Sakakibara Akiko, Minamikawa Tsutomu, Hashikawa Kazunobu, Sakakibara Shunsuke, Hasegawa Takumi, Akashi Masaya, Furudoi Shungo, Komori Takahide
Intern Doctor, Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Lecturer, Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
J Oral Maxillofac Surg. 2015 May;73(5):1003-7. doi: 10.1016/j.joms.2014.12.006. Epub 2014 Dec 13.
Tissue that is resected for the treatment of oral tumors often includes salivary gland ducts. At their institution, the authors conserve and transfer as much of the salivary duct as possible during these procedures to avoid obstructive complications. Differentiating these obstructive complications from a metastatic node can be challenging and can confound subsequent oncologic management. This study compared and examined the effectiveness of salivary duct repositioning in decreasing the incidence of obstructive complications.
Cases of oromandibular disease treated with salivary duct resection at Kobe University Graduate School of Medicine from 2008 to 2013 were retrospectively analyzed. Thirty-two cases (25 patients) of Wharton duct resection and 31 cases (31 patients) of Stensen duct resection were included. The incidence of complications after salivary duct repositioning, duct ligation, and retention of the sublingual gland around the Wharton duct was compared.
Wharton ducts were repositioned in 30 cases and ligated in 2 cases. Complications, including oral swelling at the Wharton duct, were observed in 5 cases of repositioning and 2 cases of ligation. Stensen ducts were repositioned in 9 cases and ligated in 22 cases. The only complication reported was a single case of salivary fistula after ligation.
Salivary duct repositioning is performed to prevent blockage of physiologic salivary discharge. Complications were more frequently associated with Wharton ducts than with Stensen ducts because of the unique physiologic and anatomic characteristics of the Wharton duct. Repositioning of the salivary duct is a suitable method for preventing complications associated with the Wharton duct.
因治疗口腔肿瘤而切除的组织通常包括涎腺导管。在作者所在机构，在这些手术过程中尽可能保留并转移涎腺导管以避免阻塞性并发症。将这些阻塞性并发症与转移淋巴结区分开来可能具有挑战性，并且可能混淆后续的肿瘤治疗管理。本研究比较并检验了涎腺导管重新定位在降低阻塞性并发症发生率方面的有效性。
回顾性分析2008年至2013年在神户大学医学研究生院接受涎腺导管切除治疗的口下颌疾病病例。纳入32例（25例患者）沃顿管切除病例和31例（31例患者）腮腺管切除病例。比较涎腺导管重新定位、导管结扎以及沃顿管周围舌下腺保留术后的并发症发生率。
30例沃顿管进行了重新定位，2例进行了结扎。重新定位的5例和结扎的2例出现了包括沃顿管处口腔肿胀在内的并发症。9例腮腺管进行了重新定位，22例进行了结扎。报告的唯一并发症是结扎后1例涎瘘。
进行涎腺导管重新定位是为了防止生理性涎液排出受阻。由于沃顿管独特的生理和解剖特征，并发症在沃顿管比在腮腺管更常见。涎腺导管重新定位是预防与沃顿管相关并发症的合适方法。
