Endoscope-assisted submandibular sialoadenectomy: a pilot study.

PURPOSE: To describe an endoscopic technique for submandibular sialoadenectomy in humans, as well as the equipment, instrumentation, and pertinent anatomy. MATERIALS AND METHODS: Six submandibular sialoadenectomies were carried out in 5 patients (3 women, 2 men; mean age, 26.6 years; range, 16 to 42 years) via a 15 to 20 mm neck incision for insertion of the endoscopic camera and surgical instruments. RESULTS: All operations were successful without conversion to an open surgery. Operative time was 20 to 120 minutes (mean, 65 minutes). All patients were discharged the day after surgery. There were no postoperative complications (hematoma, nerve injury, infection). All patients experienced a mild degree of edema, which had resolved totally at the 6-month follow-up visit. All patients were satisfied with the outcome and especially the cosmetic result. CONCLUSIONS: Absence of extensive scars, nontraumatic dissection, and magnification of anatomic structures are the most obvious advantages of this innovative technique.     

Minimally invasive video-assisted submandibular sialoadenectomy: a preliminary report

Open-field sialoadenectomy is the first-choice treatment for submandibular disease. Conventional surgery is based on the transcervical approach. The present study aims to demonstrate the feasibility of a minimally invasive video-assisted sialoadenectomy and to describe a new technique to perform it. A 52-year-old man affected by chronic sialoadenitis underwent minimally invasive video-assisted sialoadenectomy under general anesthesia. The ultrasound scanning of the submandibular gland showed a 6.5-cm hypertrophic gland with dilatated intraglandular ducts and a 2-cm long intraglandular sialolith. After surgery, no static or dynamic nerve deficiencies were detected, but slight temporary deficiency of the marginalis mandibulae nerve recovered in 15 days. Cosmetic results satisfied the patient. Minimally invasive video-assisted submandibular sialoadenectomy can be a feasible and safe procedure, which could be a valid choice to conventional surgery if performed on selected cases. More experience must be collected to analyze the cost-effectiveness.     

Robotic sialoadenectomy of the submandibular gland via a modified face-lift approach

The purpose of this study was to describe and analyse the advantages and disadvantages of submandibular gland (SMG) resection using a robotic surgical system through a modified face-lift approach. The authors performed robotic sialoadenectomy of the SMG on 5 patients using the daVinci robot system through a modified face-lift approach. Three robotic arms were inserted through a modified face-lift incision; a face-down 30-degree endoscopic arm and two operative arms. The right arm was equipped with a harmonic scalpel and the left arm with a Maryland forceps. In all patients, robotic sialoadenectomy of the SMG was completed successfully. Diagnoses were sialolithiasis in two patients, pleomophic adenoma in two patients, and ranula in one patient. The mean robotic operative time was 90.2 min (range 62–185 min) and that for setting the robotic system was 8.2 min (range 5–15 min). No significant intra-operative or postoperative complications were observed. All patients were satisfied with the outcome and especially the cosmetic results at their last follow-up visit. In the authors opinion robotic sialoadenectomy of the SMG is technically feasible and secures a better cosmetic outcome than endoscopic submandibular resection.     

Tuberculous submandibular lymphadenitis

Two cases of tuberculous submandibular lymphadenitis were reported. Painless, gradually enlarging masses that did not respond to antibiotic therapy were noticed. Histologic examination of surgically extirpated specimens disclosed tuberculous lymphadenitis in both cases.     

老年性慢性颌下腺炎

目的 研究老年性慢性颌下腺炎的临床特点和其诊治。方法收集年龄在50岁以上、临床诊断为颌下腺肿瘤、术后病理诊断为慢性炎症的患者。X线检查无结石、无舍格伦综合征及相关自家免疫性疾病。结果35例的临床表现均为无意发现颌下区肿块，其与进食无关。病理表现为腺泡破坏、慢性炎症细胞浸润，有的闰管腔内存在微小钙化。结论老年患者颌下腺肿块、影像学检查无结石和占位性病变，应考虑诊断老年慢性颌下腺炎，不必切除颌下腺。     

Intraoral submandibular gland excision

(Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;88:661-3)     

Effect of sialoadenectomy on the carriage of Candida albicans in the mouths of rats

Xerostomia provoked in rats by surgical removal of the major salivary glands significantly increased oral carriage of Candida albicans. Five weeks after 3 oral inoculations of 10⁸ CFU, C. albicans were found in the mouths in 50% of normal animals but after 8 weeks in none. In xerostomic rats, 100% had oral C. albicans after 5 weeks and after 18 weeks, 66.6% still harboured yeasts. Over the whole experimental period the amount of C. albicans was greater in the mouths of sialoadenectomized than in normal rats.     

Sialolithiasis of the submandibular gland

Sialolithiasis of the salivary gland is a benign pathology that occurs most frequently in the submandibular gland because of its anatomic features. Depending on the sialolith size and calcification degree, it can be visible in radiographic examinations. Commonly, patients may experience pain and/or edema, when the ducts are obstructed. The authors report the case of sialolithiasis of the submandibular gland in a 42-year-old, female, white-skinned patient, noticed during routine dental examination. Following diagnosis confirmed by clinical and radiographic examinations, the treatment plan consisted of surgery for removal of the calcified mass. The prognosis is often good, and generally there is no recurrence.     

Idiopathic submandibular abscesses in children

Idiopathic submandibular abscesses are often observed in young children and the report concerns 31 children treated over a period of 3 years. Their origin is unknown. As all these abscesses were lymph node abscesses in the submandibular region, it is assumed that they are due to minor oral and nasal cavity traumatic lesions secondarily infected. Antibiotic treatment and surgical drainage resulted in quick resolution and recurrences were never observed.