Objective: To evaluate an advanced sialoendoscopy technique used synergically with external shockwave lithotripsy procedure for complicated sialoliths cases.

Methods: We present a long term experience of a total 192 patients that were classified for high risk failure of removal in standard endoscopic guided technique. Patient selection criteria will be discussed. They were treated both with extracorporeal shock wave lithotripsy (ESWL) and sialoendoscopic guided surgery, in complicated cases, and thus we were able to salvage the salivary gland from resection.

Results: Within the follow-up period of five years 95% of the patients who underwent this treatment modality were free from stones and symptoms. The techniques which were used for stone removal included pure endoscopic approach and endoscopic assisted extra ductal surgery.

Conclusion: The combination of the sialoendoscopic guided surgery and ESWL is a highly effective treatment modality for removing complicated salivary gland stones with minimal collateral damage. It is an effective method for dissociation of closely related stones to overlying tissue. This method reduce the need for salivary gland resection, and favors the advancement toward minimally invasive surgical techniques.