Department of Otolaryngology Head and Neck Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan.
Int J Oral Maxillofac Surg. 2011 Feb;40(2):169-72. doi: 10.1016/j.ijom.2010.09.020. Epub 2010 Nov 2.
Sialolithiasis frequently causes a variable degree of inflammation of the submandibular gland and stone removal can be a critical issue when incursion is deep, causing neck infection or abscess formation. The authors present their 6-year experience of performing sialolithectomy with CO(2) laser. Nineteen patients with stones in Wharton's duct were treated with CO(2) laser. Topical anaesthesia was applied by maintaining the patient in an upright position after spraying 10% lidocaine onto the oral cavity. The laser was set up in continuous mode at 4-6 W with a focusing spot. Locating the stone was accomplished by manual palpation or lacrimal probe insertion with or without the aid of radiological images. The success rate was 95%; only one procedure was unsuccessful, necessitating stone removal under general anaesthesia. Mean stone size was 0.37 cm. Only one patient developed ranula after laser surgery. The results suggest that transoral CO(2) laser sialolithectomy is simple and safe, with a low incidence of complications, and can be readily managed on an out-patient basis. This technique can be chosen for first-line treatment of sialolithiasis in cases where the stone is above the hilum of Wharton's duct.
涎石病常引起下颌下腺不同程度的炎症，当结石侵入较深时，取出结石是一个关键问题，可能导致颈部感染或脓肿形成。作者介绍了他们使用 CO2 激光进行涎石切除术的 6 年经验。19 例 Wharton 管结石患者接受了 CO2 激光治疗。局部麻醉是通过在口腔喷洒 10%利多卡因后让患者保持直立姿势来实现的。激光设置为连续模式，功率为 4-6 W，使用聚焦光斑。通过手动触诊或泪道探针插入（有或没有放射学图像的帮助）定位结石。成功率为 95%；只有一次手术不成功，需要在全身麻醉下取出结石。平均结石大小为 0.37 厘米。仅有 1 例患者在激光手术后出现舌下囊肿。结果表明，经口 CO2 激光涎石切除术简单、安全，并发症发生率低，可在门诊进行。对于位于 Wharton 管壶腹上方的结石，该技术可作为涎石病的一线治疗方法。
