内镜下经口入路颌下腺切除术的临床分析

目的探讨内镜辅助经口入路颌下腺切除的有效性、安全性和可行性。方法经鼻插管全麻后，沿颌下腺导管开口至磨牙后区的下颌舌颌沟做弧形切口，内镜辅助下分别沿下颌下腺导管，切断与颌下腺有关的神经、血管、导管，将颌下腺切除。结果5例患者均顺利切除颌下腺，1例出现暂时性舌体麻木，2周后恢复。无面神经下颌缘支及舌下神经损伤,无其他并发症。颈部无瘢痕，美容效果好。结论内镜辅助下经口入路颌下腺切除术安全、可行，值得临床推广应用。     

Salivary gland transplantation for dry eye disease: Indications,techniques, and outcomes

The transplantation of salivary glands to the eye serves as a substitute for restoring tear volume in patients with severe dry eye disease. The lacrimal gland and salivary glands share similar acinar-ductal organization with some differences in the nature of secretions. This review summarizes the comparative anatomy of salivary and lacrimal glands, various salivary gland transplantation techniques, their indications, outcomes and complications along with future perspectives. Autologous microvascular submandibular gland transplantation (SMGT) into the temporal fossa with duct placement into the conjunctival fornix improves tear volume considerably but provides a hyposmolar tear film, which can induce corneal edema (in 3.5-40% of eyes). The transplanted submandibular graft improves tear volume and stability but visual acuity and conjunctival inflammation remain unchanged. The transplanted submandibular gland maintains stable function in the long-term and can have hypersecretion in 24–60% secondary to persistent autonomic innervation. Partial SMGT, gland reduction surgery, topical atropine gel or Botulinum Toxin A injection are options for treatment of postoperative epiphora. Minor salivary gland transplantation (MSGT) into the upper and/or lower conjunctival fornix results in an average improvement of 2–4 mm in Schirmer values compared to 16 to > 30 mm observed in eyes after SMGT. Reflex epiphora is rarely a problem in MSGT. Both MSGT or SMGT can improve the ocular surface and quality of life of patients with severe, debilitating dry eye disease. However, postoperative visual acuity and outcomes of corneal transplantation are still inconsistent. More studies and additional technical improvements are needed to further improve the results of these procedures.     

Primary Submandibular Tuberculosis: An Unusual Cause of Submandibular Salivary Gland Enlargement

A case report of very rare Primary Tuberculosis of Submandibular Gland. This is presented in view of its rarity and highlighting the importance of histopathological examination and Polymerase chain reaction (PCR) to reach the final and exact diagnosis of disease.     

声辐射力脉冲弹性成像诊断干燥综合征涎腺病变

目的 探讨声辐射力脉冲弹性成像（ARFI）诊断干燥综合征（SS）涎腺病变的价值。方法 收集SS患者38例（SS组）及同期健康志愿者29名（对照组）,以声触诊组织量化（VTQ）技术对所有受检者双侧腮腺和颌下腺行ARFI,检测其剪切波速度（SWV）;绘制ROC曲线,获得SWV诊断SS的最佳阈值,采用Pearson相关系数分析SWV值与实验室指标的相关性。结果 SS组腮腺、颌下腺SWV值均高于对照组（P均<0.01）。ARFI诊断腮腺SS的最佳阈值2.14 m/s,敏感度、特异度、Youden指数及曲线下面积（AUC）分别为94.7%、86.2%、0.809及0.971。ARFI诊断颌下腺SS的最佳阈值1.94 m/s,敏感度、特异度、Youden指数及AUC分别为86.8%、82.8%、0.696及0.899。腮腺SWV值与SS患者的血沉（ESR）、IgG、类风湿因子水平呈正相关（P均<0.05）;颌下腺SWV值与SS患者的IgA、ESR、IgG水平呈正相关（P均<0.05）。结论 ARFI诊断SS具有较高价值,可定量提供SS腺体的硬度值,并可反映疾病活动状况,进而对疗效进行评估。     

156例颅颌面骨折治疗的临床分析

目的回顾性研究颅颌面骨折患者的治疗方法。 方法选取佛山市中医院口腔颌面外科2017年1月至2019年12月收治的156例颅颌面骨折患者,经过急诊CT确诊有颅脑外伤并颌面部骨折患者为纳入标准。首先于脑外科处理颅脑外伤,给予护脑、抗炎、脱水等对症处理,病情稳定后手术治疗行颌面部骨折切开复位内固定术,术中麻醉注意保持血压稳定,术后继续脑外科及口腔科专科对症治疗,并康复治疗3 ~ 6个月。 结果156例颅颌面骨折损伤患者中,16例患者张口受限,9例有面瘫症状,其余患者康复满意。 结论颅颌面骨折患者治疗应评估好手术时机择期手术,围手术期应密切观察患者颅脑病情变化。     

The Diagnostic Dilemma of a Parasympathetic Schwannoma in the Submandibular Gland

Schwannomas are benign soft tissue tumours that arise from nerve sheath cells. They are rare in the salivary glands and are thought to arise from the parasympathetic nerves. We report the case of a 69-year-old man who presented with a painless right submandibular mass that appeared to resemble a pleomorphic adenoma on ultrasonography and, on this basis, proceeded to surgical excision of the gland. We review the relevant literature and highlight the diagnostic pitfalls.     

成人表皮干细胞和汗腺细胞的体外分离和培养

背景：人表皮干细胞和汗腺细胞的分离培养及鉴定,为探讨人表皮干细胞再生汗腺的可行性打下基础。目的：探讨体外分离培养人表皮干细胞及汗腺细胞的有效方法。方法：采集不同年龄段的泌尿外科患者术后包皮组织,充分清洗消毒后去除皮下组织,将其修剪成0.5cm×0.5cm的皮片,用Ⅳ型胶原纯化、富集成人表皮干细胞,倒置相差显微镜观察细胞形态：使用免疫荧光染色对成人表皮干细胞表型进行分析;CCK-8检测细胞的增殖曲线;采用胶原酶消化法从人全层无损伤皮肤中分离提取汗腺细胞,并进行扩增和鉴定。结果：倒置相差显微镜下见分离培养的成人表皮干细胞呈卵圆形、细胞之间紧密相连,呈铺路石状,免疫荧光染色显示细胞表达CK19、β1整合素。倒置相差显微镜下见汗腺细胞呈扁平多角形,表达汗腺细胞标志细胞CK7、18、19及CEA。结论：本实验结果说明胶原酶消化法分离培养成人表皮干细胞及汗腺样细胞是可行的。     

下颌下入路手术治疗Hangman骨折的解剖与临床应用

目的：探讨下颌下入路手术的解剖要点及其治疗Hangman骨折的临床疗效。方法对5具成人新鲜尸体标本下颌下区的重要血管和神经进行解剖观察,并测量舌下神经与喉上神经内侧支之间纵向的最短距离;其中男3具、女2具,年龄39~62岁,均排除颈椎相关疾病病史。回顾分析2006年12月—2012年1月第二军医大学附属长征医院脊柱外科采用下颌下入路手术治疗21例Hangman骨折患者的临床资料,其中男14例、女7例,年龄27~59岁;根据Levine-Edward分型,Ⅱ型骨折18例,Ⅱa型骨折2例,Ⅲ型1例。结果下颌下入路的相关重要解剖结构在尸体解剖中得以充分显露,舌下神经与喉上神经内侧支之间纵向的最短距离为（21．7±3．1) mm,通过适当牵拉能够充分暴露C2、C3水平,满足Hangman骨折手术治疗操作要求。21例临床病例随访（21．3±8．1)个月,骨折愈合均良好,术后神经症状及颈肩部疼痛程度均较术前明显改善,JOA 改善率为64．9%。1例术中减压过程中出现脑脊液漏,术中行明胶海绵及Surgiflo填塞处理,术后常压引流3 d未引出脑脊液,引流拔除后手术切口愈合良好;1例术后出现声音嘶哑症状,2个月后自行恢复。结论下颌下入路可充分显露手术内固定治疗Hangman骨折所需的手术节段,手术疗效满意。熟知下颌下三角区域解剖结构、重要神经血管的走行是手术成功、减少手术并发症发生的关键因素。     

Clinicopathologic Analysis of Pituitary Adenoma: A Single Institute Experience

Pituitary adenoma (PA) is a common benign neuroendocrine tumor; however, the incidence and proportion of hormone-producing PAs in Korean patients remain unknown. Authors analyzed 506 surgically resected and pathologically proven pituitary lesions of the Seoul National University Hospital from 2006 to 2011. The lesions were categorized as: PAs (n = 422, 83.4%), Rathke''s cleft cysts (RCCs) (n = 54, 10.6%), inflammatory lesions (n = 8, 1.6%), meningiomas (n = 4), craniopharyngiomas (n = 4), granular cell tumors (n = 1), metastatic renal cell carcinomas (n = 2), germinomas (n = 1), ependymomas (n = 1), and unsatisfactory specimens (n = 9, 1.8%). PAs were slightly more prevalent in women (M: F = 1:1.17) with a mean age of 48.8 yr (9-80 yr). Immunohistochemical analysis revealed that prolactin-producing PAs (16.6%) and growth hormone-producing adenomas (9.2%) were the most common functional PAs. Plurihormonal PAs and nonfunctioning (null cell) adenomas were found in 14.9% and 42.4% of patients with PAs, respectively. The recurrence rate of PAs was 11.1%, but nearly 0% for the remaining benign lesions such as RCCs. 25.4% of patients with PAs were treated by gamma-knife after surgery due to residual tumors or regrowth of residual tumor. In conclusion, the pituitary lesions and the proportions of hormone-producing PAs in Korean patients are similar to those of previous reports except nonfunctioning (null cell) PAs, which are unusually frequent.

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