{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T03:04:50Z","timestamp":1787799890639,"version":"build-2784847793"},"reference-count":35,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2017,12,15]],"date-time":"2017-12-15T00:00:00Z","timestamp":1513296000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2018,10]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>To assess results after treatment of difficult\/complex sialolithiasis with extracorporeal shock\u2010wave lithotripsy (ESWL) and intraductal pneumatic lithotripsy (IPL).<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Retrospective study in a tertiary referral center.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Altogether, 63 stones were diagnosed in 38 patients with difficult\/complex sialolithiasis. Forty\u2010nine stones were treated with fragmentation using both ESWL and IPL. Stones accessible with the sialendoscope were treated primarily with IPL in multiple sialolithiasis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Seventy\u2010one ESWL procedures and 57 IPL were performed in our patients. Forty\u2010nine stones were treated by 67 ESWL procedures and 52 IPL. ESWL converted sialoliths from sialendoscopically untreatable into sialendoscopically treatable cases in 94.7%; the treatment then was completed by a total of 52 IPL procedures. ESWL was performed before IPL (81.6%), in combination with IPL (7.9%) and after (10.5%). Complete fragmentation was achieved in 97.9%. Four stones each were treated with ESWL and IPL alone in multiple sialolithiasis. Altogether, 53 stones were treated by 57 IPL procedures. Complete fragmentation was achieved in 98.1% of the 53 stones. ESWL and IPL were the dominant treatment modalities in 84.1% of all 63 stones treated. Of all 38 patients, 92.1% became stone\u2010free and all became symptom\u2010free. All the glands were preserved. Multiple stones were treated in 34.2% of the patients; of these, 92.3% became stone\u2010free.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>These results show that patients with difficult and complex sialolithiasis can be treated with high success rates of\u2009&gt;\u200990% using a multimodal, minimally invasive, and gland\u2010preserving treatment approach. ESWL and IPL played a key role in this multimodal treatment regime in\u2009&gt;\u200980% of stones.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>4. <jats:italic>Laryngoscope<\/jats:italic>, 128:E332\u2013E338, 2018<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.27037","type":"journal-article","created":{"date-parts":[[2017,12,16]],"date-time":"2017-12-16T21:28:01Z","timestamp":1513459681000},"source":"Crossref","is-referenced-by-count":29,"title":["Multimodal treatment in difficult sialolithiasis: Role of extracorporeal shock\u2010wave lithotripsy and intraductal pneumatic lithotripsy"],"prefix":"10.1002","volume":"128","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7838-6490","authenticated-orcid":false,"given":"Michael","family":"Koch","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology and Head and Neck Surgery University of Erlangen\u2013Nuremberg Erlangen 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