自体下颌下腺移植治疗重症干眼症的供体制备

采用血管化自体下颌下腺移植治疗9例重症干眼症患者。1例患者部分移植腺体坏死;1例患者发生下颌下腺导管瘘;其余7例术后恢复良好。3个月后随访,1例眼干症状改善,人工泪液使用减少,其余8例眼干症状改善明显或基本消失,停用人工泪液,临床疗效满意。认为血管化自体下颌下腺移植治疗重症干眼症的疗效确切,成功率较高,是目前值得推荐的治疗重症干眼症的方法。     

面动脉伴行静脉作为自体颌下腺移植回流静脉的可靠性探讨

目的 探讨面动脉伴行静脉作为血管化自体颌下腺移植供区静脉的可靠性,以期为临床提供指导.方法 对1999年8月至2007年11月期间完成的117例共122侧血管化自体颌下腺移植回顾性研究,根据腺体移植时所选用供区静脉的不同,将全部病例分成3组:面静脉组(93侧)、伴行静脉组(27侧)和腺门静脉组(2侧),并分析各组腺体移植术后静脉危象的发生率及其处理情况.结果 术后共有16侧移植腺体出现静脉危象,其中面静脉组14侧(15%),伴行静脉组2侧(7%),两者差异有统计学意义(P<0.01).面静脉组中有7侧因静脉危象导致失败(8%),伴行静脉组中有2侧因静脉危象导致失败(7%),两者差异无统计学意义(P>0.05).结论 面动脉伴行静脉是自体颌下腺移植可靠的回流静脉,只要管径合适,面动脉伴行静脉应作为自体颌下腺移植的首选供区静脉.     

血管化自体下颌下腺移植治疗重症角结膜干燥症的初步研究

目的:应用血管化自体下颌下腺移植的方法治疗重症角结膜干燥症,并评价其疗效.方法:纳入重症角结膜干燥症患者4例,将患者下颌下腺移植至颞部,完成血管吻合,并将移植腺体导管重新开口于患眼.术后监测移植腺体血运并调控其分泌功能,对患眼治疗效果进行评估.结果:2017—2019年共治疗了4例患者的5只眼,其中1例接受双侧眼部手术...     

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。     

去上皮逆行面动脉-颏下动脉颏下岛状瓣修复上颌术后缺损

目的：探讨去上皮逆行面动脉-颏下动脉颏下岛状瓣对上颌骨术后缺损的修复效果。方法：回顾性研究我科自2007年3月-2009年1月应用去上皮逆行面动脉-颏下动脉颏下岛状瓣修复上颌骨术后缺损病例13例。其中男9例。女4例。所有病例均经病理学检查确诊,其中10例诊断为上颌牙龈鳞状细胞癌,其余3例诊断为硬腭鳞状细胞癌。依据Brown等提出的上颌骨缺损分类法,术后缺损为2a型．用以同期修复的面动脉-颏下动脉岛状瓣长度约8～10cm．宽度约4～5cm。结果：面动脉-颏下动脉岛状瓣的存活率为92.3％（12／13）,未见供区并发症及面神经下颌缘支损伤。随访8～24个月．1例原发灶复发后死亡,2例颈淋巴结复发。结论：去上皮逆行面动脉-颏下动脉颏下岛状瓣具有安全、简单、易于改良等优点,适用于无区域性淋巴结转移的恶性肿瘤术后上颌骨缺损修复。     

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。     

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。     

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...     

甘草甜素对小鼠颌下腺纤维肉瘤移植瘤抑制作用的实验研究

甘草具有解毒功效，广泛应用于临床。我们研究它的主要水溶性物质甘草甜素(glycyrrhizin，GL)的抗肿瘤作用及其机制。     

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。     

Transplantation of a reverse facial artery pedicled submandibular gland in a dog

This study was performed to evaluate the possibility of using reverse facial artery pedicled submandibular gland transfer for treating keratoconjunctivitis sicca. A reverse facial artery pedicled submandibular gland, including the duct, from a beagle dog was transplanted into the temporal region in the same animal. 99mTc pertechnetate scintigraphy was used to monitor graft viability, and the grafted glands were examined histologically 12 weeks after transplantation. Postoperative 99mTc pertechnetate scintigraphy demonstrated viable salivary gland tissue in the transplanted region. Histologically, some of the acinar cells in the graft had atrophied. The transplantation of a reverse facial artery pedicled submandibular gland was successful and may be a simple, reliable treatment for patients with 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.     

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.     

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.