自体颌下腺移植治疗角结膜干燥症实验研究

目的 通过兔自体颌下腺移植试验,研究自体颌下腺移植治疗角结膜干燥症的可行性,移植术中、术后可能发生的问题及解决方法。方法 健康大耳白家兔20只,分成2组。试验组功除泪腺,通过血管吻合移植自体颌下腺至左颞部,导管植入外下穹隆结膜;对照组仅切除泪腺,不移植颌下腺。术后观察2个月,于术后1、2、3、4及8周分别进行施墨试验、移植眼泪液唾液淀粉酶测定、移植颌下腺造影、移植腺体及角膜组织病理学检查。结果 对照组兔术后施墨试验滤纸条长度低于术前,移植组施墨试验滤纸条长度高于术前。移植眼唾液淀粉酶浓度高于术前。移植腺体造影可清楚显示移植颌下腺完好的导管及腺泡结构,组织病理学观察,移植成功腺体结构正常,移植侧角膜无受破坏现象。结论 自体颌腺移植可适当增加角结膜干燥症兔泪液量,移植腺体分泌的唾液不会对眼部结构造成破坏,是治疗角治膜干燥症的有效方法。施墨试验及唾液淀粉酶浓度测定对壑移植腺体是否成活及移植腺体功能具有重要意义。移植颌下腺造影是检查移植腺体结构及功能的一种较好方法。     

血管化自体下颌下腺移植术后腺体功能的变化及干预

目的 总结血管化自体下颌下腺移植术后腺体功能的变化规律，分析各种干预方法的效果。方法 接受血管化自体下颌下腺移植治疗并获得手术成功的重症角结膜干燥症患者40例，手术后通过施墨试验监测移植后腺体的分泌功能。对其中部分患者在其休眠期内分别给予热敷加按摩、红外线理疗、辣椒刺激和使用博利康尼等干预措施，对比应用上述措施之后腺体分泌功能的变化。结果 血管化自体下颌下腺移植成功后，腺体功能的变化分为4个阶段，即：术后短暂失功能期、术后暂时性泪溢期、术后腺体休眠期以及术后功能恢复稳定期。在腺体休眠期内，采用局部热敷并按摩腺体、红外线理疗、辣椒刺激等方法可促进腺体分泌，但是使用博利康尼后对腺体分泌没有显著影响。结论 血管化自体下颌下腺移植成功后，腺体功能的变化有其规律性，其中在第3阶段即腺体休眠期内，应采取必要的干预措施促进腺体分泌，以避免导管堵塞。     

自体颌下腺移植治疗角结膜干燥症术后泪液成份分析

目的 了解自体颌下腺移植术后泪液成份的变化。方法 采用实验室常规方法检测移植术后8例患者泪液及30例正常人泪液,颌下腺液的化学成份并进行比较。测定项目包括;淀粉酶,溶菌酶,钠、钾、钙、磷,渗透压,尿素、肌酐,尿酸,总蛋白、免疫球蛋白,甘油三脂,葡萄糖,酸碱度等。结果 正常人泪液中各种成分在唾液中均可检出;移植术后的“唾液泪液”（S-T）中淀粉酶（AMY）呈高分泌状态;钠（Na)含量低于正常泪液;渗透压介于唾液与泪液之间,呈低渗,尿酸（Ua)含量高于正常泪液;溶菌酶（LZ）含量明显低于正常泪液。结论 颌下腺移植术后S-T液的性质介于正常泪液与颌下腺液之间;高分泌水平的AMY表明移植腺体保持良好的分泌功能。AMY可作为腺体移植成活的生化标准;某些成分的明显差异能否对移植效果造成影响,有待进一步观察。     

治疗角结膜干燥症自体颌下腺移植的血管处理

目的总结血管化自体颌下腺游离移植治疗角结膜干燥症的血管处理方法。方法对1999年8月至2004年4月完成的68例血管化自体颌下腺游离移植的血管处理作回顾性研究，分析受区和供区的血管、术后血管危象的发生和处理以及腺体的成活情况。结果68例游离颌下腺移植的供区和受区动脉均为颌外动脉与颞浅动脉，所用供区静脉中，面前静脉55例，颌外动脉伴行静脉12例，腺门静脉1例；所用受区静脉中，62例为颞浅静脉，1例为颢深静脉，5例经头静脉桥接后，回流至颈外静脉或颈内静脉的属支。术后10例出现血管危象，其中9例静脉危象，1例动脉危象，1例静脉危象经抢救腺体获得成活，本组移植腺体的成活率为86．8％（59／68）。结论血管化自体颌下腺移植的静脉变异较大，应根据每一病例的具体特点作出相应的处理，其中以颌外动脉伴行动脉与颞浅静脉的吻合最为可靠，显微镜下的血管吻合有助于降低术后血管危象的发生率，提高移植腺体的成活率。     

放疗对小型猪腮腺颌下腺舌下腺微血管损伤影响的实验研究

目的:观察放疗对小型猪腮腺、颌下腺、舌下腺的微血管损伤状况。方法:将6只实验用小型猪分为2组。2组动物进行放疗,将双侧腮腺、颌下腺、舌下腺加入放射野中,放疗组20Gy/每侧,对照组0Gy/每侧。放疗结束后4 h处死两组动物,取两组动物腮腺、颌下腺、舌下腺标本行HE染色与CD31免疫组化染色,观察放疗早期3种腺体微血管密度变化。结果:两组小型猪腮腺、颌下腺、舌下腺CD31阳性染色颗粒数有显著差异(P＜0.05);3个腺体间统计结果有显著性差异(P＜0.05);腮腺与颌下腺及舌下腺有显著性差异(P＜0.05),颌下腺与舌下腺无显著性差异。结论:放疗可导致小型猪腮腺、颌下腺、舌下腺微血管密度明显减低,且各腺体间微血管密度减低有差异,腮腺的损伤程度大于颌下腺和舌下腺。     

小型猪用于颌面外科实验的探讨

动物实验是医学研究的重要手段.目前国内外实验动物品种繁多,但许多与人类差异较大,而与人类近似的灵长类动物,又因其来源、价格等因素而应用受限.猪是国外40年代即开发的实验动物品种,在解剖组织学及生理学等方面与人有极大的相似性,因其躯体肥大,也给实验带来不便.我国从90年代起开     

蚯蚓提取物用于小型猪牙盖髓的实验研究

目的 观察蚯蚓提取物对小型猪牙修复性牙本质形成的作用.方法 用蚯蚓提取物对30颗小型猪牙进行直接盖髓,对照组30颗牙采用氢氧化钙盖髓;分别于术后2、4、12周运用组织病理学方法观察其促进修复性牙本质形成的效果.结果 蚯蚓提取物盖髓后2周,骨样修复性牙本质团块形成,未见到创面周围牙髓变性坏死.盖髓后4周,穿髓孔下有修复性牙本质形成,大部分牙已将穿髓孔封闭.盖髓后12周,穿髓处可见完整的牙本质桥形成,结构致密,髓腔及根管内牙髓组织基本正常.氢氧化钙盖髓组:术后2周界面可见牙髓变性坏死区,有薄层牙本质团块形成,4～12周逐渐形成完整的牙本质桥,形成速度与蚯蚓提取物组相似.结论 本实验提示蚯蚓提取物能促进小型猪牙髓组织损伤的修复,形成修复性牙本质.     

小型猪正畸牙根吸收实验动物模型的建立

目的：初步探讨利用小型猪建立牙根吸收动物模型的可能性。方法：选用中国农业科学院提供的中国实验用小型猪,一侧用镍钛镙簧内收下前牙,另一侧作为自身对照。结果：分别进行肉眼观察、病理切片和扫描电镜均显示受力侧有牙根吸收,对照侧未见。结论：在牙根吸收的研究中,该种系的小型猪可以建立稳定可靠的牙根吸收模型,并提供进一步研究的平台和材料。     

表皮生长因子与胶原蛋白复合物对小型猪修复性牙本质形成作用的实验研究

目的：观察表皮生长因子(Epidermal growth factor,EGF)与胶原蛋白海绵(col1agen sponge,CS)复合物对小型猪修复性牙本质形成的影响。方法：选用实验用小型猪牙齿36颗,采用EGF／CS复合物为材料进行直接盖髓术,通过组织病理学方法常规制备牙-颌骨联合切片,光学显微镜下观察修复性牙本质形成情况,并与氢氧化钙糊剂直接盖髓对照。结果：小型猪牙用EGF／CS直接盖髓术后2周,穿髓孔周边可见修复性牙本质团块形成,团块周围有成牙本质细胞样细胞围绕;术后4周有完整的修复性牙本质桥形成;术后12周修复性牙本质桥增厚且结构致密,严密封闭穿髓孔,桥体近髓腔面形成明显的管样牙本质,下方为整齐排列的典型成牙本质细胞。用氢氧化钙糊剂直接盖髓,术后2周可见穿髓孔处有炎症坏死区,只有少量钙化团块形成,术后4～12周逐渐形成完整的修复性牙本质桥,但形成速度较慢且牙本质桥厚度较薄。结论：EGF与胶原蛋白复合物显著促进牙髓细胞分化和修复性牙本质形成,是一种有临床应用价值的生物活性盖髓剂。     

小型猪正畸牙根吸收实验动物模型的建立

目的:初步探讨利用小型猪建立牙根吸收动物模型的可能性.方法:选用中国农业科学院提供的中国实验用小型猪,一侧用镍钛镙簧内收下前牙,另一侧作为自身对照.结果:分别进行肉眼观察、病理切片和扫描电镜均显示受力侧有牙根吸收,对照侧未见.结论:在牙根吸收的研究中,该种系的小型猪可以建立稳定可靠的牙根吸收模型,并提供进一步研究的平台和材料.     

An experimental study of the management of severe keratoconjunctivitis sicca with autologous reduced-sized submandibular gland transplantation

We have evaluated transplantation of reduced submandibular glands for the treatment of severe keratoconjunctivitis sicca. Thirty-four rabbits were allocated into three groups: dry eye (controls, n=10), transplantation of whole submandibular glands (n=12), and transplantation of reduced submandibular glands (n=12). Outcome measures included the results of Schirmer's test and the Rose Bengal test, and histological examination of the cornea and the transplanted gland. Volume of tears significantly increased after transplantation of the whole gland, but did not change after transplantation of the reduced gland compared with dry eyes induced preoperatively. Neither transplantion group had keratoconjunctivitis sicca postoperatively. There were no histological abnormalities in the transplanted tissues. The results that the surgical technique of using reduced submandibular glands for transplantation was feasible, and that the secretion from the reduced gland was similar to that from a normal lacrimal gland. In conclusion, transplantation of a reduced submandibular glands is feasible in the treatment of keratoconjunctivitis sicca.     

Vascular clinical anatomy of the submandibular gland

ObjectiveThe aim of this study is to describe in depth the precise anatomy of the vascular supply of the submandibular gland, trying to determine the existence of patterns of glandular vascularization. Knowledge of these patterns could facilitate surgical management of the gland and the submandibular gland flap.Material and methodsNeck dissections of formaldehyde preserved human cadavers were performed. Submandibular and transmandibular approaches were used during the dissections. All the vascular branches found were registered and classified into 2groups: main or accessory branches. The anatomical data analyzed was: The diameter and length of the main and accessory branches, as well as the most important measurements of the submandibular gland flap pedicle.Results33 glands were dissected to study the arterial supply of the submandibular gland (17 right, 16 left; 17 males, 16 females) and 29 were dissected to study the venous supply (15 left, 14 right; 15 males,14 females). A total of 123 arterial branches were found reaching the 33 submandibular glands (47 main and 76 accessories) and 116 venous branches were found draining the 29 submandibular glands (47 main branches and 69 accessory branches). A constant main venous branch that ran parallel to the Wharton duct and drained in the sublingual vein was found in all of cases (Concomitant Wharton Duct Vein or CWDV).ConclusionThe CWDV is a constant venous branch for the drainage of the gland and should be considered as venous pedicle during the dissection of submandibular gland flaps.     

Parasympathectomy induces morphological changes and alters gene-expression profiles in the rat submandibular gland

Objective

The chorda-lingual (CL) nerve carries parasympathetic fibers to the hilum of the sublingual and submandibular glands (SMGs) and evokes the secretion of saliva. The effect of cutting the CL nerve on the biological processes in SMGs was investigated by examining the gene-expression profiles in the SMGs after a surgical parasympathectomy.

Methods

At day 3 after the CL nerve cut, the changes in the SMGs at both the experimental cut and contralateral control sides were analysed by microarray and light microscopy. The expression levels of 6 selected genes were confirmed by real-time PCR, Western blot and immunofluorescence staining.

Results

The wet weight of the parasympathectomised SMGs decreased significantly compared to that of the contralateral side (p < 0.05). Histological analyses after the parasympathectomy showed a widened interacinar space as well as some atropic changes to the acini of the SMGs in the cut side. Microarray analysis revealed that twofold differential expression in mRNA expression in the parasympathectomized SMGs were detected in 88 genes (0.004%): 41 genes were overexpressed, 11 were underexpressed and 36 were unknown. Changes of the expression of 6 selected genes detected by Western blot and/or real-time PCR were consistent with the microarray data.

Conclusion

The important genes involved in biological processes for salivation were identified through a large-scale gene expression analysis.     

Large sialolith in the submandibular gland of a child

Sialolithiasis is a disorder encountered by oral surgeons that is rarely seen in children, although it is rather common in adults. Most sialolith found in children are smaller than 5 mm in diameter, and the majority of reported cases have been treated by surgically. We report a 9-year-old boy with a sialolith that measured 12 × 3.5 × 3 mm, which had developed in Wharton's duct and was then spontaneously passed.     

Postnatal expression of sialin in the mouse submandibular gland

Objective

Sialin has been identified as a sialic acid and aspartate/glutamate transporter. Both cytoplasmic localization and the plasma membrane labelling pattern suggested that sialin may possess multiple transport functions in different cell types. In mouse embryos, sialin expression was primarily detected in the central nervous system. However, sialin shows widespread and high-level expression in adult tissues. Despite its ubiquitous expression and important functions, the postnatal expression profile and subcellular localization of sialin in the salivary gland remains elusive. The aim of the present study was to investigate the expression and subcellular distribution of sialin during postnatal development in the mouse submandibular gland (SMG).

Design

Six SMGs from both female and male C57BL/6 mice were collected at P10, P30 and P90, and the material from each littermate of either sex was pooled to extract total RNA and tissue protein. The remaining tissues were immediately fixed in 10% neutral buffered formalin for histological analysis. The mRNA and protein expression levels of sialin were examined by quantitative real-time RT-PCR and Western blot analysis. The subcellular distribution of sialin was analysed by immunohistochemistry and immunofluorescence.

Results

The postnatal expression level of sialin in the mouse SMG was comparable with that in brain at each time point tested. The temporal expression of sialin in the SMG gradually increased during postnatal maturation. Immunohistochemical and immunofluorescence analysis demonstrated that sialin was predominantly expressed on the basal cytoplasmic membrane of acini and ducts, as well as in some myoepithelial cells in the SMG.

Conclusions

The high-level expression and subcellular distribution pattern of sialin in the SMG suggest that sialin may play an important role in the transport and secretion of saliva.     

失副交感神经支配对大鼠颌下腺分泌功能的影响

目的观察大鼠颌下腺失副交感神经支配后近远期分泌功能的变化,探讨失副交感神经支配调控颌下腺分泌、治疗口干的可能性。方法将20只雄性成年SD大鼠分为实验组（12只）和正常对照组（8只）。实验组行右侧鼓舌神经切除术,实验组左侧及正常对照组颌下腺均未处理。术后1、12和24周采用希尔默试验（Schirmer test）检测颌下腺的分泌功能。结果 进食刺激状态下实验组手术侧腺体的唾液流率明显低于非手术侧[(27.13±3.28)、(33.00±12.98)和(27.50±5.20) mm]和正常对照组[(30.25±3.86)、(28.00±3.46)和(27.00±4.32) mm](P＜0.05),证实术后颌下腺失去副交感神经支配。但在静息状态下,术后各时间点实验组手术侧腺体的唾液流率显著高于非手术侧[(1.91±0.62)、( 1.33±0.29)和(2.38±1.79) mm]和正常对照组[(1.90±0.34)、(1.53±0.46)和(1.48±0.39) mm](P＜0.05);非手术侧与正常对照组腺体唾液流率的差异无统计学意义。结论采用颌下腺失副交感神经支配治疗口干有一定的可能性。     

下颌下腺脱细胞载体的制备及超微结构观察

目的：制备天然的下颌下腺脱细胞载体材料，观察脱细胞后的超微结构变化。方法：采用化学除垢剂法，对SD大鼠的下颌下腺进行脱细胞处理，通过透射电镜及扫描电镜对细胞载体进行观察。结果：透射电镜下见，下颌下腺细胞溶解破坏，只残留一空虚的陷窝。扫描电镜显示，正常的下颌下腺细胞呈球状，表面略凸凹不平。而脱细胞处理后，细胞形态消失，胶原纤维交叉排列，呈网状结构。结论：Triton X-100脱细胞处理的下颌下腺细胞成分完全消失，而胶原纤维为主的基质成分排列正常。     

Actinomycosis originating in the submandibular gland: Report of a case

We report herein a very rare case of actinomycosis originating in the submandibular gland in which malignancy was suspected. A 56-year-old man visited our clinic with a chief complaint of painless mass in the right submandibular region. From the imaging diagnosis, we suspected malignant tumor in the submandibular gland. Under general anesthesia, right radical neck dissection and excision of the submandibular gland with the above mass were carried out. Histopathological diagnosis of actinomycosis in the submandibular gland was made. Because the focus exists within the gland, we consider this case as a primary submandibular gland actinomycosis. Two years postoperatively, the tumor has not recurred. On diagnosis, it is necessary to differentiate this disease with other benign or malignant tumors.