This protocol addresses sialolithiasis of the parotid gland in the specific situation where the calculus is located in the middle or proximal duct, or the hilar region — an anatomically challenging location that influences which interventional strategies are feasible.
When duct anatomy limits the utility of other approaches, the structured evidence-based regimen for this scenario centres on a combined endoscopic–transcutaneous approach. The full sequence of steps, indications, and decision criteria are available in the complete protocol.
Full regimen details, procedural algorithm, and decision points are in the protocol below.DOI: 10.1007/s00405-025-09697-y
Stones in the Middle or Proximal Duct and Hilar Region
If the anatomy of the duct system is unsuitable—e.g., due to narrowness of the duct lumen or duct variations—then ESWL, intSE, or ISWL may not be promising, leaving the combined endoscopic–transcutaneous approach as an alternative.
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