Foletti Jean Marc, Graillon Nicolas, Avignon Simon, Guyot Laurent, Chossegros Cyrille
Attending Surgeon, Aix-Marseille University, Laboratory of Applied Biomechanics, French Institute of Science and Technology for Transport, Spatial Planning, Development, and Networks (IFSTTAR), Marseille, France; and Department of Maxillofacial Surgery, Public Assistance Hospital of Marseille, University Hospital Center Nord, Marseille, France.
Attending Surgeon, Department of Maxillofacial Surgery, Public Assistance Hospital of Marseille, University Hospital Center Nord, Marseille, France; and Department of Maxillofacial Surgery, Public Assistance Hospital, University Hospital Center Conception, Pôle Plastic, Reconstructive, ORL and Maxillofacial Departement, Marseille, France.
J Oral Maxillofac Surg. 2018 Jan;76(1):112-118. doi: 10.1016/j.joms.2017.06.009. Epub 2017 Jun 14.
To suggest a decision tree for the choice of the best minimally invasive technique to treat submandibular and parotid calculi, according to the diameter of the calculi and their position in the excretory duct.
Submandibular and parotid ducts can both be divided into thirds, delineated by easily recognizable landmarks. The diameter of calculi is schematically classified into 1 of these 3 categories: floating, slightly impacted, or largely impacted.
Using 3 criteria, the type of gland involved (G), the topography (T) of the calculus and its diameter (D), a 3-stage GTD classification of calculi was established. Next, the best indication for each available minimally invasive technique (sialendoscopy, transmucosal approach, a combined approach, intra- or extracorporeal stone fragmentation) was determined for each calculus stage.
The minimally invasive treatment options are numerous and have replaced invasive resection surgical approaches (submandibulectomy and parotidectomy) in the management of salivary calculi, significantly improving the prognosis of these diseases. We emphasize the need for flexibility in the surgical indications and challenge the dogma of "all endoscopic" management of salivary calculi.
根据结石直径及其在排泄管中的位置，提出一种用于选择治疗下颌下腺和腮腺结石的最佳微创技术的决策树。
下颌下腺导管和腮腺导管均可分为三段，由易于识别的标志划定。结石直径大致分为以下3类之一：漂浮型、轻度嵌顿型或重度嵌顿型。
采用3个标准，即受累腺体类型（G）、结石的位置（T）及其直径（D），建立了结石的三阶段GTD分类。接下来，针对每个结石阶段确定了每种可用微创技术（唾液腺内镜检查、经黏膜途径、联合途径、体内或体外碎石）的最佳适应证。
微创治疗选择众多，在唾液腺结石的管理中已取代了侵入性切除手术方法（下颌下腺切除术和腮腺切除术），显著改善了这些疾病的预后。我们强调手术适应证需要灵活性，并对唾液腺结石“全内镜”管理的教条提出质疑。
