Shimada Taketoshi, Okano Hiroyuki, Hisa Yasuo
Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Acta Otolaryngol. 2006 Oct;126(10):1112-4. doi: 10.1080/00016480600621680.
A 50-year-old woman presented with a 10-year history of swelling of the left cheek during and after meals. She regularly pushed the cheek hard to decrease the swelling by excreting the saliva. She did not have pain or fever. She also complained of bronchial asthma and allergic rhinitis. Magnetic resonance imaging (MRI) revealed bead-like dilatation (3x4 cm) of the left parotid duct with hypointensity on T1-weighted MRI and hyperintensity on T2-weighted MRI. Technetium 99m-pertechnetate (Tc-99m) scintigraphy demonstrated hypofunction of the left parotid gland and retention of radioactive substrate in the left parotid duct even after acid loading. Since bougienage was impossible, we decided to perform a drainage operation. We exposed, fenestrated and sutured the duct wall to the buccal mucosa to make a large orifice. We inserted a Penrose drain for 1 month to avoid stenosis of the orifice. No complication was observed postoperatively, and drainage was still adequate at the most recent examination 3 years after the operation. Smears of saliva from the parotid duct with Hansel staining revealed numerous eosinophils, and fibrinous sialodochitis was diagnosed.
一名50岁女性，有10年病史，表现为进餐期间及餐后左侧脸颊肿胀。她经常用力挤压脸颊以排出唾液来减轻肿胀。她没有疼痛或发热症状。她还患有支气管哮喘和过敏性鼻炎。磁共振成像（MRI）显示左侧腮腺导管呈串珠样扩张（3×4厘米），在T1加权MRI上呈低信号，在T2加权MRI上呈高信号。锝99m-高锝酸盐（Tc-99m）闪烁显像显示左侧腮腺功能减退，即使在酸负荷后放射性底物仍滞留在左侧腮腺导管内。由于无法进行探条扩张，我们决定进行引流手术。我们暴露导管、开窗并将导管壁缝合至颊黏膜以形成一个大的开口。我们插入一根橡皮引流管1个月以避免开口狭窄。术后未观察到并发症，在术后3年的最近一次检查中引流仍然充分。用汉塞尔染色法对腮腺导管唾液涂片显示有大量嗜酸性粒细胞，诊断为纤维蛋白性涎管炎。
