70例颧上颌复合体骨折类型与眶下神经损伤的相关分析

目的 比较不同类型颧上颌复合体（zygomaticomaxillary complex,ZMC）骨折后眶下神经的损伤情况。方法 参照经典Zingg分类法,对2015年收治的70例单侧ZMC骨折进行分类,并测定其患侧与健侧眶下神经支配区皮肤的痛阈及两点辨别觉。利用不对称指数（asymmetry index,AI）对眶下神经损伤情况进行比较。应用SPSS19.0软件包对数据进行统计学分析。结果 70例ZMC骨折患者患侧眶下神经支配区均有不同程度感觉异常。对痛阈的测定结果显示,不同骨折类型间眶下神经损伤程度存在显著差异（P<0.05）;两点辨别觉测定结果显示,B型与C型较A型骨折神经损伤程度更严重（P<0.05）,B型与C型骨折间神经损伤无显著差异。结论 ZMC骨折容易引起眶下神经损伤, B型骨折患者神经损伤情况最重, A型骨折神经损伤最轻。     

计算机辅助导航系统在单侧颧眶复合体骨折中的应用

目的：探讨计算机辅助手术导航系统在单侧颧眶复合体骨折治疗中的应用及效果评价。方法：应用计算机辅助导航系统对15例单侧复杂颧眶骨折的患者进行术前设计及模拟、术中实时导航定位,术后评价其治疗效果。结果：计算机辅助导航系统在重建颧眶形态和实现双侧颧面部对称性方面具有明显优越性,骨折复位整体偏差小于1mm。结论：计算机辅助导航系统对单侧颧眶复合体骨折术中复位有明确的指导意义,对于颧眶复合体骨折复位的整体评价更为客观真实。     

经眶周小切口治疗颧骨复合体骨折

目的：介绍经眶周小切口复位同定颧骨复合体骨折（ZMC）的方法与疗效。方法：共治疗93例ZMC骨折，其中单纯经眶周（眉弓外侧和下睑缘下）小切口复位58例（62％），眶周小切口＋上颌前庭沟切口复位35例（38％）。术后行临床疗效和影像学观察，随访半年。结果：84例（90％）痊愈，面部畸形与眼球功能障碍完全恢复，眶周无明显瘢痕；9例（10％）明显改善。结论：ZMC骨折经眶周小切口入路治疗创伤小，疗效好，可同期进行眶底探查与眶底骨缺损重建，对复杂性骨折还需联合口内切口复位固定。     

波及眼眶骨折时罕见的眼科并发症

面部骨折常波及眶壁。眶壁常呈Le FortⅡ、Ⅲ型骨折,颧弓上颌骨粉碎性骨折。所有眶部骨折病人均应检查眼球情况。结膜下出血、眶周瘀斑和水肿,骨擦音,眶缘呈台     

耳颞切口联合下睑缘切口治疗颧眶复合体骨折

目的:评价耳颞切口联合下睑缘切口入路可吸收接骨板坚强内固定治疗颧眶复合体骨折的疗效。方法:采用耳颞切口联合下睑缘切口,显露复位颧弓骨折段后应用可吸收接骨板对21例颧眶复合体骨折患者进行坚强内固定,应用面形、张口、伤口愈合情况评价手术效果。结果:21例患者均开口度正常,颧面部及眼部畸形明显改善,伤口甲级愈合,手术效果良好。结论:以耳颞切口联合下睑缘切口入路,可吸收接骨板行颧眶复合体骨折坚强内固定,操作简便,损伤小,并发症少,效果良好。     

头皮冠状切口不同位置切开骨膜对面神经的影响

目的:研究头皮冠状切口手术时,行表浅肌肉腱膜系统(superficial muscle aponeurotic system,SMAS)下分离,不同位置切开骨膜暴露骨折的位置,对面神经颞支、颧支损伤的影响。方法:对27例面中部骨折行头皮冠状切口患者分别采用,方法Ⅰ:沿SMAS下分离至眶上缘上2cm处和颧弓上1.5cm处,先在此切开骨膜和颞深筋膜浅层,分离暴露骨折;方法Ⅱ:沿SMAS下分离至眶上缘和颧弓处,然后再在眶上缘上2cm和颧弓上1.5cm切开直至暴露骨折;方法Ⅲ:同方法Ⅱ分离至眶上缘及颧弓处并直接切开骨膜,暴露骨折。术后7d、1个月、半年随访,对比三种方法的优劣。结果:方法Ⅱ和方法Ⅲ在术后出现不同程度面神经颞支、颧支受损症状,方法Ⅰ术后未出现面神经损伤症状。结论:头皮冠状切口行SMAS下分离至眶上缘上2cm处和颧弓上1.5cm处,切开暴露骨折,是一种临床安全可行的方法。     

数字化导板在陈旧性颧眶骨折治疗中的应用

［摘要］ 目的 探讨数字化复位导板在陈旧性颧眶骨折治疗中的价值。方法 7例陈旧性颧眶骨折患者术前应用快速成形技术制作塑料外科导板,术中参照导板进行骨折的复位和固定。所有患者均进行手术前后的面部对称性CT影像测量,并进行配对t检验。结果 7例患者手术过程均顺利,术后面部对称性有显著提高(P<0.001)。结论 数字化导板对陈旧性颧眶骨折的复位有明确的参照意义。     

经结膜切口入路行颧眶复杂骨折治疗的临床应用

目的 评价经结膜切口入路行颧眶复杂骨折手术的效果。方法 对46例54侧颧眶复杂骨折,采用结膜切 口入路并向外眦延伸5~10 mm,43例附加口腔前庭黏膜切口,将骨折断端解剖复位后,采用钛板进行眶缘坚强内固定,钛网进行眶底粉碎性骨折的重建。结果 46例颧眶复杂骨折患者术后左右颧部基本对称,眼球位置解剖复位,效果满意。术后无明显不良并发症,仅1例出现右侧角膜上皮剥脱,1例出现结膜水肿消退延迟,经用药后均恢复正常。结论 经结膜切口入路能充分暴露颧眶复杂骨折,避免了面神经损伤、面部瘢痕等并发症,是治疗颧眶骨折的较好的手术入路。     

眶下进路在颧骨复合体骨折中的应用

目的:寻求颧骨复合体骨折手术治疗减小面部遗留瘢痕的方法。方法:对51例患者采用改良式眶下进路治疗颧骨复合体骨折,对以往眶下缘切口从睑缘改为骨性眶下缘位置即在患者下睑缘下1cm处,相当于眼轮匝肌下方眼袋的位置作同眼轮匝肌方向一致的弧形切口,切开皮肤皮下组织,钝性分离,推眼轮匝肌向上后直达眶下缘,切开骨膜,暴露眶下缘骨折处,其它小切口未做改变。术后均随访2～3个月,对其疗效进行评价。结果:切口隐蔽性好,而且可以充分暴露眶下缘、眶外侧壁、颧弓以及颧牙槽嵴骨折端,所有患者术后均Ⅰ期愈合,患者术后颧骨左右对称性、咬合功能及局部感觉均获得满意效果,除1例由于是疤痕体质面部小切口疤痕比较明显外,其余病例面部疤痕均不明显。结论:该方法创伤小,显露好,路径短,顺皮纹方向,只留下线样切口愈合,疤痕小不影响面部的整体美观。     

3D打印术前设计和内镜辅助在颧骨颧弓骨折复位固定术中的应用

目的: 探讨3D打印术前设计和内镜技术应用于颧骨颧弓骨折复位固定手术的可行性及效果。方法: 选择4例B型颧骨颧弓骨折患者,均伴发颧弓骨折,面部凹陷明显伴开口受限。术前行CT扫描后将数据转化为STL格式,3D打印骨折模型和镜像模型,在模型上完成手术设计和钛板预弯制。手术采用耳屏前小切口和颧弓表面隧道手术入路,内镜辅助下完成颧弓骨折的复位及坚固内固定。结果: 所有患者术后面部恢复对称性,面部凹陷消失,开口度正常,面部瘢痕不明显,无感染和神经损伤等并发症。结论: 术前3D模型手术设计降低了内镜辅助下行颧弓骨折复位固定术的难度,提高了手术精准度,避免了头皮冠状切口,创伤小,美容效果好。     

Investigation of infraorbital nerve injury following zygomaticomaxillary complex fractures

Summary The aim of this study was to investigate the severity of infraorbital nerve injury following zygomaticomaxillary complex fractures and to estimate the treatment methods facilitating its functional recovery. A total of 478 patients with unilateral zygomaticomaxillary complex fractures were treated. Infraorbital nerve sensory disturbances were diagnosed in 64·4% of the patients. Injury of the infraorbital nerve was expressed as asymmetry index, which was calculated as a ratio between the affected side and the intact side electric pain detection thresholds at the innervation zone skin before treatment and 14 days, 1, 3, 6 and 12 months postoperatively. A mean asymmetry index of 0·6 ± 0·03 and 1·9 ± 0·5 was registered for 57 (11·9%) patients with hyperalgesia and for 251 (52·5%) patients with hypoalgesia, respectively. As a result of retrospective analysis of infraorbital nerve sensory disturbances and its functional recovery, infraorbital nerve injury severity was classified as mild, moderate and severe. It was found that the dynamics and outcome of the functional infraorbital nerve recovery depend on the severity of the injury and the presence of infraorbital canal damage. Function was completely recovered within 3 months after treatment in cases with mild nerve injury. In moderate cases, complete recovery was seen within 6 months and in 34·6% of the severe cases, within a 12‐month period after treatment when infraorbital nerve decompression was performed according to the stated indication. Treatment based on infraorbital nerve injury classification offers a better prognosis for complete recovery of the infraorbital nerve function.     

25例颧上颌复合体骨折诊治方法的探讨

目的:对颧上颌复合体(ZMC)骨折的致伤原因、三维CT检查及坚强内固定方法进行回顾性分析。方法:25例患者均经三维CT检查、图像重建并行坚强内固定手术治疗,术后随访3～12个月。结果:25例患者中,交通事故伤13例(52%),工业事故伤5例(20%)。局部塌陷畸形21例,咬合紊乱19例,张口受限15例,复视伴眼并发症17例,眶下神经支配区麻木11例,5例伴有上颌矢状骨折。25例患者三维CT重建图像均清晰显示主体解剖图像及周围关系,图像直接显示了颌骨骨折的部位及空间结构关系。所有患者选用微型钛板行坚强内固定手术治疗,22例获得满意效果。结论:对于ZMC骨折患者,通过选择局部切口、冠状切口及前庭沟切口,用微型钛板行坚强内固定术,可以获得满意的疗效。     

颧上颌复合体骨折的诊断与治疗

颧上颌复合体是面部最突出的部位之一,由于其解剖部位的特殊性,颧上颌复合体骨折在面中部骨折中占有相当大的比例。骨折后不仅引起局部凹陷畸形,甚至导致开口受限、复视等功能障碍。作者结合文献复习和临床经验,对颧上颌复合体骨折的原因、临床表现、治疗方法、手术入路和术后并发症等进行了讨论。认为眉侧切口联合口内切口入路,可以避免冠状切口的种种弊端。此法可在直视下开放复位,较好地暴露颧骨、上颌骨连接处及眶下区骨折,切断颧骨咬肌附丽,松解颧骨骨折块,再进行内固定,效果良好。手术后瘢痕小,面神经功能无损伤,外形及功能恢复良好,值得推广。     

面中骨折术后眶下神经损伤恢复的临床观察

目的：观察面中骨折后眶下神经损伤的恢复状况。方法：对28例面中骨折后眶下神经损伤的患者，术后通过患者自述、针剌检测、两点辨别觉及直流感应电测仪测定眶下神经的恢复状况及恢复时间。采用SPSS12．0软件包对数据进行t检验。结果：25例患者的眶下神经损伤得到恢复，神经恢复时间在4-6个月，平均25周：3例患者未能恢复．成为永久性损伤。未发现慢性神经性疼痛患者。结论：大部分骨折后眶下神经损伤是暂时的、可恢复的，极少数为永久性损伤。对伤后6个月神经功能仍未恢复的患者，可考虑行眶下神经减压术。     

Branching patterns of the infraorbital nerve and topography within the infraorbital space

The infraorbital nerve (ION) is the terminal branch of the maxillary nerve; it supplies the skin and mucous membranes of the middle portion of the face. This nerve is vulnerable to injury during surgical procedures of the middle face. Severe pain and loss of sense are noted in patients whose infraorbital nerve is damaged. In the study presented here, we investigated the branching pattern and topography of the ION, about which little is currently known, by dissecting 43 hemifaces of Korean cadavers. In most cases, the infraorbital artery was located in the middle (73.8%) and superficial to the ION bundle (73.8%) at its exit from the infraorbital canal. The ION produced four main branches, the inferior palpebral, internal nasal, external nasal, and superior labial branches. The superior labial branch was the largest branch of the ION produced the most sub-branches. These sub-branches were divided into the medial and lateral branches depending upon the area that they supplied. We were able to classify four types of branching pattern of the external and internal nasal branch and the medial and lateral sub-branches of the superior labial branch of the ION at the site of their emergence through the infraorbital foramen (types I-IV). Type I, where all four branches are separated occurred the most frequently (42.1%). These findings will help to preserve the ION while performing certain types of maxillofacial surgery, such as removal of a tumor from the upper jaw and fracture of the upper jaw.     

Neurolytic effects of ampicillin on the rat infraorbital nerve

J Oral Pathol Med (2012) 41 : 268–271 Purpose: The aim of this study was to investigate the histomorphological changes of the infraorbital nerve of rats treated with ampicillin. Materials and Methods: The infraorbital nerve was approached through the infraorbital foramen, and 0.01 ml of ampicillin dissolved in distilled water was injected taking care not to damage the nerve. Saline solution was used in control animals. Nerves were dissected and after routine histology processing analysed by light microscopy. Results: Cross‐section of the nerve treated with ampicillin showed damaged axons with disintegration of heavily myelinated fibres, while thinly myelinated fibres remain unaffected. In the saline group, no damage was observed. The signs of regeneration of the damaged infraorbital nerves were detected on the fourth post‐operative week. Conclusion: Ampicillin can cause peripheral nerve damage when injected perineurally.     

A comparison of the local anesthetic efficacy of the extraoral versus the intraoral infraorbital nerve block

BackgroundThe efficacy of the extraoral infraorbital nerve block has not been studied sufficiently to ensure its appropriate clinical use. To compare the local anesthetic efficacy of the extraoral versus the intraoral infraorbital nerve block, the authors conducted a prospective, randomized crossover study.MethodsForty adult participants randomly received extraoral infraorbital nerve blocks of 1.8 milliliters of 2 percent lidocaine with 1:100,000 epinephrine at one appointment and intraoral infraorbital nerve blocks of 1.8 mL of 2 percent lidocaine with 1:100,000 epinephrine at another appointment in a crossover design. After administering the injections, the authors used an electric pulp tester to assess the maxillary central and lateral incisors, canine, premolars and first molar for pulpal anesthesia in four-minute cycles for 60 minutes. They considered anesthesia to be successful when the participant had no response to two consecutive 80 readings (the maximum output) with the electric pulp tester.ConclusionsThe authors found that the extraoral and intraoral infraorbital nerve blocks were ineffective in providing profound pulpal anesthesia of the maxillary central incisor (15 percent success rate) and lateral incisor (22 percent success rate). The pulpal anesthesia success rate was 92 percent for the canine for both types of nerve blocks, 80 to 90 percent for first and second premolars and 65 to 70 percent for the first molar, with no significant differences (P < .05) between the two nerve blocks. Pulpal anesthesia did not last for an hour in any of the teeth. Needle insertion pain and postoperative sequelae were more common after the extraoral infraorbital nerve block was administered.Clinical ImplicationsBoth nerve blocks would be ineffective in the central and lateral incisors. Both nerve blocks would be somewhat successful in the canine and premolars but not in the first molar.     

眶下径路治疗颧骨复合体骨折的临床评价

目的：对眶下径路治疗颧骨复合体骨折的临床疗效进行评价。方法：对65例颧骨得合体骨折作临床分析,经眶下径路作开放整复加微型钛板坚强固定手术。结果：（1）眶下径路术野暴露充分;（2）颧骨复合体骨折复位快,对位精确;（3）微型钛板固定坚固;（4）无面神经损伤等并发症;（5）疗效优良率达96．9％。结论：眶下径路适宜于颧骨复合体骨折的治疗。     

Communication of infraorbital nerve and facial nerve: anatomic and histologic study

The maxillary nerve, second division of the trigeminal nerve, is entirely sensory. It has been reported that drooling may occur later in the event of fracture of the zygoma in which hypesthesia prevails. The aim of the study is to elucidate additional detailed anatomy of the infraorbital plexus, consisting of the superior labial branch of the infraorbital nerve and facial nerve in the cheek. The authors dissected infraorbital nerves and facial nerves in 16 cadavers. Most terminals of the zygomatic branch of the facial nerve emerged from under the levator labii superiors and zygomatic muscle and infraorbital nerve. A hazardous zone of infraorbital plexus is found in a circle 36 mm in diameter. Its center is located 22 mm below the inferior orbital foramen. This hazardous zone of infraorbital plexus should be kept in mind when performing any procedures related to zygoma, maxilla, or deep cheek injuries.