经口下颌下腺切开术加导管袋形缝合术：治疗下颌下腺近端涎石病的一种合适方法；一项长期随访研究
Transoral submandibulotomy plus duct marsupialization; an appropriate approach for the treatment of proximal submandibular sialolithiasis; a long-term follow-up study.
作者信息
Salehpour Sepehr, Berjis Nezamoddin
机构信息
Department of Otolaryngology, Isfahan University of Medical Sciences Isfahan, Iran.
出版信息
Int J Physiol Pathophysiol Pharmacol. 2022 Dec 15;14(6):303-310. eCollection 2022.
BACKGROUND
Sialolithiasis is the most common salivary gland-related disease worldwide, leading to sialadenitis. Although there is no serious problem with surgical removal of stones at the middle and distal parts of the Wharton's duct, the approach for treating proximal stones located near to hilum and its adjacent parenchyma is a challenge. The current study has aimed to evaluate the outcome of transoral submandibulotomy for submandibular gland stone treatment.
METHODS
This study was conducted on 63 patients with proximal (or deep hilar) submandibular sialolithiasis treated with transoral submandibulotomy and duct marsupialization from January 2011 to April 2019 in Pars hospital. Complications of the old fashion surgery (transcervical submandibulectomy) were assessed in this method (number and size of the stone(s), relapse of sialolithiasis-related obstructive symptoms, partial or complete removal of the stone(s), sialolithiasis recurrence, postoperative surgical or nonsurgical intervention, foreign body sensation, and taste sensation quality).
RESULTS
The stone(s) was located at the proximal of the duct in 68% of the cases, while 32% of the stones were located at the deep hilar region. The mean size of the stones was 1.28±0.51 cm. Postoperative inflammation, postoperative pain, sialolithiasis recurrence, obstructive symptoms, postoperative nonsurgical intervention, postoperative surgical intervention, reduced taste sensation, and foreign body sensation were presented in 24%, 29%, 29%, 44%, 14%, 6%, 11%, and 10% respectively. Eighty-nine percent of recurrences were healed spontaneously.
CONCLUSION
Considering the cosmetic advantage due to the lack of cervical surgery scar (which is mandatory in old fashion transcervical method), long-term follow-up of transoral submandibulotomy showed successful outcomes regarding neurological impairment, postoperative pain and inflammation and incredibly complete stone removal that was found in all of the patients. In addition, submandibular duct marsupialization is recommended based on our study.
背景
涎石病是全球最常见的涎腺相关疾病，可导致涎腺炎。虽然沃顿管中、远端结石的手术摘除没有严重问题，但治疗位于腺门及其邻近实质附近的近端结石的方法具有挑战性。本研究旨在评估经口下颌下切开术治疗下颌下腺结石的效果。
方法
本研究对2011年1月至2019年4月在帕尔斯医院接受经口下颌下切开术和导管袋形缝合术治疗的63例近端（或深部腺门）下颌下涎石病患者进行。采用这种方法评估传统手术（经颈下颌下腺切除术）的并发症（结石的数量和大小、涎石病相关梗阻症状的复发、结石的部分或完全清除、涎石病复发、术后手术或非手术干预、异物感和味觉质量）。
结果
68%的病例结石位于导管近端，32%的结石位于深部腺门区域。结石的平均大小为1.28±0.51厘米。术后炎症、术后疼痛、涎石病复发、梗阻症状、术后非手术干预、术后手术干预、味觉减退和异物感的发生率分别为24%、29%、29%、44%、14%、6%、11%和10%。89%的复发患者可自愈。
结论
考虑到经口下颌下切开术没有颈部手术瘢痕（这在传统经颈手术中是必需的）带来的美容优势，长期随访显示该手术在神经损伤、术后疼痛和炎症方面取得了成功的结果，并且所有患者的结石均完全清除。此外，根据我们的研究，建议行下颌下导管袋形缝合术。
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