Combes J, Karavidas K, McGurk M
Salivary Gland Service, Department of Oral and Maxillofacial Surgery, Guy's Hospital, London, UK.
Int J Oral Maxillofac Surg. 2009 Aug;38(8):813-6. doi: 10.1016/j.ijom.2009.02.026. Epub 2009 Apr 26.
Submandibular salivary stones account for most symptomatic sialoliths and most are treated by adenectomy. Transoral removal of proximal or hilar stones is an alternative approach that preserves the functioning gland. Between 1999 and 2006, 186 consecutive patients had transoral removal of 186 stones in the proximal third or hilum of the submandibular gland. Both patient and treatment details were recorded prospectively and outcome assessed by a structured questionnaire. Stone removal was achieved in 99% (185/186) of cases treated. Morbidity was low and there were no intra-operative complications. At median follow up of 28 months (range 4-62 months) 4% (7/186) had subsequently undergone sialadenectomy for persisting symptoms. 105/186 responded to a questionnaire, 76% (80/105) were symptom-free and in a further 17% (18/105) symptoms were mild. No patient had lingual nerve anaesthesia but 6% (6/105) reported a mild tingling. 93% (97/105) were pleased to have had the operation. Submandibular stones can be reliably retrieved from the proximal portion of the duct or hilum with minimal morbidity. Evolving review data suggests that the incidence of recurrent disease is low at 2 years, suggesting that this technique may be a viable alternative to adenectomy.
下颌下涎石占大多数有症状的涎石，大多数通过腺切除术治疗。经口切除近端或腺门部结石是一种保留功能腺体的替代方法。在1999年至2006年期间，186例连续患者经口切除了下颌下腺近端三分之一或腺门部的186颗结石。前瞻性记录患者和治疗细节，并通过结构化问卷评估结果。99%（185/186）的治疗病例结石被成功取出。发病率低，术中无并发症。中位随访28个月（范围4 - 62个月），4%（7/186）的患者随后因症状持续而接受了涎腺切除术。186例中有105例回复了问卷，76%（80/105）无症状，另有17%（18/105）症状轻微。没有患者出现舌神经麻醉，但6%（6/105）报告有轻微刺痛感。93%（97/105）的患者对接受该手术感到满意。下颌下结石可从导管近端或腺门部可靠取出，发病率极低。不断更新的综述数据表明，2年时疾病复发率较低，提示该技术可能是腺切除术的一种可行替代方法。
