Modern management of obstructive salivary diseases P. Capaccio, S. Torretta, F. Ottavian, G. Sambataro, L. Pignataro
Acta Otorhinolaryngol Ital 2007: 27(4): 161–172 Obstructive salivary pathology is a relatively common medical problem, and during last 15 years there was an increasing public demand for minimally invasive surgery. Recent technological advances have led to the development of a number of conservative options for the therapeutic management of salivary lithiasis disorders, such as calculi and duct stenosis. Treatment by sialoendoscopy, intracorporeal and extracorporeal lithotripsy, interventional radiology, video-assisted conservative surgical removal of parotid and sub-mandibular calculi has been developed worldwide as an alternative to open surgical procedures. The techniques were used either alone or in combination, usually as a day case or one-day case under local or general anaesthesia. The multi-modal approach is completely successful in about 80% of patients and reduces the need for gland removal in 3%, thus justifying the combination of, albeit, time-consuming and relatively expensive techniques as part of the modern and functional management of salivary calculi. Sialoendoscopy is also of high value in the diagnosis and treatment of other salivary gland diseases, such as microliths, mucous plugs or foreign bodies. It was also useful for local management of inflammatory conditions. A minimally invasive approach to the management of obstructive salivary gland diseases is to be encouraged. All four techniques described have low morbidities and afford the possibility of retaining a functional gland.