半冠状切口结合小钛板固定治疗颧骨复合体骨折

目的 观察半冠状切口结合小钛板固定治疗颧骨复合体骨折的疗效。方法 25例颧骨复合体骨折患者，其治疗方案均采用半冠状切口下完成骨折复位，继以小钛板内固定，术后随访3～12月，观察治疗效果。结果所有病例术后创口均Ⅰ期愈合，无术后并发症发生，面部外形及功能恢复满意。结论 半冠状切口结合小钛板固定治疗颧骨复合体骨折具有切口隐蔽、安全、固定可靠及可以早期进行功能锻炼等优点，疗效满意，值得临床推广。     

改良头皮冠状切口在治疗颧骨复杂性骨折中的临床应用

目的　探讨改良头皮冠状切口入路在治疗颧骨颧弓骨折中的应用并分析其预后情况。方法　回顾性分析2008～2016年颧骨颧弓骨折患者236例,均一期完成经改良头皮冠状切口入路颧骨颧弓骨折切开复位坚固内固定术,术后进行康复性张口训练,术后3～6个月随访切口感染、面瘫、咬合关系、张口度、面部畸形和主观满意度等指标,评估预后恢复情况。结果　所有患者术后均无切口感染、皮下血肿、颞区凹陷、秃发、永久性面瘫且面容满意恢复,合并有咬合关系紊乱和张口受限的患者,术后均恢复功能性咬合及理想张口度。主观满意度达到97%。结论　改良头皮冠状切口在颧骨颧弓三维立体结构重建中,具有术野清晰、复位精确、面容恢复好、瘢痕隐蔽的优点,有助于面神经及血管等结构的保护,降低手术并发症的发生率。     

耳屏前弧形切口行颧骨复合体骨折切开复位内固定术的围手术期护理

目的：探讨38例应用耳屏前弧形切口治疗颧骨复合体骨折患者围手术期护理。方法术前行充分的颧骨复合体三维CT检查准备及心理干预，术后创口放置负压引流管，做好口腔护理，早期张口训练等。结果本组病例均取得外形及功能良好的恢复效果，无明显畸形，张口受限明显改善。结论耳屏前弧形切口径路手术方法和精心护理，对颧骨复合体骨折术后患者的恢复起重要作用。     

冠状切口在治疗面中部骨折中的应用

近年,我们用头皮冠状、半冠状切口施行面中部骨折手术10例,男8例,女2例, 17～44岁,平均35岁,单纯性颧弓骨折1例,颧骨、颧弓合并眶外缘骨折3例,颧骨、颧弓伴上颌骨骨折6例,2例采用双侧冠状切口,8例采用半冠状切口,加用附加切口6例.麻醉采用鼻插管静脉复合麻醉,以能在术中检查咬牙合关系及进行牙弓夹板栓结.将含肾上腺素的生理盐水注射在切口区,以减少术中出血,冠状切口自一侧耳屏前上端经颅顶连线切开至对侧耳屏前,距发际后2～3cm,切口最低位于耳垂平面,切开皮肤、皮下组织、帽状腱膜及骨膜,沿骨面及颞浅筋膜浅层表面剥离,下翻头皮瓣,分离至颧弓上约2cm时切开颞浅筋膜浅层,继续向下分离至颧弓,同时在眶下缘外侧切开额骨骨膜,在骨膜下分离,暴露眶外侧壁.颧骨、上颌骨骨折,眶下缘骨折也可经附加的口内切口和睑缘下切口暴露骨折断端复位打孔,用小型或微型钛板或钢丝固定.对陈旧性骨折用锯将骨折片断离后移动复位固定,术后常规放置负压引流,头帽加压,术后10d拆线.10例患者不仅恢复了面容及咬牙合功能,而且面部无明显可见瘢痕, 1例感头皮顶区麻木;1例缝线感染,延期愈合;余者均未出现神经损伤,感染等并发症.     

2种手术入路治疗颧骨复合体骨折的对照分析

颧骨的突出位置和形态使其易遭受损伤,颧骨骨折发生率在面部骨折中仅次于鼻骨。因其解剖、生理特点及面部美观的要求,对颧骨复位体骨折入路的选择显得尤其重要。究竟是选择离骨折部位近的局部小切口入路还是选择隐蔽手术瘢痕、但远离骨折部位的半冠状切口、唇龈切口入路,尚有争议。为了对比2种手术入路的优劣性,本文回顾性     

面中部骨折整复方法的探讨(附41例报告)

目的探讨面中部骨折的修复方法.方法采用冠状切口或面部小切口联合口内切口为41例面中部骨折施行复位,微型钛板坚固内固定及Medpor植入等.结果41例均取得满意效果,术后无严重并发症.结论采用头皮冠状切口或面部小切口联合口内切口可充分暴露手术野,完成骨折复位、固定及Medpor植入,恢复面部支架及残缺外形,使面中部损伤的外形及功能整复良好.     

手术入路的选择在面神经保护中的作用

头皮冠状和耳屏切口因其切口位置隐蔽、面部不留瘢痕、术野显露充分,已成为颌面外科治疗面中部骨折、眶上缘骨折、眶外侧缘骨折、颧骨颧弓骨折的常用方法。2006—03—2012—06期间我院采用头皮冠状和耳屏切口进路结合微型钛板坚强内固定治疗68例颌面部骨折患者,现就如何防止该术式的常见并发症——面神经损伤的方法探讨如下。     

颅面联合进路切除眶壁骨化纤维瘤

报告15例(5～15岁)眶内骨化纤维瘤,手术10例,术前均经CT冠状面断层及活检证实。8例经颅面联合切口完全摘除肿瘤;2例因侵犯蝶鞍,未能将肿瘤完全摘除。手术采用双冠状头皮瓣切口,切开额骨一部分以暴露硬脑膜后,在硬膜下施术。缺损的眶壁用自家肋骨或丙烯酸脂铝合金板重建。术后数月眼球即复位。随访3～5年临床及X线检查均无复发。肿瘤组织学检查     

半冠状切口加下睑切口修复颧骨与上颌骨复杂骨折2例

颧骨及鼻部是面部最为突出的支架骨,容易遭受外伤而发生不同类型骨折,甚至并发上颌骨复杂骨折,导致面部畸形等并发症。我科收治2例颧骨与上颌骨复杂骨折患者,经半冠状切口加下睑切口修复颧骨与上颌骨复杂骨折,获得满意疗效,报告如下。     

钛板坚固内固定术治疗面中部骨折的手术径路探讨

目的：总结分析坚固内固定术治疗面中部骨折的手术切口及暴露方法，探讨骨折复位及固定钛板的合理手术径路。方法：对76例手术病例进行总结，将骨折发生的部位及面部切口在每次手术中被使用的次数进行计数统计，分析各种手术径路的手术适应证及优缺点。术后随访半年以上，观察咬合功能恢复情况及面部美容效果。结果：上颌骨、颧骨骨折发病率较高，唇龈沟及下睑缘下隐蔽小切口的使用次数最多。半年后，面部切口愈合良好，无明显手术瘢痕形成，咬合功能恢复好。结论：合理选用手术切口能兼顾骨折部位暴露及面部美学效果。     

Rechnergestützte Insertion von Zygomatikumimplantaten (Br?nemark-System) nach ablativer Tumorchirurgie

Installation of fixtures for prosthetic reconstruction of the upper jaw in patients with extensive bone and soft tissue defects is still a challenge. The new fixture developed by Br?nemark System achieves immediate prosthetic reconstruction by anchoring implants in the zygomatic bone to offer sufficient support without bone grafts. The dimension of these zygomatic fixtures and the complex anatomy due to previous surgical procedures demand specific treatment for a precise and safe insertion of the implants. On the basis of an axial spiral CT data set, the STN navigation system (Stryker-Leibinger/Zeiss) was used for preoperative planning and intraoperative control of the insertion of zygomatic fixtures after subtotal maxillectomy. Computer-assisted insertion of zygomatic fixtures was successfully completed. The implants could be positioned precisely as preoperatively planned. The use of zygomatic fixtures after ablative tumor surgery with resection of the maxillary bone provides immediate prosthetic reconstruction without additional bone grafting. Computer-assisted insertion of these implants improves preoperative planning and facilitates clinical procedure.     

Bewertung einer wenig invasiven Therapie von Jochbeinfrakturen mit einem Klassifikationsvorschlag

The pre- and postoperative symptoms of zygomatic bone fractures were examined in a follow-up study to prepare a classification proposal. A differential indication for minimally invasive therapy modes was looked for with respect to this proposal. Therapy of isolated zygomatic bone fractures consisted in repositioning with a hook and miniplate fixation across the frontozygomatic suture. The aims of this study were clinical and radiological assessment of the repositioning result in terms of aesthetics and stability and quantification of the postoperative remission of disturbances of sensitivity of the infraorbital nerve. A total of 52 patients were examined. After the operation (on average after 3.5 days following the trauma) they were followed-up postoperatively for 12 months according to a strict schedule. Preoperatively, 49 patients reported disturbances of sensitivity of the infraorbital nerve. Other symptoms, such as periorbital haematoma and flattening of the zygomatic prominence, were observed in 49 patients and 45 patients, respectively. All fractures were repositioned well as assessed clinically and radiologically. The aesthetic result was evaluated as symmetric and durable in all cases. Six months postoperatively 41 patients reported normal sensitivity in the area of the infraorbital nerve. In only five patients (10.2%) was the sensitivity loss persistent throughout the entire follow-up period. Patients with primarily lacking diplopia developed neither eye motility disturbances nor postoperative enophthalmus in the following period. It can be concluded that the treatment of an isolated zygomatic bone fracture which satisfies aesthetic and functional requirements is possible by reposition and fixation with one miniplate at the lateral orbital rim. An additional osteosynthesis at the infraorbital rim or at the zygomaticomaxillary crista is not necessary. A routine revision of the orbital floor is only indicated in cases of preoperative diplopia. A zygomatic bone fracture connected with diplopia should be classified as combined zygomatic-/orbital floor fracture.     

Computed tomography in maxillofacial trauma

Computed tomography (CT) has become the key diagnostic modality in the evaluation of head trauma. Experience with CT in the preoperative assessment of maxillofacial injuries is limited, however. Plain films and multidirectional tomography have been used until now to define fractures in the facial region. We examined 27 patients sustaining maxillofacial trauma with CT scans. Ten patients were studied in the coronal plane, 12 in the axial plane, and the reMayning 5 in both the axial and coronal planes. Polycycloidal tomography in the coronal and/or sagittal plane was obtained in 18 patients for comparison with the CT scan. Fracture lines, bony fragments, and associated skeletal deformities were clearly identified by CT scan in all 27 patients permitting the diagnosis of zygomatic, orbital floor, nasoethmoidal complex, LeFort, temporal bone, frontal sinus, and mandible fractures. More importantly, concommitant intracranial injuries including epidural and intracerebral hematomas, traumatic encephalocoele, and pneumocephalus were readily seen. In addition, facial and orbital soft tissue structures including the globe, optic nerve, orbital fat, and extraocular muscles were easily examined by adjusting the CT level and window settings. Overall, CT yielded additional information not available from polytomography in 15 of 18 cases when both modalities were used. Multidirectional tomography is currently superior to CT scanning if fine, intrinsic bone detail is required. However, we have found that complex fractures with fragmentation are more easily identified on CT scans than conventional tomography because of superior contrast resolution of computed tomography. With improved spatial resolution, CT scanning may totally supplant multidirectional tomography in the evaluation of maxillofacial trauma.     

先天性鼻内脑膜脑膨出合并异位神经胶质瘤（附1例报道并文献复习）

 目的探讨先天性鼻部脑膜脑膨出合并鼻外神经胶质瘤的诊断和治疗。方法收集上海交通大学医学院附属第九人民医院收治的1例鼻内脑膜脑膨出合并鼻外神经胶质瘤患儿,并结合文献进行复习。入院后行鼻腔鼻窦CT扫描及头颅MRI,根据影像学检查结果制定手术方案,在全麻下行鼻内镜下鼻腔肿物切除术及颅底骨质缺损修补术联合鼻外径路外鼻肿物切除术,术后予应用透过血脑屏障的抗炎治疗。结果鼻根部及鼻腔肿块一次性切除,愈合良好,无脑脊液鼻漏、脑膜炎、鼻中隔穿孔、视力障碍及癫痫等并发症,随访1年无复发。术后病检提示鼻根部及鼻腔内送检肿物见神经胶质细胞,考虑为异位神经胶质瘤和脑膜脑膨出。结论对于婴幼儿先天性鼻部脑膜脑膨出,鼻腔鼻窦CT及头颅增强MRI是重要的诊断依据,根据病变部位制定不同的手术的方式。鼻内镜具有视野清晰、损伤小、出血少、并发症少的优点。颅底骨质缺损修补的关键是根据骨缺损面积,予肌肉、筋膜、软骨瓣或骨片填塞漏口。     

Giant cell tumor of the mandible

A 53-year-old woman presented with left mandibular area pain, trismus, and facial numbness that had persisted for 4 years. Physical examination revealed a 3×5 cm, hard, non-tender, and round mass on the left mandibular area. Computed tomography and magnetic resonance imaging revealed an expansile tumor involving the left mandibular ramus and temporomandibular joint area with bone destruction, extending to the base of middle cranial fossa and left zygomatic bone. The mass at the segment of left mandible and zygomatic bone, and base of middle cranial fossa was removed. Pathological examination of the mass revealed a giant cell tumor. The defect was reconstructed with iliac bone for the mandible and temporal bone and fascia for the cranial bone and dura. The case is described along with a review of the literature.     

Usefulness of CT scans in malignant external otitis: effective tool for the diagnosis,but of limited value in predicting outcome

Computerized tomography (CT) scanning is a well recognised tool for the diagnosis of malignant external otitis. To investigate the degree of correlation between CT findings scan and the patients clinical status focusing on a subgroup of patients with cranial nerve palsies. Diagnosis of malignant external otitis was confirmed in 23 patients (average age 71 years, age range 39–87) based on criteria of severe pain, otitis externa refractory to conventional treatments and possibly diabetes mellitus and pseudomonas detection. CT was performed on 23 of these patients. Results from these scans were analysed and correlated with patient clinical status. Retrospective analysis of CT images and medical notes were used for data analysis.The CT scans of all 23 patients showed evidence of involvement of disease outside the external auditory canal, confirming the diagnosis. Sixteen out of 23 patients (70%) demonstrated evidence of bone erosion. Four of the 16 showed involvement of the petrous apex. From our subset of ten patients with cranial nerve involvement, eight demonstrated evidence of bone erosion and two showed mastoid and middle ear involvement without bone erosion. All four patients with petrous apical involvement presented with cranial nerve palsies (two lower cranial nerve palsies, one seventh nerve palsy and one combined lower and seventh nerve palsy). CT scanning was found to be a fast and economical tool in the initial assessment of patients with malignant external otitis. Petrous apex involvement was constantly associated with cranial nerve palsies, usually the lower cranial nerves. CT findings of temporal bone in itself however, were not closely correlated to the clinical outcome of the patients.     

New method of identifying the internal auditory canal as seen from the middle cranial fossa approach

OBJECTIVES: The middle cranial fossa approach allows one to remove acoustic tumors and preserve the facial nerve and hearing. However, there are no consistent landmarks on the surface of the temporal bone to identify the internal auditory canal. This study was designed to identify the internal auditory canal by use of external and internal references as seen during the middle cranial fossa approach. METHODS: We dissected 32 temporal bones using the middle cranial fossa approach and measured the distances from the posterior origin of the zygomatic arch to an imaginary coronal line between the foramen spinosum and the foramen ovale. We measured the angle between the lines drawn from the posterior origin of the zygomatic root to the foramen spinosum and from the foramen spinosum to the porus of the internal auditory canal. RESULTS: The distances were 14.7 mm and 22.9 mm, respectively, and the angle was roughly 90 degrees. CONCLUSIONS: In this study, we found external and internal landmarks that help to locate the internal auditory canal.     

64排螺旋CT多平面重建和容积再现图像在面中部复杂骨折中的临床应用

目的：探讨64排螺旋CT多平面重建（MPR）及容积再现（VR）图像在面中部复杂骨折中的临床应用价值。方法：对46例面中部复杂骨折患者进行64排螺旋CT薄层扫描,容积数据传送到工作站进行MPR和VR三维成像。结果：46例面中部366处骨折,MPR图像对面中部各部位骨折的显示率为100％;VR图像对颧骨、颧弓、下颌骨骨折的显示率为100％,对上颌骨骨折的显示率为94．3％、眼眶骨折为93．2％、筛骨骨折为13．0％、蝶骨骨折为55．6%,平均显示率为86．3％。VR图像能够通过图像旋转、切割等功能从不同方向观察骨折的位置、范围、骨碎块的移位,了解骨折线的走行及外伤所致的畸形情况。结论：MPR结合VR成像对面中部骨折的诊断治疗具有很高的临床应用价值。64排螺旋CT图像能提高对深部纲微骨折的显示．     

Cranial base fracture and rhino cerebrospinmal fluid leakage. A case report

Oto cerebrospinal fluid leakage occurs frequently in skull base fractures but it is not always recognized which may produce potentially serious consequences on the prognosis. The aim of this study is to present a case of an extended skull base fracture with bad defined symptoms. A male in coma was admitted to our hospital following a road accident. Imaging revealed a fracture that transversally crossed the squamous occipital bone and petrous portions of temporal bone on the right, the sphenoid bone, and the left zygomatic bone. Ten days later the patient regained consciousness presenting symptoms of right complete hearing loss, cephalalgia and fever. Lumbar puncture showed a Gram negative germ growth. After specific antibiotic treatment he underwent surgery with exclusion of the middle ear and the mastoid from outside by obliterating the Eustachian tube, sealing the surgical cavity (subtotal petrosectomy) with abdominal fat and closing the external auditory canal as a blind sac. At the same time, nasal fibroendoscopy was also performed to close the fistulas in the sphenoid region. Since the cephalalgia persisted further CT examination was performed and revealed another fracture rima in the ethmoid bone. Nasal fibroendoscopy was performed again to close this fistula. The symptoms thus disappeared and the patient has continued to be symptom-free during the two years follow-up. Skull base fractures may involve various bone structure (petrous portion of temporal bone, ethmoid, sphenoid, parietal bone). As a result of the complex anatomy of the skull base, the fracture may damage numerous vital structures (cranial nerves, internal carotid artery, cavernous sinus, jugular vein etc) and the dura mater, causing cerebrospinal fluid leak. When the fracture in the petrous bone is transversal, it is highly important not to delay surgery. In fact the otic capsule does not repair but the bone step is covered by a thin layer of fibrous tissue. For this reason patients, with clear damage to the otic capsule, risk meningitis. Fistulas in the ethmoid are the most difficult to diagnose and the easiest to underestimate. It is fundamental to follow the appropriate diagnostic procedure.     

实验性犬侧颅底骨缺损修复材料的研究

为达到修复颅底骨硬脑膜缺损的目的，通过手术造成狗侧颅底骨及硬脑膜大面积缺损模型，利用自体阔筋膜或与细胞生长促进因子－骨形成蛋白进行修复，观察移植后不同时期所修复组织的成活及成骨的组织学变化情况，探讨了阔膜修复硬脑膜后组织学变化，证实生物膜与骨形成蛋白是一种理想的颅底缺损修复材料，为临床修复硬脑膜、颅底缺损等提供了参考。