一次性18Gy放射对大鼠颌下腺损伤的实验研究

目的:观察一次性18 Gy放射对大鼠颌下腺组织学形态和唾液流率的改变。方法:40只大鼠随机分为实验组和对照组,每组20只。实验组一次性18 Gy局部照射大鼠颌下腺区域,对照组只麻醉不放射。8周后处死所有大鼠,处死前插管法提取大鼠颌下腺唾液,称取其质量,计算唾液流率,比较两组唾液流率的改变。处死后取颌下腺组织,经4%多聚甲醛固定,切片,HE染色,镜下观察颌下腺的组织学形态。结果:放射后实验组进食进水量下降、活动减少。实验组饮水频率高于对照组。对照组的唾液流率为(18.64±8.23)μL/min,实验组的唾液流率是对照组的57.42%,为(10.70±2.22)μL/min。HE染色显示,放射后实验组颌下腺细胞变性,间质血管充血,腺泡细胞内的空泡数量明显增多。结论:放射后大鼠颌下腺唾液流率明显降低,放射后8周,组织学形态出现显著变化。放疗对大鼠颌下腺组织学形态和唾液分泌功能的远期影响,尚需进一步观察和研究。     

大鼠腮腺及颌下腺唾液的收集

目的:探讨大鼠腮腺及颌下腺唾液的收集方法。方法:采用微型Lashley吸盘法收集大鼠腮腺唾液,经口内颌下腺导管口直接插管法收集颌下腺唾液。毛果芸香碱刺激唾液分泌,假设唾液的比重为1.0 g/cm3,以唾液重量代表其体积,记录唾液流率。结果:大鼠腮腺唾液流率(9.9±1.4)μL/m in,颌下腺导管插管唾液流率(19.9±10.8)μL/m in。结论:可以采用微型吸盘法收集大鼠腮腺唾液,经口内颌下腺导管口直接插管法收集大鼠颌下腺唾液。     

口干患者残余唾液和小唾液腺分泌物的分析

口干情况下口腔黏膜湿度和唾液蛋白对维持口腔功能具有重要作用。已有报道指出正常受试者口腔黏膜湿度和残余唾液蛋白浓度之间呈负相关关系。本文对正常受试者和唾液量偏少患者残余唾液量和小唾液腺分泌物量及它们的蛋白浓度进行了测量,并且调查了唾液量偏少患者口干严重程度导致这些测量指标的变化情况。材料和方法31名口干患者,无刺激全唾液流率<0.15ml/min。其中的20名患者组成实验组,与实验组性别和年龄相匹配的20名正常受试者组成对照组。另外根据无刺激全唾液流率将31名患者分为严重口干组和轻度口干组,前者无刺激全唾液流率为0ml/min…     

腮腺区域切除术对动、静态唾液总流率的影响

目的探讨腮腺区域性切除术对动、静态唾液总流率的影响及在保留残余腺体功能方面的作用。方法对行腮腺区域性切除术的腮腺良性肿瘤患者30人,分别于手术前和术后3个月收集静态混合唾液、酸刺激动态混合唾液及双侧腮腺液,计算各组唾液流率,并进行统计学分析。结果术前患侧腮腺流率明显低于健侧。所有病例手术后患侧腮腺均能收集到唾液,但流率明显降低;而静态及动态唾液总流率与术前相比没有明显降低。结论腮腺良性肿瘤的发生明显影响腮腺唾液分泌功能。腮腺区域性切除术后患侧腮腺仍能够保留部分分泌功能。腮腺区域性切除术虽未能引起对侧腺体代偿,但对患者口腔内唾液分泌总量的影响较小。     

A型肉毒素对兔失副交感神经颌下腺唾液分泌的影响

BTX-A后1、2、4、12周时,静息状态颌下腺分泌量均较失副交感神经的对侧分别减少38.8%、56.5%、47.7%和38.6%,并且差异均有统计学意义(P<0.05);进食状态颌下腺分泌量均较失副交感神经的对侧减少,1周时减少46.2%,差异有统计学意义(P<0.05);分泌液中淀粉酶、钠、钾、氯离子及蛋白浓度无明显变化.结论 兔失副交感神经颌下腺内局部注射BTX-A可以抑制颌下腺的分泌.     

小型猪颌下腺自体再植的实验研究

目的 在小型猪体内建立颌下腺自体再植模型，并观察再植后颌下腺的组织学变化。方法 小型猪8只(16侧颌下腺)分为三组：第一组，4侧颌下腺移植到自体腹股沟区；第二组，6侧颌下腺原位再植到颌下区，导管外置于皮肤；第三组，6侧颌下腺原位再植到颌下区，导管开口于口腔前庭。术后以导管口分泌情况及移植腺体病理检查确定手术效果。结果 第一组术后腺体全部发生血栓，腺体未能成活。第二组腺体成活有分泌3例，导管阻塞3例。第三组术后腺体成活有分泌5例，导管阻塞1例。病理检查结果显示成活腺体术后一周内，部分浆液细胞和粘液细胞可见明显的凋亡和变性。结论 小型猪领下腺不适合移植到腹股沟区。采用自体原位再植可成功建立小型猪颌下腺再植模型，其中导管开口于皮肤手术操作相对简单，适于短期观察。导管开口于口腔前庭的远期效果优于导管外置，适于长期观察。移植后腺细胞凋亡及变性可能是自体颌下腺移植术后发生休眠期时腺体分泌减少、变粘稠的病理学基础。     

可调式活动牵引器治疗上颌唇侧倒置阻生中切牙效果评价

目的：评价一种新型可调式活动牵引器治疗上颌唇侧倒置阻生中切牙的临床效果。方法 ：选择年龄7～10岁上颌唇侧倒置阻生中切牙患者10例（10颗患牙），使用一种新型可调式活动牵引器（专利证书号：11012293），联合外科助萌进行牵引治疗。术前和术后即刻拍摄CBCT，术后对阻生中切牙(治疗组)及对侧同名牙(对照组)进行牙髓电活力测试及牙周探诊，评价治疗效果。采用SPSS 23.0软件包对数据进行统计学分析。结果：10例患者牵引成功率为100%，平均治疗时间（8.60±1.26）个月。术后治疗组无松动、无牙龈红肿、牙髓坏死及牙周袋出现，但唇侧牙龈略有退缩，其唇侧牙龈高度[(10.58±0.45) mm]显著高于对照组[(9.47±0.31) mm](P<0.01)。治疗组生长发育水平高于对照组：其根长及根尖孔变化量[(2.80±1.09) mm、(1.79±0.59) mm]高于对照组[(1.84±0.97) mm、(0.96±0.40) mm]。术前治疗组牙根发育迟缓，其根长[(7.28±1.03) mm]与对照组[(9.80±1.46) mm]相比较短，根尖孔宽度[(2.18±0.6...     

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。     

咀嚼麦芽糖醇口香糖对唾液流率及pH值的影响

目的 探讨咀嚼麦芽糖醇口香糖对唾液流率与pH值的影响.方法 选10例志愿者,分别检测咀嚼麦芽糖醇口香糖或木糖醇口香糖前后不同时间段唾液的流率和pH值.应用SPSS 12.0软件分析.结果 咀嚼2种口香糖10 min内,唾液流率显著增加,在2～4 min时达到峰值,实验组和对照组分别为(4.24±0.30)mg/min和(4.53±0.19)mg/min.唾液pH值在2～4 min时上升至(7.16±0.15)和(7.02±0.20).两组的唾液流率与pH值之间差异均无统计学意义(P>0.05).结论 咀嚼麦芽糖醇口香糖也能促进唾液分泌,提高唾液pH值.     

生津活血中药在头颈部放疗中对涎腺功能影响的研究

目的探讨生津活血中药在头颈部肿瘤患者放疗过程中对涎腺功能的影响。方法将38例首程放疗的患者随机分为实验组(中药加放疗)18例和对照组(单纯放疗)20例。对放疗前及放疗不同剂量时的口干程度、pH值、唾液流率及淀粉酶浓度进行比较。结果随放疗剂量的增加,2组患者口干程度增加,唾液流率与淀粉酶浓度均降低。在放疗至20、40 Gy时实验组的唾液流率和淀粉酶浓度均较对照组高。但在达到60 Gy时,2组数据则趋于接近。另外,患者的主观口干程度与客观的唾液流率下降程度之间并不直接对应。结论①头颈部肿瘤患者在放疗过程中辅以生津活血中药,可在一定程度上改善口干症状,但并不足以预防放射性口干症的发生。②患者的口干严重程度和唾液流率下降程度之间并不严格对应,患者主观的口干程度并不能作为反映唾液腺功能受损程度的可靠指标。     

颌下腺部分切除术后腺体外分泌功能的临床研究

目的研究颌下腺部分切除术后颌下腺外分泌功能的改变。方法 52例颌下腺良性肿瘤患者,随机分为A、B两组,A组患者行颌下腺肿瘤和瘤周腺体区域性切除术,即颌下腺部分切除术;B组患者行肿瘤和颌下腺腺体全切除术,即常规颌下腺良性肿瘤手术。术前及术后1周、2周、1个月及半年,分别检测2组患者5 min内舌下区平均静息唾液分泌量,并进行对照分析。结果术前2组患者5 min内舌下区平均静息唾液分泌量基本相等;术后1周、2周、1个月及半年,5 min内舌下区平均静息唾液分泌量A组明显高于B组,A组患者5 min内舌下区平均静息唾液分泌量于术后1周、2周、1个月及半年的顺序递增,术后半年唾液分泌量比术前稍有减少,而B组患者术后唾液分泌量约为术前一半。结论颌下腺部分切除术充分保留了颌下腺的外分泌功能,保留的颌下腺组织外分泌功能随时间的推移逐步恢复。     

The contribution of oral minor mucous gland secretions to the volume of whole saliva in man

To determine the contribution of minor mucous gland secretions to total saliva by a direct method, flow rates of both unstimulated and sour lemon drop (SLD)-stimulated saliva were initially determined in 15 subjects. The right and left lingual nerves were then anaesthetized to halt submandibular and sublingual secretion, and both parotid ducts were cannulated. The only remaining saliva in the mouth was that secreted by minor salivary glands. Unstimulated and SLD-stimulated minor mucous gland secretions were then collected and the median percentage contributions to whole saliva were calculated to be 8 and 7 per cent, respectively. Comparable results were obtained on 3 subjects using an indirect method similar to that of Schneyer (1956). With the left parotid duct cannulated, subjects maintained a constant, SLD-stimulated, left parotid flow rate of 1 ml/min and the remaining mixed saliva was collected to determine its flow rate. The right parotid and the submandibular and sublingual glands were then also cannulated and the flow rate from these glands determined whilst that from the left parotid was maintained at 1 ml/min. The contribution from minor mucous glands was the difference between the flow rate of mixed saliva and the combined flow rate from the right parotid, submandibular and sublingual glands.     

The effect of X-ray irradiation on the function and saliva composition of rat parotid and submandibular/ sublingual glands

Radiation therapy to the head and neck area frequently causes severe salivary gland dysfunction and xerostomia. Morphological studies of irradiated salivary glands have suggested that the submandibular/sublingual gland may be less radiosensitive than the parotid gland. The purpose of this study was to evaluate the effect of radiation on major salivary gland functions in rats with radiation-induced xerostomia. The effect of salivary gland irradiation on salivary function was examined in specific pathogen-free Sprague-Dawley rats. The animals were irradiated with a single exposure of either 22 Gy or 32 Gy. Stimulated saliva excretion time was measured for the parotid and submandibular/ sublingual glands, and the total protein in saliva was analysed. Our results showed that the saliva flow rate and protein concentration of parotid saliva were significantly reduced in the 32 Gy-irradiated rats.     

Transplantation of vascularized submandibular gland in dogs.

PURPOSE: Presently, treatments for xerostomia only target symptoms, as an active therapy method has not been established. Herein, we discuss the possibility of using a submandibular gland allograft technique for the disease. MATERIALS AND METHODS: Using a vascularized submandibular gland transplantation method, we extracted portions of the submandibular gland, including the duct and chorda tympani branches, from beagle dogs and placed them into the submental region of age- and weight-matched dogs. We then measured the amount of saliva secretion and examined the grafted glands histologically. RESULTS: Sufficient quantities of saliva were secreted from the grafted glands with pilocarpine treatment. Histologic findings showed that the acinar cells in the grafted and untreated contralateral glands had some atrophy, as compared with the normal glands; however, periodic acid Schiff staining showed that they produced saliva. CONCLUSIONS: Transplantation of vascularized submandibular glands into dogs was successful and may become a novel treatment strategy for patients with xerostomia.     

Gland-sparing neck dissection: oncological and functional outcomes in oral cancer patients

This study was performed to evaluate the subjective and objective functional outcomes of patients who had undergone submandibular gland-sparing neck dissection. All data were obtained from patients treated in a single hospital. Seventy-seven patients who had undergone complete submandibular gland sparing (CSGS) were included in the study. Cancer prognosis items were recorded. The subjective outcomes included patient self-evaluation of mouth dryness and the evaluation of the presence of saliva secretion following the application of digital pressure. Saliva scintigraphy served as the objective test. Self-reported xerostomia was compared between the CSGS patients and a control group of patients who had undergone unilateral submandibular gland removal (USGR; n = 74). In the CSGS group, local recurrence occurred in 3.8% of the 80 cancer sites, and neck recurrence occurred in 5.9% of neck dissection sites. Regarding the subjective measurements, 7.0% of the CSGS patients reported xerostomia and 91.9% demonstrated saliva secretion by digital pressure. Scintigraphy revealed actively secreting glands, with 42.9% of them showing normal gland function; none of the patients had severe xerostomia. The relative risk of dry mouth was significantly higher in the USGR patients than in the CSGS patients (P < 0.001). Submandibular gland sparing during neck dissection was found to result in satisfactory saliva secretion, with a relatively small risk of local or neck recurrence.     

Parasympathectomy increases resting salivary secretion in normal and irradiated submandibular glands of rats

Fluid and ion secretion from the submandibular gland (SMG) is mainly regulated by parasympathetic nerves. This study evaluated the effect of parasympathectomy on salivary secretion from normal and irradiated rat SMGs from 1 to 24 wk after denervation. Although stimulated salivary secretion was significantly lower in denervated SMGs compared with contralateral self‐controls, the resting salivary flow rates were markedly higher in the denervated SMGs at 1, 12, and 24 wk after denervation. The levels of muscarinic acetylcholine M1 and M3 receptors, as well as of aquaporin 5, were up‐regulated. Notably, although irradiated SMGs showed significantly lower resting and stimulated salivary secretion rates than non‐irradiated SMGs, the resting salivary secretion rates of the irradiated and denervated SMGs were markedly higher than seen in the irradiated self‐control SMGs at 1, 12, and 24 wk after parasympathectomy, and were even higher than seen in the non‐irradiated sham‐operated rats. The expression of M1 and M3 receptors was similarly elevated. Taken together, our results suggest that parasympathetic denervation increases resting salivary secretion of both normal and irradiated SMGs. This approach might provide a potential modality for relieving radiation‐induced xerostomia, which is a common complication following treatment of head and neck cancer.     

Effect of cevimeline on radiation-induced salivary gland dysfunction and AQP5 in submandibular gland in mice

The aim of this study was to clarify the effects of the muscarinic receptor agonist, cevimeline, on saliva flow and expression of aquaporin5 (AQP5) in submandibular gland after X-ray irradiation. Using a previously established radiation-induced xerostomia model mouse, saliva flow from at 7 days before irradiation to at 28 days after irradiation was investigated in mice that were treated with cevimeline before or after irradiation. Radiation caused a significant decrease in saliva flow compared with nonirradiated salivary glands. Cevimeline post-treatment also caused a significant decrease in saliva flow. In contrast, cevimeline pre-treatment did not significantly decrease saliva flow. Expression of AQP5 fluorescent intensity and mRNA were also analyzed. Irradiation significantly decreased expression of AQP5 in submandibular gland. However, pre-treatment with cevimeline prevented this decrease in AQP5 expression. These data suggest that pretreatment with cevimeline prevents radiation-induced xerostomia and radiation-induced decrease in expression of AQP5 in submandibular gland.     

The effect of food consistency and dehydration on reflex parotid and submandibular salivary secretion in conscious rats

Changes in salivary secretion with different consistency of diet and dehydration were studied in male Wistar rats under unrestricted conditions. To measure the salivary secretion, a stop-flow method was used. There was little unstimulated salivary secretion from the parotid and submandibular glands, but eating solid, powdered, and liquid diets induced parotid and submandibular saliva. There was no significant change in the volume and flow rate of saliva in bilateral parotid glands during the eating of solid diets. The solid and powdered diets induced significantly more salivary secretion from the parotid gland than did the liquid. The salivary flow rate with solid diets was significantly greater from the parotid gland than from the submandibular. On the other hand, the salivary flow rate with the liquid diet was significantly smaller from the parotid gland than from the submandibular. Appreciable amounts of submandibular saliva, but little parotid saliva were secreted during grooming. Clearly, parotid and submandibular saliva have different roles in the rat. When injected intraperitoneally with 1.5 M NaCl solution or water-deprived for 24 h, rats took longer to eat the solid diets, and had increased salivary volume and decreased flow rate from the parotid gland. These results indicate that the moisture content of the diet and the dryness of the mouth alters the volume of parotid saliva secreted in rats and show that parotid saliva plays an important part in mastication and swallowing.     

颌下腺转位预防放射性口干的初步研究

目的评价颌下腺转位于颏下间隙后腺体功能及预防头颈部放疗导致的口干的效果。方法将3例头颈癌患者的颌外动脉和面前静脉近心端切断，保留该动静脉的远心端，并将其作为蒂，游离颌下腺后将其转位于颏下间隙。颈部放疗时屏蔽转住的颌下腺。术前术后以及放疗后检测颌下腺唾液流量，并填写华盛顿大学生活质量调查表。结果通过唾液流量分析，3例转住的颌下腺均成活。其中2例经放疗后20个月随访的患者，转住的颌下腺保存一定的泌唾功能，患者无口干症状。结论颌下腺转位于颏下区可保存其功能，有助于预防头颈癌患者放疗导致的口干。