下颌骨内外侧面副孔分布的比较研究及临床意义

目的　通过对国人下颌骨内外侧面副孔的数量及分布特征的比较研究 ,探讨其与肿瘤浸润的关系。方法　将74块下颌骨的内外侧面分为 2区 6部 ,在 1 0～ 2 0倍显微镜下观察各区、部的副孔数。结果　副孔的数量在不同的标本上相差很大 ,内、外侧面相应各区各部的副孔数比较 ,经U检验 ,P <0 0 0 1 ,差异显著 ,内侧面多于外侧面。结论　副孔为肿瘤由骨皮质表面进入松质骨提供了直接通路 ,内侧面副孔数显然多于外侧面 ,为肿瘤细胞由内侧面骨皮质表面入侵松质骨提供了有利途径     

下颌骨的显微解剖学特征及其临床意义

目的：探讨口腔肿瘤向下颌骨浸润蔓延的传播扩散途径(模式)以及在微创术中保留下颌骨的可行性。方法：将60例成人下颌骨以染料浸泡后，在10～20倍的体视显微镜下进行观察。结果：在经染料浸泡的标本上，渗入着色剂的副孔清晰可见。下颌骨内侧面着色副孔的出现率比外侧面的多；在外侧面，下区上部的着色副孔数最多；在内侧面，下区中部的着色副孔数最多。结论：口腔肿瘤向下颌骨的浸润蔓延可能有3种传播扩散途径：(1)口腔肿瘤经下颌骨外侧面的副孔向下颌骨浸润扩散；(2)口腔肿瘤经下颌骨内侧面的副孔向下颌骨浸润扩散；(3)口腔肿瘤一旦侵及骨髓腔，便可在下颌骨内经下颌管迅速传播扩散至其它部位。     

下颌骨内外侧面副孔的分布

肿瘤细胞可经口腔的血液循环浸润至下颌骨的网状骨质,这在无牙的牙槽嵴上经副孔播散已有研究,也可经下颌骨其它部位的副孔浸润下颌骨。在1988年张奎启曾对下颌骨无名孔的孔径及不同部位的出现率进行了观测,但对国人下颌骨副孔的研究只在近年来才有报道。本文通过对下颌     

下颌骨内侧面副孔的观测及其临床意义

目的 :观测下颌骨内侧面副孔的数量与分布 ,探讨其与肿瘤浸润的关系。方法 :将 74块下颌骨内侧面分为 2区 6部 ,在 1 0～ 2 0倍显微镜下观察各区、部的副孔数量及分布规律。结果 :副孔数量在不同的标本上相差很大 ,平均为 (78.7± 34 .4)个。上区的副孔数比下区的少 ,在上区 ,下颌切迹部副孔数量最多 ,其次为髁突部和冠突部 ;在下区 ,中部副孔数量最多 ,其次为上部和下部。在下颌孔的内侧面副孔的出现率最高 (99.3 % ) ,其次为两侧的颏结节 (72 .8% )、颏结节上方的正中孔 (68.9% )及二腹肌窝(66 .2 % )。结论 :副孔为肿瘤由骨皮质表面进入网状骨质提供了直接通路 ,在下颌孔的内侧面及沿下颌管出现的副孔使这个区域最易受肿瘤播散的侵及     

下颌骨外侧面副孔的观测及其临床意义

目的 :观测下颌骨外侧面副孔的数量与分布 ,探讨其与肿瘤浸润的关系。方法 :将 74块下颌骨内侧面分为 2区 6部 ,在 10～ 2 0倍显微镜下观察各区、部的副孔数及分布规律。结果 :副孔的数量在不同的标本上相差很大 ,平均为 (4 9.4± 2 0 .6)个。上区的副孔总数比下区的少 ,在上区 ,髁突部副孔数量最多 ,其次为冠突部和下颌切迹部 ,平均分别为 (2 .3± 1.8) ,(0 .7± 1.1)和 (0 .3± 0 .7)个 ;在下区 ,上部副孔数量最多 ,其次为中部和下部 ,平均分别为 (12 .5± 6.2 ) ,(5 .0± 3 .8)和 (3 .8± 2 .6)个。结论 :副孔为肿瘤由骨皮质表面进入网状骨质提供了直接通路 ,上部出现的副孔使这个区域最易受肿瘤播散的侵及。     

下颌骨内侧面下颌副孔的位置

目的　研究下颌副孔的位置 ,探讨肿瘤细胞向下颌骨播散的可能途径。方法　应用大体解剖方法对 82例下颌骨内侧面下颌副孔的位置进行研究并统计分析。结果　各标本之间副孔数差异很大 ,下颌副孔冠状区出现率为 5 7 3 2 %、切迹区 71 95 %、髁区 5 7 3 2 % ,上、中、下区出现率分别为 73 17% ;73 17%和98 78%。结论　下颌骨内侧面下颌副孔为口腔内肿瘤细胞播散到下颌骨的途径之一 ,未经放疗的病例应切除磨牙后区和冠状突而保留下颌骨的其余部分     

胃癌手术切缘残留与病理类型的关系

目的：探讨胃癌切除术标本切缘癌残留与病理类型的关系。方法：通过对术中大体标本观察与术后病理分型的相关性分析，讨论切缘癌残留的原因。结果：癌灶部位与切缘癌残留间无统计学差异；癌的大体类型和组织学类型与切缘癌残留有明显统计学差异Ｐ〈０．０５。：应重视术前胃镜病理检查，根据不同大体类型和组织学类型选择适合病人的最佳手术方案，有条件时最好结合术中冷冻判断切缘有无癌残留。     

下颌骨切除术患者围手术期护理

下颌骨切除术是治疗下颌骨肿瘤的经典术式，但术后患者的容貌受损、发音和吞咽困难，且疼痛较重，并发症发生率较高，使护理工作面临许多新的问题。现将51例对行下颌骨切除术患者的护理体会报告如下。     

下颌骨切牙舌侧孔的解剖学观察

乌鲁木齐地区出土的199例汉族成人下颌骨上观察测量了切牙舌侧孔的位置、孔数、形态、方向和孔径。并通过10侧尸头局部解剖证实:此孔在成人为下齿槽神经切牙支分布于切牙舌侧牙龈分支的通道。并在1例童尸上发现:此孔除有上述神经分支外,还有舌动脉的分支舌下动脉进入此孔。     

副下颌孔及周围骨孔的应用解剖

目的 研究副下颌孔及下颌孔与周围解剖结构间的关系,为临床手术提供参考的同时丰富解剖学资料。方法 选取200例成人干燥下颌骨,观察副下颌孔和无名孔的数量,用游标卡尺等测量最大副下颌孔内侧最低点和下颌孔内侧最低点到髁突内极、喙突尖端、下颌切迹最低点、下颌小舌尖、颏棘、下颌角、下颌角前切迹、下颌最后一颗磨牙远中中点的距离及下颌骨后缘的水平距离,并进行统计学分析。结果 副下颌孔出现率为30.75%,双侧同时出现多见;无名孔多为（13.51±3.98）个,主要位于下颌孔与下颌切迹水平之间;最大副下颌孔内面最下点到髁突内极、喙突尖端、下颌切迹最低点、下颌小舌尖、颏棘、下颌角、下颌角前切迹、下颌最后一颗磨牙远中中点的距离及下颌骨后缘的水平距离分别为（33.70±3.67）mm、（37.13±4.44）mm、（20.13±3.59）mm、（7.58±2.05）mm、（74.93±4.55）mm、（26.69±5.36）mm、（31.57±4.77）mm、（25.40±4.96）mm、（11.09±2.85）mm。下颌孔内面最下点到髁突内极、喙突尖端、下颌切迹最低点、下颌小舌尖、颏棘、下颌角、下颌角前切...     

The relationship between accessory foramina and tumour spread on the medial mandibular surface

The medial cortical surface of the mandible can be involved by tumour infiltration from the floor of the mouth. A detailed study of spread via accessory foramina through the edentulous alveolar crest has been previously undertaken, but no similar study has been carried out for the medial surface. In order to gain further appreciation of the mode of tumour spread, a study of the number and distribution of accessory foramina on the medial mandibular surface was performed on 89 mandibles. The number of foramina varied greatly from specimen to specimen. In the ascending ramus above the inferior dental foramen, 3 mandibles showed no foramina; the condylar section possessed the greatest proportion followed by the sigmoid and the coronoid. On the rest of the medial surface below the inferior dental foramen, all specimens showed at least 1 accessory foramen; the greatest concentration was in the middle third along the path of the inferior dental canal, followed by the upper third and the lower third section. Accessory foramina were repeatedly present at certain dedicated sites. The medial facing wall of the inferior dental foramen was found to be the commonest dedicated site (98.3%) followed by foramina on either side of the genial tubercles (71.9%), the digastric fossa (71.9%) and the median foramen above the genial tubercles (64%). The findings of this study are in keeping with the current observation that the lower border is least commonly involved in tumour spread. In view of the presence of accessory foramina along the inferior dental canal and especially on the medial facing wall of the inferior dental foramen, it is imperative to preclude tumour spread in this region prior to undertaking the conservative rim resection procedure. Medial to the symphysis the alveolar mucosa dips down almost to the level of the dedicated foramina in the vicinity of the genial tubercles. As a general rule the attached muscle forms a barrier to tumour spread except in the later stages, however, in irradiated mandibles resistance to spread has been previously reported to be diminished. Under these circumstances, it is possible that the numerous accessory foramina reported in this study could facilitate a direct pathway into the cancellous bone.     

Relationship between accessory foramina and tumour spread in the lateral mandibular surface

The spread of tumour cells to the mandible has been well recognised and invasion of the edentulous alveolar ridge by tumour through accessory foramina has been documented. Tumour infiltration can also occur through the lateral cortical plate, but the number and distribution of accessory foramina on this surface has not been reported. Lateral surfaces of 89 mandibles were examined and accessory foramina which showed a direct communication with the underlying cancellous bone were charted. It was found that the number of accessory foramina varied greatly from specimen to specimen. Only 70.8% of mandibles showed foramina in the coronoid, sigmoid and condylar sections; of these 93.7% exhibited foramina in the condylar section, 23.8% in the coronoid and only 19% in the sigmoid section. This finding confirms that the current practice of conserving part of the ascending ramus posterior to the coronoid process following surgery is sound. Similarly in the rest of the lateral surface, foramina were present in the upper third section in 97.8% of mandibles, 61.8% in the lower third and 58.4% in the middle third sections. This result justifies the principle of rim resection in appropriate cases and the recognition that the alveolar section is commonly invaded before the rest of the body. The number and distribution of foramina may be of greater significance following radiotherapy when the foramina could provide multiple direct channels for invasion of tumour cells from the lateral surface to the medulla.     

Multiple accessory foramina of the mandibular ramus: risk factor for oral surgery

A 27-year-old female was referred to our hospital with a chief complaint of removal of an impacted right mandibular third molar. Panoramic radiography showed two small circular radiolucencies on the right mandibular ramus. Computed tomography revealed that one of the radiolucencies was an accessory foramen located lateral to the mandibular ramus, and the other radiolucency was an accessory foramen located medial to the ramus; it was also connected to the mylohyoid groove. Continuity with the mandibular canal was confirmed for both accessory foramina. After explaining the risks of extraction, the patient decided against surgery and the impacted tooth was left in situ. Most patients have at least one or more accessory foramina in the mandible; however, accessory foramina of the lateral aspect of the mandibular ramus have not been reported. The high resolution of cone-beam computed tomography and three-dimensional reconstructed images enable improved detection of accessory foramina. Therefore, additional accessory foramina that are similar to those found in the present case could be found in the future using such imaging modalities.     

The clinical anatomy of accessory mental nerves and foramina

Since three‐dimensional computed tomography was developed, many researchers have described accessory mental foramina. The anatomical and radiological findings have been discussed, but details of accessory mental nerves (AMNs) have only been researched in a small number of anatomical and clinical cases. For this article, we reviewed the literature relating to accessory mental foramina (AMFs) and nerves to clarify aspects important for clinical situations. The review showed that the distribution pattern of the AMN can differ according to the position of the accessory mental foramen, and the reported incidence of AMFs differs among observation methods. A review of clinical cases also revealed that injury to large AMF can result in paresthesia. This investigation did not reveal all aspects of AMNs and AMFs, but will be useful for diagnosis and treatment by many dentists and oral and maxillofacial surgeons. Clin. Anat. 28:848–856, 2015. © 2015 Wiley Periodicals, Inc.     

The relationship between the tibialis posterior tendon and the accessory navicular.

Out of a total of 116 cadaver feet, 29 specimens were selected by means of palpation of the tuberosity of navicular for a possible presence of the accessory navicular. They were then radiographed and the accessory navicular was detected in ten. Also three fresh amputation specimens with an accessory navicular were added to the study. A total of 13 legs was dissected and in nine of them, the tibialis posterior tendon inserted directly into the accessory navicular without extending to the sole of the foot. In these feet, the second part of the tibialis posterior tendon originated from the accessory navicular, extending to the normal insertions. There was no connection between these two parts and when traction was applied to either one, no movement was observed in the other. Also a fibrocartilaginous mass was detected in four specimens, probably formed to resist the friction between the tendon and the bone. These results may explain the pronated foot in the presence of the navicular, due to the loss of the function of the tibialis posterior tendon.     

The relationship between the medial collateral ligament and the medial meniscus: a topographical and biomechanical study

The functional influence of the medial collateral ligament on the medial meniscus is still discussed controversially. Commonly, a strong fixation of the meniscus by the collateral ligament is described. Injury to the medial meniscus is explained by its reduced mobility due to its strong adherence to the medial collateral ligament. The analysis of 10 plastinated series of the medial femorotibial compartment prove that only few fibres of the ligament radiate into the meniscus. To define the possible contribution of these fibers to the stability of the medial meniscus, experiments on two fresh frozen knee joints were performed. The distal femur was separated by cutting the capsule. The medial collateral ligament was detached carefully from its femoral insertion. The tibial head with both menisci was fixed in a clamping system. A translucent, exact acrylic glass copy of the femoral component to which the medial collateral ligament was reinserted, allowed studying the behaviour of the medial meniscus under axial compression (500 N). Firstly, stress was applied while the collateral ligament was proximally fixed and under tension; then the same experiment was performed after femoral detachment of collateral ligament. All plastinated series revealed only some deep and tender fibrous bundles of the medial collateral ligament radiating into the medial meniscus proximally and posteriorly. The behaviour of medial meniscus was exactly the same in both stress experiment series. The conclusion is that there is no relevant influence of the medial collateral ligament on the stability of the medial meniscus.