The imaging of stones in the salivary glands and ducts poses a challenge, even to experienced ultrasound examiners. This study investigated whether the ‘twinkling artefact’, which occurs at internal calcific foci during Doppler ultrasound examinations, is useful for detecting salivary gland stones.

In a model test, 20 salivary stones were analysed in vitro, via Doppler ultrasound, with regard to their representability and the triggering of the twinkling artefact. In a follow-up study, 28 patients with sialolithiasis and food-related large salivary gland swellings were examined, using both power and colour Doppler modes, with regard to the twinkling artefact. All ultrasound examinations were performed by an experienced examiner and retrospectively graded by two experienced sonographers.

All stones could reliably be detected using the twinkling artefact in the model test. Twenty-seven of 28 salivary stones (96 per cent) also showed twinkling in vivo, during patient assessment. The power Doppler mode showed a significantly higher intensity level of twinkling than the colour Doppler mode (p < 0.0001).

The twinkling artefact is a very reliable sign for the diagnosis of sialolithiasis. Power Doppler is superior to colour Doppler for detection of the twinkling artefact.

To review our experience with therapeutic sialendoscopy in both the submandibular and parotid glands in order to determine prognostic factors and improve successful outcomes.

Single-centre, retrospective chart review.

The medical records of patients who had undergone sialendoscopy for sialolithiasis were reviewed, and demographic details, stone data (location, size, multiplicity, mobility), and operative technique and success were recorded.

Eighty-five patients were included: 70 patients with submandibular stones and 15 with parotid stones. Sialendoscopy was successful in all cases. Complete endoscopic removal was successful in 51 per cent of patients with submandibular stones and 47 per cent of those with parotid stones. Size (less than 5 mm) and distance from the papilla (less than 3 cm) were significant factors affecting success for patients with submandibular duct stones. However, this was not the case for patients with parotid duct stones, with neither variable achieving significance; nevertheless, numbers were small.

Stone size and location significantly affect the success of therapeutic sialendoscopy in submandibular glands.

To examine the outcomes and treatment cost of transoral removal of submandibular calculi, and to compare the outcomes and costs of other reported techniques.

Retrospective review of 60 consecutive patients undergoing transoral removal of submandibular calculi. All clinical, operative, post-operative and follow-up data were collated and outcomes analysed.

A total of 61 submandibular glands were treated by the transoral approach. Patients with multiple stones (p = 0.034) and stones in the proximal submandibular duct (p = 0.0028) were at greater risk of requiring submandibular gland excision, compared with patients with single stones and stones in the distal duct, respectively. There was a significant difference between the gland preservation rate during the first versus the second half of the study (p = 0.028). Larger calculi were significantly more likely to be seen in the proximal duct (p < 0.001). The mean operating time (28 minutes) and length of hospital stay for transoral removal of submandibular calculi was much less than those for other treatment techniques.

Symptomatic salivary stones in the middle or proximal parotid duct have previously been treated by gland excision, which is associated with a 3–7 per cent risk to the facial nerve. Minimally invasive approaches to the management of salivary duct calculi have been devised over the past decade. Fluoroscopically guided basket retrieval, lithotripsy and intra-oral stone removal under general anaesthesia have found favour with most surgeons. Endoscopically controlled intracorporeal shock wave lithotripsy using the pneumoblastic lithotripter has been replaced by electrohydraulic lithotripsy (used in sialolith treatment).

The electrokinetic lithotripter is normally used for the treatment of lower ureteric stones, and has the benefit of minimal concomitant tissue damage. We have extended its use to the treatment of parotid duct calculi. We present initial results for its use in the treatment of a proximal parotid duct stone.

Application of the shock wave to the stone under direct vision avoided injury to the duct or to any local structure. The patient made an uneventful recovery and was asymptomatic after 18 months' follow up.

Continuous, endoscopically monitored electrokinetic lithotripsy with good irrigation gives a well illuminated field and absolute delivery of energy to the target. It avoids the side effects caused by impact of the shock wave on the parotid duct and adjacent anatomical structures, thereby making it a safer procedure.