularly with parotid stones, ESWL has a place in treatment regimens if it is available.

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

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8746135/

  In summary, the main change in the treatment algorithm is that the development of ISWL has led to a reduction in the indications for ESWL. […] Removal of the gland should be considered in therapy-resistant cases, when there are persistent symptoms, and in accordance with the patients wishes. […] In summary, experience shows that as ISWL has become more important, ESWL has lost its importance in the management of parotid stones, although it is still a substantial element in the treatment algorithms in units that have access to it.

• #42 Sialolithiasis – Salivary Stones – What Causes Them and How to Manage | Iowa Head and Neck Protocols

  https://medicine.uiowa.edu/iowaprotocols/sialolithiasis-salivary-stones-what-causes-them-and-how-manage

  Sialolithiasis – Salivary Stones – What Causes Them and How to Manage […] MANAGEMENT […] Conservative management: […] Antibiotics / analgesics / mouthwashes / sialogogues / massaging the gland […] Failing conservative management: […] Decision to intervene surgically is dependent on the requests of an informed patient and the clinicians successful correlation of symptoms with the pathologic process of sialectasis. […] Counsel re: […] Gland removal as a a definitive invasive but usually (not always) successful approach with an emphasis on alternatives […] Sialendoscopy with laser fragmentation and basket removal – […] Small stones ( 3 mm) reported 97% success rate with wire basket removal w/o fragmentation […] Larger stones ( 3 mm) reported 35% success with wire basket removal w/o fragmentation; increases to 72% with fragmentation; unusual to approach larger stones without attempted laser fragmentation

• #43 Sialolithiasis – Salivary Stones – What Causes Them and How to Manage | Iowa Head and Neck Protocols

  https://medicine.uiowa.edu/iowaprotocols/sialolithiasis-salivary-stones-what-causes-them-and-how-manage

  Extracorporeal Lithotripsy […] Available in Germany and other sites in Europe but not in the United States- external lithotripsy may permit spontaneous extrusion of fragmented parotid stones in 40% of cases […] Often done along with sialendoscopy to assist in removal of stone fragments […] Pneumatic Lithotripsy […] Open Approaches to Parotid Stones and Lab Preparation Missouri Sialendoscopy Course April 17 2015 […] Salivary Stone Removal with Ductoplasty from Submandibular Gland.

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

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8746135/

  Treatment for sialolithiasis has undergone significant changes since the 1990s. Following the development of new minimally invasive and gland-preserving treatment modalities, a 40-50% rate of gland resection was reduced to less than 5%. Extracorporeal shock-wave lithotripsy (ESWL), refinement and extension of methods of transoral duct surgery (TDS), and in particular diagnostic and interventional sialendoscopy (intSE) are substantial parts of the new treatment regimen. […] It has also become evident that combining the different treatment modalities further increases the effectiveness of therapy, as has been especially evident with the combined endoscopic-transcutaneous approach. […] Intraductal shock-wave lithotripsy (ISWL) has led to remarkable improvements thanks to the introduction of new devices, instruments, materials, and techniques, after earlier applications had not been sufficiently effective.

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

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8746135/

  Treatment for sialolithiasis has undergone significant changes since the 1990s. Following the development of new minimally invasive and gland-preserving treatment modalities, a 40-50% rate of gland resection was reduced to less than 5%. Extracorporeal shock-wave lithotripsy (ESWL), refinement and extension of methods of transoral duct surgery (TDS), and in particular diagnostic and interventional sialendoscopy (intSE) are substantial parts of the new treatment regimen. […] It has also become evident that combining the different treatment modalities further increases the effectiveness of therapy, as has been especially evident with the combined endoscopic-transcutaneous approach. […] Intraductal shock-wave lithotripsy (ISWL) has led to remarkable improvements thanks to the introduction of new devices, instruments, materials, and techniques, after earlier applications had not been sufficiently effective.

• #46 Sialolithiasis / Salivary Stones – Clinical features, Treatment options – Dr Sanu P Moideen

  https://drsanu.com/articles/sialolithiasis-salivary-stones-clinical-features-treatment-options/

  For stones in the proximal duct or within the gland, complete removal of the affected gland may be necessary. […] Lithotripsy (breaking down stones using sound waves) has proven effective, especially for stones smaller than 7 mm in diameter. Lithotripsy may be enhanced by fluoroscopically guided basket retrieval or sialendoscopy. […] Sialendoscopy, a minimally invasive technique, has become increasingly popular for both diagnostic and therapeutic purposes. It can be combined with lithotripsy and balloon dilation of stenotic ducts. […] Laser lithotripsy or other forms of piezoelectric or electromagnetic lithotripsy are alternatives that have shown good results, with minimal side effects. […] Post-operative care plays a significant role in ensuring successful recovery and preventing recurrence after treatment for sialolithiasis, particularly following surgery or lithotripsy. Key considerations include: Pain Management, Hydration and Sialogogues, Massage and Duct Care, Monitoring for Infection, Follow-up Appointments.

• #47 Sialolithiasis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK549845/

  Treatment of salivary stones that do not respond to external shockwave lithotripsy is with a combined transcutaneous and endoscopic approach (assuming the stone is visible under endoscopy). […] Sialadenectomy for the treatment of sialolithiasis is rarely necessary with modern treatment techniques.

• #48 Salivary Stones: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/24344-sialolithiasis

  Sialolithiasis treatments include massage, heat application and, sometimes, surgery. […] Sialolithiasis treatment depends on the size and location of the stone. Treatments may include home remedies, antibiotics, in-office stone removal or, in some cases, surgery. […] Most of the time, salivary gland stones go away on their own with conservative treatment. You might be able to push the stone out of your salivary duct by drinking lots of water, applying heat or massaging the area. […] If you’ve developed an infection as a result of a salivary gland stone, your healthcare provider will probably prescribe antibiotics. […] If home remedies aren’t successful, your healthcare provider may try to remove the stone by gently probing the area with a blunt instrument. […] Larger salivary gland stones may require surgery. During this procedure, a surgeon inserts an endoscope into your salivary duct to locate the stone.

• #49 Salivary Duct Stones | Children’s Hospital of Philadelphia

  https://www.chop.edu/conditions-diseases/salivary-duct-stones

  In some cases when the stone is larger or there are multiple stones, surgery called sialolithotomy may be necessary to cut out the stone. In the operating room, the surgeon will make an incision in the area of the floor of the mouth where the stone is located, remove the stone and close the opening. This preserves gland function. More extensive surgery, removing the entire gland, may be required if the gland with the stone becomes infected or has damaged the gland.

• #50 Sialolithiasis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK549845/

  Sialolithiasis is the most frequent cause of salivary gland swelling, affecting the major salivary glands: parotid, submandibular, and sublingual glands. […] Initial management is conservative, with various minimally invasive surgical options available for persistent cases. […] A variety of treatment options exist for sialolithiasis, including sialogogues, direct massage of distal stones out of the duct, and other procedures including interventional sialography, lithotripsy, sialoendoscopy, and surgery. […] Management of sialolithiasis should begin with conservative measures, including massaging the salivary gland, nonsteroidal anti-inflammatory drugs, and sialogogues. […] Further treatment is dictated based on the sialolith’s size, number, and location if conservative management is unsuccessful.

• #51 Salivary Endoscopy | Stony Brook Medicine

  https://www.stonybrookmedicine.edu/patientcare/surgery/patient-care/clinical/ent-surgery/services/salivary-endoscopy

  However, the new endoscopic approach offers safe access to the gland with local infiltration of steroids, thus decreasing inflammation to the gland. Up to 75% of patients have shown improvement of their symptoms with this intervention. […] Steroids can also be injected in cases of radiation-induced sialadenitis. […] In cases of larger stones, a combined approach can be utilized in which endoscopic manipulation of the stone is done with transoral sialodochoplasty, or incision on the duct, to remove the stone with marsupialization. This provides markedly less risk of morbidity compared to an open approach.

• #52 Salivary Gland Stones: Symptoms, Causes, and Treatment

  https://www.webmd.com/oral-health/salivary-gland-stones-symptoms-causes-treatments

  If a stone is detected, the goal of treatment is to remove it. For small stones, stimulating saliva flow by sucking on a lemon or sour candies may cause the stone to pass spontaneously. […] For larger, harder-to-remove stones, doctors usually make a small incision in the mouth to remove the stone. […] More and more, doctors are using a newer and less invasive technique called sialendoscopy to remove salivary gland stones. […] For people with recurrent stones or irreversible damage to the salivary gland, surgical removal of the gland may be necessary. […] In addition, antibiotics are prescribed if salivary stones have caused infection.

• #53 Sialolithiasis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK549845/

  Treatment of salivary stones that do not respond to external shockwave lithotripsy is with a combined transcutaneous and endoscopic approach (assuming the stone is visible under endoscopy). […] Sialadenectomy for the treatment of sialolithiasis is rarely necessary with modern treatment techniques.

• #54 Managing Your Salivary Stone: Causes, Symptoms, and Treatment – Sunrise Dentistry

  https://sunrise-dentistry.com/blog/managing-your-salivary-stone-causes-symptoms-and-treatment/

  Salivary stones often get noticed when there is a bump or discoloration on the floor of the mouth. They are accompanied by discomfort, pain, and swelling because the saliva is pooling and creating pressure. […] Treatment will depend on the number, size, shape, consistency, and location of the salivary stone. […] Smaller stones can be treated with home remedies like over-the-counter anti-inflammatory drugs or painkillers, warm compresses, and rehydration. Antibiotics are only prescribed if with infection. Experts also recommend lemons because they promote saliva flow. Another easy salivary stone removal technique is massage. This works well in dislodging small stones. […] Larger stones, however, will require dental professional services. An endoscopic procedure known as sialendoscopy will be performed to remove salivary gland stones. This was developed and first used in Europe. It uses a tiny lighted scope, inserted into the gland. It will give a good view of the duct system. Using micro instruments, the stone can be removed to relieve the blockage. This is an outpatient procedure and done under local anesthesia only. […] If the stone caused irreversible damage or is recurrent, surgical removal of the gland may be necessary.

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

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8746135/

  In summary, the main change in the treatment algorithm is that the development of ISWL has led to a reduction in the indications for ESWL. […] Removal of the gland should be considered in therapy-resistant cases, when there are persistent symptoms, and in accordance with the patients wishes. […] In summary, experience shows that as ISWL has become more important, ESWL has lost its importance in the management of parotid stones, although it is still a substantial element in the treatment algorithms in units that have access to it.

• #56 Salivary Stones: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/24344-sialolithiasis

  In rare instances, you may need to have your salivary gland surgically removed. Healthcare providers reserve this treatment for people with severe, recurring (returning) symptoms, or if the stone is in a location that isn’t amendable to removal by conservative means. […] In many cases, sialolithiasis goes away on its own or with conservative, at-home treatments, such as heat application, gentle massage and sucking on sour candy.

• #57 Salivary Stone Release – Exodontia

  https://exodontia.info/salivary-stone-release/

  Almost half of the Submandibular Calculi lie in the distal third of the duct and are amenable to simple surgical release through an incision (cut) directly onto the stone. […] If the Submandibular Gland has been damaged by recurrent infection and fibrosis or calculi have formed within the gland, the gland may require removal. […] Alternative methods of treatment have emerged such as the use of Extracorporeal Shock Wave Lithotripsy (ESWL) and more recently the use of Endoscopic Intracorporeal Shockwave Lithotripsy (EISWL), in which shockwaves are delivered directly to the surface of the stone lodged within the duct without damaging adjacent tissue (piezoelectric principle). […] Submandibular Gland Removal may be indicated following failure of lithotripsy or if the size of an intra-glandular stone is 12 mm as the success of lithotripsy may be 20% in such cases. […] In the case of small calculi, the treatment of choice should be medical, instead of surgical. […] Surgical removal of the calculus (or even of the whole gland) has traditionally been used as an alternative to medical therapy, whenever the latter was not possible or when it proved ineffective.

• #58 Current diagnostics and treatment of salivary stones – Medizinonline

  https://medizinonline.com/en/current-diagnostics-and-treatment-of-salivary-stones/

  Salivary gland removal: The submandibular gland or parts of the parotid gland can be surgically removed. However, there is a risk of facial nerve damage, ranging from 7 to 17% depending on the literature. Fortunately, this form of therapy can be considered ultima ratio, which today needs to be performed in only a few cases. […] After conservative therapeutic approaches using sialogoga and glandular massage, the simplest surgical therapy for stones near the entrance remains salivary duct slitting. Gland removal, with its not inconsiderable risks to the facial nerve, has been therapeutically displaced by newer, gentler treatment methods, particularly extracorporeal shock wave lithotripsy and sialendoscopy, which can be performed both diagnostically and interventively.

• #59 Ask a Doctor: Salivary Stones – UTHSC Ear, Nose, & Throat – Memphis

  https://uthscent.com/ask-a-doctor/ask-a-doctor-salivary-stones/

  Salivary stones are small white stones that form in the salivary glands that connect to your mouth and can block the flow of saliva. […] Initial treatment of stones can include applying moist heat and gently massaging the glands. Lemon drops or other tart candies can help stimulate salivation and ibuprofen or other anti-inflammatories can help relieve pain. […] Treatment is usually needed to remove these stones; patients should not remove them on their own as this can cause damage or scarring. Your physician can remove the stones by using a small blunt instrument, or you can have a procedure to remove them in the hospital. […] Generally, the procedure to remove them is a sialendoscopy, which is a minimally invasive procedure. During this procedure, the surgeon passes a small scope into the salivary duct to visualize and remove the stone. Recovery is rapid and does not require stitches or cause pain. […] In more serious cases, the removal of a salivary gland might be necessary. While the chance of risk with the salivary gland surgery is small, risks include bleeding, infection, scarring, or nerve damage.

• #60 Sialolithiasis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK549845/

  Sialolithiasis is the most frequent cause of salivary gland swelling, affecting the major salivary glands: parotid, submandibular, and sublingual glands. […] Initial management is conservative, with various minimally invasive surgical options available for persistent cases. […] A variety of treatment options exist for sialolithiasis, including sialogogues, direct massage of distal stones out of the duct, and other procedures including interventional sialography, lithotripsy, sialoendoscopy, and surgery. […] Management of sialolithiasis should begin with conservative measures, including massaging the salivary gland, nonsteroidal anti-inflammatory drugs, and sialogogues. […] Further treatment is dictated based on the sialolith’s size, number, and location if conservative management is unsuccessful.

• #61 Sialolithiasis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK549845/

  Mobile submandibular stones measuring less than 5 mm located within the distal duct should initially undergo management with endoscopy. […] Impacted submandibular stones within the distal duct and stones larger than 5 mm should have treatment with transoral duct slitting. […] External shockwave lithotripsy (ESWL) is an option for not palpable stones or visualized under endoscopy. […] Surgical excision of the submandibular gland should be a last resort. […] Salivary stones within the parotid duct that measure less than 7 mm and are mobile require endoscopic removal. […] If endoscopic management is unsuccessful or the stones have become impacted, external shockwave lithotripsy is considered the most appropriate second-line therapy with subsequent endoscopic removal of fragmented stones.

• #62 Sialolithiasis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK549845/

  Mobile submandibular stones measuring less than 5 mm located within the distal duct should initially undergo management with endoscopy. […] Impacted submandibular stones within the distal duct and stones larger than 5 mm should have treatment with transoral duct slitting. […] External shockwave lithotripsy (ESWL) is an option for not palpable stones or visualized under endoscopy. […] Surgical excision of the submandibular gland should be a last resort. […] Salivary stones within the parotid duct that measure less than 7 mm and are mobile require endoscopic removal. […] If endoscopic management is unsuccessful or the stones have become impacted, external shockwave lithotripsy is considered the most appropriate second-line therapy with subsequent endoscopic removal of fragmented stones.

• #63 Sialolithiasis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK549845/

  Mobile submandibular stones measuring less than 5 mm located within the distal duct should initially undergo management with endoscopy. […] Impacted submandibular stones within the distal duct and stones larger than 5 mm should have treatment with transoral duct slitting. […] External shockwave lithotripsy (ESWL) is an option for not palpable stones or visualized under endoscopy. […] Surgical excision of the submandibular gland should be a last resort. […] Salivary stones within the parotid duct that measure less than 7 mm and are mobile require endoscopic removal. […] If endoscopic management is unsuccessful or the stones have become impacted, external shockwave lithotripsy is considered the most appropriate second-line therapy with subsequent endoscopic removal of fragmented stones.

• #64 Sialolithiasis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK549845/

  Mobile submandibular stones measuring less than 5 mm located within the distal duct should initially undergo management with endoscopy. […] Impacted submandibular stones within the distal duct and stones larger than 5 mm should have treatment with transoral duct slitting. […] External shockwave lithotripsy (ESWL) is an option for not palpable stones or visualized under endoscopy. […] Surgical excision of the submandibular gland should be a last resort. […] Salivary stones within the parotid duct that measure less than 7 mm and are mobile require endoscopic removal. […] If endoscopic management is unsuccessful or the stones have become impacted, external shockwave lithotripsy is considered the most appropriate second-line therapy with subsequent endoscopic removal of fragmented stones.

• #65 Sialolithiasis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK549845/

  Treatment of salivary stones that do not respond to external shockwave lithotripsy is with a combined transcutaneous and endoscopic approach (assuming the stone is visible under endoscopy). […] Sialadenectomy for the treatment of sialolithiasis is rarely necessary with modern treatment techniques.

• #66 Salivary Stone Release – Exodontia

  https://exodontia.info/salivary-stone-release/

  Almost half of the Submandibular Calculi lie in the distal third of the duct and are amenable to simple surgical release through an incision (cut) directly onto the stone. […] If the Submandibular Gland has been damaged by recurrent infection and fibrosis or calculi have formed within the gland, the gland may require removal. […] Alternative methods of treatment have emerged such as the use of Extracorporeal Shock Wave Lithotripsy (ESWL) and more recently the use of Endoscopic Intracorporeal Shockwave Lithotripsy (EISWL), in which shockwaves are delivered directly to the surface of the stone lodged within the duct without damaging adjacent tissue (piezoelectric principle). […] Submandibular Gland Removal may be indicated following failure of lithotripsy or if the size of an intra-glandular stone is 12 mm as the success of lithotripsy may be 20% in such cases. […] In the case of small calculi, the treatment of choice should be medical, instead of surgical. […] Surgical removal of the calculus (or even of the whole gland) has traditionally been used as an alternative to medical therapy, whenever the latter was not possible or when it proved ineffective.

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

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8746135/

  Techniques involving combined approaches have been refined and modified. […] Recent trends have revealed a potential for significant changes in therapeutic strategies for both major salivary glands. For the submandibular gland, ISWL has replaced ESWL and TDS to some extent. For parotid stones, ISWL and modifications of TDS have led to reduced use of ESWL and the combined transcutaneous-sialendoscopic approach. […] The primary indication for ISWL is with stones in which gland-preserving treatment is not possible using the well-established techniques. […] ISWL has been used for difficult sialolithiasis as a single-mode treatment, and also in combination with other techniques. […] Although ISWL may replace ESWL in some indications, particularly with parotid stones, ESWL has a place in treatment regimens if it is available.

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

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8746135/

  Techniques involving combined approaches have been refined and modified. […] Recent trends have revealed a potential for significant changes in therapeutic strategies for both major salivary glands. For the submandibular gland, ISWL has replaced ESWL and TDS to some extent. For parotid stones, ISWL and modifications of TDS have led to reduced use of ESWL and the combined transcutaneous-sialendoscopic approach. […] The primary indication for ISWL is with stones in which gland-preserving treatment is not possible using the well-established techniques. […] ISWL has been used for difficult sialolithiasis as a single-mode treatment, and also in combination with other techniques. […] Although ISWL may replace ESWL in some indications, particularly with parotid stones, ESWL has a place in treatment regimens if it is available.

• #69 Salivary stones: symptoms, aetiology, biochemical composition and treatment | British Dental Journal

  https://www.nature.com/articles/sj.bdj.2014.1054

  Salivary stones, also known as sialoliths, are calcified concrements in the salivary glands. The management of salivary stones depends on the size and location of the stone. The management of salivary stones is focused on removing the salivary stones and preservation of salivary gland function which depends on the size and location of the stone. Conservative management of salivary stones consists of salivary gland massage and the use of sialogogues. Other therapeutic options include removal of the stone or in some cases surgical removal of the whole salivary gland. The primary objective in the treatment of sialolithiasis should be preservation of gland function in combination with a low level of complications and discomfort for the patient. Non-invasive conservative management of sialolithiasis consists of gland massage, in combination with use of sialogogues and irrigation. This treatment has the highest success rate when stones are small and located in the duct. When an infection is suspected, antibiotics should be prescribed. Nearly all intraductal submandibular and parotid stones can be removed by a relatively simple intraoral approach under local anaesthesia. After stone removal, it is recommended that salivary gland massage is carried out several times a day, combined with a sour diet and sialogogues to stimulate the salivary flow. Invasive management of sialolithiasis may consist of extracorporeal shock-wave lithotripsy, sialoendoscopy or surgical removal. Most patients experience no complaints or discomfort, but a normal functioning gland, after sialolith therapy that does not include surgical removal of the gland. Recurrence of sialoliths is rather uncommon, and is estimated to occur in 1-10% of the patients.

• #70 Salivary stones: symptoms, aetiology, biochemical composition and treatment | British Dental Journal

  https://www.nature.com/articles/sj.bdj.2014.1054

  Salivary stones, also known as sialoliths, are calcified concrements in the salivary glands. The management of salivary stones depends on the size and location of the stone. The management of salivary stones is focused on removing the salivary stones and preservation of salivary gland function which depends on the size and location of the stone. Conservative management of salivary stones consists of salivary gland massage and the use of sialogogues. Other therapeutic options include removal of the stone or in some cases surgical removal of the whole salivary gland. The primary objective in the treatment of sialolithiasis should be preservation of gland function in combination with a low level of complications and discomfort for the patient. Non-invasive conservative management of sialolithiasis consists of gland massage, in combination with use of sialogogues and irrigation. This treatment has the highest success rate when stones are small and located in the duct. When an infection is suspected, antibiotics should be prescribed. Nearly all intraductal submandibular and parotid stones can be removed by a relatively simple intraoral approach under local anaesthesia. After stone removal, it is recommended that salivary gland massage is carried out several times a day, combined with a sour diet and sialogogues to stimulate the salivary flow. Invasive management of sialolithiasis may consist of extracorporeal shock-wave lithotripsy, sialoendoscopy or surgical removal. Most patients experience no complaints or discomfort, but a normal functioning gland, after sialolith therapy that does not include surgical removal of the gland. Recurrence of sialoliths is rather uncommon, and is estimated to occur in 1-10% of the patients.

• #71 How to Diagnose Salivary Gland Stones – Prof. Dr. Teoman Dal, ENT Specialist

  https://www.teomandal.com/en/how-to-diagnose-salivary-gland-stones

  The therapeutic approach of surgical removal of the salivary glands in patients with salivary gland stones has today become considerably less common, after the beginning of the availability of the technologies that make it possible to reduce large stones by breaking them with the sialendoscopy procedure. […] Various treatments are recommended with intent to reduce the risk of recurrence after the removal of stones. These can be listed as follows; Taking drugs that increase the secretion of saliva, Increasing the water intake, Massage that promotes the salivary flow, Antibiotic treatments intended for preventing infections, Cortisone treatments intended to prevent stricture (narrowing) formation in the ducts.

• #72 Salivary stones: symptoms, aetiology, biochemical composition and treatment | British Dental Journal

  https://www.nature.com/articles/sj.bdj.2014.1054

  Salivary stones, also known as sialoliths, are calcified concrements in the salivary glands. The management of salivary stones depends on the size and location of the stone. The management of salivary stones is focused on removing the salivary stones and preservation of salivary gland function which depends on the size and location of the stone. Conservative management of salivary stones consists of salivary gland massage and the use of sialogogues. Other therapeutic options include removal of the stone or in some cases surgical removal of the whole salivary gland. The primary objective in the treatment of sialolithiasis should be preservation of gland function in combination with a low level of complications and discomfort for the patient. Non-invasive conservative management of sialolithiasis consists of gland massage, in combination with use of sialogogues and irrigation. This treatment has the highest success rate when stones are small and located in the duct. When an infection is suspected, antibiotics should be prescribed. Nearly all intraductal submandibular and parotid stones can be removed by a relatively simple intraoral approach under local anaesthesia. After stone removal, it is recommended that salivary gland massage is carried out several times a day, combined with a sour diet and sialogogues to stimulate the salivary flow. Invasive management of sialolithiasis may consist of extracorporeal shock-wave lithotripsy, sialoendoscopy or surgical removal. Most patients experience no complaints or discomfort, but a normal functioning gland, after sialolith therapy that does not include surgical removal of the gland. Recurrence of sialoliths is rather uncommon, and is estimated to occur in 1-10% of the patients.

• #73 Sialolithiasis / Salivary Stones – Clinical features, Treatment options – Dr Sanu P Moideen

  https://drsanu.com/articles/sialolithiasis-salivary-stones-clinical-features-treatment-options/

  Technological advances have significantly improved the management of sialolithiasis, offering less invasive and more effective treatment options. Some of the notable recent developments include: Sialendoscopy-Assisted Surgery, Balloon Dilation, Robotic-Assisted Gland-Sparing Surgery, Newer Lithotripsy Techniques. […] While there is no guaranteed way to prevent sialolithiasis, the following measures may reduce the risk or recurrence: Adequate Hydration, Sialagogues, Good Oral Hygiene, Avoiding Risky Medications.

• #74 Sialolithiasis / Salivary Stones – Clinical features, Treatment options – Dr Sanu P Moideen

  https://drsanu.com/articles/sialolithiasis-salivary-stones-clinical-features-treatment-options/

  Technological advances have significantly improved the management of sialolithiasis, offering less invasive and more effective treatment options. Some of the notable recent developments include: Sialendoscopy-Assisted Surgery, Balloon Dilation, Robotic-Assisted Gland-Sparing Surgery, Newer Lithotripsy Techniques. […] While there is no guaranteed way to prevent sialolithiasis, the following measures may reduce the risk or recurrence: Adequate Hydration, Sialagogues, Good Oral Hygiene, Avoiding Risky Medications.

• #75 Sialolithiasis / Salivary Stones – Clinical features, Treatment options – Dr Sanu P Moideen

  https://drsanu.com/articles/sialolithiasis-salivary-stones-clinical-features-treatment-options/

  Technological advances have significantly improved the management of sialolithiasis, offering less invasive and more effective treatment options. Some of the notable recent developments include: Sialendoscopy-Assisted Surgery, Balloon Dilation, Robotic-Assisted Gland-Sparing Surgery, Newer Lithotripsy Techniques. […] While there is no guaranteed way to prevent sialolithiasis, the following measures may reduce the risk or recurrence: Adequate Hydration, Sialagogues, Good Oral Hygiene, Avoiding Risky Medications.

• #76 Removing Salivary Stones – Eye & Ear Foundation of Pittsburgh

  https://eyeandear.org/2021/11/removing-salivary-stones/

  Salivary endoscopy for salivary stones was the November 3rd webinar topic hosted by The Eye Ear Foundation with presenter Dr. Barry Schaitkin, Professor, Department of Otolaryngology, Emeritus Program Director, Otolaryngology Residency Program at the University of Pittsburgh Dept of Otolaryngology. […] The goal of salivary endoscopy is to remove the obstruction and preserve the salivary glands. […] If the stone is small, it can be removed with local sedation. If the stone is large, extracorporeal shock waves which have been around since 1986 can be used to break it into smaller pieces. […] Two companies in Europe invented a very small version of this that is used in the office without anesthesia and can sit on the skin. […] What the U.S. does have are laser procedures. […] After stone removal, all patients have an endoscopy to make sure there are no stone fragments or other stones present. […] Recovery time increases with the size of the stone. […] A very large stone and incision means being uncomfortable for three to five days. […] Dr. Schaitkin thinks there will be something available within the next five to 10 years.

• #77 Azthena logo with the word Azthena

  https://www.news-medical.net/news/20130419/Obstructive-salivary-gland-disease-treatment-an-interview-with-Thomas-Cherry-Cook-Medical.aspx

  What our early tools do is allow you to more easily access those ducts. The small instrumentation with our guidewires helps us to get in and then we have our dilator set which allow us to open up the papilla (opening of the salivary duct) so it widens and opens up that area. […] We also have our nitinol extractor baskets which allow us, once weve accessed the duct and maintained access using the introducer, along with the endoscopes to go in and take out and retrieve the stones that are inside the ducts. […] We are developing more interventional tools to help complete the procedure and broaden the patients that can be treated through more minimally-invasive salivary endoscopy.

• #78 Removing Salivary Stones – Eye & Ear Foundation of Pittsburgh

  https://eyeandear.org/2021/11/removing-salivary-stones/

  Salivary endoscopy for salivary stones was the November 3rd webinar topic hosted by The Eye Ear Foundation with presenter Dr. Barry Schaitkin, Professor, Department of Otolaryngology, Emeritus Program Director, Otolaryngology Residency Program at the University of Pittsburgh Dept of Otolaryngology. […] The goal of salivary endoscopy is to remove the obstruction and preserve the salivary glands. […] If the stone is small, it can be removed with local sedation. If the stone is large, extracorporeal shock waves which have been around since 1986 can be used to break it into smaller pieces. […] Two companies in Europe invented a very small version of this that is used in the office without anesthesia and can sit on the skin. […] What the U.S. does have are laser procedures. […] After stone removal, all patients have an endoscopy to make sure there are no stone fragments or other stones present. […] Recovery time increases with the size of the stone. […] A very large stone and incision means being uncomfortable for three to five days. […] Dr. Schaitkin thinks there will be something available within the next five to 10 years.

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

  https://www.mdpi.com/2077-0383/11/1/231

  To illustrate these changes, we are here providing an updated treatment algorithm, including tried and tested techniques as well as promising new treatment modalities. […] The primary indication for ISWL is with stones in which gland-preserving treatment is not possible using the well-established techniques. […] Although ISWL may replace ESWL in some indications, particularly with parotid stones, ESWL has a place in treatment regimens if it is available. […] In summary, the main change in the treatment algorithm is that the development of ISWL has led to a reduction in the indications for ESWL. […] Removal of the gland should be considered in therapy-resistant cases, when there are persistent symptoms, and in accordance with the patient’s wishes. […] In conclusion, recent advances in sialendoscopy-guided treatment for salivary stones have been made and have been reported in published studies during the last 5–10 years. The literature results point to the growing importance of ISWL, for which very good results have been reported. This has led to an expansion of the scope for less invasive, gland-preserving treatment.

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

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8746135/

  Treatment for sialolithiasis has undergone significant changes since the 1990s. Following the development of new minimally invasive and gland-preserving treatment modalities, a 40-50% rate of gland resection was reduced to less than 5%. Extracorporeal shock-wave lithotripsy (ESWL), refinement and extension of methods of transoral duct surgery (TDS), and in particular diagnostic and interventional sialendoscopy (intSE) are substantial parts of the new treatment regimen. […] It has also become evident that combining the different treatment modalities further increases the effectiveness of therapy, as has been especially evident with the combined endoscopic-transcutaneous approach. […] Intraductal shock-wave lithotripsy (ISWL) has led to remarkable improvements thanks to the introduction of new devices, instruments, materials, and techniques, after earlier applications had not been sufficiently effective.

• #81 Salivary stones: symptoms, aetiology, biochemical composition and treatment | British Dental Journal

  https://www.nature.com/articles/sj.bdj.2014.1054

  Salivary stones, also known as sialoliths, are calcified concrements in the salivary glands. The management of salivary stones depends on the size and location of the stone. The management of salivary stones is focused on removing the salivary stones and preservation of salivary gland function which depends on the size and location of the stone. Conservative management of salivary stones consists of salivary gland massage and the use of sialogogues. Other therapeutic options include removal of the stone or in some cases surgical removal of the whole salivary gland. The primary objective in the treatment of sialolithiasis should be preservation of gland function in combination with a low level of complications and discomfort for the patient. Non-invasive conservative management of sialolithiasis consists of gland massage, in combination with use of sialogogues and irrigation. This treatment has the highest success rate when stones are small and located in the duct. When an infection is suspected, antibiotics should be prescribed. Nearly all intraductal submandibular and parotid stones can be removed by a relatively simple intraoral approach under local anaesthesia. After stone removal, it is recommended that salivary gland massage is carried out several times a day, combined with a sour diet and sialogogues to stimulate the salivary flow. Invasive management of sialolithiasis may consist of extracorporeal shock-wave lithotripsy, sialoendoscopy or surgical removal. Most patients experience no complaints or discomfort, but a normal functioning gland, after sialolith therapy that does not include surgical removal of the gland. Recurrence of sialoliths is rather uncommon, and is estimated to occur in 1-10% of the patients.

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

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8746135/

  In summary, the main change in the treatment algorithm is that the development of ISWL has led to a reduction in the indications for ESWL. […] Removal of the gland should be considered in therapy-resistant cases, when there are persistent symptoms, and in accordance with the patients wishes. […] In summary, experience shows that as ISWL has become more important, ESWL has lost its importance in the management of parotid stones, although it is still a substantial element in the treatment algorithms in units that have access to it.

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

  https://www.mdpi.com/2077-0383/11/1/231

  To illustrate these changes, we are here providing an updated treatment algorithm, including tried and tested techniques as well as promising new treatment modalities. […] The primary indication for ISWL is with stones in which gland-preserving treatment is not possible using the well-established techniques. […] Although ISWL may replace ESWL in some indications, particularly with parotid stones, ESWL has a place in treatment regimens if it is available. […] In summary, the main change in the treatment algorithm is that the development of ISWL has led to a reduction in the indications for ESWL. […] Removal of the gland should be considered in therapy-resistant cases, when there are persistent symptoms, and in accordance with the patient’s wishes. […] In conclusion, recent advances in sialendoscopy-guided treatment for salivary stones have been made and have been reported in published studies during the last 5–10 years. The literature results point to the growing importance of ISWL, for which very good results have been reported. This has led to an expansion of the scope for less invasive, gland-preserving treatment.

• #84 Understanding Sialolithiasis: Symptoms, Diagnosis, and Treatment

  https://home.hippoed.com/blog/understanding-sialolithiasis-symptoms-diagnosis-and-treatment

  Patients with sialolithiasis often present with swelling of the affected salivary gland, especially noticeable around meal times, when salivary flow increases, leading to pain and tenderness. […] Differentiating sialolithiasis from similar conditions is essential, as each requires a different treatment approach. […] If left untreated, sialolithiasis can lead to significant complications, including obstruction caused by stones, which can impede salivary flow, creating a favorable environment for bacterial infections. […] Management of sialolithiasis largely depends on the size and location of the stone: Conservative Management: Many cases of a small sialolith in an otherwise stable patient can be managed with hydration, warm compresses, non-steroidal anti-inflammatory drugs (NSAIDs), and sialogogues substances that stimulate saliva production. […] Sialogogues help stimulate saliva and may aid in managing sialolithiasis. […] In cases where patients show signs of sialadenitis such as fever, purulent discharge, or significant inflammation antibiotics are indicated, as is potential transfer to a higher level of care.

• #85 Salivary stones: symptoms, aetiology, biochemical composition and treatment | British Dental Journal

  https://www.nature.com/articles/sj.bdj.2014.1054

  Salivary stones, also known as sialoliths, are calcified concrements in the salivary glands. The management of salivary stones depends on the size and location of the stone. The management of salivary stones is focused on removing the salivary stones and preservation of salivary gland function which depends on the size and location of the stone. Conservative management of salivary stones consists of salivary gland massage and the use of sialogogues. Other therapeutic options include removal of the stone or in some cases surgical removal of the whole salivary gland. The primary objective in the treatment of sialolithiasis should be preservation of gland function in combination with a low level of complications and discomfort for the patient. Non-invasive conservative management of sialolithiasis consists of gland massage, in combination with use of sialogogues and irrigation. This treatment has the highest success rate when stones are small and located in the duct. When an infection is suspected, antibiotics should be prescribed. Nearly all intraductal submandibular and parotid stones can be removed by a relatively simple intraoral approach under local anaesthesia. After stone removal, it is recommended that salivary gland massage is carried out several times a day, combined with a sour diet and sialogogues to stimulate the salivary flow. Invasive management of sialolithiasis may consist of extracorporeal shock-wave lithotripsy, sialoendoscopy or surgical removal. Most patients experience no complaints or discomfort, but a normal functioning gland, after sialolith therapy that does not include surgical removal of the gland. Recurrence of sialoliths is rather uncommon, and is estimated to occur in 1-10% of the patients.

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