Botulinum toxin for ductal stenosis and fistulas of the main salivary glands

This study was performed to present the authors’ experience with botulinum toxin therapy for salivary stenosis and salivary fistula in terms of the procedure, dosage, effectiveness, and complications. A retrospective study of all patients treated in the maxillofacial surgery department for salivary stenosis or fistula from January 2014 to September 2018 was performed. Intraglandular injections of incobotulinumtoxinA (Xeomin) were utilized. The frequency of relapse and the pain recorded before injection and at 3 months after each injection or fistula resolution were assessed. Swallowing dysfunction or any diffusion of toxin into the facial muscles was recorded. This study included 22 patients (mean age 53 years). Botulinum therapy was indicated for parotid duct stenosis in 14 patients, submandibular duct stenosis in four patients, and parotid fistula in four patients. The frequency of relapse (P = 0.0001) and pain level (P = 0.0001) decreased after botulinum therapy. The average duration of the botulinum effect was 4.50±2.00 months after the first injection. No complication was observed. Botulinum therapy with 100 IU of Xeomin proved effective at resolving salivary fistula. Botulinum therapy is an effective treatment for symptoms of salivary duct stenosis in patients for whom minimally invasive procedures have failed. Botulinum therapy can also be used for the treatment of salivary fistulas.     

Factors influencing the long-term results of autologous microvascular submandibular gland transplantation for severe dry eye disease

We assessed long-term outcomes of autologous microvascular submandibular gland (SMG) transplantation for severe dry eye disease and investigated factors influencing long-term results. From August 1999 to January 2015, 185 patients (200 eyes) with severe dry eye received SMG transplantation. Subjective assessments and ophthalmologic evaluations were performed before and after transplantation. Follow-up results showed successful transplantation in 180 of 200 eyes (success rate: 90%), resulting in marked symptomatic relief of xerophthalmia. Surgery failed due to vascular thrombosis (15 glands) and duct obstruction (5 glands). Follow-up data were available for 163 eyes. Epiphora occurred in 98 (60.1%) eyes and was effectively managed by surgical reduction of graft, topical atropine gel and botulinum toxin injection. Wharton’s duct obstruction occurred in 16 (10.6%) eyes and was treated by duct reconstruction. Subjective satisfaction was achieved in 143 (87.7%) eyes. Mean score of fluorescent staining reduced from 11.25 ± 1.42 to 7.25 ± 3.37. Postoperative best-corrected visual acuity improved in 85 (56.3%) eyes. Our clinical experience proved that SMG transplantation is effective and grants long-term improvement in severe dry eye. Secretory function of transplanted SMGs remains active and stable. Blood vessel thrombosis, Wharton’s duct obstruction, and epiphora are primary factors influencing results.     

Botulinum toxin A for patients with orofacial dystonia: prospective,observational, single-centre study

The objective of this study was to demonstrate the efficacy of intramuscular botulinum toxin type A (BTX-A) as a method of controlling the symptoms of focal facial dystonia. A prospective, longitudinal, observational, pre–post (case-series) single-centre study was conducted over a period of 3 months, involving 30 patients with focal dystonia. The patients were enrolled on a first-come, first-served basis. For all patients, the abnormal movements were evaluated using the Abnormal Involuntary Movement Scale (AIMS). The AIMS results were recorded immediately before BTX-A injection (primary predictor variable) and after 3 months (the toxin reaches its maximum effect 2 weeks after injection, and the effect is maintained for 3 months). An improvement in AIMS score was the primary outcome variable. Treatment efficacy was evaluated using the Pearson correlation index with a level of significance of P < 0.05. The average age of the study subjects was 70.9 ± 12.7 years (20 female, 10 male). The mean dose of BTX-A used was 27.4 ± 20.5 U. The mean improvement in AIMS score after treatment was 5.2 ± 4.2. A significant correlation was found between the dose applied and the reduction in AIMS score (P < 0.05). BTX-A can be used in the treatment of focal dystonia and provides reproducible results.     

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...     

层粘连蛋白对体外培养颌下腺细胞影响的研究

目的：研究层粘连蛋白（laminin，LN）对鼠颌下腺细胞（rat submandibular gland cells，RSGCs）生长及分泌功能的影响。方法：取对数生长期的第2代大鼠颌下腺细胞用于实验，按加入不同浓度LN分4组（0、5．0、25．0和50．0mg／L）进行培养，相差显微镜的观察，绘制生长曲线，MTT比色法、自动生化分析仪检测LN对细胞增殖及淀粉酶分泌功能的影响。结果：培养的RSGCs免疫组化鉴定CK8．13、S-100蛋白染色呈阳性，波形丝蛋白染色呈阴性。培养72h后MTT法检测5．0-50．0mg／LLN组细胞吸光度A值与对照组比较差异有统计学意义（P〈0．05）。培养96h后检测培养液中淀粉酶的含量，各浓度组与对照组相比差异无统计学意义（P〉0．05）。结论：LN能促进RSGCs的黏附和增殖并保持RSGCs的正常分泌功能。     

Bilateral gustatory sweating in the submandibular region after bilateral neck dissection successfully treated with botulinum toxin

Gustatory sweating (or chorda tympani syndrome) in the submandibular region is a rare complication of cervical surgery. We report a 66-year-old patient who had been referred for the management of a squamous cell carcinoma of the mobile tongue. She was treated by bilateral neck dissection and bilateral resection of the submandibular glands. Bilateral gustatory sweating in the submandibular region developed 10 years later and was successfully treated with bilateral injections of botulinum toxin type A.     

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。     

����ٽ�ʯ�о���������״

颌下腺结石是临床上最常见的颌下腺非肿瘤性疾病,多数病例需手术治疗.单纯手术治疗技术简单,短期内效果较好,但由于临床医生对颌下腺腺体功能的保留与功能恢复的促进重视不够,致使颌下腺摘除术广泛应用于临床,不仅损失了腺体这一功能器官,而且在颈部留下明显的手术瘢痕和凹陷畸形.     

A gland of diverse pathology and unpredictable behaviour: our experience of primary submandibular gland malignancies

Submandibular gland tumours are relatively uncommon tumours and demonstrate diverse histological types and a variable prognosis. The aim of this study was to analyze our experience with submandibular malignancies over a period of 6 years (January 2009 to December 2015). Patient data from the 6-year period were reviewed retrospectively and 51 patients with submandibular malignancies were identified. Demographic data, clinicopathological details, treatment received, complications, and follow-up were recorded. The mean age of the 51 patients at presentation was 49.1 years. They were followed up for a mean 20.3 months. Nine of 47 patients (19.1%) developed distant metastasis during follow-up, while only three (6.4%) developed local recurrence. Disease-free survival at 2 years was 69.7% and overall survival at the end of 2 years was 77.8%. Actuarial 5-year survival was 57.8% when all subtypes were considered. The overall mean time to recurrence was 10 months (6–24 months). Nodal positivity was the only prognostic factor that was significant on multivariate analysis, while age, sex, perineural invasion, and grade were not. With advances in surgical and radiotherapy techniques, loco-regional control rates have improved greatly; however, effective adjuvant treatment to prevent systemic relapse is still lacking.     

Botulinum toxin for the treatment of bruxism

Aims: Botulinum toxin, the most potent biological toxin, has been shown to be effective for a variety of disorders in several medical conditions, when used both therapeutically and cosmetically. In recent years, there has been a rising trend in the use of this pharmacological agent to control bruxing activity, despite its reported adverse effects. The aim of this review was to provide a brief overview to clarify the underlying essential ideas for the use of botulinum toxin in bruxism based on available scientific papers.

Methodology: An electronic literature search was performed to identify publications related to botulinum toxin and its use for bruxism in PubMed. Hand searching of relevant articles was also made to identify additional studies.

Results: Of the eleven identified studies, only two were randomized controlled trials, compared with the effectiveness of botulinum toxins on the reduction in the frequency of bruxism events and myofascial pain after injection. The authors of these studies concluded that botulinum toxin could be used as an effective treatment for reducing nocturnal bruxism and myofascial pain in patients with bruxism.

Conclusion: Evidence-based research was limited on this topic. More randomized controlled studies are needed to confirm that botulinum toxin is safe and reliable for routine clinical use in bruxism.     

Carbachol improves secretion in the early phase after rabbit submandibular gland transplantation

Oral Diseases (2010) 16 , 351–359 Objectives: To investigate the changes in the muscarinic receptor signaling pathway with submandibular gland (SMG) transplantation and whether carbachol improves secretion in transplanted SMGs. Materials and methods: SMG autotransplantation was performed in a rabbit model. Carbachol (1 μM) was infused into the transplanted glands from postoperative day 1–7. The expression of the M1 and M3 muscarinic receptors, aquaporin‐5 (AQP5), and phosphorylated extracellular signal‐regulated kinase 1/2 (p‐ERK1/2) was measured by RT‐PCR, immunoblotting or immunofluorescence. The content of inositol 1, 4, 5‐trisphosphate (IP₃) was measured by radioimmunoassay. Results: Salivary flow of the transplanted SMGs was decreased after transplantation. As well, the expressions of M1 and M3 receptors and their downstream signaling molecules, IP₃, p‐ERK1/2 and AQP5, were all reduced. Atrophy of acinar cells was shown in transplanted glands. However, all these alterations were reversed after carbachol treatment for 7 days. Furthermore, carbachol directly increased the mRNA expression of AQP5 and phosphorylation of ERK1/2 in cultured neonatal rabbit SMG cells. Conclusion: A lack of acetylcholine and downregulation of the muscarinic receptor signaling pathway is involved in the early hypofunction of transplanted SMGs. Carbachol treatment could be a new therapeutic strategy to improve secretion and prevent the obstruction of Wharton’s duct in the early phase after SMG transplantation.     

AQP6和AQP5在人下颌下腺上的免疫组化定位

目的检测水通道蛋白亚型AQP6和AQP5在人下颌下腺的分布情况。方法对源自10例行颈淋巴清扫术患者的正常颌下腺组织,通过免疫组织化学染色方法,标记确定人下颌下腺组织中AQP6和AQP5的分布情况。结果 AQP6在部分颌下腺腺泡细胞质中表达。AQP5在浆液性腺泡和粘液性腺泡顶膜以及分泌小管均有表达,而闰管和纹状管未见表达。结论 AQP6在部分颌下腺腺泡细胞中表达,与AQP5相协调,参与唾液中水和阴离子的分泌调节。     

血管化自体颌下腺移植术中重建血液循环的护理配合

目的 探讨和总结血管化自体颌下腺移植术中重建血液循环的护理配合措施.方法 分析2005年1月-2009年3月北京大学口腔医院手术室完成的56例血管化自体颌下腺移植手术的临床资料,总结术中血液循环重建时的护理配合体会.结果 56例自体颌下腺移植手术结束时,移植腺体的血液循环全部重建满意,吻合口血流通畅,没有血栓形成.术后...     

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.