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舌前腺囊肿的诊断与治疗

2012-02-08 15:21:02 来源: 作者: 人气:0 评论:0
舌前腺是人唾液腺中较小的一对腺体,位于舌腹、距舌尖约1.0 cm 的中线两侧,大小0.5cm×0.5 cm ~1.0 cm×1.0 cm,为实性圆形腺体,包膜不明显,左右腺体紧邻,中间仅隔一层很薄的结缔组织。

以往对舌前腺囊肿(mucocele of the anterior lingual salivary glands,glands of Blandin and Nuhn)的治疗主要以小黏液腺囊肿的治疗方案为依据,存在一些不足。若采用常规囊肿及受累腺体的整体切除,对小黏液腺囊肿,因其体积小,位置表浅,绝大多数可以治愈而不再复发,是可行的;但舌前腺体积大,位置深,对舌前腺囊肿采用传统手术方式,仅将囊肿累及的部分舌前腺体切除,因切除不全,残留大部分舌前腺体而容易导致复发,或伤及邻近腺泡,引起复发。患侧舌前腺与健侧有纤维隔分离, 手术容易伤及对侧腺体,引起对侧新生囊肿。因此,对舌前腺囊肿,应采取囊肿及同侧舌前腺体完整摘除的方法。若囊肿较大、基底较硬、位置居中、累及双侧舌前腺, 应采取囊肿加双侧舌前腺切除的方式, 采用纵行切口。若囊肿及腺体不大,按切口方向,对位缝合即可。若囊肿较大并累及双侧舌前腺,应采用横向缝合, 尽可能保持舌尖形态。

   

The human tongue contains three distinct sets of minor salivary glands namely, the glands of Von- Ebner, the glands of Weber & the glands of Blandin & Nuhn. The glands of Blandin & Nuhn are mixed mucus and serous glands that are embedded within the musculature of the ventral surface of anterior tongue. They are not lobulated or encapsulated. Each gland is approximately 1-8mm wide and 12- 25mm deep & consists of several small independent glands. They drain by means of 5-6 small ducts that open near the lingual frenum. The composition of saliva from the glands of Blandin & Nuhn is unknown.. Mucoceles of the anterior lingual salivary glands (glands of Blandin and Nuhn) are relatively uncommon, with only isolated case reports and case series in the literature. This type of mucocele represents an estimated 2%-8% of all mucoceles. Trauma to the excretory duct of a mucus gland, resulting in rupture of the duct and release of mucus into the tissue, is probably the most important causative fac tor in the production of a mucocele. The most common site for mucocele is lower lip wherein the maxillary canine impinges on it Presence of fibrous tissue is probably of considerable importance in limiting the spread of extravasated mucus. Increased amyladase activity and to a lesser extent alkaline phosphatase activity has been reported with fibroblasts in the extravasation mucoceles and may be a manifestation of increased fibroblastic activity.


Diagnostic difficulties with superficial mucoceles can arise clinically if they appear simultaneously with a mucosal disorder or microscopically when the true nature of the specimen is not suspected by the reporting pathologist. The lesion can be clinically diagnosed as vascular lesion, pyogenic granuloma, polyps or squamous papillomata depending on the degree of vascularity, scarring & acinar atrophy. A history of trauma , rapid onset , alterations in size , bluish color , fluid filled consistency , & recovery of mucus with fine needle aspiration are helpful in the clinical diagnosis of mucoceles of the glands of Blandin & Nuhn . Special stains like mucicarmine and alcian blue, are helpful in identifying mucin that is present freely in tissues or in the foamy macrophages. During surgery the glands of Blandin & Nuhn, that are deep in the musculature resulting in recurrence of the lesion. Careful clinical evaluation of these lesions especially in pediatric age group & preoperative awareness of the surgical anatomy of the glands of Blandin & Nuhn, may avoid further enlargement and complications, as well as minimize the need for repeated surgical procedures.
 

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