口腔颌面部异物临床分析

对第四军医大学口腔医学院近10年收治106例口腔颌面部异物取出的适应证、异物定位、手术入路及方法等进行了讨论,着重讨论了大血管周围或已伤及大血管的异物存留处理方法,重型颌面损伤中异物存留的处理。认为一般情况下口腔颌面部异物均应力争取出,但异物小而深在,患者年龄较小、临床无症状、取出过程可能伤及重要的血管神经或者与严重伤情无直接关系的异物可暂不取出。     

颌面颈部异物伤20例诊治分析

目的：探讨颌面颈部异物伤的诊断和治疗方法。方法：总结20例颌面颈部异物伤病例,对诊断、定位和手术方法进行分析,观察治疗效果。结果：20例异物伤病例明确诊断后均成功手术取出异物,术后恢复良好。结论：颌面颈部异物伤手术风险大,术前明确诊断,准确定位,结合术者良好的手术技巧和责任心是异物取出的关键。     

口腔颌面部异物36例临床分析

目的:探讨口腔颌面部异物伤的诊断与治疗及影像学诊断的重要性。方法 :选择2003-01—2010-12期间收治的,影像和病历资料完善的口腔颌面部异物存留伤36例。分析异物类型,并对临床疗效进行评估。结果:36例异物存留伤患者中,金属异物12例,非金属异物24例。择期异物取出26例;需要急诊清创者10例,而清创术可一期取出异物者6例,4例延期取出。30例经常规X线片检查后,需经CT或三维CT检查进一步定位,评估手术取出的可行性及风险。其中26例经手术取出,4例保留并观察。结论:三维CT在非金属异物存留伤诊疗中起到重要的作用;必须根据异物大小、部位及与周围大血管的毗邻关系,患者全身情况等综合因素判定是否手术及手术时机。     

口腔颌面部金属异物手术治疗体会

口腔颌面部金属异物手术治疗体会云南西双版纳农垦第一职工医院口腔科（６６６１０１）李来军口腔颌面部外伤所致金属异物存留的病例并非少见。尤其是深部异物存留，手术取出成为一个较困难的问题。以往手术前摄Ｘ线片定位，使用的是平面定位，手术时常有一定的盲目性，使...     

10年石块异物致开口受限1例报告

口腔颌面部异物存留软组织内较多见,但异物存留颌面部10余年,尔后致开口受限者临床少见。本文报告1例52岁男性患者,右上颌磨牙后区10年石块异物致开口受限1年余,对其临床表现、X线及CT检查结果、治疗经过进行总结,提示口腔颌面外科医师在临床诊疗工作中,要详细询问患者病史,借助必要的辅助检查,对颌面部肿物做出尽可能明确的诊断与鉴别诊断。     

颌面深部血管性疾病的诊断与综合治疗

目的 研究颌面部血管性疾病的影像学诊断与治疗的临床意义。方法 对1988年8月至2000年7月的12年间在我院就诊的12例颌面深部血管性疾病的放射学检查及治疗效果进行评价。结果 12例均行DSA造影检查。7例经血管造影明确诊断后，即经导管作超选择性颈外动脉分支的栓塞治疗，其中3例血管畸形的患者经永久性栓塞治疗治愈，随诊3年无复发；2例经永久性栓塞治疗后均于1年内复发，经再次栓塞及手术，病理证实为蔓状血管瘤；另2例经栓塞治疗后1周内行手术治疗，病理诊断亦为蔓状血管瘤。其余5例造影后行手术治疗，病理诊断除1例为海绵伏血管瘤外，均为毛细血管瘤。结论 血管造影是颌面深部血管性病变的重要诊断手段；手术是颌面深部血管性疾病主要的治疗措施；颌面深部血管性疾病的完善治疗有赖于多种治疗方法的完美结合。     

口腔颌面部深部间隙金属异物手术治疗体会：附20例报告

不论平时或战时因火器伤致口腔颌面部金属异物存留的病例并非少见,尤其是深部间隙内异物存留,手术取出成为一个较困难的问题。术前异物的准确定位,将给手术途径提供方便条件。以往手术前摄X线片定位,仅是平面定位,手术时仍有一定的盲目性,使手术失败。我科收治了口腔颌面部深部间隙的金属异物共20例,在X线电视透视机屏幕下手术取出金属异物,获得了较满意的效果。现报道如下。     

经口摘除颅底面侧深区金属异物9例报告

经口摘除颅底面侧深区金属异物９例报告第三军医大学第三附属医院颌面外科况明才，杨茂进，杨西川体内异物摘除是一个较棘手的问题。位于深部组织的金属异物取出难度更大。自１９８４年以来，我科收治颌面颈部异物６５例，均成功取出，规将经口腔摘除颅底、面侧深区金属异...     

颌面部异物的治疗

由于各种原因 ,如火器伤、交通事故 ,颌面部常有异物存留。口腔颌面部解剖结构复杂 ,有面神经、三叉神经、涎腺、导管及重要的血管 ,且颌面部窦、腔多 ,并与颅脑和咽喉毗邻 ,这在临床上给颌面部异物诊断和治疗带来困难。本文分析了颌面部不同性质异物的诊断及不同部位异物取出的特点。1　材料和方法 :1 1　临床资料 :　 1988年至 1999年收治口腔颌面外科异物存留病人 2 3例 ,男性 13名 ,女性 10名 ,年龄 12～ 4 5岁 ,平均 2 5 7岁 ,其中金属异物 14例 (汽枪弹 9例、猎枪弹 1例、铁屑 4例 ) ,非金属异物 9例 (玻璃碎片 5例、木质 2例、橡皮…     

面部玻璃异物1例报道

<正>面部外伤后异物存留的病例并不少见。对于单个的、较大的、位置表浅的异物,手术取出相对较为容易;而对于大量的、细小的、位置较深且较分散的异物,要做到手术彻底清除,对口腔颌面外科医生而言是一个挑战[1]。兹有右侧面部玻璃刺伤后大量异物存留的病例1例,该病例经过手术治疗后,达到彻底清除的效果,现报道如下。1临床资料患者女性,69岁,自诉9 h前不慎摔倒,头部撞碎玻璃门后,右侧面部被下方的玻璃刺入,即感患     

Surgical approach plus Nd:YAG laser irradiation for the management of hemangioma in deep maxillofacial region]

This article introduces a new method for the management of cavernous hemangioma in deep maxillofacial region.Common surgical approach was carried out to expose the mass of hemangioma,then Nd:YAG laser was irradiated it without tumor removal.Immediatelly shrinking of hemangioma can be seen in all these seven cases.The therapeutic effect was satisfied in 3-12 months follow up.With the basic research of the rabbit facial nerve's Nd:YAG laser injured detecting experiment.We discussed its indication,advantage and interaction between laser and peripheral tissue.Our result shown that this new way is a good method for hemangioma in deep maxillofacial region as its advantages of skin preventing and peripheral normal tissue preserving     

Impacted foreign bodies in the maxillofacial region-diagnosis and treatment

Foreign bodies are often encountered by oral and maxillofacial surgeons and may present a diagnostic challenge to the trauma surgeon due to many factors such as the size of the object, the difficult access, and a close anatomic relationship of the foreign body to vital structures. They are usually a result of injuries or operations. Fragments of broken instruments can be left behind and entire teeth or their fragments can be displaced during extraction. The approach to this kind of injury should be sequential and multidisciplinary, beginning with the trauma unit that will provide maintenance of the airways, hemodynamic stabilization, and, but only if necessary, neurologic, ophthalmologic, and vascular evaluation. With a view to illustrating and discussing the diagnosis and treatment of this kind of injury, this study reports impacted foreign bodies in oral and maxillofacial region. The following data were collected: age, sex, race, etiology, occurrence of fracture, anatomic location of the fracture, daytime of the traumatic event, type of the object, signal and symptoms, type of imaging examination used, type of anesthesia, approach, transoperative complication, period between surgery and hospital liberation, and the occurrence of death. Foreign body injuries in the maxillofacial region can place the patient's life at risk, so a correct initial treatment performed by a multidisciplinary team increases the survival of this kind of patient.     

Management of retained foreign bodies in missile injuries of the maxillofacial region

This study evaluates 22 patients with retained foreign bodies in the maxillofacial region that were all caused by penetrating missile injuries. Surgical intervention for the retrieval of the foreign bodies was carried out in 20 patients through the existing wounds and through separate incisions; all patients were followed up for a minimum of 2 months during which all the complications were registered and managed. Preoperative imaging is a prerequisite for the accurate localization of the foreign body and the subsequent successful removal of it. All patients developed complications that were categorized in this study into those that result from the injury itself and those that occur because of the retrieval procedure, the latter category being mostly easily managed. In general, all foreign bodies in the maxillofacial region should be removed; the surgeon involved should weigh the benefits and the perils of the removal, and the patient should be well informed about the possibility of the failure of removal of the foreign body.     

口腔颌面部金属异物取出61例临床总结

目的:探讨口腔颌面部金属异物最佳手术取出途径。方法:将我科1999—2008年口腔颌面部金属异物61例诊治情况进行分析总结。结果:61例中的65个口腔颌面部金属异物都顺利取出,没有发生伤口感染,创口均愈合良好。结论:口腔颌面部异物应用平板探测器X线数字成影(DDR)线片,必要时可行三维CT重建准确定位,在明确诊断后,尽量沿着原创口选择手术途径,如明视下手术取出困难可在X线透视下取出。     

Epidemiologie und Behandlungsmanagement bei Schockraumpatienten mit Gesichtsschädelverletzungen

Objective

To minimize overall mortality and optimise reconstructive and cosmetic outcome in severely injured patients with maxillofacial injuries the interdisciplinary coordination of several surgical disciplines is required. It is still discussed controversy whether patients with maxillofacial fractures benefit from early fracture repair or if delayed operative management also yields in good results.

Methods

Herein we analysed the data of 1252 severely injured patients between May 1998 through June 2002 in our trauma department regarding fractures of the maxillofacial region, injury severity, length of ICU stay and postoperative complications in patients with either early (within 72?hours) or delayed (>?3?days) facial fracture repair.

Results

147 patients had severe facial fractures. Average age was 39.8 years (3–87 years), mean ICU was 25 (+/– 16) and the overall mortality 12% (n?=?18). The most common cause for the injuries were traffic accidents in 45%. 78 patients (53%) underwent surgical repair of the maxillofacial fractures; 18 patients had early fracture repair and 60 patients had delayed operative repair. We found 4 complications (22%) in the early repair group and 13 local complications (21%) in the group with delayed surgical repair.

Conclusion

Delayed repair of maxillofacial injuries in severely injured patients is feasible and yields in good results compared to early fracture repair.     

下颌骨爆炸性损伤致伤效应的实验研究

目的 :观察新型点爆源爆炸伤后颌骨的致伤效应。方法 :选用 0 .1g微球形爆炸源于兔颌面部引爆致伤 ,分别于伤后 6h、3、7d观察伤情 ,并在伤区外 0 .5、1.0cm处切取下颌骨标本 ,HE、改良三色法染色、墨汁灌注制作骨磨片观察下颌骨的病理变化及微循环变化。结果 :下颌骨致伤后 6h伤区骨断端骨组织无明显变化 ;伤后 3d骨断端明显炎细胞浸润 ,未见明显骨坏死 ;伤后 7d骨断端骨质不完全坏死 ,0 .1cm外骨质结构基本正常 ,皮质骨及松质骨出现明显的修复活动。结论 :爆炸伤伤口污染严重 ,但爆炸伤后下颌骨反应特性与普通骨折相似     

口腔颌面部高速投射物伤致牙周膜间接损伤的实验研究

目的：研究口腔颌面部高速投射物伤导致的牙周膜间接损伤的特点。方法：将18只实验犬随机分为6组,以直径6．0 mm、质量0．88 g的高速投射物致伤右下颌骨体部第四前磨牙根尖下方区域,但不直接伤及牙齿;分别于伤后6h、24h、3d、7d、2w及4w处死实验犬,观察右下颌第四前磨牙、第二前磨牙及左下颌第二前磨牙牙周膜的组织病理学表现。结果：右下颌第四前磨牙和第二前磨牙的牙周膜损伤较明显,但病理学变化可逆;左下颌第二前磨牙牙周膜仅见一过性血管扩张、充血。结论：口腔颌面部高速投射物伤可导致牙周膜发生间接损伤,病理学变化可逆;损伤程度随着牙齿与伤区距离的增加而递减。     

光学导航技术在口腔颌面深部间隙异物取出术中的应用

目的:探讨光学导航技术应用于口腔颌面深部异物留置取出术的适应条件和临床价值。方法:对5例口腔颌面部外伤后异物留置于深部间隙的患者在导航辅助下行异物取出术,术前进行三维CT和数字减影血管造影检查,对异物进行空间定位,并将CT的Dicom数据导入STN导航系统中,用于术前手术规划和术中导航。术中观察导航系统的实时性和精确性,评价导航技术对口腔颌面部深部间隙异物取出的有效性。结果:在光学导航技术辅助下,5例留置的异物均能通过微创入路顺利定位和取出,术中未发现神经、血管损伤,术后亦未发现感染、呼吸困难等并发症。术后随访3～12个月,患者主诉症状均缓解,功能和面型取得了满意的效果。结论:光学导航技术在口腔颌面深部间隙异物取出术中的应用,尤其在解剖位置复杂和危险的区域,可以提高手术的精确性、微创性和安全性。     

超声联合CT导航行颅颌面颈部金属异物取出术32例临床分析

目的：研究超声联合CT导航行颅颌面颈部金属异物取出术的手术方法和临床疗效。方法：回顾分析32例颅颌面颈部金属异物滞留患者的临床资料,通过超声联合CT导航实施异物取出。结果：32例患者的颅颌面颈部共滞留金属异物194颗,其中通过超声导航取出36颗,通过CT导航取出153颗,取出率达97.4%;术中定位准确,出血量少,术后患者均无明显手术并发症。结论：采用超声和CT导航,可精确定位并安全取出滞留于颅颌面颈部的金属异物,避免损伤重要的生理解剖结构,取得了良好的临床疗效。