Modern management of obstructive salivary gland disease.

Aims: To investigate the results of a minimally invasive approach to the management of obstructive salivary gland disease.

Materials and methods: Five hundred and thirty-seven patients with symptomatic obstructive salivary gland disease (455 calculi, 82 strictures) consisting of 330 submandibular and 207 parotid cases were treated using minimally invasive techniques. Extra-corporeal shock wave lithotripsy (ECSWL), fluoroscopically guided basket retrieval, or intra-oral stone removal under general anaesthesia, were used for salivary calculi, either alone or in combination. Strictures were treated using fluoroscopically guided balloon dilatation.

Results: ECSWL achieved complete success (stone and symptom free) in 87/221 (39%) of cases (84/218 primary, 3/3 secondary) of which submandibular 43/131, parotid 44/90. Basket retrieval cured 124/166 (75%) cases (103/136 primary, 21/30 secondary) of which submandibular 80/109, parotid 44/57. Intra-oral surgical removal provided a cure in a further 137/143 (96%) submandibular cases (99/101 primary, 36/38 secondary and 2/4 tertiary). The overall success rate for the three techniques was 348/455 (76%). Balloon dilatation resulted in complete elimination of the stricture in 44/82 (54%) and a reduction in the stricture in 32/82 (39%) and no improvement in 6/82 (7%). Review at six months showed resolution 14/32 (44%), improvement 16/32 (50%) and no change 2/32 (6%) of symptoms.

Conclusions: A minimally invasive approach to the management of obstructive salivary gland disease is to be encouraged. All four techniques described have a low morbidity and afford the possibility of retaining a functional gland.