涎腺内镜辅助颌下腺腺门结石取出术疗效分析

目的 分析涎腺内镜辅助颌下腺导管腺门段结石取出术的疗效.方法 2005年12月至2011年3月在北京大学口腔医学院·口腔医院经影像检查发现的颌下腺腺门结石患者80例,采用涎腺内镜探查颌下腺导管,观察结石及导管炎症情况,并在内镜辅助下取石.术后随访3～6个月,分析内镜辅助下取石的效果及术后并发症.结果 80例颌下腺腺门结石患者中,71例结石被完全取出,5例结石大部分取出,4例结石未取出,取石成功率为95％ (76/80).76例结石成功取出者中 8例由网篮套索取出;59例采用了涎腺内镜辅助下口内切开取石术;9例经网篮套索及口内切开法取出结石.术后并发症主要为暂时性舌神经麻痹(1例)及舌下腺囊肿(2例).结论 涎腺内镜技术对于颌下腺腺门结石是一种安全有效的诊疗手段,可减少并发症的发生,并可避免结石残留.     

涎腺内镜在颌下腺导管及导管内病变中的临床应用

目的:评价涎腺内镜在颌下腺导管及导管内病变中的临床应用.方法:选择自2006年9月至2007年2月因颌下区反复肿胀而在我科就诊的21例患者,行涎腺内镜诊治,其中男12例,女9例,年龄12～42岁,左侧14例,右侧7例.16例行颌下腺造影检查,5例行下颌横断咬合片检查.结果:X线片显示颌下腺导管阳性结石5例,其他原因致颌下腺导管阻塞16例.涎腺内镜检查显示:1)颌下腺导管病变:导管狭窄3例,扭曲2例,导管息肉2例,憩室2例.2)颌下腺导管内病变:阳性结石5例,阴性结石7例,粘液栓及脓栓在所有病例中均有不同程度的表现.涎腺内镜术后,阻塞症状基本消失,无明显并发症发生.结论:涎腺内镜是一种有前途的新技术,在颌下腺导管及导管内病变的诊断和治疗中是一种安全、有效、微创的方法.     

下颌下腺腺门区扩张与导管结石存在的相关性研究

目的:研究下颌下腺导管解剖形态的改变与涎石形成的关系。方法 :回顾性分析372例下颌下腺导管结石患者,在接受内镜治疗过程中镜下观察到的导管解剖形态资料,并用自凝塑料复制10例离体下颌下腺导管解剖形态铸型,分析导管解剖形态的改变与涎石形成的关系。结果:372例涎腺镜术中有326例在镜下发现涎石,在所发现的426颗结石中约67%的涎石位于导管腺门端1/3或腺门区。在发现涎石的病例中,内镜探查导管系统发现87.4%的病例存在腺门区壶腹状扩张现象。10例下颌下腺导管铸型均直观地表现出导管系统树形结构及腺门区壶腹状扩张现象。结论:下颌下腺导管结石患者普遍存在腺门区壶腹状扩张现象。大部分下颌下腺导管结石位于近导管腺门端1/3或腺门区。     

口内取石后内镜导管探查治疗下颌下腺导管后部结石

目的:探讨下颌下腺导管后部结石的治疗方法。方法:对40例下颌下腺导管后部结石口底黏膜切口,导管切开取石,应用涎腺内镜探查导管,使其通畅,随访术后腺体恢复和导管分泌情况。结果:36例局麻下取石,4例因肥胖手术视野较差和局麻下手术患者配合困难而采用全身麻醉,40例患者均成功取石。随访35例术后6月～1年没有再出现进食后下颌下肿胀,下颌下腺质地逐渐变软,舌下肉阜处导管口有清亮液分泌28例。结论:口内取石简便了取石方法,联合内镜导管探查有助于下颌下腺导管通畅,有利于取石后恢复和保存腺体功能。     

内镜用于唾液腺疾病的微创诊断和治疗

Endoscopy:aminimallyinvasiveprocedurefordiagnosisandtreatmentofdiseasesofthesalivaryglandsSixyearsofpracticalexperience.ZieglerCM,StevelingH,SeubertM,etal.BrJOralMaxillofacSurg,2004,42(1):1-7.微创技术目前在外科领域广为应用,涎腺内镜是其中之一,为唾液腺疾病的诊治提供了有价值的手段。本文对72例唾液腺进行了内镜检查,并发症轻微。主要用于下颌下腺及腮腺的涎石病诊治,尤其利于阴性结石的诊断和取出,从而保留了腺体功能,免除了手术治疗。内镜用于唾液腺疾病的微创诊断和治疗…     

涎石症研究进展

涎石症的确切发病因素和形成机制尚不清楚，目前主要是对唾液成分和导管解剖改变的研究；应用磁共振涎管造影和涎腺内镜能较直观地显示涎石，是早期诊断涎石症的可靠手段；随着微创技术在涎石取石中的应用和改进．越来越多的涎石症患者不需行腺体切除术，从而得以保留腺体及其功能。作者对涎石症的病因学、诊断和治疗方法的研究进展作一综述。     

下颌下腺导管大型结石的治疗及预后

目的:总结内镜辅助下经口内行下颌下腺导管大型结石取石术的经验。方法:收集近10年间下颌下腺导管结石病例,结石最长径均>1 cm。所有病例均进行肿胀症状VAS评分,选取病程较长(≥1年)者,应用99mTc放射性核素显像评估腺体功能。所有大型结石均在内镜辅助下经口内路径行取石术,未成功取出者则行患侧下颌下腺摘除术。利用VAS评分对取石术后患者进行疗效评估。结果:在642例取石术中,106例(16.5%)为下颌下腺导管大型结石病例。其中,19例患者在术前进行放射性核素检查,6例患侧腺体功能完全丧失,9例部分丧失,4例患侧与健侧相比无显著差异。经口内路径取石术成功率为95.3%(101/106)。内镜探查发现,29例患者导管远端残余结石,利用抓钳或套石篮成功取出23例残余结石。术后随访显示,所有患者术后腺体肿胀症状缓解。结论:下颌下腺大型结石可行口内路径取石术并保留腺体,大部分患者在术后腺体肿胀症状完全消失。     

涎腺内镜诊治慢性阻塞性下颌下腺炎14例报道

目的：评价涎腺镜在诊断和治疗慢性阻塞性下颌下腺炎中的价值。方法：对14例临床诊断为慢性阻塞性下颌下腺炎的患者进行涎腺镜检查．了解导管壁和导管内的表现，并同时通过涎腺镜进行相应的治疗，包括液电碎石术、钳取术和套石篮取石术、导管清扫扩张术．将结石或黏液栓子取出。结果：14例患者涎腺镜诊断的阻塞原因分别是：阳性结石10例、阴性结石1例，黏液栓子1例，管壁严重增生2例(其中1例结石嵌入)。11例患者成功应用治疗性涎腺镜取出结石或去除黏液栓子，导管扩张灌洗后阻塞症状消失；3例治疗失败，原因主要为导管增生、结石嵌入。术后无明显并发症发生。结论：涎腺镜能直观地了解涎腺导管内的病变表现，明确导管阻塞原因，并可同时进行相应的治疗，为慢性阻塞性下颌下腺炎的诊断和治疗提供了新的有效方法。     

下颌下腺阳性结石的锥形束CT诊断

目的 研究下颌下腺结石在锥形束CT（CBCT）影像上的特征。方法 收集84例下颌下腺结石患者的临床基本资料,包括年龄与性别,以及CBCT影像资料,记录影像资料中结石的数目、形态、大小,以及位置情况,再进一步行统计分析。结果 84例患者共计有阳性结石128个,22例患者（占26.19%）具有多发结石;结石形态可分为点状、类圆形、椭圆形、长条形以及不规则形,其中椭圆形最多;结石大小与其水平位置相关,越靠后的结石,其大小具有增大的趋势;发生在导管前段的结石有50个（占39.06%）,发生在导管后段的结石有78个（占60.94%）,结石水平位置与垂直位置间存在相关性（P<0.000 1）。结论 CBCT对下颌下腺结石各项特征的评估,以及辅助临床诊断和制定治疗计划具有重要的价值。     

CBCT定位结合涎腺镜指导颌下腺后段导管结石的处理策略

目的:探讨CBCT定位结合涎腺镜指导颌下腺后段导管结石的处理策略。方法:回顾分析颌下腺后段导管结石初治的患者共77例的CBCT和临床资料,以CBCT矢状位三维成像,磨牙后纵线为解剖标志线,并根据结石横径和位置将患者分为4组,Ⅰ组：线后结石(n=22);Ⅱ组：线前直径>4 mm结石(n=33);Ⅲ组：线前直径<3 mm结石(n=17);Ⅳ组：线前直径3～4 mm结石(n=5)。对Ⅰ组患者手术从口外入路摘除腺体同时去除结石,对Ⅱ组30例在内镜辅助下口内旁路切口取出结石保留腺体(预定方案), 3例切除腺体(改行方案)。Ⅲ组16例均通过涎腺内镜从导管内直接取出(预定方案), 1例通过口内旁路取出(改行方案)。Ⅳ组3例通过涎腺内镜从导管内直接取出(预定方案), 2例改为口内旁路方案。结果:预定方案手术成功率Ⅰ组100%,Ⅱ组90.9%,Ⅲ组94.1%,Ⅳ组60%。并发面神经损Ⅰ组2例(9.0%),舌神经损伤Ⅰ组4例(18.1%),Ⅱ组12例(40.0%)。术后结石复发Ⅱ组2例(6.7%),Ⅲ组1例(6.7%)。结论:CBCT定位结合涎腺镜指导颌下腺后段导管结石清除术能够在尽量保留腺体...     

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阻塞性涎腺疾病在临床上较为常见,随着涎腺镜技术的发展及应用,人们对其认识不断深入。本文主要通过回顾近几年来涎腺镜技术的临床应用,探讨阻塞性涎腺疾病的病因及治疗进展。     

涎腺内镜在慢性颌下腺炎病因诊断中的价值--78例临床报告

目的：评价涎腺内镜在慢性颌下腺炎病因诊断中的价值。方法：对78例因颌下腺反复肿胀就诊的患者行颌下腺涎腺内镜检查,明确导管系统的病变。结果：7例因导管重度狭窄放弃检查,71例完成涎腺内镜检查（91．0％）。59例通过涎腺内镜可发现明确的导管系统病变,其中结石31例,23例存在导管增生扩张、粘液栓及纤维素样渗出形成;导管息肉2例,导管畸形2例。多数病例导管内壁可见不同程度的充血、糜烂性炎症。此外,12例患者通过内镜未发现可观察到的明确的病变。结论：涎腺内镜可直观、有效地观察颌下腺导管系统的病变,具有较高的诊断价值。     

釉质白垩色斑病损的微创治疗

本文介绍了一项白垩色斑病损的微创治疗方法。该技术通过微量磨除釉质表面的过矿化层，之后每天使用家庭酪蛋白磷酸肽-无定形磷酸钙复合体（casein phosphopeptide—amorphous calcium phosphate complexes，CCP—ACP），达到釉质的再活化。这一技术可以不使用修复方法而去除白垩色斑病损。微磨除联合长期的CCP—ACP家庭应用可作为替代修复手段治疗白垩色斑病损的选择。     

Primary tuberculosis of submandibular gland

Salivary gland tuberculosis is a rare pathology and does not always have the diagnostic guidelines led by previous tubercular localizations. Tubercular bacillus can reach the salivary gland in different ways, but the condition that most frequently causes a tubercular infection is the decay of the human organism defensive capacity toward the germ.A 15-year-old Romanian boy presented with a swelling in the left submandibular region. Normal extraoral, intraoral examination, and routine diagnostic examinations were performed. In order to make a final diagnosis, we performed a surgical left submandibular gland sialo-adenectomy operation to enable a histologic examination of the withdrawn tissue.Microscopic examination of the gland and lymph nodes showed a chronic necrotizing phlogosis of tubercular type. Previous routine examinations have been important only after final diagnosis to confirm that the submandibular tubercular localization was a primary infection.Diagnosis of this kind of disease is extremely difficult and is made with certainty only with the histologic examination, as happened in our case.     

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.     

Sialoendoscopy: A new approach to salivary gland obstructive pathology

BACKGROUND: During the last 13 years, there has been a growing interest in and use of minimally invasive treatment techniques. Salivary gland endoscopes provide an accurate means of diagnosing and providing minimally invasive surgical treatment for salivary gland diseases. METHODS: The authors review the relevant literature and provide the history of sialoendoscopy. They also report on the treatment methods they use, including instruments and techniques, and their experiences. RESULTS: The authors' overall success rate for parotid endoscopic sialolithotomy is 86 percent, and their overall success rate for submandibular endoscopic sialolithotomy is 89 percent. Their success rate for treating strictures is 81 percent. CLINICAL IMPLICATIONS: The endoscopic technique opens new horizons in the field of salivary gland diseases. Salivary gland stones and sialadenitis no longer are absolute indications for sialadenectomy. Owing to growing experience and surgical skills, new endoscopic techniques are in clinical use, and there is constant improvement in endoscopic treatment success rates. CONCLUSIONS: Sialoendoscopy is a promising new method for use in the diagnosis, treatment and postoperative management of sialadenitis, sialolithiasis and other obstructive salivary gland diseases.     

腮腺深部肿瘤手术治疗

目的了解腮腺深部肿瘤的发病情况.方法总结我院30例腮腺深部肿瘤诊治经验对诊断、治疗及术后注意事项有重要参考价值.结果本组病例经术前诊断及手术治疗,达到了预期目的.结论常规腮腺切口或下颌骨截断手术方法对于腮腺深部肿瘤治疗能取得比较理想效果.     

Minimally legally invasive dentistry

One disadvantage of the rapid advances in modern dentistry is that treatment options have never been more varied or confusing. Compounded by a more educated population greatly assisted by online information in an increasingly litigious society, a major concern in recent times is increased litigation against health practitioners. The manner in which courts handle disputes is ambiguous and what is considered fair or just may not be reflected in the judicial process. Although legal decisions in Australia follow a doctrine of precedent, the law is not static and is often reflected by community sentiment. In medical litigation, this has seen the rejection of the Bolam principle with a preference towards greater patient rights. Recent court decisions may change the practice of dentistry and it is important that the clinician is not caught unaware. The aim of this article is to discuss legal issues that are pertinent to the practice of modern dentistry through an analysis of legal cases that have shaped health law. Through these discussions, the importance of continuing professional development, professional association and informed consent will be realized as a means to limit the legal complications of dental practice.