Chen Chuan-jun, Guo Ping, Chen Xiao-yang
Professor, Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wanan Medical College, Wuhu, Anhui, China.
Assistant Professor, Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wanan Medical College, Anhui, Wuhu, China.
J Oral Maxillofac Surg. 2015 Apr;73(4):675.e1-7. doi: 10.1016/j.joms.2014.10.012. Epub 2014 Oct 22.
Some believe that the recurrence of sublingual ranula results from incomplete removal of the sublingual gland (SLG), but recurrence remains in some patients who undergo repeated excision of the remnant SLG, and the final solution to the recurrence is to remove the ipsilateral submandibular gland (SMG). In the authors' experience, preoperative aspirate from a sublingual ranula was a thick mucus-like fluid resembling egg white, whereas that from recurrent cyst after removal of the SLG was thin serous fluid. Based on the difference of the aspirated fluids, the authors speculated that the recurrent cystic mass might not be a ranula, but rather iatrogenic saliva leakage from the SMG through the previous surgically damaged excretory duct of the SLG (Bartholin duct) that opens into the SMG duct (Wharton duct).
A gross anatomic study was performed of the ductal system of the SLG and the anatomic communication between the Bartholin duct and Wharton duct.
Four anatomic SLG duct variants were found. 1) The SLG has 1 Bartholin duct that seems to fuse with the Wharton duct but does not join the Wharton duct, running parallel to the Wharton duct and opening at its own orifice adjacent to and a short distance from the orifice of the Wharton duct (35.8%). 2) The SLG has 1 Bartholin duct that empties into the middle section of the Wharton duct (32.1%). 3) The SLG has 2 Bartholin ducts, one of which joins the Wharton duct and the other opens at its own orifice near that of the Wharton duct on the floor of the mouth (7.1%). 4) The SLG has many fine ducts (Rivinus ducts) that open at the floor of the mouth with no relation to the Wharton duct (25.0%). Of the 4 anatomic SLG duct variations, types 2 and 3 form immediate anatomic communication between the Bartholin duct and Wharton duct (39.2%).
Several conclusions can be made from the present anatomic findings. 1) A certain proportion of Bartholin ducts open into the Wharton duct, and "recurrent ranula" after removal of the SLG can result from iatrogenic saliva leakage from the SMG through the surgically severed Bartholin duct if the aspirated fluid from the "recurrent cyst" is a thin seriflux. 2) The Bartholin duct emptying into the Wharton duct should be ligated during removal of the SLG to prevent local saliva accumulation from the SMG or even caudal "recurrence" as plunging ranula. 3) The surgical incision for SLG removal should be sutured loosely so that the surgically severed Bartholin duct with communication to the Wharton duct can reopen at the floor of mouth as an outlet for possible saliva leakage from the SMG and saliva accumulation can be avoided.
一些人认为舌下腺囊肿复发是由于舌下腺（SLG）切除不完全，但在一些接受残余SLG反复切除的患者中仍会复发，而解决复发问题的最终方法是切除同侧下颌下腺（SMG）。根据作者的经验，舌下腺囊肿术前抽吸物是一种浓稠的黏液样液体，类似蛋清，而SLG切除后复发囊肿的抽吸物是稀薄的浆液性液体。基于抽吸液的差异，作者推测复发性囊性肿物可能不是舌下腺囊肿，而是医源性唾液通过先前手术损伤的SLG排泄管（巴托林导管）从SMG漏出，该排泄管开口于SMG导管（沃顿导管）。
对SLG的导管系统以及巴托林导管与沃顿导管之间的解剖学连通情况进行大体解剖学研究。
发现了4种SLG导管的解剖变异类型。1）SLG有1条巴托林导管，似乎与沃顿导管融合但未汇入沃顿导管，与沃顿导管平行走行，并在其自身开口处开口，该开口与沃顿导管开口相邻且相距不远（35.8%）。2）SLG有1条巴托林导管，汇入沃顿导管的中段（32.1%）。3）SLG有2条巴托林导管，其中1条汇入沃顿导管，另1条在口腔底部靠近沃顿导管开口处的自身开口处开口（7.1%）。4）SLG有许多细小导管（里维努斯导管），在口腔底部开口，与沃顿导管无关（25.0%）。在这4种SLG导管解剖变异类型中，第2型和第3型在巴托林导管与沃顿导管之间形成直接的解剖连通（39.2%）。
从目前的解剖学发现可以得出几个结论。1）一定比例的巴托林导管开口于沃顿导管，如果“复发性囊肿”的抽吸液是稀薄的浆液性液体，那么SLG切除后出现的“复发性舌下腺囊肿”可能是医源性唾液通过手术切断的巴托林导管从SMG漏出所致。2）在切除SLG时应结扎汇入沃顿导管的巴托林导管，以防止SMG的局部唾液积聚甚至像坠入性舌下腺囊肿那样出现尾部“复发”。3）切除SLG的手术切口应宽松缝合，以便与沃顿导管相通的手术切断的巴托林导管能在口腔底部重新开放，作为SMG可能漏出唾液的出口，从而避免唾液积聚。
