American Journal of Otolaryngology最新文献

英文中文

Efficacy of acupuncture combined with various traditional Chinese medicine therapies for peripheral facial paralysis: A systematic review and network meta-analysis 针刺联合各种中医疗法治疗周围性面瘫的疗效：系统评价和网络荟萃分析

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2026-01-01 DOI: 10.1016/j.amjoto.2026.104787

Mengzhong Li , Wenjie Liang , Wei Liang , Jianguo Zhang , Xiaoping Lei

Background and purpose

This meta-analysis aimed to evaluate whether acupuncture combined with other traditional Chinese medicine (TCM) therapies is more effective in the treatment of peripheral facial palsy (PFP) than acupuncture alone.

Methods

Eight databases were searched until May 2025. Two independent reviewers extracted relevant data on study characteristics and used the Cochrane Risk of Bias Assessment Tool 2 (RoB2) to assess the risk of bias of the included studies.

Results

266 articles were included. Results showed that compared with acupuncture alone, acupuncture combined with tuina and cupping (surface under the cumulative ranking curve (SUCRA) = 99.33%) was the most effective intervention for improving the overall effective rate; acupuncture combined with topical application of TCM (SUCRA = 90.61%) was the optimal approach for enhancing facial nerve function (House-Brackmann (HB) scale); acupuncture combined with herbal fumigation and steaming therapy (SUCRA = 80.40%) was the best intervention for improving social function (Facial Disability Index - Social Function (FDIS)) in patients with facial paralysis; acupuncture combined with pricking blood (SUCRA = 87.62%) was the most effective method for improving physical function (Facial Disability Index - Physical Function (FDIP)) in patients with facial paralysis; and acupuncture combined with cupping and pricking blood (SUCRA = 86.90%) was associated with the lowest incidence of adverse reactions.

Conclusion

This study showed that interventions such as acupuncture+tuina+cupping, acupuncture+topical application of TCM, acupuncture+herbal fumigation and steaming therapy, and acupuncture+pricking blood are all associated with facial nerve recovery and demonstrate superior efficacy compared with acupuncture alone.

背景与目的本荟萃分析旨在评价针灸联合其他中医疗法治疗周围性面瘫（PFP）是否比单独针灸更有效。方法检索至2025年5月。两名独立审稿人提取了研究特征的相关数据，并使用Cochrane偏倚风险评估工具2 （RoB2）评估纳入研究的偏倚风险。结果共纳入266篇文献。结果表明，与单独针灸治疗相比，针灸联合推拿、拔罐（累计排序曲线下曲面(SUCRA) = 99.33%）对提高总有效率最为有效；针刺结合中药外敷是增强面神经功能的最佳方法（supra = 90.61%）（House-Brackmann （HB）量表）；针刺配合中药熏蒸治疗（SUCRA = 80.40%）是改善面瘫患者社会功能（面部残疾指数-社会功能（FDIS））的最佳干预措施；针刺联合刺血治疗对改善面瘫患者身体功能（面部残疾指数-身体功能（FDIP））最有效（SUCRA = 87.62%）；针刺联合拔罐刺血（SUCRA = 86.90%）不良反应发生率最低。结论本研究表明，针刺+推拿+拔罐、针刺+中药外敷、针刺+中药熏蒸疗法、针刺+刺血等干预措施均与面神经恢复相关，且效果优于单纯针刺。

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引用次数: 0

Dual-scale fusion vision transformer model for vocal cord leukoplakia risk stratification: A multicenter study 声带白斑风险分层的双尺度融合视觉变形模型：一项多中心研究

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2026-01-01 DOI: 10.1016/j.amjoto.2026.104789

Jie-Lin Huang , Li-Juan Li , Ji-Qing Zhu , Li-Zhou Dou , Yu-Meng Liu , Yan Ke , Yu-Da Zhao , Mei-Ling Wang , Jian-Hui Wang , Quan-Mao Zhang , Xiao-Guang Ni

Objective

This study aimed to develop an artificial intelligence (AI) system for accurate three-tier risk stratification of vocal cord leukoplakia (VCL), with particular focus on distinguishing high-risk lesions (severe dysplasia and carcinoma in situ) from low-risk and malignant lesions, while enhancing diagnostic performance among clinicians with limited experience.

Methods

This retrospective multicenter study analyzed 8510 laryngoscopic images from 743 patients across three tertiary hospitals in China. A dual-scale Vision Transformer (ViT) architecture was constructed, integrating multi-scale feature analysis with cross-attention fusion mechanisms. The model was rigorously evaluated through internal-external validation and a prospective reader study involving 12 endoscopists of varying expertise.

Results

The AI system demonstrated superior performance in three-tier classification, achieving F1-scores of 0.883 (95% CI: 0.869–0.896) and 0.861 (95% CI: 0.844–0.878) for high-risk lesion identification in internal and external validation, respectively. AI assistance significantly improved junior endoscopists' sensitivity from 67.1% to 81.4% (P < 0.001), effectively narrowing diagnostic performance disparities with senior experts. The system maintained robust generalizability across institutions, with 90.5% accuracy under heterogeneous imaging protocols.

Conclusion

The proposed AI framework provides a clinically effective solution for reliable VCL risk stratification and reduces diagnostic variability between clinicians. Validated across multiple centers, this dual-scale ViT approach establishes a novel paradigm for laryngoscopic diagnosis and holds significant potential to standardize diagnostic workflows in resource-limited settings.

本研究旨在开发一种人工智能（AI）系统，对声带白斑（VCL）进行准确的三层风险分层，重点区分高风险病变（严重发育不良和原位癌）与低风险和恶性病变，同时提高经验有限的临床医生的诊断能力。方法本回顾性多中心研究分析了中国三所三级医院743例患者的8510张喉镜图像。构建了一种融合多尺度特征分析和交叉注意融合机制的双尺度视觉变压器（ViT）体系结构。该模型通过内部外部验证和涉及12名不同专业知识的前瞻性读者研究进行了严格评估。结果人工智能系统在三层分类中表现优异，在内部和外部验证中分别获得f1分0.883 （95% CI: 0.869-0.896）和0.861 （95% CI: 0.844-0.878）的高危病变识别。人工智能辅助显著提高了初级内窥镜医生的敏感度，从67.1%提高到81.4% (P < 0.001)，有效地缩小了与高级专家的诊断表现差距。该系统在不同的机构中保持了强大的通用性，在不同的成像方案下准确率达到90.5%。结论所提出的人工智能框架为可靠的VCL风险分层提供了临床有效的解决方案，并减少了临床医生之间的诊断差异。通过多个中心的验证，这种双尺度ViT方法为喉镜诊断建立了一种新的范例，并在资源有限的环境中具有标准化诊断工作流程的巨大潜力。

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引用次数: 0

A single-center, randomized, double-blinded, placebo-controlled clinical study on the efficacy and safety of voriconazole ear drops in the treatment of otomycosis 一项单中心、随机、双盲、安慰剂对照的伏立康唑滴耳液治疗耳真菌病的疗效和安全性临床研究

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2026-01-01 DOI: 10.1016/j.amjoto.2026.104792

Shen'er Qian , Guolin Tan , Hongyi Tan , Lihua Chen , Yonghong Yu , Ru Gao , Wei Li

Objective

This study aimed to investigate the efficacy and safety of voriconazole ear drops.

Methods

A single-center, randomized, double-blind, placebo-controlled clinical design was adopted. A total of 108 patients with otomycosis were enrolled and randomly assigned in a 2:1 ratio to the experimental group (n = 72) and the control group (n = 36). The experimental group received voriconazole ear drops for 7 days followed by placebo for 7 days; the control group received the treatments in reverse order. The primary efficacy endpoint was the clinical response rate. Secondary endpoints included improvement in ear symptoms and signs, and the recurrence rate after discontinuation of treatment.

Results

The experimental group showed significant superiority over the control group in the clinical response rate (62.50% vs 38.89%, P < 0.05). Among the secondary endpoints, the improvement rates for ear fullness and ear swelling were significantly higher in the experimental group (P < 0.05), while no significant statistical differences were observed for the other symptoms. The recurrence rate after treatment discontinuation was 7.89%. Regarding safety, no drug-related clinical abnormalities, adverse events, or serious adverse events were observed in any patient.

Conclusion

Voriconazole ear drops demonstrated good efficacy and safety in the treatment of otomycosis, showing significant therapeutic effects particularly against filamentous fungal infections. Topical application showed no significant toxicity, indicating promising clinical application prospects.

目的探讨伏立康唑滴耳液的有效性和安全性。方法采用单中心、随机、双盲、安慰剂对照的临床设计。共纳入108例耳真菌病患者，按2:1的比例随机分为实验组（72例）和对照组（36例）。试验组患者先服用伏立康唑滴耳液7 d，再服用安慰剂7 d；对照组按相反的顺序进行治疗。主要疗效终点为临床有效率。次要终点包括耳部症状和体征的改善以及停止治疗后的复发率。结果实验组在临床有效率上明显优于对照组（62.50% vs 38.89%, P < 0.05）。在次要终点中，实验组在耳丰满、耳肿胀方面的改善率显著高于对照组（P < 0.05），其他症状的改善率差异无统计学意义。停药后复发率为7.89%。在安全性方面，未观察到任何患者出现与药物相关的临床异常、不良事件或严重不良事件。结论伏立康唑滴耳液治疗耳真菌病疗效好，安全性高，对丝状真菌感染疗效显著。局部应用无明显毒性，具有良好的临床应用前景。

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引用次数: 0

The role of metformin in dysplastic mucosa of the larynx: A follow up study 二甲双胍在喉粘膜发育不良中的作用：一项随访研究。

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-12-11 DOI: 10.1016/j.amjoto.2025.104769

Diana N. Kirke , Diana S. Shaari , Corina Din-Lovinescu , Andrew Blitzer , Marshall Strome

Objective

This longitudinal case series reports our ongoing experience with metformin, an oral antihyperglycemic drug, as a possible agent to halt the progression of dysplastic lesions to carcinoma, in those with previously treated head and neck squamous cell carcinoma (HNSCC).

Design

Case series.

Results

Three patients were included who had laryngeal dysplasia (age 66.67 ± 7.09; range 59–73 years; 3 male) with a follow up time of 17 to 88 months. The average dose of metformin was 500 mg twice daily. Two patients showed complete or partial regression of the dysplastic mucosa, while the third demonstrated a worsening of dysplasia after he halted treatment for six weeks.

Conclusion

Metformin is a safe agent that has the potential to prevent progression of laryngeal dysplasia in patients with a history of HNSCC. Further studies are needed to verify and expand on this limited case series.

目的：这个纵向病例系列报告了我们正在进行的二甲双胍治疗的经验，二甲双胍是一种口服降糖药物，可以阻止先前治疗过的头颈部鳞状细胞癌（HNSCC）患者的发育不良病变进展为癌。设计：案例系列。结果：3例喉发育不良患者（年龄66.67±7.09岁，年龄59 ~ 73岁，男性3例），随访时间17 ~ 88个月。二甲双胍的平均剂量为500毫克，每日两次。两名患者表现出完全或部分增生不良粘膜消退，而第三名患者在停止治疗六周后表现出增生不良恶化。结论：二甲双胍是一种安全的药物，有可能预防有HNSCC病史的患者喉部发育不良的进展。需要进一步的研究来验证和扩展这一有限的病例系列。

引用次数: 0

Preliminary study on classification and treatment of type I variant preauricular fistula 变异型耳前瘘分型及治疗的初步探讨。

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-12-08 DOI: 10.1016/j.amjoto.2025.104782

Haigang Zhang

引用次数: 0

Preliminary study on classification and treatment of type I variant preauricular fistula 变异型耳前瘘分型及治疗的初步探讨

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-12-08 DOI: 10.1016/j.amjoto.2025.104781

Kanu Lal Saha

引用次数: 0

Sarcopenia and postoperative morbidity in head & neck cancer: A systematic review and meta-analysis 头颈癌骨骼肌减少症与术后发病率：一项系统综述和荟萃分析。

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-12-06 DOI: 10.1016/j.amjoto.2025.104758

Michael Xie , Han Zhang , Phillip Staibano , Zahra Abdallah , Michael K. Gupta , Nhu Tram Nguyen

Objective

To identify the prognostic value of sarcopenia in surgically treated HNC patients on postoperative morbidity.

Design

Systematic review and meta-analysis.

Information sources, study selection, and methods

EMBASE, MEDLINE, SCOPUS, and CINAHL databases were searched from January 1, 1946 to November 4, 2024. Published trials and observational studies reporting the association of sarcopenia and postoperative complications in surgically treated HNC patients were included. Two reviewers independently screened, extracted, and appraised studies using Covidence. Disagreements were resolved through consensus, and/or by consulting a third reviewer. Data were pooled using a random-effects model in RevMan 5.4.1.

Results

Of 6345 screened studies, 17 out of the 23 included studies had outcomes which were incorporated in the meta-analysis (2884 patients from studies between 1996 and 2024). The meta-analysis revealed a statistically significant association between sarcopenia and all postoperative complications (odds ratio (OR) 2.26, 95 % CI [1.54, 3.33], p < 0.0001), postoperative complications grade 3 (OR 2.34, 95 % CI [1.80, 3.03], p < 0.00001), fistula (OR 2.64, 95 % CI [1.68, 4.16], p < 0.0001), and flap complications (OR 2.77, 95 % CI [1.58, 4.85], p = 0.0004). Subgroup analysis revealed the high risk of bias studies did not significantly bias the results (p = 0.76), but the different measurements of sarcopenia contributed significant heterogeneity (p < 0.00001). The level of evidence is moderate, primarily due to publication bias, for all outcomes, as per GRADE.

Conclusions

In patients undergoing curative surgery for HNC, preoperative sarcopenia is associated with higher odds of postoperative complications.

目的：探讨手术治疗的HNC患者肌肉减少症对术后发病率的预后价值。设计：系统回顾和荟萃分析。信息来源、研究选择和方法：检索1946年1月1日至2024年11月4日的EMBASE、MEDLINE、SCOPUS和CINAHL数据库。已发表的试验和观察性研究报告了手术治疗的HNC患者肌肉减少症与术后并发症的关系。两名审稿人独立筛选、提取和评价了使用covid - ence的研究。分歧通过协商一致和/或咨询第三方审稿人来解决。数据采用RevMan 5.4.1中的随机效应模型进行汇总。结果：在6345项筛选的研究中，23项纳入的研究中有17项的结果纳入了荟萃分析（来自1996年至2024年研究的2884名患者）。荟萃分析显示，肌肉减少症与所有术后并发症之间存在统计学意义上的相关性（优势比（OR） 2.26, 95% CI [1.54, 3.33], p）。结论：在接受根治性手术的HNC患者中，术前肌肉减少症与术后并发症的发生率较高相关。

{"title":"Sarcopenia and postoperative morbidity in head & neck cancer: A systematic review and meta-analysis","authors":"Michael Xie , Han Zhang , Phillip Staibano , Zahra Abdallah , Michael K. Gupta , Nhu Tram Nguyen","doi":"10.1016/j.amjoto.2025.104758","DOIUrl":"10.1016/j.amjoto.2025.104758","url":null,"abstract":"<div><h3>Objective</h3><div>To identify the prognostic value of sarcopenia in surgically treated HNC patients on postoperative morbidity.</div></div><div><h3>Design</h3><div>Systematic review and meta-analysis.</div></div><div><h3>Information sources, study selection, and methods</h3><div>EMBASE, MEDLINE, SCOPUS, and CINAHL databases were searched from January 1, 1946 to November 4, 2024. Published trials and observational studies reporting the association of sarcopenia and postoperative complications in surgically treated HNC patients were included. Two reviewers independently screened, extracted, and appraised studies using Covidence. Disagreements were resolved through consensus, and/or by consulting a third reviewer. Data were pooled using a random-effects model in RevMan 5.4.1.</div></div><div><h3>Results</h3><div>Of 6345 screened studies, 17 out of the 23 included studies had outcomes which were incorporated in the meta-analysis (2884 patients from studies between 1996 and 2024). The meta-analysis revealed a statistically significant association between sarcopenia and all postoperative complications (odds ratio (OR) 2.26, 95 % CI [1.54, 3.33], <em>p</em> < 0.0001), postoperative complications grade 3 (OR 2.34, 95 % CI [1.80, 3.03], <em>p</em> < 0.00001), fistula (OR 2.64, 95 % CI [1.68, 4.16], <em>p</em> < 0.0001), and flap complications (OR 2.77, 95 % CI [1.58, 4.85], <em>p</em> = 0.0004). Subgroup analysis revealed the high risk of bias studies did not significantly bias the results (<em>p</em> = 0.76), but the different measurements of sarcopenia contributed significant heterogeneity (<em>p</em> < 0.00001). The level of evidence is moderate, primarily due to publication bias, for all outcomes, as per GRADE.</div></div><div><h3>Conclusions</h3><div>In patients undergoing curative surgery for HNC, preoperative sarcopenia is associated with higher odds of postoperative complications.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 1","pages":"Article 104758"},"PeriodicalIF":1.7,"publicationDate":"2025-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145713039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-12-05 DOI: 10.1016/j.amjoto.2025.104783

Ziyu Chen , Hang Su , Juanjuan Hao , Fenghua Zhang

引用次数: 0

Continuous positive airway pressure vs palatal surgery: Outcomes in obstructive sleep apnea treatment 持续气道正压与腭部手术：阻塞性睡眠呼吸暂停治疗的结果

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-12-05 DOI: 10.1016/j.amjoto.2025.104776

Alec Kadrie , Jonathan Laredo , Evan Thomson , M. Boyd Gillespie

Objective

To compare short- and long-term clinical outcomes of continuous positive airway pressure versus palatal surgical interventions such as uvulopalatopharyngoplasty, including their impacts on sleep apnea-related cardiac, respiratory, and metabolic comorbidities.

Study design

Retrospective cohort study.

Setting

Database study using the TriNetX Network of Tennessee (2014–2024).

Methods

Adult patients diagnosed with obstructive sleep apnea and treated with either continuous positive airway pressure or palatal surgery were identified. Propensity score matching was performed to balance demographics and preexisting comorbidities between groups. Primary outcomes were cardiopulmonary events, and secondary outcomes were new-onset type 2 diabetes and weight change. Odds ratio with 95 % confidence intervals were computed across outcome measures.

Results

A total of 5030 continuous positive airway pressure and 220 palatal surgery patients met inclusion criteria. Following matching, 220 patients remained in each group. Patients treated with continuous positive airway pressure had significantly higher odds of post-treatment electronic medical record coding of acute respiratory failure (OR 4.67, [2.27, 9.60]), pulmonary hypertension (OR 20.0, [2.71, 147.7]), and new-onset atrial fibrillation/flutter (OR 3.32, [1.60, 6.96]) compared to the surgical cohort. No significant differences were observed in myocardial infarction, stroke, or new-onset type 2 diabetes.

Conclusion

Patients treated with continuous positive airway pressure had higher odds of post-treatment electronic medical recording coding of cardiorespiratory complications than those undergoing palatal surgery. These findings highlight potentially important differences between treatment modalities in long-term obstructive sleep apnea related comorbidities.

目的比较持续气道正压通气与腭外科手术（如悬雍垂腭咽成形术）的短期和长期临床结果，包括它们对睡眠呼吸暂停相关的心脏、呼吸和代谢合并症的影响。研究设计回顾性队列研究。基于田纳西州TriNetX网络的数据库研究（2014-2024）。方法对诊断为阻塞性睡眠呼吸暂停的成人患者进行持续气道正压通气或腭部手术治疗。进行倾向评分匹配，以平衡组间人口统计学特征和先前存在的合并症。主要结局是心肺事件，次要结局是新发2型糖尿病和体重变化。在结果测量中计算95%置信区间的优势比。结果5030例持续气道正压通气患者和220例腭部手术患者符合纳入标准。配对后，每组保留220名患者。与手术组相比，持续气道正压治疗的患者在治疗后电子病历编码中出现急性呼吸衰竭（OR 4.67,[2.27, 9.60]）、肺动脉高压（OR 20.0,[2.71, 147.7]）和新发心房颤动/扑动（OR 3.32,[1.60, 6.96]）的几率明显更高。在心肌梗死、卒中或新发2型糖尿病方面没有观察到显著差异。结论持续气道正压治疗患者出现心肺并发症电子病历编码的几率高于腭部手术患者。这些发现强调了长期阻塞性睡眠呼吸暂停相关合并症的治疗方式之间潜在的重要差异。

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引用次数: 0

Surgical strategy in submandibular sialolithiasis: Impact of stone location and size on approach selection and outcomes 下颌下涎石症的手术策略：结石位置和大小对入路选择和结果的影响。

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

American Journal of Otolaryngology

Pub Date : 2025-12-04 DOI: 10.1016/j.amjoto.2025.104768

Joo Hyun Kim

Purpose

To evaluate how stone location and size influence surgical approach selection in submandibular sialolithiasis, and to identify computed tomography (CT)-based imaging predictors to aid preoperative planning.

Methods

We retrospectively reviewed 428 consecutive surgeries (March 2020–December 2024). Preoperative non-contrast CT classified stones as distal duct, mid-duct, hilum, or intraglandular. Surgical approaches were transoral ductal incision, sialendoscopy-assisted removal, and external submandibular gland excision. Group comparisons used standard parametric/non-parametric tests. Receiver operating characteristic (ROC) analysis assessed size thresholds associated with selection of an invasive approach.

Results

Distal duct stones were most often treated by transoral incision (83.7 %), mid-duct stones by sialendoscopy-assisted removal (58.1 %), and intraglandular stones by external excision (71.0 %). Stones in the hilum/intraglandular regions were significantly larger than those in distal or mid-duct locations (p < 0.001). ROC analysis identified 5.5 mm as the optimal cutoff for predicting selection of an invasive approach (AUC = 0.83; sensitivity 74.2 %; specificity 78.9 %). Overall surgical success was 97.8 %. Complication rates varied by approach, lowest after sialendoscopy-assisted removal (4.4 %) and highest after external excision (15.2 %).

Conclusions

A simple CT-based framework incorporating stone location and size was associated with approach selection and outcomes in submandibular sialolithiasis. Using a 5.5 mm size threshold alongside anatomic zoning may help guide minimally invasive, gland-preserving strategies and reduce morbidity. Prospective validation is warranted.

目的：评估结石的位置和大小如何影响下颌下涎石症的手术入路选择，并确定基于计算机断层扫描（CT）的成像预测指标，以帮助术前计划。方法：我们回顾性分析了428例连续手术（2020年3月- 2024年12月）。术前非对比CT将结石分类为导管远端、导管中端、门部或腺体内。手术入路为经口导管切开、鼻内镜辅助切除及外颌下腺切除。组间比较采用标准参数/非参数检验。受试者工作特征（ROC）分析评估了与选择有创入路相关的大小阈值。结果：远端胆管结石多采用经口切开（83.7%），中端胆管结石多采用鼻内镜辅助切除（58.1%），腺内胆管结石多采用外切（71.0%）。门部/腺体内区域的结石明显大于远端或导管中位置的结石(p结论：一个简单的基于ct的框架，结合结石的位置和大小，与下颌骨涎石症的入路选择和结果有关。使用5.5 mm的阈值与解剖分区可能有助于指导微创，腺体保留策略和降低发病率。前瞻性验证是必要的。

{"title":"Surgical strategy in submandibular sialolithiasis: Impact of stone location and size on approach selection and outcomes","authors":"Joo Hyun Kim","doi":"10.1016/j.amjoto.2025.104768","DOIUrl":"10.1016/j.amjoto.2025.104768","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate how stone location and size influence surgical approach selection in submandibular sialolithiasis, and to identify computed tomography (CT)-based imaging predictors to aid preoperative planning.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed 428 consecutive surgeries (March 2020–December 2024). Preoperative non-contrast CT classified stones as distal duct, mid-duct, hilum, or intraglandular. Surgical approaches were transoral ductal incision, sialendoscopy-assisted removal, and external submandibular gland excision. Group comparisons used standard parametric/non-parametric tests. Receiver operating characteristic (ROC) analysis assessed size thresholds associated with selection of an invasive approach.</div></div><div><h3>Results</h3><div>Distal duct stones were most often treated by transoral incision (83.7 %), mid-duct stones by sialendoscopy-assisted removal (58.1 %), and intraglandular stones by external excision (71.0 %). Stones in the hilum/intraglandular regions were significantly larger than those in distal or mid-duct locations (<em>p</em> < 0.001). ROC analysis identified 5.5 mm as the optimal cutoff for predicting selection of an invasive approach (AUC = 0.83; sensitivity 74.2 %; specificity 78.9 %). Overall surgical success was 97.8 %. Complication rates varied by approach, lowest after sialendoscopy-assisted removal (4.4 %) and highest after external excision (15.2 %).</div></div><div><h3>Conclusions</h3><div>A simple CT-based framework incorporating stone location and size was associated with approach selection and outcomes in submandibular sialolithiasis. Using a 5.5 mm size threshold alongside anatomic zoning may help guide minimally invasive, gland-preserving strategies and reduce morbidity. Prospective validation is warranted.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"47 1","pages":"Article 104768"},"PeriodicalIF":1.7,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145713001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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