Treatment of Sialolithiasis of the Parotid Gland with Stone Located in the Papilla or Distal Excretory Duct
Clinical Scenario
This protocol addresses parotid gland sialolithiasis where the calculus is situated in the papilla or the distal excretory duct — a location that directly determines the appropriate interventional strategy.
Specific Condition
The stone is located in the papilla or distal excretory duct of the parotid gland. Stone size and consistency are the principal determinants of which interventional approach is selected in this setting.
Management Approach
Management centres on interventional procedures targeted at the duct system, with the technique selected according to stone characteristics. The full evidence-based selection algorithm — including first-choice options based on ductal anatomy — is detailed in the structured protocol.
References
DOI: 10.1007/s00405-025-09697-y
- Stones in the Papilla and Distal Excretory Duct
- Mobile stones not exceeding 3–5 mm in size are an ideal indication for extraction with intSE using instruments such as a basket or forceps, if necessary after application of ISWL.
- Endoscopic mobilization or fragmentation is indicated for stones 5–7 mm in size.
- If the stones have a weak consistency, mechanical fragmentation using microdrills is a possible solution in some cases.
- However, in general, in particular if the stones are of a hard consistency and/or are greater than 7 mm, ISWL represents an excellent treatment modality with high success rates.
- Major changes from the earlier algorithm are the fact that intSE or ISWL are the first choice if the anatomy of the duct system permits.
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