Thomas W Walsh, Douglas Jennifer E, Rassekh Christopher H
1 Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
2 Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Otolaryngol Head Neck Surg. 2017 May;156(5):834-839. doi: 10.1177/0194599817696308. Epub 2017 Mar 14.
Objective To determine the accuracy of the 2 most utilized imaging modalities in obstructive sialadenitis secondary to sialolithiasis-computed tomography (CT) and ultrasonography (US)-using sialendoscopic findings as a comparison standard. To review the impact of CT and US on the management of sialolithiasis managed with sialendoscopy alone and through combined approaches. Study Design Retrospective cohort study. Setting Quaternary academic referral center. Subjects and Methods All cases of patients undergoing sialendoscopy by a single surgeon for suspected parotid and submandibular gland pathology between the October 2013 and April 2016 were reviewed. Results Sixty-eight patients were in this cohort, of whom 44 underwent US, CT, and sialendoscopy; 20 underwent CT and sialendoscopy only; and 4 underwent US and sialendoscopy only. The sensitivity and specificity were 65% and 80% for US and 98% and 88% for CT, respectively. These 68 patients had 84 total stones addressed, with 79 being removed and 5 remaining in situ. The methods of stone removal were sialendoscopy alone (34 stones), open transoral approaches (36 stones), and an external approach: transcervical for submandibular and transfacial for parotid (11 stones). Conclusion US had a lower sensitivity (65%) than what has been reported in the literature (70%-94%), and the majority of missed stones were anterior Wharton's duct stones. These sialoliths were likely missed due to an incomplete examination. US and CT were complementary in this study, and the findings suggest that both modalities can be utilized to optimize the outcome of sialendoscopy and combined approaches.
以唾液腺内镜检查结果作为比较标准，确定在涎石病继发的阻塞性涎腺炎中最常用的两种成像方式——计算机断层扫描（CT）和超声检查（US）的准确性。回顾CT和US对仅通过唾液腺内镜检查以及联合其他方法治疗涎石病的管理的影响。研究设计：回顾性队列研究。研究地点：四级学术转诊中心。研究对象和方法：回顾了2013年10月至2016年4月期间由一名外科医生对疑似腮腺和下颌下腺病变进行唾液腺内镜检查的所有患者病例。结果：该队列中有68例患者，其中44例接受了US、CT和唾液腺内镜检查；20例仅接受了CT和唾液腺内镜检查；4例仅接受了US和唾液腺内镜检查。US的敏感性和特异性分别为65%和80%，CT的敏感性和特异性分别为98%和88%。这68例患者共有84颗结石，其中79颗被取出，5颗留在原位。结石取出方法包括单纯唾液腺内镜检查（34颗结石）、经口开放手术（36颗结石）以及外部手术：下颌下腺经颈手术和腮腺经面手术（11颗结石）。结论：US的敏感性（65%）低于文献报道（70%-94%），大多数漏诊的结石是沃顿管前部结石。这些涎石可能由于检查不完整而漏诊。在本研究中，US和CT具有互补性，研究结果表明这两种方式均可用于优化唾液腺内镜检查及联合治疗方法的效果。
