二次印模加开窗减压印模技术在低平牙槽嵴患者全口义齿修复中的应用

目的观察二次印模加开窗减压印模技术在低平牙槽嵴患者全口义齿修复中的应用效果。方法选择38例低平牙槽嵴的无牙患者,用二次印模加开窗减压印模技术取得全口义齿精确的终印模,并行全口义齿修复。结果本组进行严格正中、前伸及侧方调后,经临床戴用、随访均示固位良好,进食时义齿稳定;修复后仅3例有黏膜压痛,经复诊调磨后症状消失。结论对于低平牙槽嵴患者,二次印模加开窗减压印模技术能提高印模准确性,有助于提高低平牙槽嵴全口义齿的固位力,提高咀嚼效率,减少复诊次数。     

开闭口式硅橡胶取模对三类牙槽嵴全口义齿修复边缘适合性的对比研究

目的研究三类牙槽嵴患者制取开闭口式硅橡胶印模后全口义齿修复的边缘适合性。方法选取2016-01～2018-01在修复科就诊的全口牙列缺失患者,按照Atwood分级法,二级牙槽嵴18例,三级牙槽嵴20例,四级牙槽嵴12例。将这三类牙槽嵴又各自等分为观察组和对照组,每组25例。观察组采用闭口式硅橡胶印模行全口义齿修复。对照组采用开口式硅橡胶印模行全口义齿修复。修复后1个月内,统计患者因边缘不合适来诊的次数、调磨的区数及各区调磨过的次数。结果全口义齿修复1个月内,三类牙槽嵴中观察组调磨的次数均显著少于对照组(P 0. 05),尤其是四级牙槽嵴(P 0. 01)。观察组三级和四级牙槽嵴调磨的区数显著少于对照组(P 0. 05)。观察组二级牙槽嵴调磨的区数与对照组比较差异无统计学意义(P0. 05)。其中下颌磨牙区边缘调磨的次数为最多,其次为上颌磨牙区。结论闭口式硅橡胶取模制作的全口义齿边缘适合性要明显高于开口式硅橡胶取模,而且在牙槽嵴条件越差的时候效果越明显。     

90例全口义齿患者对美观满意度调查

目的老年人戴用全口义齿的满意度调查。方法调查90例需要重新修复全口义齿的病例旧义齿使用情况,调查内容包括患者牙槽嵴情况、人工牙磨耗程度及义齿基托形态等,戴用全口义齿后面下1／3距离、颌位关系、面部丰满度、合平面、人工牙排列位置,患者重新义齿修复的原因及对旧义齿的满意度等。结果患者对旧义齿美观满意度为55．5％,咀嚼功能满意度为58．6％。重新修复原因分别为：义齿固位不良者86．7％,面部欠丰满者45．6％,咀嚼无力者38．9％,人工牙不满意者37．8％,黏膜疼痛者23．3％,义齿损坏者21．1％。患者主观评价旧义齿面下1／3距离短和面部欠丰满分别为67．7％和45．6％。旧义齿基托边缘过薄占57．8％,合平面偏高、偏低分别占23．3％、12．2％,人工牙排在牙槽嵴顶占96．7％,人工牙磨耗占90％。结论老年人全口义齿修复有美观的要求。成功的全口义齿应能最大程度地取代失去的组织,因此印模时应能正确复制前庭沟的宽度,人工牙应排列在唇、颊向内的力与舌向外的力保持平衡的原天然牙的位置。牙槽嵴条件丰满的患者尽量选用瓷牙或硬质树脂牙。     

生物功能性全口义齿修复牙列缺失的效果观察

目的评价生物功能性修复系统（BPS）全口义齿的临床治疗效果。方法将80例全口牙列缺失患者随机分为观察组和对照组各40例，分别采用BPS全口义齿和传统全口义齿进行修复治疗。治疗后3个月，观察两组患者主观评价情况，并采用吸光度法测试义齿的咀嚼效率。结果两组牙槽嵴正常者均获得较高的满意度和咀嚼物吸光度值（P〉0．05）；观察组牙槽嵴低平者满意度和咀嚼物吸光度值均高于传统全口义齿（P〈0．05）。结论BPS全口义齿对于牙槽嵴低平患者的治疗效果优于传统全口义齿。     

下颌牙槽嵴增高术的进展

老年人失牙和全口无牙患者远远高于其他年龄段。失牙后由于全身和局部因素失牙区牙槽嵴发生持续不可逆的吸收，使牙槽嵴萎缩和变形，造成义齿修复困难。因此，有必要通过牙槽嵴增高术来改善义齿修复和种植体植入条件，恢复咀嚼功能。牙槽嵴增高术可分为相对和绝对增高术，前者是指唇颊沟加深术，又叫牙槽嵴延伸术；后者包括骨移植、生物材料植入、牵引成骨等。现对牙槽嵴增高术的情况及进展介绍如下。     

自凝软衬垫用于下颌总义齿修复12例疗效分析

对牙列缺失患者行义齿修复过程中,部分年龄较大患者常因牙槽嵴吸收、下颌呈低平状,戴用义齿后出现不定点、无规则压痛,临床检查无明显压痛点,经磨改效果亦不好。我们对12例此类患者采用软性衬垫材料经义齿组织面行重衬处理,取得良好效果,现报告如下。一般资料:本组患者年?..     

隐形义齿修复牙列缺损258例

近年来我们采用隐形义齿修复治疗牙列缺损患者 2 5 8例 ,疗效满意。现报告如下。临床资料 :2 5 8例患者中前牙列缺损 10 6例 ,后牙列缺损143例 ,上下全口义齿 (颌间关系正常且牙槽嵴丰满 ) 3例 ,食物嵌塞防治基托 2例 ,制作颌垫 2例 ,腭护板、矫正保持器各1例。病例选择标准为上下前牙缺失 ,基牙临床牙冠较长 ,并有 5°以内倒凹 ;缺牙区有足够的排牙间隙即咬颌不能过低 ,以利于“T”形固定孔设计。方法及结果 :采用美国 Valplast公司生产的隐形义齿材料。 1牙体预备 :在缺失区保留 5°以内基牙倒凹 ,后牙缺失制备颌支托凹 ,利用组织倒凹固…     

舌侧集中牙合与解剖式牙合全口义齿修复低平牙槽嵴患者的满意度对比

随着年龄的增长,牙槽嵴逐渐吸收萎缩以至低平,低平牙槽嵴无牙牙合患者是全口义齿修复中的难点。特别是牙列缺失过久并经多次解剖式牙合全口义齿修复的老年患者,修复效果往往欠佳,难以满足患者的功能需求。近年来,口腔修复学     

舌侧集中在义齿修复中的研究进展

牙列缺失是老年患者最常见的疾病之一。据调查,65岁以上老年人患牙列缺损者在美国为26%,欧洲为15%～78%,印度尼西亚为24%,中国为11%。牙列缺失后,由于咀嚼功能的丧失,牙槽嵴失去牙齿的生理性刺激而加速吸收。全口义齿     

唇腭裂牙槽嵴畸形的植骨修复术

唇腭裂的牙槽嵴裂是畸形中的一部分,唇腭裂修复后易留有口腔前庭瘘,影响发音及口腔卫生,使恒牙阻萌或错位萌出,牙槽嵴裂隙致鼻翼基底部失去骨支持而出现鼻翼塌陷,严重地影响面容和咀嚼功能,已逐渐引起重视。目前,唇腭裂牙槽嵴畸形的植骨修复已成为唇腭裂序列治疗中的重要部分,它不仅可以关闭口鼻腔前庭瘘,增加上颌骨的稳定性,重建牙槽弓的完整性;而且可预防牙弓的横向缩窄,改善裂隙鼻翼基底高度;也为以后的二期外科正畸手术、义齿修复,以及面部畸形的矫正打下基础。1　植骨术供区的选择自体骨移植修复牙槽嵴裂,常选择髂骨、肋骨、颅骨及下颌…     

3D Image-Guided Percutaneous Radiofrequency Thermocoagulation of the Maxillary Branch of the Trigeminal Nerve Through Foramen Rotundum for the Treatment of Trigeminal Neuralgia

Percutaneous radiofrequency thermocoagulation of the trigeminal ganglion through the foramen ovale is a well-established procedure for the treatment of trigeminal neuralgia (TN). However, this approach can be tricky when individual trigeminal sub-branch nerve block is required. We report our initial experience of image-guided radiofrequency thermocoagulation of the maxillary branch through the use of foramen rotundum.From February 2012 to February 2015, we treated 25 patients with isolated TN of the maxillary branch. Radiofrequency thermocoagulation of the maxillary branch through the foramen rotundum was performed under fluoroscopy. TN pain was evaluated using the visual analogue scale both before and after the procedure.The mean preoperative visual analogue scale score was 8.6 ± 0.8. The pain completely disappeared after the initial procedure in 22 patients and after a second procedure in 2 patients. An additional patient had a postoperative visual analogue scale score of 2 and did not undergo further treatment. Facial numbness occurred in 23 patients but was tolerable. Patients were followed up for a mean of 14.74 months (range, 1–29 months). Recurrence was observed in 9 patients (36%) during the follow-up period. All recurrences were well managed with repeat procedures.Percutaneous radiofrequency thermocoagulation of the maxillary branch through the foramen rotundum under fluoroscopy is a safe and effective procedure for the treatment of isolated TN of the maxillary branch.     

显微血管减压术治疗35例原发性三叉神经痛患者疗效分析

目的 探讨显微血管减压术治疗原发性三叉神经痛(PTN)的手术技巧以及手术效果.方法 回顾性分析35例原发性三又神经痛患者显微血管减压术的手术操作、治疗效果以及并发症.结果 术中将微血管隔开、减压后,34例患者疗效显著,无脑脊液漏等严重并发症发生,1例复发.结论 显微血管减压手术是治疗原发性三义神经痛的有效治疗方法.     

建立三叉神经痛慢性缩窄环术大鼠模型的体会

目的 建立三叉神经痛慢性缩窄环术大鼠模型,并总结经验.方法 经口腔入路暴露并结扎眶下神经,建立三叉神经痛慢性缩窄环术大鼠模型.观察术后不同时段大鼠对机械刺激的反应阈值(疼痛阈值)及相关的痛觉行为变化.结果 手术组术后14 d,在眶下神经支配区域内,大鼠出现痛觉超敏现象,与术前及对照组比较差异有统计学意义(P<0.05).结论 大鼠眶下神经的慢性环扎损伤可导致三叉神经痛出现.     

Results of pudendal nerve neurolysis-transposition in twelve patients suffering from pudendal neuralgia

PURPOSE: Pudendal neuralgia caused by nerve compression may be improved by surgical decompression of the pudendal nerve. This study was undertaken to determine if clinical symptoms, electrophysiological investigations, and the efficacy of preoperative pudendal nerve blocks could be used to predict the efficacy of surgery. METHODS: Twelve consecutive patients complaining of anal pain, genital pain, or both, exacerbated in the sitting position and unsuccessfully treated by analgesic drugs before referral were studied. In these 12 patients decompression of the pudendal nerve was performed after unsuccessful CT-guided injection of corticosteroids in the pudendal nerve at the ischial spine or after pain relapse following successful injections. Nineteen nerves were decompressed by surgery, and the compressed area was located between the sacrospinal and sacrotuberal ligaments for 18 nerves. RESULTS: Three months after surgery, four patients were totally relieved, and three were only partially improved. After 21 months of follow-up, three patients were cured, one was slightly improved, and eight remained in pain. In the three patients cured by surgery, pain completely disappeared for at least two weeks after a nerve block repeated twice before surgery, whereas pain relief was observed in only one of the nine other patients (P = 0.018). None of the three patients cured by surgery were being treated for depression, whereas six of the nine remaining patients were receiving antidepressants or were followed by a psychiatrist (P = 0.09). Results of surgery did not depend on other preoperative clinical or electrophysiological data. CONCLUSIONS: This preliminary study suggests that complete disappearance of pain for at least two weeks after a nerve block repeated twice before surgery may be the best criterion to predict success. Based on this criterion, surgery would have been performed in four patients in this study, of whom three would have been cured.     

The Long-Term Effective Rate of Different Branches of Idiopathic Trigeminal Neuralgia After Single Radiofrequency Thermocoagulation: A Cohort Study

To evaluate the efficacy of computed tomography (CT) guided single radiofrequency thermocoagualtion (RFT) in 1137 patients with idiopathic trigeminal neuralgia after a follow-up period of 11 years, specially focused on duration of pain relief in different branches of trigeminal nerve, side effect, and complications.Retrospective study of patients with idiopathic trigeminal neuralgia treated with a single CT guided RFT procedure between January 2002 and December 2013.The mean follow-up time was 46.14 ± 30.91 months. Immediate postprocedure pain relief was 98.4%. V2 division obtained the best pain relief rate: 91%, 89%, 80%, 72%, 60%, and 54% at 1, 3, 5, 7, 9, and 11 years, respectively. No statistical difference pairwise comparison was in other groups. The complications included masseter muscle weakness, corneitis, diplopia, ptosis, hearing loss, limited mouth opening, and low pressure headache. Masticatory weakness mostly occurred in patients with V3 branch involvement, while Corneitis and Diplopia all in patients with V1 branch involvement. No mortalities observed during or after RFT.All different branches division of trigeminal neuralgia achieved comparable satisfactory curative effect; V2 obtained the best excellent pain relief, after RFT procedure. Facial numbness is inevitable after RFT, which patients who have pain in all 3 trigeminal divisions and patients who desire no facial numbness should be cautious. Masticatory weakness is mainly related with V3 injured, while Corneitis and Diplopia in patients with V1 injured by RFT.     

Glossopharyngeal neuralgia; a cause of cardiac arrest

Glossopharyngeal tic douloureux or neuralgia is a comparatively rare but well-recognized syndrome. In respect to the stabbing paroxysmal nature of the pain and its relation to specific trigger zones, it is exactly comparable to the commoner trigeminal tic douloureux. In neurosurgical clinics the two types of neuralgia occur in a ratio of about one to forty.The significance of cardiac arrest and syncope associated with glossopharyngeal neuralgia was first emphasized by Riley and associates,¹ in a brief report of two cases in 1942. This report called attention to the afferent pathway of the carotid sinus reflex through the glossopharyngeal nerve and suggested the correlation of the simultaneous neuralgia and excessive stimuli to the sinus reflex. Neither of the two cases was reported to have been subjected to operation. Since then, no other reports of similar cases have come to light in medical literature. However, one of us (Ray) had the opportunity of examining such a case with Dr. Jefferson Browder in 1943 and this patient was relieved of all symptoms by intracranial section of the glossopharyngeal nerve.Because of the importance of further establishing the authenticity of the syndrome and calling wider attention to the importance of its recognition, there is justification for reporting another comparable case.     

Orofacial pain.

Orofacial pain is an area of considerable interest in aging. Orofacial nociceptive pain arises mainly from injury or disease afflicting the teeth or the supporting structures of the teeth (periodontium); however it may arise from other intraoral or nonintraoral structures. Because of the rich innervation of the orofacial complex, pain may be referred to remote sites. Neuropathic pains, such as trigeminal neuralgia and postherpetic neuralgia, result from nerve injury and are usually seen only in older adults. Establishment of the source and cause of the pain results in effective pain management.     

Oral mucosal disorders in institutionalized elderly people

The aim of the study was to investigate the type and incidence of oral mucosal disorders in the elderly, any relationship between these disorders and the wearing of dentures, and the associated subjective symptoms of pain. The subjects were 480 residents of 24 municipal old people's homes in different parts of Finland: 153 males and 327 females, age range 65-100 years. The methods used were clinical examination and interview. Clinical examination showed about 60% of the elderly to have one or more oral mucosal disorders. Altogether, 431 pathological conditions were recorded, with changes of the surface of the tongue the most frequent. Hyperplasia and/or denture-related ulcerations and press-points were found in 43% of denture wearers. The interviews revealed that only 17% of those with oral mucosal disorders had symptoms of pain, most frequently caused by press-points and ulcerations. The absence of subjective symptoms emphasizes the importance of frequent oral examinations, especially of the oral mucosa.     

Carbamazepine and the lung

A 69 yr old man was admitted with a 10 day history of fever, arthromyalgia, dyspnoea, dry cough and pleuritic pain. Temperature was 38 degrees C; tachypnoea 36 rpm. Extensive crackles were audible over both upper lung fields. Chest X-ray showed bilateral alveolar infiltrates. Forced vital capacity was 49% of predicted, and carbon monoxide transfer coefficient was 32% of predicted value. The patient had been taking carbamazepine for one month because of a trigeminal neuralgia. After withdrawal of the drug he gradually recovered.