涎腺内镜辅助颌下腺腺门结石取出术疗效分析

目的 分析涎腺内镜辅助颌下腺导管腺门段结石取出术的疗效.方法 2005年12月至2011年3月在北京大学口腔医学院·口腔医院经影像检查发现的颌下腺腺门结石患者80例,采用涎腺内镜探查颌下腺导管,观察结石及导管炎症情况,并在内镜辅助下取石.术后随访3～6个月,分析内镜辅助下取石的效果及术后并发症.结果 80例颌下腺腺门结石患者中,71例结石被完全取出,5例结石大部分取出,4例结石未取出,取石成功率为95％ (76/80).76例结石成功取出者中 8例由网篮套索取出;59例采用了涎腺内镜辅助下口内切开取石术;9例经网篮套索及口内切开法取出结石.术后并发症主要为暂时性舌神经麻痹(1例)及舌下腺囊肿(2例).结论 涎腺内镜技术对于颌下腺腺门结石是一种安全有效的诊疗手段,可减少并发症的发生,并可避免结石残留.     

口内取石后内镜导管探查治疗下颌下腺导管后部结石

目的:探讨下颌下腺导管后部结石的治疗方法。方法:对40例下颌下腺导管后部结石口底黏膜切口,导管切开取石,应用涎腺内镜探查导管,使其通畅,随访术后腺体恢复和导管分泌情况。结果:36例局麻下取石,4例因肥胖手术视野较差和局麻下手术患者配合困难而采用全身麻醉,40例患者均成功取石。随访35例术后6月～1年没有再出现进食后下颌下肿胀,下颌下腺质地逐渐变软,舌下肉阜处导管口有清亮液分泌28例。结论:口内取石简便了取石方法,联合内镜导管探查有助于下颌下腺导管通畅,有利于取石后恢复和保存腺体功能。     

下颌下腺导管内结石位置分布及形态研究：附65例临床分析

目的：分析下颌下腺导管内结石的位置和形态,研究结石的分布规律。方法：对连续就诊的65例下颌下腺导管结石患者通过口底双合诊和下颌横断片判断结石的位置,手术取石,其中57例经口内直接切开导管取石或内镜辅助下取石,8例行下颌下腺切除术后取石,观察、测量术后所取结石的形状和大小。结果：下颌下腺导管结石在导管中发生的位置由前向后依次升高,62.5%患者结石位于导管的后段,结石以圆形和椭圆形为多,位于后段者体积多较大。结论：下颌下腺导管结石好发于导管后段,原因可能与导管后段的某些特殊解剖形态有关。     

内镜在慢性阻塞性涎腺炎诊断中的初步研究

目的　应用内镜技术了解涎腺的内在表现和慢性阻塞性涎腺炎的病因。方法　根据唾液腺解剖特点 ,设计唾液腺内镜 ,应用其对 1 9例慢性阻塞性涎腺炎进行诊断 ,了解导管壁和导管内变化 ,明确发病原因。结果　内镜下可见颌下腺导管阻塞原因以结石多见 ,占 9/ 1 2 ;而腮腺导管内以内壁增生为主 ,占 5/ 7;少数患者可见分支导管部分阻塞。结论　内镜能直接了解涎腺的内在表现 ,明确慢性阻塞性涎腺炎的发病原因 ,可同时进行治疗 ,具有较广阔应用范围及前景     

内镜辅助面部小切口腮腺导管结石取出术的临床应用

目的 探讨唾液腺内窥镜辅助下经面部小切口手术取腮腺导管深部结石的治疗方法.方法 2014~2015年期间共诊治6例腮腺导管结石患者,结石均位于咬肌前缘后方的腮腺导管.手术过程为全麻下手术,先用涎腺内窥镜探及腮腺导管结石,以内窥镜灯光作为引导在面部相应位置行皮肤小切口,分离显露结石部位的腮腺导管,同时保护面神经;切开导管取出结石,重建导管.结果 所有患者腮腺导管术后均恢复畅通,复诊半年无腮腺导管阻塞症状出现.结论 唾液腺内窥镜辅助经面部小切口取石术为治疗腮腺导管深部结石提供了较好的治疗方案.     

涎腺内窥镜:诊断和治疗涎石病的新技术

涎石病在涎腺疾病中十分常见,大多数结石发生于颌下腺(80％～90％),发生于腮腺者较少见(5％～20％),其原因主要与上皮细胞周围钙化、细菌或异物有关。涎石病的诊断主要靠临床和X线检查,wharton导管内的结石,94.7％可经口内X线片发现。但Stensen导管内的结石,由于大多数可透过射线,X线检查难以发现。颌下腺导管结石的治疗方法取决于结石的部位,腺体外的导管结石均可从口内取出,而腺体内的结石,首选治疗为颌下腺摘除术。Stensen导管内     

精囊内镜用于诊断和治疗11例阻塞性唾液腺疾病的效果评价

目的: 探讨精囊内镜用于阻塞性唾液腺疾病诊断和治疗的可行性及疗效。方法: 选取2018年10月—2019年7月青岛大学附属青岛市市立医院口腔颌面外科收治的11例阻塞性唾液腺疾病患者,其中腮腺3例,下颌下腺8例。术前通过CT检查判断有无结石及其数目、位置和大小。全麻下应用精囊内镜在直视下观察导管壁及导管内的变化,明确发病原因,并进行相应治疗和评价疗效。结果: 术前CT检查3例腮腺和1例下颌下腺未见明显结石影像;7例下颌下腺可见导管内单发或多发性高密度结石影。10例患者成功应用精囊内镜取出结石,或利用导管扩张、灌洗,去除黏液栓子后,阻塞症状消失;1例因导管口狭窄明显,附加口底小切口,引入腔镜进行取石。术后6~12个月随访均无阻塞症状复发。结论: 精囊内镜可用于阻塞性唾液腺疾病的诊断和治疗,可部分替代涎腺镜的功能,属于一种创新性微创治疗方案。     

涎腺疾病

非肥胖型糖尿病小鼠自发性涎腺炎的发生与发展;家兔失神经支配腮腺导管改道术后唾液成分的分析;涎腺导管癌9例报道及文献复习;颌下腺导管内涎石取出术的疗效分析;副腮腺涎石病;     

涎腺内镜在颌下腺导管及导管内病变中的临床应用

目的:评价涎腺内镜在颌下腺导管及导管内病变中的临床应用.方法:选择自2006年9月至2007年2月因颌下区反复肿胀而在我科就诊的21例患者,行涎腺内镜诊治,其中男12例,女9例,年龄12～42岁,左侧14例,右侧7例.16例行颌下腺造影检查,5例行下颌横断咬合片检查.结果:X线片显示颌下腺导管阳性结石5例,其他原因致颌下腺导管阻塞16例.涎腺内镜检查显示:1)颌下腺导管病变:导管狭窄3例,扭曲2例,导管息肉2例,憩室2例.2)颌下腺导管内病变:阳性结石5例,阴性结石7例,粘液栓及脓栓在所有病例中均有不同程度的表现.涎腺内镜术后,阻塞症状基本消失,无明显并发症发生.结论:涎腺内镜是一种有前途的新技术,在颌下腺导管及导管内病变的诊断和治疗中是一种安全、有效、微创的方法.     

内镜用于唾液腺疾病的微创诊断和治疗

Endoscopy:aminimallyinvasiveprocedurefordiagnosisandtreatmentofdiseasesofthesalivaryglandsSixyearsofpracticalexperience.ZieglerCM,StevelingH,SeubertM,etal.BrJOralMaxillofacSurg,2004,42(1):1-7.微创技术目前在外科领域广为应用,涎腺内镜是其中之一,为唾液腺疾病的诊治提供了有价值的手段。本文对72例唾液腺进行了内镜检查,并发症轻微。主要用于下颌下腺及腮腺的涎石病诊治,尤其利于阴性结石的诊断和取出,从而保留了腺体功能,免除了手术治疗。内镜用于唾液腺疾病的微创诊断和治疗…     

Sialolith crystals localized intraglandularly and in the Wharton's duct of the human submandibular gland: an X-ray diffraction analysis

The exact cause of the formation of sialoliths is unknown. Detailed knowledge of pathogenesis of sialolithiasis and composition of sialoliths is necessary to define new therapeutic procedures. The crystalline components of 23 sialoliths of human submandibular gland were investigated by X-ray powder diffraction analysis. All of the sialoliths localized in the ducts in the submandibular gland consisted of hydroxylapatite. However, in the sialoliths in the Wharton's duct, hydroxylapatite as well as whitlockite and brushite could be found in all except one case. Whitlockite was observed more often in the nucleus of the sialoliths and it was a common co-phase along with hydroxylapatite. The nucleus in one sialolith consisted of brushite and the cortex showed a co-phase of hydroxylapatite and brushite. The occurrence of whitlockite in the sialoliths in Wharton's duct may be due to a higher concentration of calcium and phosphate in saliva in this duct.     

Combined approach to impacted parotid stones

PURPOSE: This article describes the use of combined endoscopic and ultrasound approach to locate and to extract impacted parotid stones, which cannot be retrieved by intraoral approach alone. PATIENTS AND METHODS: A total of 12 parotid glands from 7 women and 5 men (age range, 35 to 62 years) with parotid sialoliths were treated with the combined method. Eleven of 12 of the procedures were performed under local anesthesia in an outpatient clinic. The identification of the calculi was done in 5 patients with 1.3-mm sialoendoscope (Nahlieli Sialoendoscope; Karl Storz, Tuttlingen, Germany) in 6 patients with the aid of high-resolution ultrasound, and in 1 patient the location was combined endoscopy and ultrasound. The removal of the calculi was performed extraorally via minimal incision. The indications for the combined approach were 1) calculus in the posterior third of the Stensen's duct with too narrow duct anterior to it, 2) obstruction of the posterior or middle third of the Stensen's ducts leading to the calculus, 3) large (>5-mm) stones in the middle or posterior part of the duct that cannot be dilated for intraductal removal, and 4) intraparenchymal stones. RESULTS: Of the 12 patients, 9 had complete removal (75%); in 1 case with 3 sialoliths, we removed 2 and the gland remained asymptomatic. In 7 cases, the glands returned to function, 3 glands became atrophic with no function, but the gland remained asymptomatic. The aesthetic results were satisfactory in all cases, no major complications were noted. CONCLUSIONS: Combined endoscopic ultrasound approach is another minimal invasive technique for identification and removal of impacted parotid sialolithiasis.     

Is there evidence of a sphincter system in Wharton's duct? Etiological factors related to sialolith formation

The exact cause of the formation of sialoliths is unknown. Detailed knowledge of the pathogenesis of sialolithiasis is necessary to define new therapeutic procedures. The possible presence of a sphincter system in Wharton's duct has been described frequently in the context of diagnostic sialendoscopy. Serial histological examination of the entire Wharton's duct in four samples revealed no anatomical correlation for the presence of a sphincter. Secretory disturbances and viscous secretions as well as microlith formation and ductal obstruction cannot fully explain the genesis of sialoliths. The coaction of those factors with participation of bacteria leads to the development of sialoliths.     

Comparison of sialolithiasis in pediatric and adult patients

Aims

To compare the clinical characteristics of sialolithiasis between pediatric and adult patients.

Endoscopic mechanical retrieval of sialoliths

OBJECTIVE: We sought to assess the efficacy of sialoendoscopic mechanical retrieval techniques for the treatment of obstructive salivary gland disease. This study documents the authors' long-term experience with mechanical retrieval techniques, the long-term results of the procedures, the technical issues, the techniques that have been used, and the advantages and limitations of these modalities. STUDY DESIGN: Mechanical endoscopic techniques were used in a large referral center from 1993 to 2001 to treat 217 salivary glands for salivary gland sialolithiasis. RESULTS: We found that 189 of the 217 glands with salivary gland sialolithiasis became completely symptom- and stone-free, both endoscopically and by radiographs (overall success rate, 87%). In the submandibular gland group specifically, the success rate was higher, 89%. In the parotid group, it was 83%. Follow-up was continued for 40 months after treatment. No severe complications were noted. The endoscope used was the third-generation Sialoendoscope. CONCLUSION: The endoscopic mechanical retrieval of sialoliths is both safe and efficacious. This is an excellent method for the complete and certain removal of sialoliths, with minimal damage to the surrounding tissue.     

A Large Sialolith Perforating the Wharton’s Duct: Review of Literature and a Case Report

Sialolithiasis accounts for the most common cause of diseases of salivary glands. The majority of sialoliths occur in the submandibular gland or the Wharton’s duct. This article discusses review of literature, predisposing factors, signs and symptoms, diagnostic methods and various modalities available for the management of sialolithiasis. This case report presents a case of sialolith of a large size in the left Wharton’s duct, which was explored and removed via an intra-oral approach.     

Parotid sialolithiasis in Stensen's duct

Salivary duct lithiasis is a condition characterized by the obstruction of a salivary gland or its excretory duct due to the formation of calcareous concretions or sialoliths resulting in salivary ectasia and even provoking the subsequent dilation of the salivary gland. Sialolithiasis accounts for 30% of salivary diseases and most commonly involves the submaxillary gland (83 to 94%) and less frequently the parotid (4 to 10%) and sublingual glands (1 to 7%). The present study reports the case of a 45-year-old male patient complaining of bad breath and foul-tasting mouth at meal times and presenting with a salivary calculus in left Stensen's duct. Once the patient was diagnosed, the sialolith was surgically removed using local anesthesia. In this paper we have also updated a series of concepts related to the etiology, diagnosis and treatment of sialolithiasis.     

Case of sialolithiasis with severe fatty change of the submandibular salivary gland

We encountered a 57-year-old female with sialolithiasis associated with severe fatty change in the submandibular salivary gland. The submandibular salivary gland was removed under general anesthesia, and the postoperative course was uneventful. Histopathological changes observed in submandibular salivary glands with sialoliths are mainly inflammatory cell infiltration or connective tissue infiltration. On the other hand, increase in fat cells with age has been reported, but these age-related fatty changes are not severe. It was considered that the cause of the fatty change in this case was related to anoxia, which increased with long-term stasis of the duct system that was brought on by the development of the sialolith.     

涎腺内镜诊治慢性阻塞性下颌下腺炎14例报道

目的：评价涎腺镜在诊断和治疗慢性阻塞性下颌下腺炎中的价值。方法：对14例临床诊断为慢性阻塞性下颌下腺炎的患者进行涎腺镜检查．了解导管壁和导管内的表现，并同时通过涎腺镜进行相应的治疗，包括液电碎石术、钳取术和套石篮取石术、导管清扫扩张术．将结石或黏液栓子取出。结果：14例患者涎腺镜诊断的阻塞原因分别是：阳性结石10例、阴性结石1例，黏液栓子1例，管壁严重增生2例(其中1例结石嵌入)。11例患者成功应用治疗性涎腺镜取出结石或去除黏液栓子，导管扩张灌洗后阻塞症状消失；3例治疗失败，原因主要为导管增生、结石嵌入。术后无明显并发症发生。结论：涎腺镜能直观地了解涎腺导管内的病变表现，明确导管阻塞原因，并可同时进行相应的治疗，为慢性阻塞性下颌下腺炎的诊断和治疗提供了新的有效方法。     

Salivary glands: applied anatomy and clinical correlates.

The major salivary glands include the paired parotid, submandibular and sublingual glands. Salivary glands act as accessory digestive glands and produce a secretion referred to as saliva. Saliva has lubricating, cleansing, digestive and antimicrobial properties. The parotid is the largest salivary gland and saliva is secreted into the mouth via the parotid duct (Stensen's duct). The submandibular gland lies inferior to the body of the mandible and is susceptible to sialolithiases. Drainage is via the duct of the submandibular gland (Wharton's duct) into the floor of the mouth on either side of the lingual frenulum. The sublingual glands are situated under the mucosa in the floor of the mouth, on the sides of the tongue. These glands are in relationship to important nerves in the surrounding tissue. Disease processes such as chronic intraparenchymal sialolithiasis and neoplastic changes frequently mandate surgical removal of the underlying salivary gland. Detailed, applied knowledge of anatomy on a regional basis is required to avoid inadvertent nerve damage during surgery and resulting litigation.