下颌下区包块108例临床总结

目的:总结108例下颌下区包块病例的临床特点、诊断和治疗方法。方法:对以下颌下区包块为主诉收治入院的患者共108例,从临床特点、诊断和治疗等方面进行回顾性分析。结果:患者年龄集中于21～60岁,病种以慢性下颌下腺炎最多,占51.85%,而肿瘤以多形性腺瘤为主。结论:诊断主要依靠临床检查和超声影像,肿瘤病例可进行术中冰冻帮助确诊,治疗以手术为主。     

颌下区包块103例临床分析

目的：总结颌下区包块的诊断和治疗方法。方法：对103例颌下区包块诊断、治疗方法进行回顾性分析。结果：103例颌下区包块中以慢性颌下腺炎为主,囊性病变中以舌下腺囊肿口外型多见,良性肿瘤中以多形性腺瘤为主,恶性肿瘤所占比例较小。结论：颌下区包块病种较多,需详细询问病史及认真临床检查并辅以穿刺、B超、CT等手段,多可明确诊断;肿瘤则需行术前穿刺切取活检及术中冰冻切片检查;治疗方法主要以手术为主。     

慢性舌下腺炎1例临床报道及分析

目的:对慢性舌下腺炎进行临床分析,为临床诊治工作提供指导。方法 :报道所治疗的慢性舌下腺炎1例,并结合检索复习国内外相关文献,分析慢性舌下腺炎的相关特点及临床鉴别诊断要点。结果:慢性舌下腺炎属于相对少见的涎腺疾病,其临床特点与舌下腺其他疾病均有不同程度的相似处,容易误诊,而治疗方案却又大相径庭。本文结合文献分析了该病症与舌下腺肿瘤、口底鳞癌、腺样囊性癌、黏液表皮样癌、颌下腺疾病的鉴别诊断要点。结论:临床中需要提高对慢性舌下腺炎的认识,在临床中采用合适的辅助诊断办法,制定治疗方案。     

30例舌下腺恶性肿瘤临床病理分析

目的探讨舌下腺恶性肿瘤的临床病理特征及治疗方法。方法对1955-2005年四川大学华西口腔医院颌面外科收治的30例舌下腺恶性肿瘤患者进行回顾性分析。结果30例舌下腺恶性肿瘤患者中,男性18例,女性12例;平均年龄50.6岁。腺样囊性癌为舌下腺恶性肿瘤最常见的病理类型（56.7%）;临床分期中Ⅲ期最常见（56.7%）,局部复发和远处转移是患者死亡的主要原因,局部复发率为30.0%,远处转移率为26.7%。结论舌下腺恶性肿瘤以腺样囊性癌为主。手术是主要的治疗方法,原发灶切除配合颈部淋巴清扫术是达到良好治疗效果的关键,术后应适当辅助放化疗。     

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目的    探讨舌下腺恶性肿瘤的发病情况、病理特征、治疗方式及疗效特点。方法    对1979—2010年中国医科大学附属口腔医院及中国医科大学附属第一医院收治的34例经病理确诊的舌下腺恶性肿瘤病例临床资料进行回顾性分析。结果    34例舌下腺恶性肿瘤患者中,男15例,女19例;年龄20～86岁,平均52.12岁;40～60岁年龄段为22例（64.71%）;病理类型中腺样囊性癌居首位（70.59%）;治疗方式主要是局部扩大切除+颈淋巴结清扫术;3、5、10年存活率分别为82.35%、76.47%、47.06%。结论    舌下腺恶性肿瘤女性患者发病率略高于男性;腺样囊性癌和黏液表皮样癌是舌下腺常见的恶性肿瘤;首次正确选择术式,且术后辅助放化疗是降低复发和转移的主要因素。     

口腔颌面颈部恶性淋巴瘤56例临床分析

目的：探讨头颈部恶性淋巴瘤的发病特点、临床表现以及预后的相关性分析。方法：搜集56例头颈部恶性淋巴瘤病例,采用HE染色法进行观察,分析临床特点及预后情况。结果：56例头颈部恶性淋巴瘤患者中非霍奇金恶性淋巴瘤和霍奇金恶性淋巴瘤患者分别为47例（83.93%）和9例（16.07%）,常见临床体征是包块（痛性及无痛性）,感染溃疡。49例回访,7例失访。在回访中,22例（44.90%）复发,经分析表明复发率与患者的年龄及累计部位的差异具有统计学意义（P〈0.05）。发病部位依次为颈部、颌下、颏下。仅有头颈部症状者48例（85.71%）。初次诊断不明确者46例（82.14%）。1次病理诊断的确诊率为84.8%。治疗主要为手术＋化疗。患者5年生存率58%。结论：结外型恶性淋巴瘤的临床表现及组织学形态多样化,容易与临床上其他疾病相混淆。应通过病理检查及免疫组织化学检查以明确诊断。累犯≥2个部位和年龄〉50岁头颈部恶性淋巴瘤患者的复发率较高。     

168例涎腺肿瘤临床分析

目的:对涎腺肿瘤的临床和病理特点进行分析,探索涎腺肿瘤诊断治疗中存在的问题.方法:对1985～2005年间收治的经组织学确诊的168例涎腺肿瘤的临床和病理特点进行回顾性分析.结果:168例涎腺肿瘤男性多于女性.年龄在11～80岁.多发生于腮腺(67.3%),少发生于舌下腺(2.4%).良性肿瘤124例占73.8%,恶性肿瘤44例占26.2%.应用针吸细胞学检查,活检、B超、CT、MRI以及临床检查是诊断的重要措施.结论:涎腺肿瘤术前穿刺细胞学检查对诊断和治疗方案有指导意义.小的腮腺良性肿瘤,实施瘤周正常腺体切除的腮腺部分切除术,不增加复发率,并具有很多优点.     

颌面部嗜酸性淋巴肉芽肿的临床病理特点与诊断

目的：探讨嗜酸性淋巴肉芽肿（Eosinophilic Limphoid Grannuloma,ELG）的临床和病理特点,以利于正确诊治。方法：对我院10年间收治的经组织学确诊的14例ELG的临床资料、发病年龄、病理表现、实验室检查等进行回顾性分析。结果：14例ELG患者在临床上主要表现为腮腺区和颌下区无痛性软组织包块。组织学上表现为大量的嗜酸性粒细胞浸润、淋巴组织增生和滤泡形成、不同程度的纤维化、血管增生反应。结论：ELG是一种具有特殊临床和病理表现的慢性炎症性疾病,应与表现为头颈部肿块的其他疾病相鉴别,组织病理学对于诊断具有十分重要的意义。     

颈侧部囊性肿物自发性出血

目的：对18例临床少见的颈部囊性肿物自发性出血病例进行总结和分析。方法：采用回顾性分析此18例的临床特点、检查手段及处理措施。结果：该18例发病急剧，B超示包块内有液体缓慢流动，血流频谱无动脉化表现；穿刺液有大量红细胞，但不凝固。8例术后病理诊断为鳃裂囊肿伴出血，10例为囊状水瘤伴出血。结论：手术摘除是根本的治疗措施，B超、穿刺检查及术前处理对该病的诊断和手术治疗起着重要的作用。     

口腔颌面颈部恶性淋巴瘤46例临床分析

目的:回顾性分析口腔颌面颈部恶性淋巴瘤的流行病学状况、临床特点、常见误诊原因以及提高临床早期诊断的要点.方法:对46例经病理确诊的口腔颌面颈部恶性淋巴瘤的临床资料进行回顾性分析.结果:46例恶性淋巴瘤中非霍奇金淋巴瘤39例(84.8%),霍奇金淋巴瘤7例(15.2%).首发症状依次为无痛性包块、疼痛性包块、感染、溃疡.首发部位依次为颈部、颌下、颏下、口腔、腮腺区.不伴发全身症状者40例(87%).首诊诊断不明者38例(82.6%).1次病理诊断的确诊率为84.8%.治疗主要为手术 化疗.患者5年生存率58%.结论:结外型恶性淋巴瘤的临床表现呈多样化,容易被临床误诊.应提高对其认识,对高度怀疑为该病的患者应反复多次病检加免疫组化检查以明确诊断.     

彩超引导下的粗针穿刺活检术在腮腺肿瘤诊断中的应用

目的:探讨彩超引导下粗针穿刺活检在腮腺肿瘤术前诊断中的应用。方法:回顾2013~2015年于湖北省恩施州中心医院术前行彩超引导下粗针穿刺活检的腮腺肿瘤患者63例,将彩超引导下粗针穿刺活检的结果与术后组织病理学结果进行比较并统计。结果:63例腮腺肿瘤患者中,彩超引导下粗针穿刺活检诊断良性肿瘤56例,其中有1例术后病理检查报道为粘液表皮样癌,彩超引导下粗针穿刺活检诊断符合率98.2%;彩超引导下粗针穿刺活检诊断恶性肿瘤7例,彩超引导下粗针穿刺活检诊断符合率100%。彩超引导下粗针穿刺活检术术后发生并发症11例,术区疼痛6例,术区肿胀5例,无面神经损伤病例。结论:彩超引导下粗针穿刺活检术在腮腺肿瘤诊断中准确率高,术后并发症少,无不可逆性损伤。     

45例舍格伦综合征伴发唾液腺肿物误诊病例分析

目的: 分析舍格伦综合征(Sjögren's syndrome,SS)伴发唾液腺肿物误诊病例的特点,为临床诊断提供参考。方法: 回顾分析45例接受腮腺下颌下腺肿物切除术并最终病理诊断为良性淋巴上皮病患者的相关临床资料,并与唾液腺肿瘤性疾病进行对比分析。采用 Microsoft Excel构建数据库并做统计分析。结果: 45例患者均为女性,24.4%的患者累及双侧唾液腺,少数患者有口干(11.1%)、眼干(4.4%)、易疲劳(6.7%)、关节疼痛(22.2%)等临床症状,近半数患者肿物质地中等(55.6%),活动度小(53.3%)。35例患者接受CT检查,13例(37.1%)提示自身免疫性疾病,15例接受B超检查,13例接受MRI检查,分别有8例(53.3%)和10例(76.9%)提示自身免疫性疾病。结论: 以唾液腺肿物为主诉就诊的中年女性,特别是肿物累及双侧的患者,需密切排除SS后再进行手术治疗。B超及MRI可作为CT以外的附加临床常规检查,用于唾液腺肿物的初期诊断。     

52例腮腺区神经鞘瘤临床治疗及预后分析

目的: 探讨腮腺区神经鞘瘤的临床特点,并对其诊断、治疗及预后进行分析。方法: 收集2000年6月—2013年12月上海交通大学附属第九人民医院口腔颌面-头颈肿瘤科收治的52例腮腺区神经鞘瘤病例,分析患者临床特点、影像学检查、诊断、治疗及预后,采用SPSS13.0软件包进行Fisher精确检验。结果: 9例术前有面瘫、不适等神经症状,占17.31%。术前确诊率为21.15%,52例患者均行手术治疗并经病理学检查确诊。术后随访42 ~206个月,未发现肿瘤复发及恶变。28例患者术后出现不同程度面神经损伤症状,占53.85%;10例患者损伤症状消失,8例患者不同程度改善,占64.29%。当肿瘤与面神经无明显关联时,手术治疗有效率为100%;当肿瘤位于面神经上时,切除术总有效率为22.22%,囊内摘除术总有效率为85.71%,切除且同期重建总有效率为85.71%,差异具有统计学意义。结论: 腮腺区神经鞘瘤的术前确诊较难,确诊依赖病理诊断。该肿瘤需行手术治疗,术中应注意保护面神经,首选囊内摘除术;但当面神经离断及切除时,应尽可能同期行神经重建术,以期恢复患者面神经功能。     

Midcheek mass: 10 year of clinical experience

This is a literature review and retrospective chart review of ten years experience on the treatment of midcheek masses in our department. The purpose of this study is to provide the reader with an overview of the pathology of this complex anatomic area focusing the attention on the differential diagnosis and the recent surgical strategies.From May 2002 to December 2012 we enrolled 22 consecutive patients studied for masses located in the midcheek area. Only four studies were found in the literature describing the experience of individual centres reporting few cases of midcheek masses. Combined with the previously reported 37 cases, we describe 22 lesions for a total of 59 cases. Patients were evaluated with a head and neck clinical and instrumental examination. Apart from 4 cases treated with intramuscular infiltration of botulinum toxin for masseter hypertrophy, surgical approach to the lesions was varied: 10 patients received an external approach (standard parotidectomy approach or face-lift-type approach); 6 patients had the lesion removed through an intraoral approach; in 2 cases a direct skin incision was performed. In our series we found a significant rate (55.5%) of temporary complications in all the procedures performed (external, intraoral, direct skin approach). This study aims to emphasize the role of endoscope assisted surgery as a possible alternative to the traditional approaches for the management of well selected benign midcheek masses.It would be advisable to increase the study of the endoscopic anatomy of the midcheek area in order to standardize the procedure and better define the surgical indications.     

Classifying degenerative joint disease by the RDC/TMD and by panoramic imaging: a retrospective analysis

Summary The purposes of the study were to evaluate the utility of diagnosing degenerative joint disease (DJD) by the clinical finding of coarse crepitus alone, without supporting imaging studies, as defined by the RDC/TMD, and to evaluate the contribution of panoramic radiography as an aid in the diagnosis of DJD. A retrospective analysis of 372 consecutive patients with TMD was conducted. Their panoramic radiographs were evaluated for the extent of their contribution to the final diagnosis. Panoramic radiography was of no diagnostic value in 94·4% of the cases when the group was considered as a whole. When patients diagnosed with DJD were considered separately, panoramic radiography was completely sufficient for reaching the final diagnosis in 20·0% of the cases. In almost 90% of these patients, however, the clinical examination did not support the diagnosis of DJD (no coarse crepitus was found). This raises some doubts about the effectiveness of the clinical examination according to the RDC/TMD and about the utility of panoramic radiography in the definitive diagnosis of DJD, because both techniques have low accuracy (11·1% and 20%, respectively). The present study supports the current recommendations that panoramic radiography should not be ordered routinely to assess DJD, but still it is first choice when any dental problem is suspected. Further additional imaging (computerized tomography, magnetic resonance imaging) should be considered only if there is reason to expect that the findings might affect diagnosis and management. This study adds to recent criticisms of the clinical validity of the RDC/TMD, with regard to DJD.     

Diagnostic magnetic resonance imaging in synovial chondromatosis of the temporomandibular joint

The aim of this paper was to investigate the clinical and magnetic resonance imaging (MRI) features of synovial chondromatosis (SC) of the temporomandibular joint (TMJ). Fourteen patients with SC of the TMJ were included in the study. Clinical and MRI features were analysed and divided into three types based on MRI classification: type I with loose bodies, type II with homogeneous masses, and type III with a mixture of loose bodies and homogeneous masses. All SCs occurred in the superior compartment of the TMJ. There were two patients (14%) categorised as type I, five (36%) as type II and seven (50%) as type III. Four patients (29%) had disc perforation, and nine had bone erosion; among those nine, seven (78%) had type III and two (22%) type II. Histological examination showed inflammation and calcification in the synovial membrane and, and cartilage of the hyaline type in all cases. MRI has advantages in the diagnosis of SC.     

腮腺区包块诊断分析

目的:提高对腮腺区包块的诊断水平。方法:收集5年间296例腮腺区包块的临床资料,对其一般情况、疾病构成、临床表现、诊断方法等进行分析。结果:男、女之比约1.19∶1,年龄最小1岁,最大83岁;多形性腺瘤80例,占腮腺区包块的27%,占腮腺区良性肿瘤的50%;Warthin瘤50例,占腮腺区包块的16.9%,占腮腺区良性肿瘤的31.3%;炎性包块27例,占腮腺区包块的9.1%。黏液表皮样癌14例,占腮腺区包块的4.7%,占腮腺区恶性肿瘤的29.2%;腺样囊性癌7例,癌在多形性腺瘤中7例,均占腮腺区包块的2.4%、腮腺区恶性肿瘤的14.6%;鳃裂囊肿6例,占腮腺区包块的2.0%;多形性腺瘤以40～49岁年龄组及50～59岁年龄组最多见(χ2检验,P<0.005),Warthin瘤以50～59岁年龄组、60～69岁年龄组、70～79岁年龄组最多见,且40岁以前其发病率为0(χ2检验,P<0.005);炎性包块可见于任一年龄组,且以60～69岁年龄组最多见(χ2检验,P<0.005)。结论:腮腺区包块涵盖的疾病复杂,表现多样,应结合其临床表现、B超、CT、MRI等影像学检查、细针吸细胞学检查、术中快速冰冻病理检查等综合考虑选择合适的治疗或手术方案。     

颈动脉体瘤的诊断和治疗

目的:探讨颈动脉体瘤的诊治经验,提高诊断准确率和手术成功率,降低并发症发生率。方法:回顾分析1996~2005年收治的30例颈动脉体瘤患者的临床资料。结果:30例患者均行DSA检查,均诊断为颈动脉体瘤;B超检查14例,12例诊断为颈动脉体瘤;CT检查20例,16例诊断为颈动脉体瘤;MR I/MRA检查16例,14例诊断为颈动脉体瘤。22例患者行TBO检查,8例为阳性。30例患者均行手术治疗,29例患者预后良好,1例发生永久性偏瘫,随诊期间无肿瘤复发。结论:DSA检查是诊断颈动脉体瘤的最佳方法,而MR I/MRA和BUS检查在颈动脉体瘤的诊断中具有重要价值。手术切除是治疗颈动脉体瘤的首选治疗措施。DSA和TBO同时检查,能为制定手术方案提供重要参考。应做好充分的术前准备,术前常规行M atas训练。术中精细的解剖可以降低术后并发症的发生。     

Oral bisphosphonate-related osteonecrosis of the jaws: Clinical characteristics of a series of 20 cases in Spain

Objective: The objective of this study was to define the clinical characteristics of osteonecrosis of the jaws (ONJ) induced by oral bisphosphonates in a series of patients from a circumscribed area in northwest Spain. Study Design:A retrospective multicentre study was undertaken in 3 hospitals in an area with a radius less than 100 km in the Autonomous Community of Galicia (Spain). The medical records were reviewed and an oral examination was performed of patients diagnosed with oral bisphosphonate-related ONJ in the previous 3 years. Results: We detected 20 cases of ONJ (24 lesions) related to oral bisphosphonates (alendronate [16 patients] and ibandronate [4 patients]), which were mainly administered as treatment for osteoporosis (17 patients). The mean interval between initiation of treatment and confirmation of a diagnosis of ONJ was 66±43 months (range, 6-132 months); in 7 patients (35%) the interval was less than 36 months. The past history revealed hypertension in 13 cases (65%) and diabetes in 4 (20%); 7 patients (35%) were on corticosteroid treatment. Oral surgery had been previously performed in 13 patients (65%) and the remaining 7 patients (35%) had removable dental prostheses. The lesions most frequently affected the posterior mandible (62.5%). The majority of the lesions (75%) were classified as stage 2, although lesions were identified in all established clinical stages (including 2 stage 0 lesions). Conclusion: In conclusion, in the present series, ONJ induced by oral bisphosphonates typically develops in women around 70 years of age, taking alendronate, that underwent oral surgery. Most lesions are located in the posterior mandible and are classified as stage 2 at diagnosis. Some patients presented no known risk factors, suggesting that there may be risk factors still to be identified. There are well-defined patterns of clinical presentation that can facilitate early diagnosis of ONJ.     

腮腺内面神经鞘瘤的临床病理分析

目的 探讨腮腺内面神经鞘瘤的临床特点及病理特征。方法 收集2015—2020年江苏大学附属医院口腔颌面外科收治的5例腮腺内面神经鞘瘤病例,分析患者的临床资料、影像资料、病理资料、术前诊断、治疗方式及术后神经损伤情况等。结果 5例患者均为男性,年龄33~70岁。临床表现仅为境界清楚的无痛性腮腺区肿物,均不伴面神经瘫痪等症状。2例术前诊断为混合瘤,3例术前诊断为腺淋巴瘤。治疗方式为肿瘤合并神经切除后神经端端吻合术。术后随访4例患者面神经功能基本正常,仅一例患者存在H-BⅡ级面神经功能障碍症状,随访10~72个月未见复发病例及恶变。镜下肿瘤细胞呈长梭形,呈编织状排列。免疫组化示肿瘤细胞S-100蛋白在5例患者的细胞核和细胞质中呈弥漫性强阳性表达,Vimentin在5例患者胞质中均呈强阳性表达,Sox10在4例患者胞核中呈阳性表达,3例患者局灶表达CK7,细胞增殖能力标记物Ki-67阳性指数均小于3%,AE1、EMA、P63、SMA在全部病例中均呈阴性表达。结论 腮腺内面神经鞘瘤的临床表现及辅助检查均无特异性,术前确诊较为困难,需要依赖病理诊断,S-100、Vimentin可辅助诊断腮腺内面神经鞘瘤。