安氏Ⅱ类1分类拔牙病例正畸治疗后后牙关系的稳定性研究

目的　探讨安氏Ⅱ类1分类患者正畸治疗前、后后牙关系的变化趋势,分析可能影响后牙关系复发的因素。方法　选取采用拔牙治疗的安氏Ⅱ类1分类患者29例,其中男12例,女17例。根据ANB角进一步分为牙性Ⅱ类14例,骨性Ⅱ类15例。分别对其正畸治疗前、后进行模型测量和X线头影测量。结果　所有患者的Ⅱ类磨牙关系在治疗后均得到明显改善,随访时仅有少量复发。牙性Ⅱ类患者治疗后下磨牙近中移动量(4·52±2·15) mm,大于上磨牙移动量(3·62±2·62)mm,而骨性Ⅱ类患者上下磨牙近中移动量相似,但ANB角由治疗前的(6·27± 1·08)°明显减小为(4·64±1·17)°。随访时两类错患者上下颌磨牙均近中移动,且上颌磨牙移动量大于下颌磨牙。多元回归分析提示下颌骨水平向生长和上前牙不齐指数与磨牙关系复发有关。结论　Ⅱ类错患者正畸治疗后磨牙关系较为稳定。牙性Ⅱ类错磨牙关系的解除有赖于上下颌磨牙相对移动调整,骨性Ⅱ类错则依靠上下颌骨间位置关系的改变。有利的下颌生长型和上颌前牙不齐程度等与磨牙关系的保持有密切关系。     

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目的评价中西医结合治疗糜烂型口腔扁平苔藓(orallichenplanus,OLP)的临床疗效。方法选择2008年2月至2010年6月在江西省抚州市第一人民医院口腔科就诊的86例糜烂型OLP患者,随机分为试验组和对照组,各43例。试验组采用局部注射曲安奈德配合中药治疗,对照组仅局部注射曲安奈德。分别对两组患者治疗前、治疗1个月后和治疗6个月后的局部病损进行分级评定,并进行对比观察。结果治疗1个月后试验组和对照组有效率分别为83.33%和83.72%,两组比较,差异无统计学意义(χ2=0.002,P=0.962);治疗6个月后试验组有效率为76.68%,优于对照组的26.32%,差异有统计学意义(χ2=17.053,P<0.001)。结论中西医结合治疗糜烂型OLP的疗效优于单纯的局部注射治疗。     

六味地黄丸在牙周炎维护治疗中的作用

目的　观察六味地黄丸治疗慢性成人牙周炎的临床疗效。方法　选择120例曾接受过牙周治疗的慢性成人牙周炎患者,随机分为2组,对照组仅做洁治刮治根面平整(SRP),试验组在行SRP治疗后连续口服六味地黄丸5 个月,复诊检查患者牙周情况。结果　试验组用药5个月后,牙周探诊牙周袋减少0·43 mm,牙周附着增加 0·22 mm,与对照组相比差异有显著性(P<0·01)。结论　SRP加六味地黄丸治疗在减少牙周袋深度和增加牙周附着方面优于单纯的SRP,六味地黄丸是一种安全有效持久的牙周炎维护治疗的全身药物。     

开放面神经管的神经移植在腮腺癌手术修复中的应用

目的　探讨侵袭到茎乳孔及周围骨质的腮腺深叶癌切除面神经后,即刻功能性修复方法的临床效果。方法　93例腮腺癌患者分为A,B,C 3组。①A组34例采用开放面神经管,去除周围骨质,将肿瘤连同腮腺及面神经扩大切除,同时行面神经移植的治疗方法;②B组35例采用未开放面神经管,仅将癌瘤连同腮腺及受累的面神经切除;③C组24例采用癌瘤与粘连的面神经干分离,保留面神经连续性的癌瘤切除。结果　A组术前有面瘫的12例患者,术后面神经功能仅2例恢复;术前无面瘫的22例患者术后有15例面神经功能恢复。术前无面瘫的患者术后面神经功能恢复率显著高于术前有面瘫的患者(P<0·05)。B组35例患者术后均造成永久性面瘫。C组24例患者,术后面神经功能均完全恢复。术前无面瘫的患者中A组患者的局部控制率和5年生存率都显著高于B组和C 组(P<0·05);术前有面瘫的患者中A组和B组的局部控制率和5年生存率无显著差异(P>0·05)。结论　开放面神经管即刻修复面神经功能的方法,既达到肿瘤切除的彻底性,又符合功能外科的发展要求,是一种比较理想的手术方法。     

医用几丁糖治疗颞下颌关节不可复性盘前移位的临床研究

目的　观察医用几丁糖关节腔内注射对颞下颌关节不可复性盘前移位的临床治疗效果。方法　将30例颞下颌关节不可复性盘前移位患者 ,按就诊序号半随机分为试验组和对照组。试验组患者用几丁糖 1 0ml关节上腔注射治疗 ,对照组患者用强的松龙悬液 1 2 5mg关节上腔注射。注射治疗后 1d、1 4d复诊 ,测量最大张口度。结果　注射后 1 4d ,试验组患者平均张口度恢复到 (36 73± 4 6 9)mm ,比注射前增加 1 1 73mm ;对照组患者平均张口度为 (2 8 5 3± 5 81 )mm ,比注射前增加 3 86mm。试验组张口度增加值明显大于对照组 (P <0 0 5 )。结论　医用几丁糖是一种有效的治疗颞下颌关节不可复性盘前移位的生物材料。     

A型肉毒毒素复合罗哌卡因治疗三叉神经痛的疗效

目的评价A型肉毒毒素（BTX-A）复合罗哌卡因治疗特发性三叉神经痛的临床效果。 方法选取2018年12月至2019年10月在中国医科大学附属口腔医院就诊的特发性三叉神经第三支疼痛患者20例，随机数字表法分为试验组、对照组，每组10例。试验组采用BTX-A复合罗哌卡因治疗，对照组采用卡马西平治疗。两组治疗前及治疗后1 h、6 h、12 h、1周、1个月、3个月和6个月行视觉模拟量表（VAS）评分比较疼痛程度，同时统计和比较疼痛发作频率及睡眠质量，进行疗效评价。使用SPSS 20.0软件进行数据分析。 结果试验组疼痛VAS评分在治疗后1 h、1个月分别为0.4 ± 0.5和2.8 ± 3.1，分别低于对照组（1.2 ± 1.0、5.1 ± 1.4），差异均有统计学意义（t_{1 h}=-2.191，P_{1 h}= 0.047；t_1个月=-2.155，P_1个月= 0.045）；试验组治疗后1个月睡眠质量评分为7.8 ± 3.2，对照组为10.8 ± 2.4，差异有统计学意义（t=-2.395，P= 0.028）；试验组疼痛发作频率在治疗后1周、1个月、3个月均低于对照组，而在治疗后6个月高于对照组，差异均有统计学意义（t_1周=-2.900，P_1周= 0.010；t_1个月= -4.544，P_1个月= 0.001；t_3个月=-5.156，P_3个月= 0.000；t_6个月= 3.391，P_6个月= 0.003）。 结论BTX-A复合罗哌卡因可缓解特发性三叉神经痛，改善患者的睡眠状况。     

新型纳米根管充填材料体外基因毒性的初步研究

目的　采用体外微核法评价新型纳米根管充填材料nHA-PA66的基因毒性。方法　以V79细胞作为实验细胞,采用新型纳米根管充填材料nHA-PA66粉剂及混合物的浸提液作为实验组,丝裂霉素C为阳性对照组,用 MTT法检测各组的细胞毒性,以V79细胞中所形成的微核数作为标准评价材料的基因毒性。结果　实验组的MTT 值在各个时间段与阴性对照组无显著性差异(P>0·05);所形成的微核数(粉剂组:6·1±1·1/1 000;混合物组:5·7± 0·6/1 000)与阴性对照组(5·3±0·8/1 000)无显著性差异(P>0·05),而与阳性对照组(123·9±8/1 000)有显著性差异 (P<0·05)。结论　本实验显示新型纳米根管充填材料nHA-PA66无细胞毒性及基因毒性,生物相容性好。     

局部注射IL-2联合化疗对口腔鳞癌浸润淋巴细胞的影响

目的　评价IL-2局部注射联合化疗对口腔鳞癌局部免疫反应的影响。方法　34例T3、T4期口腔鳞癌患者随机分成2组接受术前治疗,其中23例行免疫化疗(IL-2局部注射合并PVP化疗),11例行单纯化疗。比较 2组患者治疗前后肿瘤浸润T淋巴细胞亚群和B淋巴细胞的变化。结果　免疫化疗组治疗前后CD4+,CD8+, CD20+相对值分别为36·96,35·65,28·65和56·61,38·52,38·70。治疗后CD4+,CD20+细胞数较治疗前明显增加 (P<0·01)。单纯化疗组治疗前后CD4+,CD8+,CD20+细胞数均无显著差异(P>0·05)。结论　IL-2局部注射联合化疗对增强口腔鳞癌患者局部免疫功能具有重要意义。     

预防矫治后前牙旋转拥挤复发的临床研究

目的　评价改良嵴上纤维切断术(MSF)及邻面去釉接触区成形术(CPR)防止矫治后前牙旋转拥挤复发的有效性及可行性。方法　129例前牙旋转拥挤患者随机分为实验组和对照组。对照组81例仅作固定矫治;实验组 48例患者除作固定矫治外,其中23例行上下前牙MSF和CPR,余25例只作上下前牙MSF;术后3组均戴维持器1·8~ 2·3年。所有患者在安放固定矫治器前(T1期)、去除固定矫治器时(T2期)和去维持器后2·4年(T3期)各取牙模1副, 比较3组患者的不整齐指数(IRID)。结果　实验组拥挤旋转复发率平均低于对照组21·6%(P<0·001);实验组内:双因素组(MSF+CPR)下颌复发率较单因素组(MSF)低6·56%(P<0·05),但两组在防止上颌拥挤复发上无显著性差异 (P>0·05)。结论　MSF能较有效地防止矫治后前牙拥挤旋转复发,MSF配合CPR对维持下前牙矫治后的稳定具有显著效果。     

256例慢性颞下颌关节盘不可复性前移位综合物理治疗远期疗效评价

目的： 观察综合物理治疗改善慢性颞下颌关节盘不可复性前移位（ADDwoR）患者症状及功能的远期临床疗效。方法： 随访2014年1月—2015年12月在我院康复科完成治疗的慢性ADDwoR患者256例（病程为8.4±9.6个月）,比较治疗前、治疗后、随访时的症状和功能,包括最大主动开口度、视觉模拟评分法（VAS）疼痛评分、下颌功能损害问卷（MFIQ）分值。随访复发频率及复发时的症状。采用SPSS17.0软件包对数据进行重复测量方差分析。结果： 平均随访时间为30.5±4.6个月,患者最大主动开口度随访时>治疗后>治疗前（P<0.05）;VAS疼痛评分随访时<治疗后<治疗前（P<0.05）;MFIQ分值随访时<治疗后<治疗前（P<0.05）。治疗后直到随访时,82.8%的患者未出现症状复发,14.5%复发,2.7%症状未见好转。37例有症状的复发患者中,70.3%为疼痛,13.5%为开口受限,13.6%为疼痛伴开口受限。结论： 综合物理治疗可显著改善ADDWoR患者的疼痛和开口受限症状,改善下颌功能,远期疗效良好。     

β－七叶皂甙钠治疗贝尔氏麻痹22例临床报告

作者用国产β－七叶皂甙钠为主的综合药物治疗贝尔氏麻痹２２例。１７例治愈，４例明显改善，总有效率９５．４％。该法针对可能的致病因素，消除神经水肿，减轻变性；减轻病人痛苦，缩短了疾病恢复过程，为治疗贝尔氏麻痹提供了新的途径。     

中西医结合治疗儿童复发性口腔溃疡的临床效果分析

目的：评价中西医结合治疗小儿复发性口腔溃疡的临床效果及对患儿免疫功能的影响。方法：76例复发性口腔溃疡的小儿患者,随机分为实验组和对照组各38例。对照组给予西药对症支持治疗,实验组患儿在此基础上联合中药方剂调理。观察两组的溃疡愈合时间,疼痛评分,治疗有效情况及对患儿免疫功能的改善情况与治疗期间的不良反应。结果：实验组治疗后的平均愈合时间明显短于对照组（ t＝6．7145,P＝0．0000）;两组的T细胞亚群含量比较,治疗后均有所改善（P＜0．05）,而实验组的CD4、CD8和CD4／CD8的改善情况明显优于对照组（P＜0．05）;两组患者治疗期间均未发生明显不良反应。结论：采用中西医结合治疗小儿复发性口腔溃疡临床疗效显著,同时可提高患儿的免疫功能。     

中西医结合治疗口腔扁平苔藓的临床疗效观察

目的观察中西医结合治疗口腔扁平苔藓(OLP)的效果。方法对60例OLP患者进行分组治疗,实验组采用中西医结合治疗方法,局部醋酸曲安奈德封闭和鱼肝油涂敷,同时服用活血化瘀中成药复方苔藓片和黄芪精进行全身调理。对照组单用上述西药局部治疗。结果实验组和对照组近、远期有效率分别为93.33%、56.67%(P<0.01);57.14%、5.88%(P<0.01);1年复发率分别为29.41%、87.50%(P<0.01),两组疗效差异有显著性。结论中西医结合较单纯西药治疗OLP疗效好,复发率低。     

阿昔洛韦联合泼尼松治疗46例贝尔面瘫的疗效评价

目的：评价抗病毒药物阿昔洛韦（aciclovir）联合糖皮质激素泼尼松（prednisone）治疗贝尔面瘫的疗效。方法：46例贝尔面瘫病者被随机分成阿昔洛韦联合泼尼松组（A＋P组，n=23）和泼尼松治疗组（P组，n=23）。A＋P组口服阿昔洛韦每日3次，每次0．4g和泼尼松每日一次，每次50mg，P组口服泼尼松每日一次，每次50mg，连续5d，接着各组均将泼尼松减量为隔日一次，每次20mg。面神经功能指数（facial nerve functional index，FNFI）作为评判疗效指标。结果：治疗后第3周A＋P组中有12例（52.1％）面神经完全恢复（FNFI=1），P组为5例（21.7％）两者有显著性差异（P〈0．05）；而治疗后第4周，A＋P组2l例（91．3％）和P组18例（78．3％）面神经完全恢复（P〉0．05）。结论：阿昔洛韦联合泼尼松治疗贝尔面瘫疗效确切，无明显副作用；疗程比单纯用泼尼松治疗有明显缩短。     

Facial palsy in the dental surgery. Case report and review

Facial palsy is a relatively uncommon condition with a variety of causes including dental intervention. A brief history of two cases of facial palsy with dental implications is presented. The aetiology of facial palsy is reviewed and the management of such cases is discussed. The option of immediate treatment of Bell's palsy with prednisone is stressed.     

Diagnosis and management of Bell's palsy

Bell's palsy (BP) is an idiopathic peripheral facial nerve paralysis of sudden onset. Its most alarming symptom is unilateral facial weakness, which can result in the inability to close the eyelids, smile, or whistle. The pathogenesis of BP is controversial and is believed to be caused by inflammation of the facial nerve at the geniculate ganglion. Many viruses, especially herpes simplex and herpes zoster, have been suggested as initiators of this inflammatory process; however, this has not been proven. This report describes the case of a 14-year-old girl with right hemifacial palsy who sought treatment one month after the onset of palsy. The patient experienced a satisfactory recovery within 30 days of treatment and has maintained a stable physical outcome after 15 months of follow-up. Early treatment based on careful investigation of BP, with particular attention given to the differential diagnosis of BP, can improve the patient's function and esthetics.     

Bell's palsy following primary tooth extraction. A case report

Bell's palsy is characterized by acute peripheral facial nerve paralysis. Unilateral paralysis of CN 7 is reported in 20 to 30 people out of 100,000 in the general population. It affects individuals of all ages. Most cases are idiopathic, while a few are identified as resulting from infectious or non-infectious causes. The association between herpes simplex virus-1 (HSV-1) and Bell's palsy has been considered since the 1970s. Few cases have been reported after tooth extraction.     

周围性面神经损伤患者对侧神经支配的研究

目的　通过测定面神经损伤患者组及大学生志愿者组面神经各分支对侧神经支配率 ,探讨周围性面肌瘫痪恢复过程中面神经对侧代偿支配的问题。方法　分别测定大学生志愿者 2 2例( 2 2侧 )及 10 8例面神经损伤患者的面神经电图对其对侧神经支配率进行分析其中损伤组又按发病原因不同 ,分为医源性损伤组、Bell氏面瘫组和创伤性损伤组 ,测试损伤支数为Ⅰ支 76支 ,Ⅱ支 81支 ,Ⅲ支 88支 ,Ⅳ支 6 6支。结果　①损伤组 3组间对侧支配率差异无显著性 (P >0 0 5 ) ;②损伤组Ⅰ、Ⅱ支对侧支配率明显高于志愿者组 (P <0 0 0 1) ;③损伤组Ⅰ支对侧支配率明显高于Ⅱ支(P <0 0 0 1)。结论　面神经损伤后 ,存在对侧神经支配功能增强的表现     

A removable oral prosthetic appliance for Bell's palsy: report of case.

An intra-extraoral removable prosthetic appliance permitted the patient, a victim of Bell's palsy, to carry on daily activities with a minimum of facial distortion, pain, speech difficulty, and emotional trauma. Perhaps thousands of other victims of Bell's palsy and strokes would benefit from such a device.     

Children with Down syndrome: oral development and morphology after use of palatal plates between 6 and 48 months of age

OBJECTIVE: The aim of this study was to describe the number of erupted teeth, sucking habits, tongue morphology, facial expression and speech in children with Down syndrome (DS) aged 48 +/- 6 months and treated from 6 months of age with palatal plates in combination with speech and language therapy. METHODS: The research took the form of a multicentre, multidisciplinary, longitudinal study of children with DS followed from the age of 6 months. A total of 37 children with DS were included. One child could not cooperate at all and was excluded from the evaluations. In combination with speech and language intervention provided by speech and language therapists, the children used palatal plates provided by dentists from 6 months of age. In the evaluation, the children in the sample (n = 36) were compared with two similarly aged control groups: one group of children with DS who never had used palatal plates (n = 31) and one group of children with normal development (n = 36). The evaluation of oral parameters was performed by dentists after calibration. Registration of facial expression and speech was done by a speech and language therapist, and the evaluation was done by two speech and language therapists and one phonetician who were calibrated in joint discussions. RESULTS: In contrast to the children with DS in the control group, the subjects in the study were found to have as many erupted teeth as the children with normal development. The prevalence of sucking habits did not differ between the three groups. Only children with DS sucked their tongue, a toy or other things in addition to a thumb or dummy. The prevalence of tongue diastase in the study group with DS was of the same magnitude as in the evaluation at the age of 18 +/- 3 months. The palatal plates were used by 57-65% of the children without any larger problems. In the study sample, the possible beneficial effects of palatal plate therapy were a lower prevalence of posterior cross-bite, a higher prevalence of frontal cusp-to-cusp relation and a lower prevalence of frontal open bite. Evaluation of facial expression and speech showed a higher score for facial expression and a better communicative capacity in the children in the study group than in the control children with DS. CONCLUSIONS: In children with DS, palatal plate therapy between 6 and 48 months of age in connection with speech and language intervention had a positive effect on occlusion, oral motor function, facial expression and speech. No harmful effects were observed. Although this is a valuable method, however, it must be emphasized that palatal plate therapy puts additional demands on already burdened children and their caretakers.