Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg, Bavaria, Germany.
Laryngoscope. 2012 Mar;122(3):552-8. doi: 10.1002/lary.22452. Epub 2011 Dec 9.
OBJECTIVES/HYPOTHESIS: The management of stenoses of Wharton's duct has so far been little investigated or systematized. The development of minimally invasive treatment methods, including sialendoscopy, has made preservation of gland function possible.
Retrospective study in a tertiary referral center.
A total of 153 stenoses of the submandibular duct were diagnosed and treated in 138 patients. Ultrasound and sialendoscopy were the first-choice diagnostic measures. A total of 62.7% of the stenoses were located in the distal, 11.1% in the middle segment, and 18.3% in the proximal to posthilar duct. Diffuse stenoses were observed in 7.8% of the cases. Sialendoscopy-assisted intraductal cortisone administration, interventional sialendoscopy, and transoral ductal surgery were the treatment options. The mean period between treatment and data collection was 52.5 months.
Fibrotic stenoses were diagnosed in 88.3% and bilateral involvement in 8.6% of the cases. Distal stenoses were treated predominantly by ductal incision (79.2%). Stenoses of the midsubmandibular duct were treated conservatively in 29.4% or with sialendoscopy or ductal incision in 35.3% of cases each. Proximal up to posthilar stenoses could be dilated by interventional sialendoscopy in 82.2%. In 25% of all diffuse stenoses, glandular resection was carried out, representing 2.6% of all stenoses. Glandular function was preserved in 97.8% of cases.
Stenoses of the submandibular duct can be treated using minimally invasive procedures and with preservation of glandular function with a high success rate. Ductal incision procedures are the most important measure, but sialendoscopy becomes more important the more centrally the stenosis is located.
目的/假设：沃顿氏管狭窄的处理方法至今仍鲜有研究或系统化。微创治疗方法的发展，包括涎腺内镜检查，使保留腺体功能成为可能。
在一家三级转诊中心进行的回顾性研究。
在 138 例患者中诊断并治疗了 153 例下颌下腺导管狭窄。超声和涎腺内镜检查是首选的诊断方法。狭窄部位位于远端的占 62.7%，中段的占 11.1%，后膜后段的占 18.3%。弥漫性狭窄占 7.8%。涎腺内镜辅助下经导管皮质类固醇注射、介入性涎腺内镜检查和经口导管手术是治疗选择。治疗与数据收集之间的平均时间为 52.5 个月。
纤维性狭窄占 88.3%，双侧受累占 8.6%。远端狭窄主要通过导管切开术治疗（79.2%）。中段下颌下腺导管狭窄保守治疗占 29.4%，经涎腺内镜或导管切开术各占 35.3%。近端至后膜后段狭窄可通过介入性涎腺内镜扩张 82.2%。所有弥漫性狭窄中有 25%进行了腺体切除术，占所有狭窄的 2.6%。97.8%的病例保留了腺体功能。
下颌下腺导管狭窄可通过微创程序和保留腺体功能进行治疗，成功率高。导管切开术是最重要的措施，但随着狭窄部位越靠近中央，涎腺内镜检查变得更加重要。
