Sialolithiasis

Sialolithiasis occurs most commonly in the submandibular gland. The vast majority of salivary stones are single, with only 3 percent occurring bilaterally. Patients with distal submandibular stones may be treated with simple sialolithotomy. Other causes of salivary gland enlargement include mumps, tumors, acute suppurative sialadenitis and granulomatous disease.     

颌下腺移位术的手术配合

笔者报道需要放疗的25位鼻咽癌病人进行颌下腺移位术的手术配合，阐述物品准备及手术体位的特殊性，认为要掌握手术全过程才能促进手术的顺利完成，提高手术的质量。     

High-resolution real-time ultrasonography of the submandibular salivary gland

Twenty "normal" volunteers underwent real-time ultrasound scanning of their submandibular salivary glands in an attempt to define the normal anatomy and ultrasound characteristics of these glands and their adjacent anatomy. It is possible to define the entire gland and portions of its duct, which measures less than 3 mm in diameter. Adjacent structures are easily seen and are constant in their relationships to the gland. Three case reports demonstrate the usefulness of this approach to various clinical problems. Real-time ultrasonography is an easily applied, non-ionizing modality to image the submandibular fossa.     

兔自体颌下腺部分移植模型的建立

背景:近年来临床上应用血管化自体颌下腺移植治疗重症角结膜干燥症取得了较好的治疗效果,但术后会出现泪溢的并发症,需要再次甚至多次手术切除部分腺体以减轻泪溢的症状.为减少自体颌下腺移植后出现的泪溢并发症,自体颌下腺部分移植是否可行尚待验证.目的:通过建立兔颌下腺部分移植的动物实验模型,探讨兔颌下腺部分移植的可行性.方法:取家兔左侧颌下腺2/3,应用显微外科血管吻合技术移植于颞侧皮下间隙,14 d后取出,苏木精-伊红染色观察其病理变化.结果与结论:15只移植腺体存活兔中7只移植的颌下腺病理切片示正常,腺体正常度在30%以上的6只,腺体正常度在30%以下的2只.结果显示87%兔部分颌下腺移植后,保留了30%以上正常的腺体结构.兔部分颌下腺移植模型构建具可行性,该结果对采用自体颌下腺部分移植治疗干眼症的手术具有参考价值.     

超声误诊颌下腺神经鞘瘤一例

1908年,外国学者Verocay首次提出了“神经鞘瘤”,这是一种来自周围神经鞘膜施旺细胞的良性肿瘤,故也称之为施万细胞瘤。好发于交感、迷走神经。25%～45%发生在头颈部,其中颈部占10%～19%,以颞骨、侧颈部和副鼻窦区最为常见,舌部也比较常见。唾液腺神经鞘瘤临床上罕见,大多出现在腮腺,而发生在颌下腺的神经鞘瘤更是罕见,仅见极少个案报道。颌下腺神经鞘瘤很少有症状,术前诊断困难。     

自体颌下腺显微移植再造泪腺治疗重症干眼病的护理

探讨自体颌下腺移植再造泪腺治疗重症干眼病的护理方法，对8例(12侧)重症干眼病患者行自体颌下腺显微移植治疗。术前进行受区皮肤准备，术后重点观察移植后颌下腺的存活状态、移植部位的血运及角膜上皮的修复情况，康复期对患者及家属进行有针对性的护理指导。随访1个月至3年，所移植颌下腺全部存活，眼干症状均明显改善，视力提高。     

Effects of low-intensity focused ultrasound on the mouse submandibular gland

Ultrasound is expected to make a considerable contribution to drug delivery systems (DDSs). We tested the hypothesis that low-intensity focused ultrasound (LIFU) increases vessel permeability in the mouse submandibular gland without causing parenchymal damage. In a preliminary study, LIFU at 3 W/cm2 with a 50% duty cycle for 2 minutes did not cause histologic damage. We therefore applied LIFU to mouse submandibular gland at these conditions before and after injecting horseradish peroxidase. Single labeling laser scanning confocal microscopy revealed positive horseradish peroxidase staining around the excretory ducts in the mucous-producing part of the gland, but absence of staining in control glands. Immunostaining for fibrinogen was positive in the same region. Fibrinogen is an intravascular protein that does not pass through intact vessels. These findings suggest that LIFU increases vessel permeability and disruption without destruction. It is anticipated that this process will be useful in establishing a DDS that uses LIFU.     

Agenesis of a submandibular gland with compensatory pseudotumoral hypertrophy of the contralateral gland: Sonographic findings

Agenesis of a submandibular gland with compensatory hypertrophy of the contralateral gland is an extremely rare disorder. Most reported cases of unilateral submandibular agenesis have been asymptomatic without any associated facial anomalies. We report a case of submandibular gland hypertrophy mimicking a mass that was detected incidentally. The absence of the contralateral submandibular gland and associated contralateral sublingual gland hypertrophy was confirmed by typical imaging findings. © 2012 Wiley Periodicals, Inc. J Clin Ultrasound 41 :15–17, 2013     

Sonographic detection of secondary MALT lymphoma of the submandibular gland.

This report describes a case of mucosa-associated lymphoid tissue (MALT) lymphoma of the lacrimal glands that recurred in the submandibular salivary glands. Gray-scale sonography showed small hypoechoic nodules, measuring less than 0.5 cm in diameter, in both submandibular glands. The echogenicity and echotexture of the rest of the submandibular glands and of the parotid glands was normal. Power Doppler sonography revealed increased vascularity within the nodules. A sonographically guided aspiration biopsy of the nodules revealed MALT lymphoma. Secondary MALT lymphoma should be considered in the presence of multiple small hypoechoic nodules in the salivary glands in patients with a history of MALT lymphoma at another location.     

Thyroid carcinoma metastasizing to the submandibular gland: Sonographic findings

Metastases to the submandibular gland are extremely rare; a literature search retuned only three previously reported cases from a thyroid gland primary site. Herein, we report two cases of metastatic thyroid carcinoma to the submandibular gland in a 64-year-old woman with PTC and a 70-year-old-woman with medullary thyroid carcinoma (MTC). The metastases were identified on CT and PET/CT in one case and on CT in the other case, but both were diagnosed with ultrasound-guided fine-needle aspiration. Our cases highlight that while rare, both PTC and MTC can metastasize to the submandibular gland.     

腺体组织损伤后体外分离下颌下腺干/祖细胞后的克隆化培养

背景:体外构建组织工程化人工涎腺需获得分化增殖良好、数量充足的种子细胞,但正常下颌下腺中很难分离出成体干细胞.目的:利用腺体组织损伤动物模型体外分离下颌下腺干/祖细胞,并进行克隆化培养.设计、时间和地点:细胞学体外观察,于2006-03/2007-01在遵义医学院贵州省细胞工程实验室完成.材料:8周龄雄性SD大鼠10只,由解放军第三军医大学动物中心提供.方法:10只大鼠采用结扎下颌下腺主导管、抑制腺体分泌来建立组织损伤模型,1周后切取腺体组织,酶消化法体外分离下颌下腺干,祖细胞,原代培养10-14 d后,挑取培养皿中形成的小的类圆形、类上皮细胞集落予以纯化,传代后进行单克隆培养.主要观察指标:下颌下腺干,祖细胞免疫细胞化学染色及免疫荧光染色结果,通过绘制生长曲线分析下颌下腺干,祖细胞体外增殖能力.结果:实验获得表达层粘蛋白的细胞具有干细胞特征,CD29呈阳性表达表明其具有高黏附、高增殖等组织干细胞特性,角蛋白19的阳性表达提示下颌下腺干,祖细胞呈上皮源性.其生长曲线近似"S"形,体外培养增殖活跃.结论:实验结果显示,下颌下腺干,祖细胞具有组织干细胞的特征,有望成为组织工程化人工涎腺构建的一类种子细胞来源.     

Dynamic sonography and CT findings of unilateral submandibular gland agenesis associated with herniated hypertrophic sublingual gland

Congenital agenesis of the submandibular gland is uncommon. We report dynamic sonography and CT findings of the unilateral submandibular gland agenesis associated with herniated hypertrophic sublingual gland tissue through the mylohyoid gap. The dynamic sonography examination applied at rest and during the modified Valsalva maneuver demonstrated hypertrophied sublingual gland prolapsing to the anterior part through the mylohyoid gap. This may be the first reported case describing dynamic sonography findings of this entity. CT confirmed the agenesis of the left submandibular gland and compensatory hypertrophy of the ipsilateral sublingual gland. © 2013 Wiley Periodicals, Inc. J Clin Ultrasound 42 :176–179, 2014     

颌下腺神经鞘瘤超声误诊1例

患者女,47岁,既往体健。因发现右下颌肿块3个月就诊。体格检查:于右下颌触及一大小约2.0 cm×3.0 cm×3.0 cm肿块,质软,表面光滑,界限清楚,移动度好,无触痛,表面皮肤无异常;余未见特殊。超声检查:右侧颌下腺探及一大小约3.9cm×2.9 cm中低回声,界清,内回声欠均匀(图1A);CDFI于其内探及条状血流信号,测得其中一支动脉收缩期峰值流速为6.49 cm/s,舒张末期流速为2.94cm/s,阻力指数为0.55(图1B)。初步诊断:右侧颌下腺实性病变(性质待定,不除外混合瘤)。于全身麻醉下行右颌下肿物切除术。术中见颌下腺实性肿块大小约4.5 cm×3.0 cm×2.5 cm,质中,边界清,包膜完整。术后病理诊断:(右颌下肿块)神经鞘瘤(图2)。     

Adrenergic interaction in mucin secretion of rat submandibular gland in vitro

Previous studies have reported that maximally effective concentrations of the "mixed" alpha and beta adrenoceptor agonists, epinephrine and norepinephrine, cause greater amounts of mucin secretion than the "pure" beta adrenoceptor agonist, isoproterenol, and that this response requires extracellular calcium. The purpose of the present study was to examine directly the nature of the effect of the putative pure alpha adrenoceptor agonist, phenylephrine, on isoproterenol-induced mucin secretion and the role of extracellular calcium in this interaction. We used a graphical method which provides a procedure for determining whether interaction between two drugs is additive, antagonistic or synergistic to analyze this interaction. Submandibular glands were removed from male rats, divided into sections and placed in modified Hank's balanced salt solution. Mucin secretion was measured as acid precipitable disintegrations per minute after labeling the submandibular gland with [14C]glucosamine. Phenylephrine caused a small but significant secretion of mucin which was blocked partially by phentolamine and completely by propranolol. Phenylephrine caused a significant shift of the isoproterenol concentration-response curve to the left of the theoretical curve expected if two drugs act additively. Mucin secretion induced by isoproterenol alone was independent of extracellular calcium concentration; however, the combination of isoproterenol and phenylephrine caused a concentration-dependency on extracellular calcium.     

保留颌外动脉和面前静脉在颌下腺摘除术中运用分析

目的探讨保留颌外动脉和面前静脉的颌下腺摘除改良术式的价值。方法选择本院4年来因炎症或良性肿瘤需要行颌下腺摘除术的患者41例,分成2组：A组采用传统的颌下腺摘除术式;B组采用保留颌外动脉和面前静脉的改良颌下腺摘除术式。观察比较两组的手术时间、出血量、患者心理顺应性。结果保留颌外动脉的颌下腺摘除术式与传统术式患者手术时间、术中出血量相当。结论保留颌外动脉和面前静脉并没有增加手术时间和出血量,患者心理顺应性更好,手术创伤小,保留下来的血管为今后可能的口腔缺损修复提供了营养基础,符合现代外科学的微创原则。