- 期刊
巨大唾液腺結石合併單側唾液腺管擴張及下頷腺萎縮－案例報告
Asymptomatic Giant Sialolith with Wharton's Duct Dilatation and Submandibular Salivary Gland Total Atrophy-A Case Report
摘要
主唾液腺主要可分為3大腺體，如腮腺、下頷腺及舌下腺，其功能為製造及分泌唾液，倘若發生阻塞時，便會產生腫脹或疼痛等症狀。而唾液腺結石是唾液腺最常見的疾病之一，發生率佔了全球成人的1%，其好發年紀為30到60歲之間，且特別容易發生在男性病患身上，臨床上小孩則較少發生。據統計，超過80%的唾液腺結石發生於下頷腺，6%發生於腮腺，只有2%於舌下腺或其他小唾液腺體。回顧文獻所提及唾液腺結石的大小不一，約90%的病例結石小於1 cm，僅不到8%的病患其結石大於1.5 cm，這些大於1.5 cm的結石則被定義為巨大唾液腺結石。在臨床上，無症狀的巨大唾液腺結石非常罕見，故我們提出此個案報告供經驗分享。此案例為48歲女性，本身無特別過去病史，因喉嚨有異物感1個月來本院門診就診，意外發現左側口底有一顆疑似腫瘤的無壓痛腫塊，經影像學檢查發現，其在下頷腺管有一顆直徑約3 cm大的唾液腺結石阻塞，合併左側唾液腺管擴張及左下頷腺完全萎縮；病患無任何臨床不適及唾液腺結石等病史。最後病患接受了經口唾液腺管取石手術，並完整移除了大小為3.5×1.4 cm的巨大結石，後續病患恢復狀況良好，於術後第4天順利出院，且病患於門診追蹤1年之久，過程並無發現任何復發情形。
關鍵字
Sialolith ； Sialolithiasis ； Sialectasis ； Submandibular gland atrophy（唾液腺結石 ； 唾液腺炎 ； 唾液腺管擴張 ； 下頷腺萎縮）並列摘要
Sialolithiasis is one of the most common diseases of salivary glands. More than 80% of the sialoliths occur in the submandibular glands. While most of the calculi are less than 10mm in size, 7.6% are larger than 15mm and are classified as giant sialoliths. We demonstrate a rare case of asymptomatic giant sialolith in the left Wharton's duct with a total atrophy of the left submandibular salivary gland. A 48-year-old female patient presented with lumping sensation for 1 month. A left mouth floor mass was found accidentally during examination and was later revealed to be a painless sialolithiasis. Image study revealed a giant sialolith in the left Wharton's duct with sialectasis and left submandibular gland total atrophy. She underwent transoral sialolithotomy with removal of a huge stone, measuring 3.5×1.4 cm in size. Sialolithiasis usually presents with typical symptoms of the involved salivary gland, and the size of calculi is usually less than 20mm. This is a rare case report of an asymptomatic giant sialolith in the Wharton's duct, causing left submandibular salivary gland total atrophy, and its diagnosis and management.