Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, MI, Italy; Otorhinolaryngology - Head and Neck Department, Humanitas Clinical and Research Center, IRCCS, Via Alessandro Manzoni 56, Rozzano, 20089, Milan, Italy.
Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele, MI, Italy; Otorhinolaryngology - Head and Neck Department, Humanitas Clinical and Research Center, IRCCS, Via Alessandro Manzoni 56, Rozzano, 20089, Milan, Italy.
Am J Otolaryngol. 2021 Mar-Apr;42(2):102821. doi: 10.1016/j.amjoto.2020.102821. Epub 2020 Oct 31.
The aim of this study was to describe the potential advantages of the transoral 3D 4K exoscope-assisted removal of calculus of the Wharton's duct.
A 24-year-old female with swelling in the left oral pelvis was diagnosed of sialolithiasis of distal Wharton's duct. A CT scan confirmed the lithiasic formation and a transoral removal in local anesthesia was planned through the 3D 4K exoscope (VITOM 3D, Karl Storz).
A high-quality magnification of the oral pelvis was obtained, with an easy identification of the entrance of the left submandibular gland's duct and the calculus. After blunt dissection the Wharton's duct was incised and the calculus removed. An angiocatheter (20G) was carefully inserted in the duct and removed after 3 days. No postoperative complications occurred. At 7 days post-operative follow-up the patient had developed a neo-ostium 5 mm from the papilla. The exoscope provided a better involvement in the surgery and more interactions of all operating room personnel, residents and students, that had access to the same field of view of the first surgeon with the perception of the depth of the surgical field with 3D technology.
The exoscope could represent a valid option for transoral removal of calculi, allowing for precise surgical dissection of the oral floor, thus reducing the risks for iatrogenic lesion of the lingual nerve. It showed also a high potential for training and educational purposes.
本研究旨在描述经口 3D 4K 内窥镜辅助下清除沃顿管涎石的潜在优势。
一名 24 岁女性因左口腔骨盆肿胀被诊断为远端沃顿管涎石症。CT 扫描证实了结石的形成，并计划在局部麻醉下通过 3D 4K 内窥镜（VITOM 3D，Karl Storz）进行经口切除。
获得了高质量的口腔骨盆放大图像，很容易识别下颌下腺导管的入口和结石。经钝性解剖切开沃顿管并取出结石。小心地将血管套管（20G）插入导管中，3 天后取出。无术后并发症发生。术后 7 天随访时，患者在乳头 5mm 处形成了一个新的口。内窥镜提供了更好的手术参与度和更多手术室人员、住院医生和学生的互动，他们可以通过 3D 技术获得与主刀医生相同的手术视野，并感知手术区域的深度。
内窥镜可作为经口切除结石的有效选择，允许对口腔底部进行精确的手术解剖，从而降低舌神经医源性损伤的风险。它在培训和教育方面也具有很高的潜力。
