Parotid gland sialolithiasis: a comprehensive systematic review and meta-analysis: Title page

Purpose: Parotid sialolithiasis represents unique diagnostic and therapeutic challenges due to the anatomy of the gland and the proximity of the facial nerve. The aim of this systematic review and meta-analysis was to evaluate the efficacy and safety of various treatment modalities for parotid gland stones. Methods: A systematic review was conducted in accordance with the PRISMA guidelines. Eligible studies were identified by searching PubMed/MEDLINE, the Cochrane Library, Scopus and Google Scholar. Eligible observational studies and clinical trials reporting on patients with parotid stones were included. The outcomes assessed included stone-free rate, symptom improvement and the presence of any complications. A single-arm random-effects meta-analysis was performed, focusing on endoscopy-only, endoscopy-assisted and extracorporeal shock wave lithotripsy (ESWL). Bias risk was assessed using the Newcastle–Ottawa Scale. Results: A total of 42 studies involving 1,559 patients were analyzed. Endoscopy-assisted removal showed the highest stone-free rate (93%, 95%CI: 90–96) and symptom improvement (91%, 95%CI: 92–99) (p < 0.05). Combined endoscopic-external approaches were effective for complex stones but had higher complication rates (24%, 95% CI: 14–37). ESWL had a lower stone-free rate (58%) but aided long-term symptom control (p < 0.05). CT-navigation did not significantly enhance clearance (80%). Most complications were minor; no permanent facial nerve injuries were reported. The quality of the evidence was limited by heterogeneity and the lack of any randomized trials. Conclusions: Endoscopy-assisted and combined approaches offer effective, gland-preserving options for parotid sialolithiasis. ESWL and laser techniques remain adjunctive but warrant further research. Prospective, standardized trials are needed to define any optimal management strategies.