Gland-preserving surgery can effectively preserve gland function without increased recurrence in treatment of benign submandibular gland tumour

The most widely accepted treatment for neoplasms of the submandibular gland usually involves excision of the entire gland. Our aim was to establish a gland-preserving operation for benign tumours of the submandibular gland and evaluate its efficacy. We treated 40 patients from January 2007 to December 2008 with benign submandibular gland tumours who were listed to have an operation that either preserved the gland or sacrificed it. Duration of operation, extent of injury to the nerve, postoperative function of the gland, aesthetic appearance, and recurrence were assessed. We found no significant difference in baseline characteristics among the 20 patients in each group (19 men; 21 women, mean (SD) age of 34 (33.8 ± 5.72) years. The extent of injury to the lingual nerve and submandibular branch, together with deformities of the facial contour, were significantly less in the group in which the gland was preserved. Postoperative salivary production and overall patients’ satisfaction were also better in that group. There was no recurrence in either group during the follow up period of 38 months–5 years. The gland-preserving procedure has advantages over the typical approach in which the gland is sacrificed. There is less risk of injury to the nerve, less deformity of the facial contour, better preservation of function, and patients are more satisfied. The gland-preserving technique should therefore be the first choice for management of benign submandibular tumours.     

Robot-assisted versus endoscopic submandibular gland resection via retroauricular approach: a prospective nonrandomized study

The aim of this study was to compare the short-term clinicopathological results of robot-assisted and endoscopic resection of the submandibular gland by the retroauricular approach.     

超声刀在开放性下颌下腺手术中的应用

]目的：通过对比超声刀与电刀在下颌下腺手术中的效果,探讨超声刀在下颌下腺手术中的临床应用价值。方法采用随机对照试验,将2013年10月—2014年7月进行的40例下颌下腺手术分为试验组和对照组,2组均由经验丰富的同一手术团队完成。试验组手术过程使用超声刀进行手术,对照组使用电刀进行手术。术后比较2组的手术时间、术中出血量、术后并发症及术后24 h和48 h引流量等指标,采用SPSS 10.0软件包对所得数据进行分析。结果2组患者的年龄构成、性别、肿块大小及疾病构成比无显著差异（P>0.05）;在相同的手术方式下,2组术后并发症无显著差异（P>0.05）;试验组手术时间、术中出血量及术后24h和48h引流量较对照组显著减少（P<0.05）。结论超声刀应用于下颌下腺手术安全可靠,较电刀有明显优势,可明显缩短手术时间、减少术中出血及术后引流量,对组织损伤小,无明显术后并发症,值得在口腔颌面外科手术中推广应用。     

下颌下腺良性肿瘤功能性手术的研究进展

下颌下腺切除术是治疗下颌下腺良性肿瘤最常用的治疗方法,但术后皮肤瘢痕、潜在的面神经下颌缘支损伤和舌神经损伤,以及腺体摘除可能导致的口干等并发症将会不同程度地影响患者的生活质量.为此,下颌下腺功能性手术日益被采用和改进,以期提高术后生活质量.本文围绕下颌下腺手术的美观切口设计,内镜和机器人辅助手术技术的应用,以及下颌下腺...     

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.     

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。     

Benign submandibular gland tumours: outcomes of gland-preserving excision by endoscopic or conventional approach

Endoscope-assisted surgery is becoming a preferred technique in salivary gland surgery. However, this technique has not yet been applied in submandibular gland (SMG) preservation surgery. This retrospective study was performed to evaluate the outcomes of endoscope-assisted gland-preserving surgery through a hairline incision in patients with benign SMG tumours. The study included 38 patients with benign SMG tumours who underwent tumour excision with gland preservation: 19 who underwent local excision of the tumour through an endoscope-assisted hairline approach and 19 who received the conventional cervical approach. The feasibility of the surgical procedure, perioperative patient variables, and postoperative appearance and functional outcomes were evaluated. Patients in both groups had their tumours removed successfully with tumour-free margins. The intraoperative blood loss, postoperative amount of drainage, mean length of the incision, and unstimulated saliva flow rate did not differ between the two groups. There was no difference in the stimulated saliva flow rate between the preserved gland and unaffected SMG. The aesthetic result was better in the endoscope-assisted hairline incision group. No tumour recurrence occurred during follow-up (range 12–52 months). Thus, gland-preserving tumour dissection appears to be a safe method for benign SMG tumours, with good functional results. Furthermore, the endoscope-assisted hairline incision is a feasible method with excellent cosmetic results.     

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.     

15例下颌下腺复发性多形性腺瘤临床病理分析

目的：观察下颌下腺复发性多形性腺瘤的临床和组织病理学特征,探讨其病因与治疗。方法：回顾分析2005 年6 月—2017 年6月我院诊治的15 例下颌下腺复发性多形性腺瘤患者的临床和病理资料。结果：15例患者中,男4例（26.67%）,女11例（73.33%）;年龄25~73岁,平均年龄39.33岁;3例（20%）复发2次,其余12例（80%）复发1次,平均复发间期是16.3 a。所有患者均采用肿物及下颌下腺切除术（除2例前次手术已切除下颌下腺者外）,术后病理均证实为复发性多形性腺瘤,多结节生长且大多包膜不完整。随访1~13 a,中位随访时间6 a,仅1例（6.67%）患者可疑复发,因其年龄较大,无手术意愿而未行再次手术治疗。结论：下颌下腺复发性多形性腺瘤尚不多见,其临床病理特征与原发性多形性腺瘤类似,手术是有效的治疗方式。     

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。     

下颌下腺切除术手术切口的探讨

下颌下腺切除手术是口腔颌面-头颈外科的经典手术之一。经典的下颌下腺切除术采用距下颌骨下缘1．5～2．0cm的平行切口，称为经颈部进路（transcervical approach）。该切口具有进路直接、显露充分、操作方便、能有效控制出血和便于扩大手术范围等优点，是下颌下腺切除术的首选切口。但该进路也有缺点，如留有颈部瘢痕，损伤面神经下颌缘支（1％～7％）、舌神经（1．4％）、舌下神经（2．9％）的可能，严重者可引起永久性神经功能障碍．少数患者还可导致唾液腺囊肿。随着对面颈部手术美容要求的提高．年轻和女性患者不愿接受下颌下区明显的永久性瘢痕以及可能引起的暂时性口角歪斜。然而，即使将切口设计在下颌下区皮纹内、以美容缝线精细缝合和采用小切口，仍会留有瘢痕。     

小切口下颌下腺摘除术的初步探讨

目的:探讨采用颌下区小切口摘除下颌下腺的改良手术方法。方法:在颌下区作30mm长的切口,对6例慢性下颌下腺炎的患者进行了腺体摘除术。术中保留颌外动脉及面前静脉。结果:手术时间40～80min,所有病例无面神经损伤,创口小。结论:改良小切口行下颌下腺摘除术切口短而美观。     

逆行面动脉为蒂的下颌下腺移植的实验研究

目的：探讨用逆行面动脉为蒂的下颌下腺移植治疗角结膜干燥症的可能性。方法：利用逆行面动脉为蒂的自体下颌下腺（包括导管）移植到实验用Beagle犬的颞部。^99mTc核素扫描监测移植的下颌下腺的活力,并且在移植12周后对移植物进行组织学检查。结果：术后^99mTc核素扫描证实在移植区域有存活的唾液腺。组织学检查发现,移植的下颌下腺部分腺泡细胞发生了萎缩。结论：逆行面动脉为蒂的下颌下腺移植治疗角结膜干燥症是一种适合和安全的治疗方法。     

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.     

大鼠下颌下腺细胞接种到脱细胞气管基质及PGA膜上的细胞相容性比较

目的:通过体外下颌下腺细胞/材料复合体的共培养,探讨SD大鼠下颌下腺细胞接种到脱细胞气管基质及PGA膜上的组织相容性。方法:将5mm×5mm×2mm大小的PGA膜(Polyglycolide)、脱细胞处理的衍生生物气管支架材料内壁表面分别接种SD大鼠的下颌下腺腺细胞,共培养后行扫描电镜观察,检测其细胞上清液中淀粉酶含量、单位面积材料上生长的细胞数、材料上细胞的增殖能力(MTT法)等。采用SPSS11.0统计软件包对数据进行相关分析。结果:脱细胞气管基质与PGA膜对大鼠下颌下腺细胞均有较好的细胞相容性。细胞在生物材料上生长的密度从大到小依次为SD大鼠气管、家兔气管、PGA膜。气管材料与PGA膜上细胞数有显著差异(P<0.05);家兔、SD大鼠气管基质组在第7天与对照组有显著差异(P<0.05),而PGA组与对照组无显著差异(P>0.05)。扫描电镜下见天然衍生生物材料上的下颌下腺细胞增殖活跃,见分泌颗粒。家兔、SD大鼠气管支架材料上培养4d后的唾液腺细胞上清液淀粉酶活性显著高于对照组(P<0.05),而PGA膜的上清液酶活性与对照组无显著差异(P>0.05)。结论:自制的脱细胞气管基质与下颌下腺细胞有较好的细胞相容性。     

颌下腺移植治疗角结膜干燥症的手术要点及并发症处理

目的 总结血管化自体颌下腺移植治疗重症角结膜干燥症的手术要点及并发症预防与处理的经验。方法 用该技术治疗23例重症角结膜干燥症，术后行^99m锝核素显像，随诊及并发症相应处理。结果 19例腺体移植成功，眼干症状消失，停用人工泪液；4例腺体未成活；5例出现泪溢，经切除部分移植腺体后症状消失；1例颌下腺导管闭锁，行导管重建术后症状减轻。结论 静脉桥接可解决腺体静脉与颞浅静脉管径不匹配问题；断离腺体前，保留颌外动脉，观察3条静脉渗血情况及游离颌一腺行颌外动脉肝素生理盐水灌注，观察3条静脉渗出情况，有助于选择合适的供体静脉。恰当处理与颌下腺移植治疗重症角结膜干燥症手术相关的各个环节，可提高手术成功率。     

Safety of the haemostatic agent Surgiflo in excisions of the submandibular gland: our experience in 17 cases

Excision of the submandibular gland is a common operation. A surgical drain is usually inserted into the wound to prevent the formation of a haematoma, but this may not be necessary. We retrospectively studied 17 patients whose submandibular glands had been excised and haemostasis achieved with Surgiflo^® (Ethicon, Somerville, USA). There were no complications or side effects. Surgiflo^® established good haemostasis, and can safely be used in place of a surgical drain.     

下颌下腺脱细胞基质的制备及其胶原成分观察

目的:制备天然的下颌下腺脱细胞基质材料,观察脱细胞后下颌下腺的组织结构,并对其成分进行分析。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,通过组织学及免疫组织化学对脱细胞基质材料进行观察及检测。结果:光镜下见下颌下腺细胞消失,基质成分呈筛网状。免疫组织化学证实,在SD大鼠下颌下腺脱细胞前后的组织中,Ⅰ、Ⅱ、Ⅲ型胶原均呈强阳性表达,而Ⅳ、Ⅴ型胶原呈弱阳性或阴性表达。结论:TritonX-100脱细胞处理的大鼠下颌下腺基质中,主要成分为Ⅰ、Ⅱ、Ⅲ型胶原蛋白。     

Role of robotic surgery in oral and maxillofacial, and head and neck surgery

We review the current status of robotic surgery in the head and neck region and its role in oral and maxillofacial surgery.     

Surgical removal of submandibular gland sialolithiasis in a 9-year-old girl: A case report

Sialolithiasis rarely occurs in children; it is observed more commonly in adults. We report a case of a 9-year-old girl with a sialolith in ‘the right anterior Wharton's duct’ resulting in a submandibular sialadenitis. Under local anaesthesia, the calculus was removed by means of a sialolithotomy. Post-operative recovery was uneventful and follow-up examinations showed recovery of the function of the affected gland.