Kieliszak Christopher R, Gill Amarbir, Faiz Mohammed, Joshi Arjun S
Division of Otolaryngology-Head and Neck Surgery, George Washington University, Washington, DC.
medical student at School of Medicine, George Washington University, Washington, DC.
JAMA Otolaryngol Head Neck Surg. 2015 Apr;141(4):373-6. doi: 10.1001/jamaoto.2014.3574.
Submandibular fistula is a rare condition that presents diagnostic and treatment challenges. Accurate diagnosis may be achieved by means of thorough physical examination, proper imaging, and usually surgical exploration. We describe the clinical significance of aberrant submandibular ductal fistula or ostium and discuss our dilemmas during sialendoscopy in 2 patients with repeated submandibular glandular swelling.
Two patients had submandibular ductal abnormalities. The first patient was found to have the ostium of the submandibular duct in an unusual anatomical location at the posterior floor of the mouth, which was identified during surgical exploration of the floor of the mouth. The second patient was found to have a submandibular ductal fistula into the floor of the mouth proximal to a calculus in the main duct (which was severely atrophic and could not be cannulated).
The precise etiology and pathogenesis of sialo-oral fistula formation are currently unknown but could be extrapolated from previously described syndromes involving ductal obstruction and inciting damage in other regions of the body. Consideration of submandibular fistula in the differential diagnosis may spare the patient morbidity of redundant invasive procedures.
下颌下瘘是一种罕见病症，在诊断和治疗方面存在挑战。通过全面的体格检查、合适的影像学检查以及通常的手术探查可实现准确诊断。我们描述了异常下颌下导管瘘或开口的临床意义，并讨论了在2例反复出现下颌下腺肿胀患者进行唾液腺内镜检查时遇到的困境。
两名患者存在下颌下导管异常。首例患者在口底后部一个不寻常的解剖位置发现了下颌下导管开口，这是在对口底进行手术探查时确定的。第二例患者发现下颌下导管在主导管结石近端通向口底形成瘘管（主导管严重萎缩，无法插管）。
唾液腺 - 口腔瘘形成的确切病因和发病机制目前尚不清楚，但可从先前描述的涉及导管阻塞和身体其他部位刺激性损伤的综合征中推断出来。在鉴别诊断中考虑下颌下瘘可避免患者进行多余侵入性操作带来的不良影响。
