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Moderne Konzepte zur Diagnostik und Therapie der Sialolithiasis

Modern concepts for the diagnosis and therapy of sialolithiasis

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Zusammenfassung

Steine sind in 60–70% aller Fälle die Ursache obstruktiver Speicheldrüsenerkrankungen. Neue minimal-invasive Techniken unterstützen den Behandler, eine adäquate Diagnose zu stellen und gleichzeitig eine befundadaptierte Therapie durchzuführen mit dem Ziel, die Drüsenfunktion vollständig zu erhalten. In dieser Arbeit wird über den aktuellen Stand der Diagnostik und Therapie der Sialolithiasis berichtet. Der Ultraschall stellt die Untersuchungsmethode der ersten Wahl dar. Die Sialendoskopie als direkt visualisierende Technik ist bei der Beurteilung von Pathologien des Gangsystems allen anderen diagnostischen Mitteln überlegen. Neben der extrakorporalen Stoßwellenlithotripsie (ESWL) haben sialographisch kontrollierte Techniken, Operationen am Gangsystem und v. a. die interventionelle Sialendoskopie zu signifikanten Veränderungen des Therapieregimes geführt. Die Sialendoskopie hat, v. a. in Kombination mit anderen Therapiemodalitäten, eine Erfolgsrate von 85–95%: Therapieresistente Fälle können mittels der kombinierten endoskopisch-transkutanen Operation in etwa 90% erfolgreich behandelt werden. Mit der Sialendoskopie allein oder in Kombination kann in 95–98% aller Fälle ein Drüsenerhalt erreicht werden.

Abstract

Sialoliths are the underlying cause of salivary gland obstructive disease in 60%–70% of cases. Modern minimally invasive techniques have enabled accurate diagnosis and findings-specific therapy with the aim of full gland-function preservation. This article provides an overview of the current diagnostic measures for and therapy of sialolithaisis. Ultrasound is the investigation of first choice and is able to recognize stones in well over 90% of cases. Sialendoscopy is a directly visualizing technique which is superior to all other diagnostic measures for the assessment of pathologic changes in the salivary duct system and the detection of stones. Treatment was significantly improved with the introduction of extracorporal shock wave lithotripsy (ESWL), sialographic-controlled techniques, surgical procedures of the duct system and in particular by interventional sialendoscopy. Interventional sialendoscopy, especially when combined with other treatment modalities, has a success rate of 85%–95%. Cases which respond poorly to therapy can be treated successfully with the endoscopic transcutaneous approach in about 90% of cases. When sialendoscopy is performed in combination with other minimally invasive treatment options the gland can be preserved in 95%–98% of all cases.

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  1. Hals-Nasen-Ohren-Klinik, Kopf- und Halschirurgie, Friedrich Alexander Universität Erlangen-Nürnberg, Waldstraße 1, 91054, Erlangen, Deutschland

    H. Iro, J. Zenk & M. Koch

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  1. H. Iro
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  2. J. Zenk
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  3. M. Koch
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Correspondence to H. Iro.

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Iro, H., Zenk, J. & Koch, M. Moderne Konzepte zur Diagnostik und Therapie der Sialolithiasis. HNO 58, 211–217 (2010). https://doi.org/10.1007/s00106-009-2075-0

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