舌下腺结石误诊为舌下腺囊肿案一则

A Case of Misdiagnosis of Sublingual Gland Stone as Sublingual Gland Cyst

[目的]为临床中诊治舌下腺结石(鬼齿)提供参考与借鉴。[方法]介绍一则将舌下腺结石误诊为舌下腺囊肿,使用火针点刺促进结石排出的医案,通过详细阐述诊治过程,并从中、西医角度切入,结合舌下腺结石的发病特点及治疗现状,讨论诊疗思路及误诊原因。[结果]舌下腺结石的临床表现与舌下腺囊肿相似,缺乏相关检查时无法明确诊断,极易误诊,西医主要以手术治疗为主,而中医对本病病机及治疗的记载较少。患者初诊诊断为舌下腺囊肿,以火针点刺促石排出,最终明确诊断为舌下腺结石,随访一年间未有复发。遇舌系带一侧肿痛时,基于舌下痰包"宜用铍针"的思想,选用新九针之一师氏粗火针,以肿为腧,意外使结石排出,机制与火针点刺痛风患者肿痛所在,促使痛风结石及痛风盐结晶排出类似。[结论]临证遇舌系带一侧肿胀时,需先辨别舌下腺囊肿与舌下腺结石。本例以火针点刺舌下腺结石起效,可为临床中诊治舌下腺结石提供新的治疗思路。

[Objective] To provide a reference for the clinical management of sublingual gland stone(ghost teeth). [Methods] This paper presented a medical case in which a sublingual gland stone was misdiagnosed as a sublingual cyst, but the stone was discharged by puncturing with fire needles. Through elaborating the diagnosis and treatment process of the case, starting from the perspective of Chinese and western medicine, combined with the incidence characteristics and treatment status of sublingual gland stones, this paper discussed the diagnosis and treatment ideas and the causes of misdiagnosis. [Results] The clinical characteristics of sublingual gland stones are similar to those of sublingual gland cysts, and in the absence of relevant examinations, it is difficult to make the diagnosis clearly and is easily misdiagnosed. Western medicine mainly focuses on surgical treatment, while the pathogenesis and treatment of this disease are less documented in Chinese medicine. The patient was initially diagnosed as sublingual gland cyst, and the stone was discharged by fireacupuncture, and the diagnosis was eventually changed to sublingual gland stone. In case of swelling and pain on one side of the lingual frenum, based on the idea of “beryllium acupuncture should be used” in the sublingual phlegm bag, SHI’s coarse fire needle, one of the new nine needles, was selected to take the swelling as the acupoint and accidentally discharge the stones. The mechanism was similar to that of the fire needle puncturing the swelling and pain of gout patients to promote the discharge of gout stones and gout salt crystals. [Conclusion] In case of swelling on one side of the tongue tether, it is necessary to identify sublingual gland cysts and sublingual gland stones, and the effectiveness of fire acupuncture on sublingual gland stones in this case can provide a new therapeutic idea for clinical diagnosis and treatment of sublingual gland stones.