Salivary gland preservation during treatment for obstructive duct and gland problems is a goal worth pursuing. Difficult cases may seem to be candidates for sialadenectomy. However, progress in endoscopic and open-surgical procedures can help the physician to find solutions that overcome difficult problems without removing the gland. Broader application of these sialendoscopic and open preservation procedures may be especially useful for physicians without access to extracorporeal lithotriptors.