上颌骨骨折合并泪道损伤临床分析

上颌骨骨折合并泪道损伤临床上并不少见。对合并泪道损伤前期诊断及处理易被忽视 ,而早期的诊断和正确处理对预后有较大影响。从整体考虑对该类疾病的关注有临床意义。本文对我科 1 993～1 999年收治的 43例上颌骨骨折合并 1 4例泪道损伤病例进行回顾性分析。1　材料与方法1 .1　临床资料本组收集上颌骨骨折病人 43例 ,男 3 9例 ,女 4例。年龄 1 3～ 62岁。原因多为工伤和交通事故伤。上颌骨骨折按ＬｅＦｏｒｔ分型[1] ,Ⅰ型 9例 ,单侧骨折 6例 ,双侧 3例 ,合并泪道损伤 2例 (2 2 2 % ) ,2侧(1 6 7% ) ;Ⅱ型 3 1例 ,单侧骨折 1 4例 ,双侧 1…     

口腔颌面部创伤

实验性骨质疏松症对下颌骨骨折愈合的影响；颧骨复合体骨折临床治疗探讨；526例下颌骨髁状突骨折临床病例回顾性研究；上颌骨骨折合并泪道损伤的早期处理及意义；重症颌面部损伤患者的首（急）诊护理；下颌骨髁突骨折治疗的Meta分析；颌面创伤3958例临床回顾；69例老年患者颌面部骨折的临床分析；颌骨骨折合并颅脑损伤的处理；颌面部外伤患者早期的个性及心理调查。[编者按]     

X线诊断单纯性和复杂性鼻眶部骨折

X线诊断52例鼻眶部骨折,年龄17～64岁,男性占90.4％。 单纯性鼻眶部骨折27例,均有鼻骨和上颌骨额突损伤,55.6％有泪后嵴和前组筛房损伤,44.4％有筛骨垂直板损伤,7.4％有筛窦眶板、后组筛房和筛骨上颌角损伤,3.7％有中鼻甲损伤,8例有颅前窝损伤。 复杂性鼻眶部骨折25例,分4型:①眶上区骨折8例,均有上颌骨额突损伤,87.5％有鼻骨损伤,62.5％有筛骨垂直板损伤,37.5％有泪后嵴和前组筛房损伤,25％有中鼻甲损伤,6例有颅前窝损伤。②眶下缘、眶下壁和颧眶部骨折7例,均有鼻骨、上颌骨额突、泪后嵴、前组筛房和筛骨上颌角损伤,71.4％有筛骨垂直板损     

三腔气囊导尿管在上颌骨手术中的应用

目的:观察上颌骨手术时使用三腔气囊导尿管行窦腔填塞的临床效果。方法:对上颌骨骨折合并上颌窦壁多发性骨折、上颌骨囊肿、上颌窦囊肿、上颌窦炎等68例患者进行手术时,将三腔气囊导尿管的顶端经下鼻道开窗处引至窦腔内,注入无菌生理盐水10 mL,留置4～5 d;无出血时抽出水囊内无菌生理盐水,观察1 d,如不再出血,经导管行窦腔生理盐水冲洗后拔管。结果:应用三腔气囊导尿管可进行窦腔压迫止血,并动态观察术后窦腔出血情况,且气囊的支撑有利于骨折的愈合和保留窦腔的腔隙。结论:三腔气囊导尿管应用于上颌骨手术,效果良好,值得推广。     

口腔颌面部损伤病人麻醉诱导气管插管方式的比较

口腔颌面部重度损伤病人往往气管插管操作困难。故选择合适的麻醉诱导插管方式至关重要。本文就我院 91年以来 48例口腔颌面部重度损伤患者手术时不同麻醉诱导插管方式分析报告如下。1　临床资料1 .1　一般资料　本组 48例 ,男性 41例 ,女 7例 ,年龄 1 1～ 68岁 ,损伤类型 :上颌骨多发骨折 5例 ,2例合并颅脑损伤 ;下颌骨多发骨折 1 8例 ;上下颌骨骨折 7例 ;面部多处刀砍伤合并颧骨骨折或上颌骨骨折 3例 ;颌面部爆炸伤 5例 ;颧骨骨折合并上颌骨骨折 4例 ;上颌贯通伤 4例 ;下颌贯通伤 2例。1 .2　麻醉处理　 48例均行气管内插管静复或静吸全麻…     

68例上颌骨骨折治疗

上颌骨骨折易并发其他器官损伤,临床处理较为困难,及时急救和早期复位固定是治疗上颌骨骨折的重要前提。现将我科自1980年至1993年收治68例上颌骨骨折作一报道。     

上颌矢状骨折的影像学特征及临床分析

目的探讨上颌骨矢状骨折的影像学特征、分类及治疗。方法 42例上颌矢状骨折以螺旋CT三维重建检查骨折区,将骨折分型及治疗。结果Ⅰ型:30例矢状骨折线自腭突、牙槽突至鼻底向上合并上颌骨横断骨折;Ⅱ型,8例骨折线自腭突、牙槽突、鼻底至眶壁;Ⅲ型,4例骨折线自腭突、牙槽突向上经上颌骨前面,至眶下壁。结论上颌矢状骨折可发生于正中或正中旁。影像学表现呈三种类型:骨折线经腭突、牙槽突向上至鼻底或梨状孔边缘,合并上颌骨横断骨折;骨折线至鼻底、犁状孔边缘、上颌骨额突至眶下壁或内侧壁;骨折线位于正中旁,自牙槽突向上经上颌骨前面直抵眶下壁。     

上颌骨骨折颅颌弹性牵引复位固定治疗体会

目的:将传统口内牙弓夹板石膏帽固定法加以改进,治疗上颌骨骨折。方法:对上颌骨骨折病例共25例,经颧弓下悬吊牵引复位固定上颌骨。结果:一般患者经过3～5d即可恢复较为理想咬合关系,纤维错位愈合的患者经15～20d恢复较理想咬合;所有患者复位后经1个月持续牵引保持,达到较好的复位效果。结论:颅颌弹性牵引复位固定法适应多种类型上颌骨骨折;术后瘢痕不明显;且取材方便,适于基层医院推广。     

微型钛板应用于颌骨骨折修复临床观察

1 材料与方法 1．1 临床资料 我院自2002年应用微型钛板治疗颌骨骨折17例，均取得满意效果。其中男性13例，女性4例，最小年龄10岁，最大年龄42岁。损伤部位：上颌骨骨折3例、下颌骨单发骨折10例、下颌骨双发骨折2例、单纯髁状突骨折1例、髁状突骨折合并下颌骨体部骨折1例。     

颌骨骨折伴颅脑损伤适时复位固定的临床探讨

目的对颌颅联合伤伴颌骨骨折患者选择合适时间进行微型钛板内固定治疗骨折的探讨。方法对47例颌骨骨折合并有颅脑损伤的患者(上颌骨35例;上下颌骨复合骨折12例)根据病情择时进行微型钛板颌骨内坚固内固定术。结果仅1例术后颅内感染(后经及时控制治愈),其余均Ⅰ期愈合,1例4个月后钛板暴露,取出。患者的咬合关系,张口度均恢复良好。47例患者未出现特殊情况,痊愈出院。结论颌骨骨折伴颅脑损伤患者,应以抢救生命为主,延期颌骨复位固定处理。     

Posttraumatic obstruction of lacrimal pathways: a retrospective analysis of 58 consecutive naso-orbitoethmoid fractures

Posttraumatic dacryostenosis represent a troublesome sequela for patients who have sustained centrofacial trauma and can determine complexity in diagnosis and treatment. This article, based on a retrospective analysis of 58 patients with naso-orbitoethmoidal (NOE) trauma, reports the incidence of posttraumatic dacryostenosis and the evolution of such impairments in consideration of fracture type. Experience in diagnosis and treatment is illustrated, and surgical outcomes 6 months after external dacryocystorhinostomy (DCR) are reported. Posttraumatic epiphora was observed in 27 patients with NOE fractures (46.5%). In 10 cases, temporary epiphora was encountered and spontaneous recovery of lacrimal drainage within 5 months was observed. In the remaining 17 cases, permanent epiphora was registered and a frequent association with delayed treatment of facial fracture repair or bone loss in the lacrimal district was found. Surgical reconstruction of lacrimal pathways was performed 6 months after primary surgery, with external DCRs in all 17 patients with epiphora and the presence of nasolacrimal duct obstruction observed with dacryocystorhinography. External DCR with a large rhinostomy achieved a success rate of 94% in the reconstruction of lacrimal drainage. Such a technique proved to be effective in the treatment of posttraumatic dacryostenosis, although patients considered the temporary presence of external scars and stenting material to be a major problem.     

Prevalence of nasolacrimal canal obstruction and epiphora following maxillary orthognathic surgery

Acquired injuries of the nasolacrimal apparatus may be the result of craniomaxillofacial surgical procedures, facial trauma, or inflammation. Injury to the nasolacrimal duct system following maxillary orthognathic surgery is rarely reported. This study evaluated the importance of early diagnosis and treatment of epiphora developing after Le Fort I surgery. The records of 83 patients who underwent maxillary orthognathic surgery over a 2-year period were reviewed. The prevalence of postoperative epiphora was 3.6% and it persisted for a mean of 32.7 days. No patient required further surgical treatment of the nasolacrimal duct obstruction. Clinicians should evaluate the lacrimal canal position and schedule close postoperative follow-up of injuries to the nasolacrimal apparatus. These may become permanent, necessitating additional surgery.     

Intraoperative lacrimal intubation to prevent epiphora as a result of injury to the nasolacrimal system after fracture of the naso-orbitoethmoid complex

Treatment of fracture of the naso-orbitoethmoid (NOE) complex is difficult. There are not only aesthetic issues but also functional consequences related to the lacrimal system. Because prophylactic lacrimal intubation for such fractures remains controversial, we have assessed the effectiveness of intraoperative lacrimal intubation to prevent epiphora as a result of such injuries. Thirteen patients diagnosed with craniomaxillofacial fractures including fractures of the NOE complex were included in the study; 10 had unilateral fractures and 3 bilateral. Computed tomography (CT) showed all patients had displaced fragments that had the potential to damage the lacrimal duct. In 7 patients the fractures included the canthal region and in 6 they did not. All patients were treated by open reduction and internal fixation under general anaesthesia, followed by intraoperative lacrimal intubation unilaterally or bilaterally as required. Lacrimal intubation with a silicone tube was successful in all 13 patients (16 sides). The tube was removed 2–9 months (mean 3.8) postoperatively and no subsequent epiphora were seen during follow-up (mean (3–29 months) 11.3 months). Lacrimal intubation for at least 2 months may prevent epiphora caused by injury to the nasolacrimal system after fractures of the NOE complex.     

内镜辅助等离子射频消融手术治疗牙源性上颌窦炎近期疗效观察

目的:探讨采用内镜辅助下等离子射频消融手术治疗牙源性上颌窦炎的效果。方法:回顾性分析35例牙源性上颌窦炎患者的资料。其中采用内镜辅助下等离子低温射频治疗患者23例,手术从患侧上颌窦前壁开窗,鼻内镜经中鼻道开口或在开窗处进路,在内镜下探查炎症病灶的具体部位,在去除病灶牙的同时,应用等离子低温射频对上颌窦内病变黏膜部分进行多点消融。其他12例患者采用柯-陆手术治疗,比较2种方法的治疗效果。结果:采用柯-陆手术患者平均住院天数11d,12例患者术后面颊肿胀明显,7例出现面部麻木,6例出现牙疼痛。采用内镜辅助下等离子射频消融手术患者平均住院5d,且未出现上述并发症。内镜辅助射频治疗组术后3个月鼻道窦口完全恢复通畅。35例患者随访3个月时未见复发。结论:与柯-陆手术相比,采用内镜辅助下等离子低温射频消融手术治疗牙源性上颌窦炎在去除病灶的同时,减少了上颌窦黏膜和骨质的损伤,减少患者住院时间,利于术后恢复,临床疗效肯定。     

114 例眼眶骨折分析

目的:探讨眼眶骨折的诊断和治疗原则。方法:回顾分析了114例眼眶骨折的患者,分类统计其临床表现和治疗方法。结果:眼球运动障碍、复视和眼球内陷发生率分别为63.2%、62.3%和59.6%;视神经损伤、泪道损伤和眼球破裂的发生率分别为15.8%、15.8%和12.3%。95.6%的患者接受了眶壁整复和人造骨植入术;72.8%的患者进行了骨折复位内固定术;部分患者进行了视神经减压术、眼球修补术和泪道手术。结论:眼球运动障碍、复视和眼球内陷是眼眶骨折的主要临床表现,视神经损伤、眼球破裂和泪道损伤亦不能忽视;眶壁整复和人造骨植入术是眼眶骨折治疗的主要术式,非单纯性眼眶骨折还需行骨折复位内固定术。     

改良正畸方法结合颌间牵引治疗复杂颌骨骨折

目的　探讨复杂颌骨骨折的治疗问题。方法　收集 6例上颌骨矢状骨折及 9例上下颌骨陈旧性骨折错位愈合的病例 ,采用改良正畸方法与颌间牵引相结合的治疗方法 ,观察治疗效果。结果　 6例上颌骨矢状骨折病人腭中缝裂隙关闭平均 10天 ,9例上下颌陈旧性颌骨骨折复位时间 2～ 7天 ,上下颌咬合关系基本恢复正常。结论　改良正畸方法结合颌间牵引治疗急性上颌骨矢状骨折及陈旧性颌骨骨折伴错位愈合是一个简单实用的治疗方法。     

Maxillary canine impactions related to impacted central incisors: two case reports

AIM: The purpose of this case report is to describe the combined surgical and orthodontic treatment of two cases with an impacted maxillary central incisor and canine in the same quadrant and to discuss the causal relationship between them. BACKGROUND: The most common causes of canine impactions are usually the result of one or more factors such as a long path of eruption, tooth size-arch length discrepancies, abnormal position of the tooth bud, prolonged retention or early loss of the deciduous canine, trauma, the presence of an alveolar cleft, ankylosis, cystic or neoplastic formation, dilaceration of the root, supernumerary teeth, and odontomas. Although impaction of the maxillary central incisor is almost as prevalent as impacted canines its etiology is different. The principal factors involved in causing the anomaly are supernumerary teeth, odontomas, and trauma. REPORTS: Case #1: A 10.5-year-old girl in the early mixed dentition stage presented with a chief complaint of the appearance of her anterior teeth. She had a Class I skeletal pattern and a history of trauma to the maxillary central incisors at age five with premature exfoliation. Radiographs revealed an impacted upper right central incisor in the region of the nasal floor, delayed eruption of the maxillary permanent central incisor, and the adjacent lateral incisor was inclined toward the edentulous space. Treatment was done in two stages consisting of surgical exposure and traction of the impacted central incisor and fixed orthodontic treatment. Case #2: An 11.5-year-old girl presented for orthodontic treatment with the chief complaint of an unerupted tooth and the appearance of her upper anterior teeth. She was in the late mixed dentition period with a Class III skeletal pattern along with an anterior cross-bite with some maxillary transverse deficiency. The maxillary right canine and central incisor were absent, but the maxillary right deciduous canine was still present. Treatment included arch expansion followed by surgical exposure and traction of the impacted teeth and fixed orthodontic treatment. SUMMARY: This case report provides some evidence of a significant environmental influence of an impacted maxillary central incisor on the path of eruption of the ipsilateral maxillary canine. When an impacted maxillary central incisor exists, the maxillary lateral incisor's root might be positioned distally into the path of eruption of the maxillary canine preventing its normal eruption. Ongoing assessment and early intervention might help to prevent such adverse situations from occurring.     

保守治疗上颌窦前壁骨折的疗效观察

目的 :观察保守治疗治疗上颌窦骨折的疗效。方法 :将24例上颌窦骨折患者中严重移位的上颌窦前壁骨片初步复位,严密缝合关闭软组织伤口。结果:24例患者,软组织伤口均一期愈合。愈合面部外形基本满意,双侧基本对称,局部无明显凹陷。X线片显示:上颌窦前壁在6个月后恢复连续,外形接近正常侧。结论:上颌窦前壁骨折常可不予固定,仅在复位固定其他部位骨折时将内陷、错位严重的骨折片初步复位,与周围骨折断端接触,软组织严密覆盖,即可提供骨修复条件。     

正畸-正颌联合矫治上颌前突畸形术后疗效及其稳定性研究

目的：探讨正畸-正颌联合矫治对上颌前突的临床疗效以及疗效的稳定性。方法：20例骨性上颌前突的恒牙列患者中联合治疗组11例,其采用上颌前份阶段性骨切开截骨术后退上颌骨并进行术前术后结合正畸进行治疗。对照组9例,行上颌前份节段性骨切开术治疗。结果：2组患者上颌前突均得到矫治,面部比例较为治疗前有明显的改善（P〈0.05）,联合治疗组的疗效的相关指标要高于对照组（P〈0.05）。结论：应用正颌-正畸联合治疗上颌前突具有患者侧貌协调、治疗效果稳定的特点,但术前正畸去代偿对疗效有一定影响。     

Early functional loading of sand-blasted and acid-etched (SLA) Straumann implants following immediate placement in maxillary extraction sockets. Clinical and radiographic result

OBJECTIVES: To present the clinical and radiographic outcome of early loading of implants inserted into fresh extraction sockets and to present a treatment protocol for early loading of the implants by 'passively fitting' abutment-free permanent fixed complete dentures (implant FCDs). MATERIAL AND METHODS: The study included 19 dentate patients treatment planned for extraction of all remaining maxillary teeth. In all, 116 Straumann-implants with sandblasted, large grit and acid etched (SLA) surface were placed: 77 (66%) inserted in fresh extraction sockets and 39 (34%) in healed bone. At least six implants were placed in each maxilla. One hundred and ten implants were loaded by permanent FCDs within 10 days after placements and six after 14 days. The patients were reexamined clinically and radiographically after 2-3 years of clinical function. All FCDs were removed for control of implant stability and evaluation of the peri-implant status. RESULTS: Owing to framework fracture, two implants were lost, corresponding to a failure rate of 2%. The radiographic measurements after 2-3 years did not reveal any difference in bone height mesial and distal of the implants placed in extraction sockets vs. in healed bone. This was interpreted as a bone gain around the implants placed in extraction sockets and a slight bone loss around the implants placed in healed bone. CONCLUSION: Early functional loading of SLA-surfaced implants following immediate placement in maxillary extraction sockets by rigid and passively fitting permanent implant FCDs is a reliable treatment alternative.