ABSTRACT
The recent advent of endoscopic procedures has compelled both plastic and neck and head surgeons to reconsider the conventional methods by which the excision of submandibular gland is classically achieved. An endoscopic intraoral approach for excision of the submandibular gland is described. This procedure is anatomically safe and can be made with minimal morbidity; a transcervical incision is avoided. Both specific instruments and solid anatomical knowledge are necessary to perform a safe and efficient glandular endoscopic excision. The essential surgical steps are as follows: 1) Careful identification of the Wharton duct and lingual nerve; 2) Retraction of the mylohyoid muscle; 3) Protection of the sublingual gland and lingual nerve; 4) Extraoral manipulation of the submandibular gland obtaining intraoral protrusion; and 5) Careful dissection of the posterior third of gland, avoiding injury on the facial artery and vein. Two patients were operated on with this technique and were very pleased with their results. No complications were registered. With advanced endoscopic instruments, new surgical technique, and surgeon experience, endoscopic intraoral excision of the submandibular gland can be the method of choice in benign neoplasia, sialolith, sialoadenitis and plunging ranula.
Subject(s)
Endoscopy/methods , Submandibular Gland/surgery , Adult , Dissection , Endoscopes , Face/blood supply , Female , Humans , Lingual Nerve/anatomy & histology , Male , Minimally Invasive Surgical Procedures , Mouth Floor/blood supply , Mouth Floor/innervation , Mouth Floor/surgery , Neck Muscles/anatomy & histology , Ranula/surgery , Safety , Salivary Duct Calculi/surgery , Salivary Ducts/anatomy & histology , Salivary Ducts/surgery , Salivary Gland Calculi/surgery , Sialadenitis/surgery , Submandibular Gland/anatomy & histology , Submandibular Gland Diseases/surgery , Submandibular Gland Neoplasms/surgeryABSTRACT
Pure red cell aplasia developed in a female patient with systemic lupus erythematosus (SLE). Erythroid colony growth was assessed in semisolid medium culture of bone marrow obtained from a normal donor and cultured in the presence of normal and patient sera. Colony forming units of erythropoiesis and burst forming units of erythropoiesis obtained from a normal donor were inhibited in the presence of patient sera. Our findings support the concept that circulating inhibitors might influence the proliferation of erythroid progenitor cells and erythroid aplasia may be an immunologically mediated syndrome.