保留下颌骨完整性的舌癌联合根治术临床探讨

目的探讨舌癌联合根治术中保留下颌骨完整性的手术方法及其适应证和临床疗效。方法对15例下颌骨舌侧骨膜未受侵犯的舌癌患者行保留下颌骨完整性的联合根治术,在舌癌原发灶1．0～1．5cm外,扩大切除原发灶及口底组织,与颈淋巴清扫组织整块切除,视口底黏膜有无受侵犯,保留或切除下颌骨舌侧骨膜,缺损采用直接拉拢缝合,带蒂皮瓣或游离皮瓣修复。结果15例患者术后面部外形无明显畸形,咬合关系无改变,咀嚼、吞咽和语言功能基本恢复正常。随访3～10年,局部复发4例,其中原发部位复发3例,均与下颌骨及其舌侧黏骨膜无关,同侧颈部复发1例。患者3年生存率73．3％（11／15）,5年生存率55．5％（5／9）。结论在严格掌握适应证的情况下,保留下颌骨完整性的舌癌联合根治术既能根治肿瘤,又使患者获得良好的生存质量。     

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目的探讨舌癌、口底癌病灶切除后即刻修复重建术中保留下颌骨牙槽突的可行性,提高患者术后生活质量。方法对2007年10月至2011年3月中国医科大学口腔医学院口腔颌面-头颈肿瘤外科收治的38例舌癌、口底癌患者(原发灶T1-T3,下颌骨无侵犯)行保留下颌骨牙槽突的病灶扩大切除、选择性或根治性颈淋巴清扫术、游离皮瓣移植舌及口底修复重建术,术后随访观察。结果所有患者随访6～38个月,原发病灶处无一例复发,转移皮瓣成活良好,口腔功能恢复良好。结论在舌癌、口底癌病灶切除及修复重建术中,通过严格地筛选病例,保留下颌骨牙槽突是完全可行的。     

保留牙列和下颌骨行舌癌根治术的近期疗效观察

目的:为提高舌癌患者术后生存质量,探讨保留牙列和下颌骨的舌癌改良根治方法,并评价其疗效。方法:回顾性分析采用保留牙列和下颌骨方式行舌癌根治术的13例T2期舌癌患者的临床资料,通过术后肿瘤有无复发和转移,患者面形、咬合、舌运动、语言和进食等情况,评价手术疗效和患者口腔功能状况。结果:随访3～23个月,1例患者肿瘤转移,其余12例患者未发现肿瘤局部复发和远处转移。全部患者术后均无咬合错乱,语言、咀嚼功能良好,面部对称无畸形。结论:保留牙列和下颌骨的舌癌改良根治方法能够获得良好的舌癌治疗效果并保存面形和口腔功能,但须选择相应的手术适应证。     

保留完整下颌骨的舌癌根治术式的探讨

目的:为减少舌癌患者术后口腔功能的丧失,提高患者术后生存质量,探讨舌癌联合根治术中保留下颌骨完整的必要性、可能性及其方法。方法:收集随访2003年5月至2004年12月本科舌癌手术患者10例(原发灶T2~T3,无明显口底侵犯或口底侵犯<0.5cm,颈部N0~N3)。同期行舌-颈联合根治术,于正中或颏孔前截断下颌骨,沿颌舌沟切开口底黏膜达舌根处,自下颌骨内侧骨面剥离骨膜及下颌舌骨肌附丽,保留下颌舌侧牙龈及部分黏膜,外展下颌骨,直视下扩大切除原发灶,取自身组织瓣(前臂桡侧皮瓣8例,胸大肌皮瓣1例,股前外侧皮瓣1例)一期修复,皮瓣边缘与下颌内侧牙龈或黏膜缝合,复位下颌骨并以钛板钛钉固定;术后常规放疗。结果:随访6~26个月,无1例于下颌骨内侧切缘部位复发,口腔功能恢复良好。结论:舌癌联合根治术中,通过严格选择病例,保留下颌骨完整是完全可行的。     

保留下颌骨下缘和舌骨上淋巴清扫舌癌根治术的评价

目的：评价保留下颌骨下缘和舌骨上淋巴清扫舌癌根治术式的可行性及适应证。方法：回顾总结10例采用该术式舌癌病例临床资料。结果：3例在术后2个月－1年半发现患侧颈淋巴转移；2年生存者9例，3年生存者4例，5年生存者2例；所有病例均无局部复发。结论：保留下颌骨下缘更有利于舌原发灶的彻底切除，避免局部复发，对未侵犯下颌骨的病例均可采用。舌骨上淋巴清扫术应慎重应用，手术应扩展至二腹肌淋巴结。术后配合系统化疗并严密观察，一旦发现颈淋巴转移灶立即行根治性颈淋巴清扫术。     

小腿内侧皮瓣在口腔颌面部术后缺损修复中的应用

目的：评价小腿内侧皮瓣在口腔颌面软组织缺损修复中的价值。方法：对2例累及舌腹部及下颌舌侧骨板的口底鳞癌．行原发灶根治术及保留颏部下缘的颏部截除术：4例舌癌均行原发灶根治术．术中保留下颌舌侧牙龈，未行下颌骨骨段切除术：2例颊部鳞癌患者行保留下颌骨下缘的原发灶根治术；8例患者均行颈淋巴清扫术．术中解剖出面动脉、颈外静脉和颈前静脉，再根据口腔缺损的范围制备相应大小及形状的皮瓣，皮瓣以胫后动、静脉为蒂。将皮瓣的胫后动脉与面动脉吻合，将皮瓣的胫后静脉与颈外静脉（或颈前静脉）吻合．然后将皮瓣与缺损区边缘严密缝合。结果：8例小腿内侧皮瓣均获得成功，口内、外伤口愈合良好，修复效果良好，覆盖于小腿内侧皮肤缺损区的皮片全部成活。结论：小腿内侧皮瓣适用于舌、口底、颊部及面颈部软组织缺损的修复。口腔颌面部肿瘤术后软组织缺损．可利用携带部分比目鱼肌的小腿内侧皮瓣进行修复。     

牙槽突裂修复术11例临床观察

目的:探讨牙槽突裂的手术方法,提高临床治疗牙槽突裂的效果。方法:选择11例牙槽突裂病例,采用改良手术方法治疗,总结临床治疗效果。结果:术后随访3～4个月,11例牙槽突裂患者牙槽嵴裂隙处移植骨生长良好,吸收较少,口内创口一期愈合;髂骨区创口愈合良好,无严重供骨区并发症。结论:通过改良手术可以较好地提高手术效果,有效减少手术并发症,对临床治疗有一定参考价值。     

围裙式颈阔肌肌皮瓣在口腔颌面部缺损修复中的应用

目的:介绍一种新颖的颈阔肌肌皮瓣术式,评价其修复口腔颌面部缺损的应用价值.方法:用围裙式颈阔肌肌皮瓣修复口腔颌面部病变切除术后缺损的患者15例.设计U形的围裙式切口制备皮瓣,保留蒂部皮肤,加宽肌蒂宽度.结果:15例围裙式颈阔肌肌皮瓣12例完全成活,3例皮瓣部分坏死.其中,修复颊黏膜、舌、牙槽突缺损的皮瓣完全成活率分别为8/9、1/3、3/3.另有2例颈部供区伤口愈合不良.所有病例经4～33个月随访,l例牙龈癌颈部瘢痕较为明显,1例舌癌舌运动受限,其余病例口腔颌面部形态、功能恢复良好.结论:和颈阔肌肌皮瓣比较,围裙式颈阔肌肌皮瓣可提供更宽的皮岛,特别适合中小型颊部软组织及牙槽突缺损的修复,舌部缺损不是该皮瓣最佳适应证.     

口底区域淋巴组织清扫术在舌癌根治术中的应用

目的:为减少舌癌患者术后复发率及转移率,探讨口底区域淋巴组织清扫术的范围、术式及其临床意义。方法:收集随访2000年5月～12月本科舌癌手术患者20例(原发灶T2或T3,未明显侵犯口底,颈部N0)。同期舌-(颌)-颈联合根治术,术中于颏孔前断离并外展下颌骨,以利直视下彻底清扫同侧口底中间带淋巴组织,达到完整舌-(颌)-颈根治。同期调查我院和外院舌癌手术后患者20例(术中口底中间带淋巴组织保留或未彻底清扫)作为对照,比较两组患者复发率与颈部淋巴结转移率。结果:实验组局部无1例复发,对侧淋巴结转移2例(T3),转移率10%。对照组口底或下颌下复发7例,对侧颈淋巴转移5例,复发转移率60%。P<0.05,有统计学显著性差异。结论:传统非连续性颈清扫并不能清除所有可能受累的淋巴结。对T2以上的舌癌患者,宜在传统的颈清术式基础上,断离、外展下颌骨,行同侧口底中间带组织的彻底清扫。     

基于CT影像的牙种植模板相关的颌骨解剖学研究

目的:通过观测成人颌骨形态结构及其周围骨突的情况,为临床口腔种植手术导板的设计、制作,模板导向孔的安置、深度和方向以及种植角度提供参考数据。方法:对临床上31例上颌骨及44例下颌骨的CT断层图像,应用3D-DOCTOR软件对其各个牙位上相应的牙槽嵴与对应牙的夹角进行观测与测量,并用统计分析软件SPSS13.0加以分析。结果:上颌骨牙长轴与牙槽突的唇腭侧偏移关系有71.92%在偏唇与偏腭20°以内,下颌骨牙长轴与牙槽突的唇腭侧偏移关系有98.68%在偏唇与偏舌20°以内。结论:颌骨牙长轴与牙槽嵴的相对偏斜度可为种植位点的选择和种植导向模板的制作提供理论依据。     

不同剂型玻璃离子水门汀溶解性比较研究

目的:研究、比较不同剂型玻璃离子水门汀的溶解性和表面微观形态改变,为临床使用提供依据.方法:将3M树脂加强型玻璃离子水门汀(水粉剂型)、GC玻璃离子水门汀(水粉剂型)及GC玻璃离子水门汀(双糊剂型)分别在人工唾液中浸泡30 d,冷热循环15000次,烘干测重,比较前后质量变化,计算溶解率,并用扫描电镜观察表面微观改变.结果:不同剂型的玻璃离子水门汀溶解率由高到低分别为3M树脂加强型玻璃离子水门汀(水粉剂型)、GC玻璃离子水门汀(水粉剂型)、GC玻璃离子水门汀(双糊剂型).3种玻璃离子水门汀经浸泡溶解后,SEM扫描表面微观形态可观察到GE玻璃离子水门汀(双糊剂型)表面形态改变较少,其他2组玻璃离子水门汀表面微观改变较多.结论:双糊剂型玻璃离子水门汀理化性能及溶解率均低于传统水粉剂型,是未来临床修复治疗的的良好选择.     

Evidence of the validity of a model of determinants of quality of restorative dental care

A model describing the relationship between self-reported quality of restorative dentistry and dentist characteristics for 119 Montana general dentists is presented. The best predictors formed a significant model explaining 22% of the variance of the quality measure. Results are contrasted with a previous estimation of the model for 102 Washington general practitioners. Evidence for the external validity of the model is presented.     

Design of clinical trials of traditional therapies of periodontitis

The present paper on the design of clinical trials of periodontal therapy first addresses the issue of the etiology of periodontal disease. It is suggested that most if not all forms of destructive periodontal disease are caused by microorganisms and that there are different forms of disease with different microbial etiologies. The progressive nature of destructive periodontal disease is subsequently discussed and it is emphasized that, in a given patient, periodontal sites which show signs of inflammation and attachment loss may not over a period of several months and years show further sign of attachment loss. The present methods of assessing periodontal disease do not allow us to discriminate between potentially active and inactive sites in untreated patients. The significance and variability of indicators of periodontal disease such as bleeding on probing, probing pocket depth and probing attachment level measurements are discussed. The errors inherent in the various measurements are analyzed and suggestions are presented describing how alterations in any of the above parameters could be identified and presented in a clinical trial. Of concern for the statistical analysis of clinical data of periodontal disease is the definition of the "experimental unit". For a number of years, the "experimental unit" in periodontal trials was the patient. It is clear, however, that different sites within the same individual show different patterns of disease progression and lesion morphology and often respond differently to periodontal therapy. Statistical analyses must consequently be designed which recognize differences in site-to-site infection and lesion morphology within a common host. Until such analyses are available, the investigator should be wary of pooling data within the same individual, since such pooling may obscure meaningful alternatives which may take place in individual periodontal sites. Some goals of periodontal therapy are subsequently identified. 4 goals are discussed more in detail, namely: to establish conditions which will allow the patient to maintain a dentition without further breakdown of the periodontium; to reduce pocket depth to establish an anatomy in the dentogingival region which with proper maintainance care will prevent the re-establishment of the subgingival infection; to gain attachment as a result of treatment; to assess the effect of a certain chemotherapeutic agent on periodontal disease.     

Experimental evidence of formation of imines in the course of reduction of hydrazones

The reduction of hydrazones is generally suggested to proceed through a reductive cleavage of the nitrogen–nitrogen bond followed by a reduction of the carbon–nitrogen bond. This sequence of reduction processes is here supported for fluorenone (V) and benzophenone (VI) hydrazones as well as by a comparison of the reduction of fluorenone and benzophenone hydrazonium ions (I,III) with corresponding imines (II,IV). Another proof of the presence of imines as intermediates is the splitting of four-electron waves of hydrazones V and VI and hydrazonium ions I and VIII into two waves at pH < 2. This has been interpreted as due to differences in slopes dE_1/2/dpH and pK_a-values of protonated hydrazine derivatives on one side and corresponding imines on the other. In this pH-range imines formed in reductions of VI and VIII are reduced in a single two-electron wave, those of I and V in two one-electron steps. Fluorenone imine (II) is sufficiently stable to allow recording of time-independent current–voltage curves between pH 6 and 11. In this pH-range the imine (II) is reduced in two one-electron steps. Benzophenone imine (IV) has been found stable between pH 4.6 and 12. At pH 4.6–8 the reduction of the imine IV takes place in a single two-electron step, at pH 8–12 in two one-electron steps. Final proof of the initial cleavage of the N–N bond is presented by comparison with the reduction of nitrones.     

Evaluation of efficacy of chemiluminescence for diagnosis of leukoplakia

ObjectiveLeukoplakia is the most common potentially malignant disorder preceding oral cancer. Chemiluminescence has been developed as an adjunct to conventional examination for the diagnosis of these potentially malignant disorders. This study was conducted to assess the efficacy of chemiluminescence in the diagnosis of leukoplakia and to compare the results with histopathological examination.Study designA total of 50 patients with leukoplakia were included from the outpatients attending the Department of Oral Medicine and Radiology, Dental Hospital, Bengaluru, Karnataka, India. These patients were subjected to conventional oral examination followed by chemiluminescent examination with Vizilite (Zila, Fort Collins, CO, USA) and biopsy for histopathological confirmation.ResultsThe sensitivity, specificity, positive predictive value, and negative predictive value of chemiluminescence were 93.75%, 55.56%, 78.95%, and 83.3%, respectively. The overall accuracy of chemiluminescence was 80%. A statistically significant association was observed between histopathology results and chemiluminescence results.ConclusionAlthough it is an easy, safe, minimal time consuming, and noninvasive technique, it has only adjunctive utility and it does not replace biopsy for the diagnosis of leukoplakia.     

正常青年Monson球面半径的测量研究

目的测量正常青年Monson球面半径。方法选择60名(男30名,女30名)正常青年制取全口印模,应用立体摄影成像的原理与方法对Monson球面半径进行测量和统计学处理。结果Monson球面的半径平均为10.173 cm,大于理论值10.160 cm,差异有显著性(P<0.01);男、女性球面半径差异无显著性。结论本实验所得到的数据可作为全口义齿修复中记录颌位关系的一个参量。     

正畸患者切牙影像失真发生情况分析

目的研究正畸患者曲面体层片上的切牙影像失真发生情况，并分析其原因。 方法从中山大学附属口腔医院放射科影像数据库中选取500例正畸患者的曲面体层片和头影测量侧位片，所有曲面体层片均采用咬合杆投照，分别从切牙牙体影像放大、缩小、牙根变短、根尖模糊等评价指标分析上下颌切牙影像失真的发生情况，在头影测量侧位片上测量中切牙根尖-对颌切牙切缘的距离，探讨切牙影像失真发生的原因。采用SPSS 19.0统计软件对所得数据进行统计学检验。 结果500例患者中，切牙牙体影像正常者共417例，切牙牙体影像失真者共83例，影像失真发生率16.6%，其中切牙牙体影像放大17例、牙体影像缩小0例、牙根变短30例，牙根影像变短伴模糊36例。影像失真患者的根尖-切缘距离大于影像正常的患者，差异有统计学意义（F = 5 187.18，P = 0）；影像失真患者的覆盖值大于影像正常的患者，差异有统计学意义（F>477，P = 0）。 结论严重牙颌面畸形如反 、深覆盖是导致曲面体层片的切牙影像失真的主要原因之一。     

颌骨动静脉畸形的栓塞治疗

目的：总结直接穿刺结合经血管内介入栓塞治疗颌骨动静脉静脉畸形的经验。方法：收治凳骨动静脉畸形患者6例,均进行了介入栓塞治疗。采用的栓塞材料为附凝血棉纤毛的螺圈,聚乙烯醇泡沫微粒和二氰基丙烯酸对丁酯。数字减影颈动脉造影在PHILIPSV300下完成。结果6例颌骨动静脉畸形患者中4,例急性出血得到了快速、有效控制,1例慢性渗血的右下 骨动静脉畸形患者,介入栓塞治疗,拔除松动的右下凳第一磨牙,有效地控制了出血,另1例伴局部软组织搏动性膨隆的上凳骨动静脉畸形患者,介入治疗后膨隆的搏动性得到明显改善,栓塞治疗后分别随访3－24个月,均未发现有口腔内渗血或出血。随访的X线片上,病灶区可见新骨形成。结论：局部穿刺结合经血管内介入栓塞治疗颌骨动静畸形是一种安全、有效的治疗方法。     

Electrodeposition of bilayers of dithiols

We report an electrochemical method to form a bilayer of dithiol. The cyclic voltammogram of the oxidative deposition of an aromatic dithiol on gold from an alkaline aqueous solution reveals two current peaks separated by more than 400 mV. The integrated charge of the oxidative current peak (B) at the most positive potential is twice that of the other oxidative current peak (A). These two oxidative current peaks were characterized by differential capacitance and electrochemical quartz crystal microbalance (EQCM) measurements. A decrease of the capacity by a factor of two, and an increase of the EQCM frequency change by a factor of two were observed when the potential was scanned from a value where only the first oxidative peak (A) is obtained, to a potential where both oxidative current peaks (A and B) are obtained. Infrared spectra show that the aromatic dithiols adsorb vertically at potentials corresponding to the current peak A and they become tilted for potentials corresponding to the current peak B. The simple relationships between the properties of the two oxidative current peaks are found to be compatible with a step-wise oxidative deposition of a bilayer of dithiol.