Gland-preserving robotic surgery for benign submandibular gland tumours: a comparison between robotic and open techniques

Benign tumours of the submandibular gland are usually treated surgically. Gland-preserving techniques, which can be used to completely remove the tumour, preserve the function of the gland and reduce complications, but conventional open operations result in obvious scars on the neck. We aimed to investigate the feasibility and efficacy of gland-preserving robotic surgery using a hairline approach. We compared robotic with open techniques for gland-preserving operations to remove benign tumours of the submandibular gland. Patients were matched for age and sex (4 in each group). All patients in the robotic surgery group had their tumours removed successfully through hairline approaches. No patient had operative complications or postoperative functional nerve deficit, and an aesthetically pleasing outcome was achieved by concealing the scars within the hairline. Robotic operations took longer than open operations. No recurrence was noted during follow-up. Gland-preserving robotic surgery is a feasible alternative to conventional techniques and has potential advantages for safety and aesthetic outcome.     

Impact of indocyanine green fluorescent image-guided surgery for parapharyngeal space tumours

In parapharyngeal space dissection, significant complications such as dysphagia and carotid artery rupture have been reported. In order to resect tumours safely in narrow parapharyngeal space, we propose indocyanine green (ICG) florescence image for navigation surgery.ObjectiveTo evaluate the usefulness of ICG fluorescent image-guided surgery for parapharyngeal space tumours.Methods0.5 mg/kg of ICG was injected via the cephalic vein. Observation of the fluorescent image was performed with HEMS (HyperEye Medical System) at 10–30 min after injection. At first, the position of the tumour was marked over pharyngeal mucosa according to ICG fluorescence imaging with HEMS. We also confirmed submucosal tumours hidden under fascia using HEMS imaging again and resected them.ResultsAll tumours displayed bright fluorescence emissions which clearly contrasted with the normal structures. Even with the submucosal tumour covered with and obscured by fasciae, we could observe the tumour clearly under HEMS imaging. Tumours behind the carotid artery and lower cranial nerves also were displayed bright fluorescence emissions and were clearly detected. As a result, we could completely remove the tumour safely and noninvasively to preserve pharyngeal functions.ConclusionICG fluorescence imaging is effective for the detection and resection of the parapharyngeal space tumours with preserving functions.     

Scope of oral and maxillofacial surgery: The psychosocial dimensions of orthognathic surgery

A group of 20 patients (12 females and 8 males) who underwent orthognathic surgery during the previous three years were surveyed. The reasons which determined the decision to undergo surgery are discussed. Patient satisfaction and the effect of surgery on psychological and social attitudes are explored.     

Recent advances in reconstructive oral and maxillofacial surgery

Reconstruction within the head and neck is challenging. Defects can be anatomically complex and may already be compromised by scarring, inflammation, and infection. Tissue grafts and vascularised flaps (either pedicled or free) bring healthy tissue to a compromised wound for optimal healing and are the current gold standard for the repair of such defects, but disadvantages are their limited availability, the difficulty of shaping the flap to fit the defect and, most importantly, donor site morbidity. The importance of function and aesthetics has driven advances in the accuracy of surgical techniques. We discuss current advances in reconstruction within oral and maxillofacial surgery. Developments in navigation, three-dimensional imaging, stereolithographic models, and the use of custom-made implants can aid and improve the accuracy of existing reconstructive methods. Robotic surgery, which does not modify existing techniques of reconstruction, allows access, resection of tumours, and reconstruction with conventional free flap techniques in the oropharynx without the need for mandibulotomy. Tissue engineering and distraction osteogenesis avoid the need for autologous tissue transfer and can therefore be seen as more conservative methods of reconstruction. Recently, facial allotransplantation has allowed whole anatomical facial units to be replaced with the possibility of sensory recovery and reanimation being completed in a single procedure. However, patients who have facial allotransplants are subject to life-long immunosuppression so this method of reconstruction should be limited to selected cases.     

9例经口入路机器人手术在口腔颌面外科应用报道

目的: 总结口腔颌面外科机器人手术的应用经验。方法: 解放军总医院口腔科应用达芬奇机器人手术系统对9例位于口腔深部肿瘤患者行经口入路机器人手术（transoral robotic surgery, TORS）,总结手术经验与体会。结果: 患者均顺利完成手术,摆位及术区暴露用时20~90 min,平均42.2 min;手术时间5~90 min,平均40.9 min。除1例双侧颈淋巴清扫术患者外,其余纯口腔入路患者8例,术后平均住院日3.25 d,术后均顺利出院,平均住院天数7.75 d。结论: 达芬奇机器人手术系统可以独立完成口腔深部肿瘤手术,但在特殊患者如舌根肿瘤手术上仍有一定困难,主要是术区暴露时间较长。     

导航手术在颅颌面外科的应用及误差控制

导航手术越来越多地应用于颅颌面种植修复、损伤、面部整复、正颌外科、放疗及射频热凝治疗。精确性是导航手术的关键,误差的控制贯穿于影像获取、配准、实时跟踪及导航手术操作的各个步骤中。本文就颅颌面外科的导航手术应用及误差控制作一综述。     

Non-technical skills in oral and maxillofacial and head and neck surgery: systematic review

The importance of teams’ and individuals’ non-technical skills in reducing adverse events is well-recognised. We undertook a systematic review of the published literature to assess the research undertaken to date on non-technical skills and behaviours within oral and maxillofacial, and head and neck (OMFS-H&N) surgery. The aim was to assess the applicability of published studies to current practice, to look at how these studies could guide future research, and look for areas that could be developed further. The search terms included ‘non technical skills’, ‘nontechnical skills’, ‘NOTSS’, ‘non-technical skills for surgeons’, ‘oral surgery’, ‘oral maxillofacial surgery’, ‘OMFS’, ‘maxillofacial surgery’, ‘head and neck surgery’, ‘microsurgery’, ‘behavioural markers’, ‘behavioural assessment tool’, and ‘behavioural ratings system’. Three publications were included, involving 83 participants. Participants consistently achieved the highest scores in the ‘situational awareness’ category and showed a tendency to achieve lower mean scores in the ‘communication and teamwork’ and ‘decision-making’ categories. The majority of research into surgeons’ non-technical skills has occurred in simulated environments and not in the genuine environments in which actual surgery is being performed on patients. Research involving ‘real’ patients has been done in the field of OMFS-H&N and this places the specialty in a stronger position than many other surgical specialties.     

超声骨刀在口腔颌面外科的临床应用进展

超声骨刀引入口腔颌面外科领域已有数十年,已有大量文献对超声骨刀的应用及特点进行了研究。本文回顾近年来关于超声骨刀的文献,对超声骨刀的工作原理、临床应用进展等做一综述,为临床医师提供参考。     

Benefits of the enhanced recovery after surgery pathway for orthognathic surgery

The enhanced recovery after surgery (ERAS) protocol was designed to improve patient outcomes and decrease complications, opioid use, and postoperative nausea and vomiting (PONV). The aim of this retrospective cohort study was to examine the effectiveness of ERAS protocols implemented in orthognathic surgeries from 2017 to 2018 at the University of Alabama at Birmingham Hospital by measuring opioid use and PONV. Two groups were identified through chart review, a non-ERAS group (traditional) of patients who had surgery without a protocol and an ERAS group of patients who had surgery with the ERAS protocol. The anesthesia and surgical teams followed a standardized protocol for perioperative management. All procedures were performed by a single surgeon and included single- and double-jaw surgeries and adjunctive procedures. The patient charts were analyzed for postoperative opioid consumption (measured in morphine milligram equivalents, MME) and PONV. IBM SPSS Statistics version 26 was used to conduct the statistical analyses. The ERAS group received less opioids during the postoperative period than the control group (31.2 MME vs 54.6 MME, P =  0.002). The ERAS group also had a lower incidence of PONV, with 1.2 episodes of PONV compared to 2.4 episodes in the non-ERAS group (P =  0.008). This study demonstrates that the ERAS protocol is effective in decreasing postoperative opioid consumption and PONV.     

E-Learning 在口腔颌面外科教学中的探索应用

随着电子信息时代的到来,医学教育的发展,E-Learning在医疗教育行业已不再是一个陌生的理念。然而在口腔颌面外科专业教学中还很少提及。E-Learning 以其强大的更新学的发展,特点以及在口腔颌面外科教学中的探索应用,为医学高校开展E-Learning教学提供参考。     

The scope of oral and maxillofacial surgery in Australia and New Zealand. A postal survey

The current scope of oral and maxillofacial surgery in Australia and New Zealand was explored with a survey of full members of the Australian and New Zealand Association of Oral and Maxillofacial Surgeons resident in the region. There was an 83 per cent usable response rate and the objectivity of the data was confirmed by check questions and material from other sources. The study showed that oral and maxillofacial surgery is the surgical specialty of dentistry with the core of referral and surgical services being dento-alveolar. However, the essential knowledge of the anatomy, pathology, and surgery of the orofacial region forms the basis for the wider scope of modern oral and maxillofacial surgery. Current surgery includes management of trauma, pathology, dentofacial deformity, and a wide range of reconstructive surgery including grafts and implants.     

头颈肿瘤患者加速康复外科方案

本项目经过历时6个月的一系列建设性会议完成。利益相关者包括口腔颌面外科医师、耳鼻咽喉科医师、麻醉师、营养师、物理治疗师、言语和语言治疗师以及护理人员。基于目前的文献证据和本团队共识,制定了一个针对头颈肿瘤患者的加速康复外科方案,本方案可供国内相关专业人员参考实施。     

我国口腔颌面外科面临的挑战及应对浅见

口腔颌面外科对口腔医学的发展具有不可磨灭的贡献,但进入21世纪后,我国口腔颌面外科的发展遇到了不少困难．面临着巨大的挑战。本文结合本地实际和个人体会,从3个方面分析了口腔颌面外科面临的挑战及应该采取的应对措施。相信随着学科的发展和广大口腔颌面外科工作者的不懈努力,口腔颌面外科必将迎来新的辉煌时期。     

中国口腔颌面外科学科发展调查分析

目的 全面了解中国口腔颌面外科学科发展的现状、发现存在的问题、提出口腔颌面外科可持续发展的策略.方法 设计"口腔颌面外科学科发展问卷调查表",对地市级以上综合医院的口腔科、口腔专科医院、口腔医学院校的口腔颌面外科规模、人力资源、业务范围、医疗工作量、人才培养等项目进行问卷调查,并与5、10年前的状况进行比较.结果 多数医疗机构口腔颌面外科医师人数、病床数、门诊人次增加,业务范围扩大,医疗水平提高.部分基层医疗机构相应医疗指标有下降,超过1/3的医疗机构口腔颌面外科研究生和进修生生源下降.结论 口腔颌面外科在持续发展,但存在基层医疗机构口腔颌面外科力量有所削弱等问题,应采取相应的策略增强学科的竞争力.     

2018例口腔颌面外科日间手术临床分析

目的:总结中南大学湘雅医院口腔颌面外科开展日间手术的临床经验,探讨日间手术在口腔颌面外科的应用效果与安全性。方法:回顾分析2014年7月—2019年6月在中南大学湘雅医院日间手术中心进行治疗的所有口腔颌面外科患者的临床资料,包括患者年龄、性别、疾病名称、麻醉与手术方式或取消原因、住院时间、延期出院原因、术后并发症发生情况及医疗费用等。选取其中手术量最多的8种疾病,以普通住院病房为对照,比较同类型疾病平均住院时间与医疗费用的差异。采用SPSS 23.0软件包对数据进行统计学分析。结果:在纳入研究期间的5年内,中南大学湘雅医院共完成口腔颌面外科日间手术2018例,疾病类型以口腔颌面部软组织肿物、牙及颌骨病变、唾液腺疾病为主。患者年龄2~77岁,平均34.45岁,男女比例为6:4。手术取消率1.13%,术后并发症发生率0.64%,平均住院时间0.89 d,延迟出院率0.40%。与普通病房相比,同类型疾病住院时间与医疗费用均显著降低(P<0.05)。结论:口腔颌面外科能够实施日间手术的疾病类型多,患者依从性好,住院时间短,医疗资源利用率高。在规范管理的前提下,安全可行,值得进一步推广应用。     

Tissue engineering technology and its possible applications in oral and maxillofacial surgery

Tissue engineering is a rapidly advancing discipline that combines the attributes of biochemical and biomaterial engineering with cell transplantation to create bio-artificial tissues and organs. For the oral and maxillofacial surgeon, the reconstruction of maxillofacial defects in hard and soft tissues is an ongoing challenge. While autologous grafts and vascularised free flaps are the current gold standard, they are not without complications at both the donor and reconstructed sites. Tissue engineering, which aims to create tissue-matched, prefabricated, prevascularised bony or soft tissue composite grafts, or both, therefore has the potential to revolutionise practice in maxillofacial surgery. We review the technology of tissue engineering and its current and future applications within the specialty, and discuss contemporary obstacles yet to be overcome.     

高精度光学导航辅助颅颌面骨畸形整复的技术方法建立与应用

目的：通过自主建立用于颅颌面手术的高精度计算机导航软硬件系统,模拟和精确设计手术方案,实现术中实时可视化手术导航。方法：（1）创建颅颌面整复手术规划及导航软件（TBNAVIS—CMFS）。（2）建立基于Polaris光学定位仪的导航工作站。（3）临床上对50例复杂颅颌面畸形患者实施导航辅助矫治与修复重建手术。结果：TBNAVIS—CMFS以清晰的界面和简洁的操作．实现了高精度数字化手术规划;导航辅助的颅颌面骨畸形整复术取得了精确可靠的手术效果,减少了手术创伤。结论：计算机导航技术结合颅颌面整复外科,将有利于从疾病诊断、术前模拟、术中导航等方面推动颅颌面外科趋于精确和微创。     

手术机器人系统在颅颌面外科中的应用及发展

近年来机器人辅助外科手术以其微创、精准、安全的特点受到了越来越多的关注。颅颌面外科传统手术严重影响美观。机器人辅助手术延伸了医生的视觉范围和可操作空间,提高了手术效果及患者术后生活质量。本文对手术机器人系统的发展以及近年来在颅颌面外科的应用进行综述。     

新型冠状病毒肺炎疫情下口腔颌面外科的护理防控

新型冠状病毒肺炎的爆发对口腔颌面外科的诊疗和护理带来了巨大的挑战。为有效防止新型冠状病毒肺炎所致的疫情蔓延,最大限度减少新型冠状病毒肺炎在医疗机构内传播的风险,本文结合国家对新型冠状病毒防控的总体要求和颌面外科专业特点,制定口腔颌面外科护理管理相关防控措施,内容涉及预检分诊、分级防护、健康教育、相关科室防控关键点以及护理操作中的防控策略等,以保证颌面外科护理工作有序进行,同时提出了新型冠状病毒肺炎感染防控期间的口腔颌面外科护理管理建议,期望对疫情期口腔颌面外科的护理管理及今后的研究提供参考。     

Salvage surgery in head and neck cancer

Salvage surgery after failed organ preservation treatment offers challenges for both the patient and the surgeon. The outcome is often uncertain and even today, 5‐year overall survival does not exceed 50 per cent. The chemoradiotherapy induced toxicity asks for meticulous discussion and planning in a multidisciplinary manner in a changing environment of increasing incidence of human papillomavirus induced oropharyngeal tumours, evolving surgical techniques and patient participation. Herein, we discuss the latest literature on salvage surgery and the need for identifying the proper prognosticators to ensure for an optimal treatment plan in potentially salvageable patients.