颌骨骨肉瘤临床及X线分析

目的 总结颌骨骨肉瘤临床及X线特点，为诊断和鉴别诊断提供临床参考。方法 复习近10年本院收治的经病理确诊的15例颌骨骨肉瘤患者的病历及X线片。结果 15例颌骨骨肉瘤中下颌骨9例，上颌骨6例。9例下颌骨骨肉瘤发生于下颌体部6例，颏部、升支、下前牙槽突各1例；8例伴有明显的疼痛和下唇麻木；8例X线表现为溶骨性破坏，1例表现为高低密度混杂影象。6例上颌骨骨肉瘤中发生于上牙槽突4例，上颌骨外侧壁2例；4例临床表现为生长较快的无痛性包块，2例伴有疼痛、麻木；5例X线表现以成骨为主，1例表现为溶骨性破坏。结论 下颌骨骨肉瘤好发于体部，早期多有疼痛、麻木等症状，X线表现以溶骨性破坏为主；上颌骨骨肉瘤好发于牙槽突，早期上颌骨局部无痛性肿胀是其重要主诉，X线表现以成骨为主。     

婴幼儿颌骨骨髓炎33例临床分析

本文对湖北医科大学口腔医学院1962～1989年住院病历中的33例要幼儿颌骨骨髓炎进行了临床分析。结果表明,血源性感染占63％,牙源性感染占12.1％,损伤性感染占24.3％,其中发生于上颌骨者占66.7％,下颌骨者占33.3％。多表现为溶解坏死型。     

颌骨中央性血管瘤的手术体会

颌骨中央性血管瘤临床上较少见 ,是发生于颌骨内的血管畸形。本文对我院 1985～ 1999年收治的 8例有完整病历记录的颌骨中央性血管瘤病例进行回顾性分析 ,以探讨该病的手术治疗方法。1　临床资料本组病例中 ,男 6例 ,女 2例 ,男女比例为 3∶1。年龄 7～ 32岁 ,平均年龄 16岁 ,19岁以下者 6例 ,约占 75 %。发病部位以下颌骨为主 ,共 7例 ,其中 1例累及升支 ,1例累及软组织 ,另 1例发生在上颌骨。2　治疗方法本组病例除 1例接受硬化治疗外 ,均采用手术治疗。行血管瘤刮除术者 1例 ,行保留下颌骨下缘的下颌骨方块切除术者1例 ,行上颌骨部分切除…     

二膦酸盐相关性颌骨骨坏死的临床分析

目的 研究药物性颌骨骨髓炎的临床特点。方法 分析2013年5月-2015年9月浙江大学附属第一医院口腔颌面外科收治的12例二膦酸盐相关性颌骨骨坏死患者的基本情况、长期用药史、出现颌骨骨髓炎时间、症状、诊治经过及疗效。结果 9例患者为下颌骨骨髓炎,3例患者为上颌骨骨髓炎。10例患者用药时间10~80个月不等,平均用药（28.00±21.42）个月。手术治疗9例,保守治疗3例：经手术治疗后创面愈合8例,骨暴露处于稳定状态1例;保守治疗患者目前定期换药。结论 静脉注射二膦酸盐类药物可导致药物性颌骨骨髓炎,下颌骨较多见,拔牙为一大诱因。目前的治疗手段多以缓解疼痛和提高生活治疗为目的,故该疾病的预防尤为重要。     

颌骨骨肉瘤24例临床分析

本文对 1982 1998年湖北医大口腔医院收治的 2 4例资料齐全 ,经病理证实的颌骨骨肉瘤进行分析 ,就该病的病因、临床表现、诊断、鉴别诊断、治疗及预后进行了探讨。临床资料本组 2 4例 ,男 17例 ,女 7例。男∶女为 2 43∶1。年龄 11月 5 0岁 ,平均年龄 3 1 75岁 ,高发年龄 2 0 40岁 (17例 )。病程 1月 8年 ,平均病程 14 71月。 6例有外伤史 ,2例有接受放射治疗病史。部位 :下颌骨 16例 ,上颌骨 8例 ,下颌骨 :上颌骨为 2∶1。其中发生于上颌骨牙槽突 4例 ,上颌窦 4例 ;发生于下颌体部 7例 ,升支部 6例 ,正中联合 3例。临床表现 :以单纯肿块…     

儿童下颌第二磨牙冠周炎致下颌骨骨髓炎的临床诊治

目的:探讨儿童下颌第二磨牙冠周炎导致下颌骨骨髓炎的临床特点及治疗方法。方法:选取2016年1月~2019年3月共收治10例儿童下颌第二磨牙冠周炎致下颌骨骨髓炎患者,平均年龄12.1岁,临床表现为面部肿胀、发硬、张口受限。10例患者均在全麻下行“下颌骨骨髓炎探查刮治活检术+冠周龈瓣切除术”,预防性“拔除下颌第三磨牙胚”。病变发生于下颌体、下颌角及下颌升支,以颊侧为主,9例出现骨质破坏,10例病例可见较广泛的骨质增生硬化、与颌骨平行的骨膜新生骨。结果:10例患者术后口内创口均愈合良好,面部肿胀消退,张口度改善,3月后复查锥形束CT显示骨质缺损区范围逐渐缩小,病变颌骨可重新塑形解剖结构接近正常。结论:儿童下颌第二磨牙冠周炎所致下颌骨骨髓炎患者的发生年龄小,早期诊断与治疗有助于防止下颌骨破坏加重,避免下颌骨发育畸形、病理性骨折及面部畸形;对于以颊侧病变为主的骨髓炎病灶,经口内切口彻底行下颌骨骨髓炎刮治术取得良好的临床治疗效果。     

127例药物性颌骨坏死患者回顾性分析：单中心10年经验总结

目的:总结分析药物性颌骨坏死(MRONJ)的临床特征,为其诊治提供参考。方法 :回顾2008年1月—2018年6月上海交通大学医学院附属第九人民医院收治的MRONJ患者共127例,按照2014年美国口腔颌面外科医师协会制定的有关MRONJ的诊断标准及分类方法,分析MRONJ发生的诱因,危险因素与好发部位,患者手术情况、效果及预后。结果:127例患者中,93例(73.23%)发生于下颌骨,30例(23.62%)发生于上颌骨,4例(3.15%)上、下颌骨同时发生。MRONJ诱因中,98例(77.17%)因颌骨局部创伤(拔牙、种植牙、牙自行脱落)导致。MRONJ分期中,0期6例(4.72%),1期13例(10.24%),2期80例(62.99%),3期28例(22.05%)。MRONJ治疗方法,0期及1期患者均接受局部切除(骨髓炎刮治、死骨摘除、颌骨部分切除);2期71例接受局部切除,8例行颌骨节段切除,1例行颌骨节段切除并同期游离皮瓣重建修复;3期17例接受局部切除,9例行颌骨节段切除,2例行颌骨节段切除并同期游离皮瓣修复。MRONJ预后,0期及1期各3例复发,2期24例复发,3期11例复...     

颌骨骨肉瘤39例临床病理分析

颌骨骨肉瘤是原发于颌骨的常见的恶性肿瘤,早期诊断对于根治及提高患者五年生存率具有重要意义。现将我院1962至1990年末收治的颌骨骨肉瘤患者39例,作一临床病理分析。 临床资料 一、性别、年龄、病程及发病部位 39例中,男24例,女15例。都诊年龄最小者9岁,最大者66岁,以17～40岁者最多见,共24例。最短病程者一个月,最长病程者六个月。发生于下颌骨者22例,上颌骨者17例。其中发生于下颌骨体者14例,下颌升枝者8例。     

儿童颌骨骨髓炎的多层CT表现

目的探讨多层CT(MSCT)在诊断儿童颌骨骨髓炎中的价值。方法 10例儿童颌骨骨髓炎病例术前均实施MSCT扫描,对MSCT数据进行图像后处理,分析其MSCT征象。结果 10例患儿中男4例、女6例。病变均发生于下颌骨的下颌角、下颌支。MSCT影像学征象包括:10例中9例出现骨质破坏;均可见较广泛的骨质增生硬化;全部病例可见与颌骨平行的骨膜新生骨;2例追踪复查,病变颌骨可重新塑形;10例中8例合并了周围的蜂窝组织炎。结论 MSCT可在术前正确诊断儿童颌骨骨髓炎,对于选择合适的临床治疗方式至关重要。     

99~mTc—MDP扫描在颌骨疾病诊断的临床应用(附25例分析)

性别:男性7例、女性18例。 年龄:年龄最小10岁、最大72岁,平均年龄25.8岁。 部位:上颌骨10例、下颌骨12例(其中髁状突1例、颌骨外病变3例。 诊断:上颌骨10例中;其中上颌骨囊肿3例、上颌骨骨髓炎2例,腭部恶性混合瘤1例,颌骨畸形4例,下颌骨12例;其中造釉细胞瘤3例,下颌骨纤维瘤3例、髁状突骨瘤1例,下颌骨囊肿1例,下颌骨恶性肿瘤3例(鳞癌、腺癌、恶性黑色素瘤各一例),下颌前突l例。颌骨外病变3例,(颌下脂肪瘤、腮腺区粘液表皮样癌、颏下结核性冷浓肿各一例)。     

Blood flow in jaw bones affected by chronic osteomyelitis

In order to study circulatory changes throughout the course of chronic osteomyelitis of the jaws, blood flow in bone affected by osteomyelitis was assessed in 14 patients, by means of laser Doppler flowmetry (LDF). The difference in perfusion between the osteomyelitic bone and corresponding sites on the opposite healthy jaw was evaluated. The patients were classified into two groups according to the clinical activity of their disease. A significantly reduced bone blood flow was recorded in the jaw during non-active stages, while an increased flow was associated with the initial stage of disease and the inflammatory exacerbations. No pre-existing vascular disorders were discovered prior to the development of this disease. However, a long standing local inflammation of the jaw bone was associated with a persistent reduction in blood flow. In 12 healthy subjects, blood flow in the left jaw was found not to be statistically different to that in the right jaw.     

Surgical treatment of jaw osteonecrosis in “Krokodil” drug addicted patients

Retrospective study of jaw osteonecrosis treatment in patients using the “Krokodil” drug from 2009 to 2013.On the territory of the former USSR countries there is widespread use of a self-produced drug called “Krokodil”. Codeine containing analgesics (“Sedalgin”, “Pentalgin” etc), red phosphorus (from match boxes) and other easily acquired chemical components are used for synthesis of this drug, which used intravenously. Jaw osteonecrosis develops as a complication in patients who use “Krokodil”. The main feature of this disease is jawbone exposure in the oral cavity. Surgery is the main method for the treatment of jaw osteonecrosis in patients using “Krokodil”.40 “Krokodil” drug addict patients with jaw osteonecrosis were treated. Involvement of maxilla was found in 11 patients (27.5%), mandible in 21 (52.5%), both jaws in 8 (20%) patients. 35 Lesions were found in 29 mandibles and 21 lesions in 19 maxillas. Main factors of treatment success are: cessation of “Krokodil” use in the pre- (minimum 1 month) and postoperative period and osteonecrosis area resection of a minimum of 0.5 cm beyond the visible borders of osteonecrosis towards the healthy tissues. Surgery was not delayed until sequestrum formation. In the mandible marginal or segmental resection (with or without TMJ exarticulation) was performed. After surgery recurrence of disease was seen in 8 (23%) cases in the mandible, with no cases of recurrence in the maxilla.According to our experience in this case series, surgery is the main method for the treatment of jaw osteonecrosis in patients using “Krokodil”. Cessation of drug use and jaw resection minimize the rate of recurrences in such patients.     

Long term clinical observation of osteomyelitis of the jaw

The incidence of osteomyelitis of the jaw has been reduced because of the recent progress in antibiotic therapy. Unlike typical cases recorded in the usual textbooks, very prolonged and difficult types of chronic osteomyelitis are also encountered. In these cases, it is difficult to recover completely by means of antibiotic therapy alone, and therefore surgical intervention is inevitable. Among 2020 cases recorded in the inpatient clinic from August 1974 to February 1987, 180 cases (8.9%) were cases of inflammatory disease (Table 1), and 46 out of 180 cases were diagnosed as osteomyelitis (25. 6%). Of the 46 cases of osteomyelitis 22 of them were classified as chronic osteomyelitis (47.8%), 13 as acute osteomyelitis (28.3%), and 8 as radiation osteomyelitis (17.4%) (Table 2). The three cases presented in this study required surgical intervention. In one case of chronic osteomyelitis surgical treatment, extraction of a tooth and sequestrectomy, was performed. Another two cases, which occurred in patients with radiation osteomyelitis, required sequestrectomy and segmental mandibulectomy, respectively.     

The adaptation of implant-supported superstructures to the alveolar crest: a follow-up of 49 cases

A prospective clinical and radiographic study has been carried out in 49 patients with a total of 252 implants. In a mixture of 17 edentulous mandibles, 20 edentulous maxillas, nine partial edentulous cases, and three single-tooth cases, prosthetic treatments were aimed at getting as close an adaptation as possible between gingival tissues and superstructure. The shortest possible abutments were used, and the implants were surgically positioned subcrestally. The results during a 5-year follow-up showed a success rate of 98.9% for fixtures in the lower jaw and 96.3% for the upper jaw with a total success rate of 97.3%. The marginal bone reduction during five years with closely adapted superstructures was 0.11 mm in the mandible and 1.1 mm in the maxilla. Our results support the use of close gingivally adapted superstructures, although oral hygiene controls and instructions are regularly advisable.     

Is primary chronic osteomyelitis a uniform disease? Proposal of a classification based on a retrospective analysis of patients treated in the past 30 years.

INTRODUCTION: Primary chronic osteomyelitis of the jaw is a rare, non-suppurative, chronic inflammatory disease of unknown aetiology. To date, classification is confusing due to a non-uniform terminology. The aim of this study was to establish a simple (clinical) classification based on patient data from our clinic. METHODS: Retrospective analysis revealed 30 cases of which clinical course, radiology, pathology, therapy and outcome were analysed. RESULTS: Both sexes were equally represented. The mean age at onset of disease was 35 years (range 5-76 years). Onset of disease revealed two peaks of incidence, one in adolescence and one after age 50 years. While clinical symptoms were similar in all cases, an increased intensity of these symptoms was noted in younger individuals as well as in the early stages of the disease. Five adults and one adolescent presented with additional non facial bone, joint and skin manifestations consistent with the diagnosis of SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome, or chronic recurrent multifocal osteomyelitis. Radiology demonstrated sclerosis, osteolysis and periosteal reaction in variable stages in all cases. However, findings were more extensive in younger patients. Histology revealed different stages of chronic inflammation in all cases. Microabscess formation was noted in 11 cases, six of which were children/adolescents.Therapy consisted mainly of surgery, antibiotics and hyperbaric oxygen therapy.At the end of the follow up period, 11 patients demonstrated complete remission, while in 14 cases amelioration and in 5 no significant improvement was noted. CONCLUSION: Based on differences in age at presentation, clinical appearance and course, radiology and histology, a subclassification into early and adult onset primary chronic osteomyelitis has been established. Cases with purely mandibular involvement should further be distinguished from cases associated with other syndromes.     

颌骨Paget氏病的临床分析及文献回顾

我院自1961～1994年,共收治颌骨PD患者5例.本文就颌骨PD的临床、病理、X线表现及诊断治疗等进行研究,以期加深对颌骨PD的认识,提高诊治水平.作者认为,在本病的诊断中X线影像学具有重要价值.     

Osteomyelitis of the jaws: a review of 141 cases

A survey of 141 cases of osteomyelitis of the jaws is presented. The salient clinical features, the aetiology and treatment of the lesions are described. A high incidence of the disease in the maxilla is noted. Lesions of the maxilla mainly occurred in patients in the first decade of life, whilst those of the mandible affected individuals in the third decade. The possible relationship between infection, blood supply to the jaw bone, and associated debilitating conditions is examined.     

Florid osseous dysplasia. A clinical-pathologic study of thirty-four cases.

Thirty-four patients with florid osseous dysplasia were studied. The majority were asymptomatic Negro women: Seventeen biopsy-proven simple bone cysts were found in affected quadrants of fourteen patients. Radiographs displayed a spectrum of sclerotic and ground-glass opacities limited to alveolar processes but not to root apices. Biopsy material was studied in all cases, and biochemical analyses of serum and cyst fluid were performed on some patients. Test results and skeletal radiographs indicate that the disease is limited to the jaws. Patients have remained asymptomatic with little alteration of radiographic patterns. Three cysts failed to heal following treatment, others filled with radiographically abnormal tissue. Chronic osteomyelitis may infrequently complicate the disease. These cases appear to represent the most exuberant manifestation of this reactive fibro-osseous jaw disease.