Karas N D
Department of Oral and Maxillofacial Surgery, University of California, San Francisco, San Francisco, California, USA.
Atlas Oral Maxillofac Surg Clin North Am. 1998 Mar;6(1):99-116.
Successful surgery of the salivary ducts relies on an understanding of the surrounding anatomy and the delicate dissection of tissues in order to reduce morbidity. Trauma to the ducts should be assessed when lacerations or wounds encroach on their paths. Early diagnosis and treatment will reduce the complications of stricture and fistula formation from these injuries. Sialoliths can be located in several places along the length of the salivary ducts. The correct diagnosis and positioning of the stone in the duct is important in establishing the appropriate surgical approach. Imaging using plain films, ultrasonography, and endoscopy can be very valuable, with sialography and CT scans helpful in cases of radiolucent stones, glandular atrophy, or suspected tumor. As the condition becomes more chronic, resulting in glandular atrophy, excision of the diseased gland is often indicated. Treatment of excessive salivary flow in patients with cerebral palsy can be managed by a combination of ductal repositioning and glandular excision. Redirection of both the parotid and submandibular glands can be accomplished, either to reroute excess salivary flow or salvage the duct in cases of lesion excision.
涎腺导管手术的成功依赖于对周围解剖结构的了解以及对组织的精细解剖，以降低发病率。当撕裂伤或伤口侵犯导管路径时，应评估导管的损伤情况。早期诊断和治疗将减少这些损伤导致的狭窄和瘘管形成的并发症。涎石可位于涎腺导管全长的多个部位。在确定合适的手术方法时，正确诊断结石在导管中的位置很重要。使用平片、超声和内镜进行成像非常有价值，唾液腺造影和CT扫描在透X线结石、腺体萎缩或疑似肿瘤的病例中很有帮助。随着病情变得更加慢性，导致腺体萎缩，通常需要切除患病腺体。对于脑瘫患者唾液分泌过多的治疗，可以通过导管重新定位和腺体切除相结合的方法来处理。腮腺和下颌下腺的重新定向都可以实现，要么重新引导过多的唾液流动，要么在病变切除的情况下挽救导管。
