**5. ESWL in the treatment of salivary stones**

ESWL sources used for salivary stones lithotripsy are either the electromagnetic source or the piezoelectric source. The electromagnetic shock wave source is more commonly used for being minimally invasive without need for anesthesia, so it can be done as an outpatient practice [26, 27]. Capaccio et al. [13] have done a prospective study on 415 patients on two groups in two time periods. Both groups received ESWL via an electromagnetic device that was preceded by ultrasonography (US) for localizing the stones. Follow‐up was done using ultrasonography at 1 week, then at 1, 3, 6 and 12 months after ESWL application. Complete stone clearance percentages were generally higher in patients with parotid duct stones (group A: 69.3% and group B:68.8%) than in those with submandibular duct stones (group A: 35.9% and group B: 48.8%). However, with US follow‐up, some residual submandibular and parotid dust stones were observed. Post‐ESWL procedures to remove the symptom‐ atic residual stones included sialendoscopy or transoral removal of stones. This proved that ESWL achieves good results for salivary stones especially parotid duct stones with small diameters.

In another retrospective study by Schmitz et al. [14], 31% of patients reached total stone clear‐ ance, and in 55% of patients, the treatment was partially successful with asymptomatic resid‐ ual stone identified using US. Failure of treatment occurred in 14% of cases.

In spite of being non‐invasive efficient alternative to surgery in management of sialadeni‐ tis, ESWL is contraindicated in the following cases: acute sialadenitis, gingivitis, pregnancy, bleeding disorders and calculi that cannot be detected using US. Relative contraindications include patients with cardiovascular diseases or artificial pace makers [13, 14].
