Clinical study of endoscopy-assisted lithectomy of parotid gland calculi via a transoral approach / 中华口腔医学杂志

Objective@#To investigate the indications and long-term outcomes of endoscopy-assisted removal of parotid gland calculi via a transoral approach.@*Methods@#From August 2005 to December 2016, 158 consecutive patients with parotid gland calculi underwent endoscopy-assisted lithectomy transorally. They included 71 males and 87 females, with an age of 5-84 years. The immediate safety and effectiveness were evaluated. After surgery, the patients were followed up, and gland function was analyzed on the basis of clinical manifestations, sialography, scintigraphy and sialometry. Postoperative sialograms were categorized into 2 types: ①type Ⅰ, the main duct was normal or had ectasia and stenosis, but no persistent contrast was seen on the functional film; ②type Ⅱ, the main duct had ectasia or stenosis, with persistent contrast media on the functional film.@*Results@#Under one endoscopic procedure, the stones (or foreign bodies) were completely removed in 134 cases and almost completely removed in 10 cases, with a success rate of 91.1% (144/158). Of the 144 successful cases, the treatment options included direct basket retrieval or forceps grasping in 77 cases, basket entrapment with direct ostium incision in 36, basket capture with perio-ostium incision in 23 and perio-ostium incision in 8 cases with impacted stones. In two of the initial 14 failure cases, the stones were discharged spontaneously 3 months after operation. During 3-120 months′ follow-up (mean 36 months) of the 146 patients, one had recurrent stone, two developed ductal obturation, 16 had mild symptoms, and the remaining 127 cases were asymptomatic. Of the postoperative sialograms in 34 stone-free patients 25 were type Ⅰ, 9 were type Ⅱ. Both scintigraphy and saliva flow rate indicated an improvement of the affected gland function in some degree (P<0.05).@*Conclusions@#Transoral endoscopy-assisted removal of parotid gland calculi is a safe and effective technique. It is mainly indicated for mobile stones in the main duct or impacted stones in the anterior third of the Stensen′s duct. Sialography, scintigraphy and sialometry show postoperative improvement of gland function in most of the cases.

Endoscopy-assisted transoral removal of deep hilar and intraparenchymal stones in the Wharton′s duct / 中华口腔医学杂志

Objective@#To investigate the different surgical approaches and long-term outcomes of endoscopy-assisted transoral removal of deep hilar and intraparenchymal stones in the Wharton′s duct.@*Methods@#From January 2008 to March 2018, 481 consecutive patients with deep hilar and intraparenchymal calculi in the Wharton′s duct underwent endoscopy-assisted transoral removal at Deparment of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology. There were 250 males and 231 females. Their ages ranged from 9-86 years. We operated 476 patients under local anesthesia on an outpatient basis, and the remaining 5 were operated under general anesthesia. On the basis of ultrasonography, spiral CT, sialography and endoscopy, the calculi were classified into 4 types: hilum stones (located at the hilum or proximally with a distance <5 mm from the hilum), infra-hilum stones (intra-glandular stones with a distance of 5-10 mm from the hilum), intraparenchymal stones (with a distance ≥10 mm from the hilum), and multiple stones (concomitant hilum and intra-glandular stones). The treatment approaches included: hilum duct slitting, intraparenchymal duct slitting, submandibulotomy and intraductal retrieval. The success rate, immediate safety and effectiveness of different types of stones were evaluated. After surgery, the patients were followed up, and gland function was analyzed on the basis of clinical symptoms and signs.@*Results@#The calculi sizes varied from 3 to 25 mm, with a mean of 7.8 mm. The calculi were located in the right submandibular gland in 259 patients, in the left submandibular gland in 219 patients and in bilateral glands in 3 patients. The calculi were successfully removed in 446 glands, with a success rate of 92.1% (446/484). The success rate varied according to the stone sites: 97.8% (363/371) for hilum stones, 64.4% (29/45) for infra-hilum stones, 4/16 for intraparenchymal stones and 96.2% (50/52) for multiple stones. The main treatment methods applied included hilum duct slitting in 347 glands, intraparenchymal duct slitting in 13, submandibulotomy in 4, intraductal retrieval in 73, and hilum duct slitting accompanied by intraductal retrieval in 9. Ductal breakage occurred in 2 glands. All patients complained of mild to moderate pain with a duration of 3-7 days. Nine had temporal lingual nerve injury. During 3-120 months′ follow-up (mean 36 months) of the total 484 glands, 1.6% (7/446) developed ranula, 1.3% (6/446) experienced obturation of the main duct and 2.0% (9/446) had recurrent stones. The remaining 95.1% (424/446) glands were symptom-free with good function.@*Conclusions@#Endoscopy-assisted transoral removal of deep hilar and intraparenchymal submandibular calculi is a safe and effective gland-preserving procedure. According to the depth, size and number of the calculi, variant surgical approaches should be attempted to maximize the success rate and to minimize the side effects.

Imaging analysis of ameloblastoma, odontogenic keratocyst and dentigerous cyst in the maxilla using spiral CT and cone beam CT / 中华口腔医学杂志

Objective@#To analyze the radiolographic features of ameloblastoma (AM), odontogenic keratocyst (OKC) and dentigerous cyst (DC) in the maxilla by spiral CT (SCT) and cone-beam CT (CBCT), and to provide useful information for the differential diagnosis of benign radiolucent lesions in the maxilla.@*Methods@#Clinical records, histopathological reports and SCT or CBCT imaging of 85 patients with primary maxillary AM, OKC or DC admitted to Peking University School and Hospital of Stomatology from December 2012 to May 2017 were collected. Radiographic characteristics including site, size, shape, cortex expansion, internal structure and effects on neighboring tissue were analyzed. For OKC and DC, the relationship between cysts and enveloped teeth was classified as centripetal, eccentric and adherent.@*Results@#The 85 patients included 56 males and 29 females, aged from 8 to 84 years old. Eighty-three patients had a single lesion, whereas 2 patients had bilateral cysts. In total, 87 lesions were analyzed, comprising 22 AM, 45 OKC and 20 DC. Among the 22 AM, 11 lesions were desmoplastic type, 16 were round-like in shape and 18 presented with buccal expansion. The shapes of the 45 OKC varied as round-like (n=26), oval (n=3), reniform (n=4), sinus-like (n=5), sinus+round (n=5) and irregular (n=2). Furthermore, 30 OKC presented with buccal expansion, 22 nearly filled the maxillary sinus and 26 were 'dentigerous'. The tooth-cyst relationship of the 'dentigerous' OKC was centripetal in 11, eccentric in 4 and adherent in 11. Among the 20 unicystic DC, 8 lesions were centripetal, 6 were eccentric and 6 were adherent type; 16 DC presented with buccal expansion.@*Conclusions@#Demosplastic type is common in maxillary AM. Most AM are round-like in shape and expand buccally. The shape of maxillary OKC varies greatly and maxillary sinus filling is common. More than a half of OKC appear 'dentigerous'. For DC and OKC, tooth-cyst relationship can be centripetal, eccentric and adherent.

Endoscopy-assisted sialolithectomy for the calculus of the Stensen's duct / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To investigate the clinical effects of endoscopy-assisted sialolithectomy for the calculus in the Stensen's duct.</p><p><b>METHODS</b>From August 2005 to July 2013, 67 consecutive patients with calculus (or foreign bodies) in the Stensen's duct underwent explorative and interventional endoscopy in our hospital. The stones (or foreign bodies) were removed by endoscopy-assisted technique. After operation, the patients were followed-up periodically, and treatment effects were analyzed.</p><p><b>RESULTS</b>Among the 67 patients, the stones (or foreign bodies) were completely removed in 58 cases, and almost completely removed in 3 cases, with a success rate of 87% (58/67). Among the 61 stone-removed cases, treatment options included direct removal with aid of basket or forceps (24 cases), basket entrapment and opening-up of the ostium (21 cases), basket entrapment and mucosal incision near the ostium (8 cases), open removal via buccal incision (2 cases) and open removal via pre-auricular flap (6 cases). During the 6-90 months' follow-up of the 61 cases, 48 cases were asymptomatic, 7 had mild symptoms, 3 developed ductal obturation, 1 had numbness in the parotid region, and the remaining 2 were missed.</p><p><b>CONCLUSIONS</b>Endoscopy-assisted sialolithectomy is a safe and effective gland-preservation technique for the patients with parotid gland calculus.</p>

Diagnostic evaluation of the temporomandibular joint osteoarthritis using cone beam computed tomography compared with conventional radiographic technology / 北京大学学报(医学版)

Objective: Osteoarthritic lesions of Temporomandibular joint(TMJ) were assessed by dental cone beam computed tomography(CBCT),and compared with conventional radiographic technology. Methods: The study was conducted retrospectively on 511 joints of 350 patients, who had undergone dental CBCT ,panoramic radiography,transcranial projection and transpharygeal projection of TMJ . The results were compared and the accuracy with CBCT was assessed. The types of osseous condylar abnormalities were observed.Results: (1) The occurrence of osteoarthritis in male and female were 59.04% and 69.66%, respectively, with no significant difference. (2) Compared with CBCT, panoramic radiography,transpharygeal projection examination showed no significant difference, with the accuracy being 90.64% and 94.10%,respectively;However, transcranial projection indicated a significant difference in comparison with CBCT and the accuracy was 86.97%. (3) A higher occurrence of osteoarthritic lesions of the condyle was sclerosis (39.86%). Bony proliferation or osteophyte (28.18%) and ill-defined cortical bone (18.90%) were followed. Conclusion: Cone beam CT, which reproduces multiple images including axial, coronal and sagittal planes of the joint, provides a complete radiographic investigation of the bony components of the TMJ. It is one of the best choices of imaging diagnosis of TMJ osteoarthritis. Panoramic radiography and transpharygeal projection examination are also good choices for showing osseous condylar abnormalities in the clinic, but transcranial projection examination is inferior.

Investigation of temporomandibular joint space of healthy adults by using cone beam computed tomography / 北京大学学报(医学版)

0.05).Conclusion:All the results of the five measurement methods showed that the condyle was located in the center of the fossa with a variation in the healthy adults in intercuspal position.The CBCT image of the sagittal middle layer of the joint could show the joint space accurately and has an important value in the research related to the changes of TMJ space.

Angiographic study of dangerous anastomasis of the external carotid artery / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To investigate the dangerous anastomasis between the external carotid artery and the intracranial arteries.</p><p><b>METHODS</b>Angiograms of the external carotid artery in 250 cases were analyzed, including 35 cases of moyamoya and 215 cases of head and neck lesions.</p><p><b>RESULTS</b>The 35 cases of moyamoya, 14 middle meningeal arteries (MMA) were found to participate in the blood supply of the brain. In addition, 11 superficial temporal arteries and 7 occipital arteries supplied the brain. All the cases with ligated external carotid artery (ECA) had the pharyngo-occipital anastomasis. Moreover, the ophthalmic arteries in three cases were found to originate from the MMA.</p><p><b>CONCLUSIONS</b>The external carotid artery has a variety of anastomasis with the internal carotid artery (ICA) and the vertebral artery. Under such circumstances, special measures must be taken to circumvent inadvertent intracranial embolization.</p>

Assessment of efficacy of endovascular embolization for central arteriovenous malformations (AVM) in the jaw / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To study the angiographic properties of central AVMs in the jaw, and to investigate the efficacy of embolization of them.</p><p><b>METHODS</b>Eleven cases of central AVMs underwent angiography and embolization, nine cases experienced surgery after embolization, and the other two cases were embolized alone; all these cases were followed up after treatment. The angiographic features and embolization results were analyzed.</p><p><b>RESULTS</b>Large venous pouches were angiographically opacified in 9 of 11 AVMs. Of the nine operated cases, curettage was safely performed. The intraoperative bleeding was evidently decreased, and the continuity of the jaw was preserved. Five of these operated cases were free of recurrence during 18 - 27 months in follow-up. The two cases embolized alone were free of recurrence during 24 months' follow-up.</p><p><b>CONCLUSIONS</b>Via arterial and venous approaches, embolization could greatly decrease the intraoperative bleeding and thus help to preserve the continuity and potentiality of development of the jaw for intraosseous AVMs, moreover, it may be curative in some cases.</p>