Sialendoscopy: Diagnostic possibilities and therapeutic options

With the improved availability of sialendoscopy (SE) during the last decade the therapeutical concept for sialoliths has remarkably changed. Due to the introduction of SE the diagnostic oportunities could be extended. Before introduction of SE, the diagnostic was focused only on the existence and size of sialoliths. Now, questions like consitence of sialoliths and their mobility in the duct system, stenoses with sialolithiasis-like symptoms as well as the evaluation of the remaining secretory capacity of the involved gland became relevant for the therapeutic decision. Furthermore there are an increasing number of therapeutic opportunities available. For some of these techniques long term experiences are missing so far. On the basis of the review of the current literature and a retrospective analysis of 256 own patients the different techniques and their indication are described. The combination of different therapeutical options of the SE and the still established extracorporal shockwave lithotripsy (ESWL) results in an important reduction of glandular resection in patients with sialolithiasis. Thus, the rate of glandular resection for the glandular submandibular can be decreased to 5 % and for the glandular parotis to 1 %. In summary, the most effective way is a stepwise approach based on the diagnostic tools of SE and including the laserlithotripsy and ESWL in the treatment of sialolithiasis.