Purpose <p>To evaluate the efficacy and safety of the combined approach in managing large salivary gland stones, with specific focus on stone elimination, symptom resolution, and postoperative complications.</p> Methods <p>A retrospective cohort study was conducted at a tertiary referral centre, including patients diagnosed with sialolithiasis between 1 October 2018 and 1 October 2023. Patients treated with the combined approach were included; those managed solely with sialendoscopy, exclusively via incision, or conservative treatment were excluded. Medical records were reviewed for outcomes including stone removal success, symptom resolution, and complications.</p> Results <p>Of 243 patients diagnosed with sialolithiasis, 33 underwent the combined approach - eight involving the parotid gland and 25 the submandibular gland. Complete stone removal was achieved in 28 cases (85%), and symptom resolution was observed in 29 cases (88%). Postoperative infections occurred in five parotid and four submandibular cases. Temporary tongue paraesthesia was noted in two submandibular cases; no nerve injuries were reported in parotid cases.</p> Conclusion <p>The combined approach is a safe and effective gland-preserving technique for large salivary gland stones, with high success rates and minimal complications. Prophylactic antibiotics may be beneficial for parotid procedures, though prospective studies are needed to define infection criteria and guide antibiotic use.</p>