颌骨动脉瘤样骨囊肿的临床及影像学分析

目的：探讨颌骨动脉瘤样骨囊肿的影像学特征和临床表现，以提高对其诊断和鉴别诊断的能力。方法：回顾分析27例颌骨动脉瘤样骨囊肿患者的临床表现和影像学资料。结果：27例患者中．男10例．女17例：年龄0．6．62岁（平均年龄23.4岁）；上颌骨7例，下颌骨20例。7例为继发性，20例为原发病变。X线平片显示．病灶长轴沿下颌骨长轴走向13例（76％）；骨质破坏呈膨胀性，病变骨与正常骨之间边界欠清，无明显的骨质反应线．骨皮质膨胀变薄或断裂，无骨膜反应；13例病灶内部有分房。CT为边界清楚的囊实性软组织肿块，内含切迹，7例骨性房隔，3例出现液-液平面。MRI上T1WI为低、等信号，T2WI均匀的高信号。27例病变中，15例（56％）为偏心型，12例（44％）为中心型．1例为骨旁型。结论：影像学检查有助于提高对本病的认识和明确诊断。     

颌骨促结缔组织增生性纤维瘤8例临床分析

目的 探讨颌骨促结缔组织增生性纤维瘤的临床表现、病理特征、治疗和预后,提高口腔医生对颌骨促结缔组织增生性纤维瘤的认识。方法 对2011至2021年间就诊于南京市口腔医院的8例颌骨促结缔组织增生性纤维瘤患者的临床资料进行回顾性分析。结果 本研究病例中男女性别比为3:1,初次发病平均年龄为（32.13±15.00）岁;病变好发于下颌骨,病理表现为轻度异型性的成纤维细胞及大量胶原纤维呈波浪状交错编织。Vimentin 100%强阳性,α-SMA阳性率为62.5%,β-catenin细胞质阳性率为62.5%,初发患者Ki-67均低于5%,S-100蛋白100%阴性。影像学表现为界限清楚不规则的单房或多房透光性病变,伴或不伴周缘硬化。初次治疗时,5例患者采用刮治术,其中2例患者复发,且预后不良;3例患者采用扩大切除术,均无复发。结论 颌骨促结缔组织增生性纤维瘤临床表现及影像学表现无特异性,主要依靠组织病理确诊;该肿瘤复发率较高,目前最佳治疗方式为手术扩大切除;局部刮治容易复发,预后不良。     

颌骨促结缔组织增生性纤维瘤的影像特征及鉴别（附病例报道）

目的：探讨颌骨促结缔组织增生性纤维瘤（DFB）的影像学特征和鉴别诊断。方法：根据1例DFB病例进行影像学分析及文献复习。结果：DFB在X线上表现为溶骨性骨质破坏,无骨膜反应;CT上见骨小梁吸收破坏,为软组织密度肿物取代,增强检查可见强化;MRI上表现为正常骨质信号消失,软组织信号出现,T1WI为均匀等信号,T2WI为不均匀高信号。结论：DFB是罕见的起源于结缔组织的原发骨肿瘤,是具有侵袭性生长特点的良性肿瘤,治疗上宜采取术区扩大切除防止复发。因此,术前从影像学上鉴别DFB对于术式选取以及治疗效果至关重要。     

口腔诊断学

直接数字化X线摄影影像后处理对头影侧位标志点清晰度的影响；颌骨骨促结缔组织增生性纤维瘤的影像学特点和鉴别诊断；18～25岁无鼾正常牙合人上气道X线头影测量与磁共振影像比较；螺旋二维及三维CT对颌面骨折的影像学研究；结合Matlab重建下颌第一磨牙CT图像的三维透视模型。     

原发于颌面部的恶性纤维组织细胞瘤的X线诊断分析——附11例病案资料

本文总结了我院近8年来经病理组织学确诊的恶性纤维组织细胞瘤11例。男性6例,女性5例;1例小于20岁,10例大于40岁;上颌骨6例、下颌骨4例、额部软组织1例。其X线表现多样,多数病例颌骨骨质破坏呈恶性征,以溶骨性破坏为主,无碎骨、死骨或肿瘤骨形成,无骨膜增生反应,病程进展迅速,累及范围广泛,常穿破骨皮质,早期形成外侵软组织肿块,不易与颌骨癌和溶骨型骨肉瘤区别。少数病例应与骨髓炎、纤维骨瘤及颌骨囊肿等鉴别。     

8例颌骨尤文肉瘤的临床及影像学特征分析

目的 探讨颌骨尤文肉瘤的临床表现及CT影像学特征。方法 回顾性分析2010年1月—2022年6月经病理证实的8例颌骨尤文肉瘤的临床表现及CT影像学特征。结果 8例颌骨尤文肉瘤病例的发病平均年龄为29.4岁，男女比例为7∶1，发病部位下颌骨后部多见（75%），早期多数有下唇麻木及淋巴结肿大表现。下颌骨尤文肉瘤影像学表现为颌骨内混杂低密度骨质破坏伴软组织肿块形成，纤维索条状及毛刷状瘤骨为其特征型影像学表现。上颌骨尤文肉瘤主要变现为溶蚀状骨质破坏，伴软组织肿块形成。骨膜成骨少见。结论 颌骨尤文肉瘤具有一定的临床及影像学特征，这有助于其影像诊断。     

8例青少年沙瘤样骨化纤维瘤临床分析

目的: 分析青少年沙瘤样骨化纤维瘤（juvenile psammomatoid ossifying fibroma, JPOF）的临床及影像学特点、治疗方法和预后。方法: 收集2016 年 2月—2020 年 10 月收治的8 例JPOF患者的临床及影像学资料,并进行随访,总结其临床表现、影像学特征、治疗和预后情况。结果: 8例JPOF患者,男4例,女4例,年龄（14.1±7.9）岁;发生于下颌骨3例,筛窦2例,上颌骨（窦）1例,鼻腔1例,额窦1例;病灶大小为（37.0±9.7）mm,临床表现以鼻塞、流涕、局部膨隆和疼痛多见。CT显示为蛋壳样骨壳包绕着圆形或类圆形内核的占位性病变,MRI呈现为混杂信号的囊实性肿瘤。8例JPOF均采用手术治疗,筛窦、上颌骨（窦）及鼻腔患者于鼻内镜下行病灶刮除联合周围骨磨除;额窦患者行开放性手术病灶刮除联合周围骨磨除;2例下颌骨JPOF患者行刮除术并磨除周围部分骨质,半年后复发,即再次手术;1例下颌骨JPOF患者行下颌骨节段性切除,并应用血管化髂骨肌复合组织瓣修复。随访至今均未见复发。结论: JPOF是一种发生于青少年且极为罕见的良性骨纤维性肿瘤,临床及影像学特点无特异性,主要依靠病理检查诊断,生长具有一定侵袭性,治疗方法为病灶刮除联合周围骨磨除。     

右下颌骨韧带样纤维瘤1例

骨韧带样纤维瘤是一种罕见的良性肿瘤，发生于颌骨者更为罕见。骨韧带样纤维瘤的临床表现、影像学检查均无特异性，而肿瘤具有侵袭性，边界不清，手术后容易复发，诊治较为困难。笔者结合文献对1例右下颌骨韧带样纤维瘤的病因、病理、X线特点、临床诊断、治疗及预后情况加以分析讨论。     

颌骨粘液瘤3例报告

3例颌骨粘液瘤患者均为女性,年龄3～52岁。发病部位为磨牙区,其中上颌骨1例,下颌骨2例。临床表现为面部肿块,质硬固定,边界不清,2例皮肤色泽正常,1例合并感染,皮肤呈暗红色,有压痛。肿块相应处的口内骨膨隆。X线检查见颌骨内有多层状和不规则破坏,多层状阴影中有走行较直的骨纹,其中1例肿瘤周围骨质有增生硬化。病程从发现包块到就诊时间最长为32年,最短为3个月。治疗:2例行颌骨部分切除,1例行半侧下颌骨切除,术后伤口     

CT诊断颌骨动静脉畸形的价值探讨

目的：比较颌骨动脉畸形的CT和X线平片表现特征,评价CT对颌骨动静脉畸形的诊断价值。方法：具有完整CT和X线平片资料的颌骨动静脉畸形患者12例,其中上颌骨5例,下颌骨7例,拍摄同骨华特位、曲面体层片和下颌骨骨正、侧斜位片,CT采用横断位和冠状位两种扫描方式。结果：颌骨动静脉畸形在CT上均表现为骨质膨隆,骨髓腔间隙增大,骨皮质完整,其内骨小梁结构消失,其间未见明显分隔或分隔纤细,5例上颌骨动静脉畸形均匀以上颌牙曹局限性的单状扩张表现为主,7例下凳骨动静脉畸形有3种表现形式;局限单囊状、弥散囊状形均以上颌牙槽骨局限性的单囊状扩张表现为主,7例下颌骨动静脉畸形有3种表现形式：局限单囊状、弥散单囊状和多个小囊状。而X线平片的表现具有多样性,结论：CT有助于颌骨动静脉畸形的早期,及时诊断,为进一步行局部穿刺介入治疗提供导向和依据。     

Image findings of B cell lymphoma of the palate

In this report, we describe image findings in a case of a 78-year-old man with malignant lymphoma of the palate, which had progressively developed 8 years after malignant lymphoma of the neck. The patient was referred to our hospital with a complaint of painless swelling of the left palate. A slightly enhanced mass without apparent bone destruction was observed in the left palate on computed tomography (CT) images. The mass showed homogeneous signal intensity by both T1- and T2-weighted magnetic resonance imaging (MRI) and the anterior part of the mass exhibited inhomogeneous enhancement, but most of the mass demonstrated homogeneous signal intensity with slight enhancement by enhanced MRI. On the basis of these image findings, the lesion was diagnosed as a benign tumor of the minor salivary glands in the palate. Histopathological examination revealed findings consistent with non-Hodgkin’s lymphoma, diffuse large B cell type (World Health Organization classification). On a gallium-67 scintigram, only the site of the lesion was positive.     

Staged protocol for resection, skeletal reconstruction, and oral rehabilitation of children with jaw tumors.

PURPOSE: The purpose of this study was to evaluate a staged protocol for resection of jaw tumors and reconstruction including implants in pediatric patients. PATIENTS AND METHODS: Nine children were evaluated retrospectively. Data included age at resection, tumor type, use of adjuvant therapy, type of bone graft, and number of implants. Occurrence of postoperative infection, tumor margins, recurrence, plate fractures, number of bone grafts, implants restored, and failures were recorded. RESULTS: Ages ranged from 3.5 to 16 years with 2 maxillary and 7 mandibular tumors. Diagnoses included giant cell lesion (n = 3), osteosarcoma (n = 2), myofibroma (n = 1), ossifying fibroma (n = 1), desmoplastic fibroma (n = 1), and ameloblastoma (n = 1). No patients experienced postoperative infection, wound dehiscence, or jaw instability after en bloc resection. One patient had recurrence of a giant cell lesion. To date (mean, 56 months; range, 24 to 93 months), there have been no additional recurrences. There was 1 plate fracture. Eight patients underwent iliac bone grafts (stage 2), and in 1 patient, the mandible regenerated. There were no graft infections or wound dehiscences. Three patients required additional bone grafting for implant placement. Twenty-three implants were placed in 7 patients without complications, and 21 implants have gone to second stage. One implant failed to osseointegrate. Six patients have had prostheses placed and loaded for a mean of 26 months (range, 5 to 64 months). One patient is scheduled for prosthetic restoration and 2 for implant placement. CONCLUSION: Pediatric maxillofacial tumors can be successfully treated by resection, rigid fixation, and delayed reconstruction with minimal morbidity and a high success rate.     

Role of magnetic resonance imaging in diagnosis of bisphosphonate-related osteonecrosis of the jaw

Objectives

To clarify the magnetic resonance (MR) imaging features of bisphosphonate-related osteonecrosis of the jaw (BRONJ), particularly those in the early stage, through a literature review and case analysis.

Methods

Literature on MR imaging of BRONJ was collected, and the MR imaging features were summarized. On MR images of patients with BRONJ, the signal intensity of the bone marrow was evaluated quantitatively by means of the contrast-to-noise ratio (CNR). The relationships of the imaging features with the presence of exposed bone, types and administration routes of bisphosphonates (BP), and duration of symptoms were investigated.

Results

Fifteen articles were identified. In the early stages, the region of osteonecrosis displayed decreased signal intensity on T1-weighted images and normal signal intensity on T2-weighted images. In the late stages, the signal intensity of the bone marrow on T2-weighted images was variable: the exposed diseased bone displayed decreased signal intensity, and the unexposed diseased bone displayed increased signal intensity. These changes were also seen in BRONJ cases. There was a significant difference in the CNR between the exposed and unexposed diseased bones on STIR images. There were no significant differences in the CNR among the three groups by types and administration routes of BP, both on T1-weighted and STIR images. Changes in the signal intensity of bone marrow were seen at the early duration of symptoms. In the early stage, the CNR on T1-weighted images had a significant correlation with duration of symptoms.

Conclusion

MR imaging may provide visualization of useful features in the early stage of BRONJ.     

Osteosarcoma of maxilla with unusual image findings in child

Osteosarcoma of the head and neck is relatively rare and accounts for less than 10 percent of all osteosarcomas in general. We report a case of osteosarcoma in which imaging and histopathology of the hard palate of an 11-year-old boy yielded atypical findings. An approximately 8×15mm lesion found in the center of the palate was hard and healthy in color. Subsequent biopsy resulted in a diagnosis of nonepithelial malignant tumor. No abnormalities were observed in the maxillary bone or tooth on panoramic or occlusal radiographs. Computed tomography images revealed a mass lesion approximately 7×9×9mm in size on the hard palate extending into the maxilla. The cortex of the maxilla adjacent to the lesion was unclear in parts. The internal structures were slightly inhomogeneous and its density was lower than that of muscle. On magnetic resonance images, the lesion was represented by low signal intensity on T1-weighted (T1W) images and high signal intensity on T2-weighted images with fat-suppression. The margin of the lesion was a little unclear and the internal structures were slightly inhomogeneous. The lesion was enhanced homogeneously on post-contrast T1W images with fat-suppression. The histopathological diagnosis was fibrogenesis-type osteosarcoma. No findings specific to osteosarcoma such as localized enlargement of the periodontal ligament space alongside the root, cortical destruction, periosteal ossification or osteogenesis were found in this case.     

冲压法上颌窦底提升术后种植体周围骨改建及影响因素分析

目的:分析牙槽嵴严重萎缩患者在冲压法上颌窦底提升术后种植体周围骨改建情况及其影响因素.方法:纳入患者41例,根据剩余牙槽骨高度(RBH)分为A组(2＜RBH≤4 mm,20例)和B组(4＜RBH≤6 mm,21例).术后1年和3年,用影像学测量技术比较2组种植体周围的骨改建情况,并建立多元线性回归模型.结果:术后1、3...     

MR imaging of tumor-like swelling in the submandibular region

Tumor-like swellings in the submandibular region were evaluated in seven patients with MR imaging. Two cases of pleomorphic adenoma and two of sialoadenitis were selected as examples of submandibular gland lesions, while a plunging ranula, dermoid cyst and lymphadenitis were selected as examples of extraglandular lesions. The pleomorphic adenoma was connected with the remaining gland on T1-weighted images. The sialoadenitis showed changes in the size, signal intensity and homogeneity of the submandibular gland itself. On the other hand, extragland lesions showed zonal interpositions between the lesion and the submandibular gland, which showed either low or high signal intensity on T1-weighted images. On T1-weighted images, the intensity of all of the lesions was either lower than or the same as the normal submandibular gland. On the other hand, all lesions showed higher signal intensity, ranging from slight to very high on T2-weighted images. Sharp margins were seen in all lesions except one sialoadenitis. The sialoadenitis showed inflammatory infiltration into the surrounding tissue. A homogeneous internal pattern was observed in the case of cystic lesions, while an inhomogeneous internal pattern was noted in the pleomorphic adenoma and in the inflammatory lesions. Gd-DTPA enhanced the T1-weighted images in three cases. Pleomorphic adenoma and lymphadenitis were enhanced inhomogeneously, whereas the ranula was not enhanced.     

36例良、恶性淋巴上皮病临床病理分析

目的：分析恶性淋巴上皮病（MLEL）、良性淋巴上皮病（BLEL）及与之相联系的黏膜相关淋巴组织型结外边缘区B细胞淋巴瘤（MALToma）的临床特点、病理学特征、发病机制、诊断、治疗及转归。方法：对13例MLEL、20例BLEL及3例MT进行免疫组化染色和HE染色观察，复习相关临床资料并随访。结果：MLEL的病理学特征为大量增生的淋巴组织中见成簇或条索状分布的肿瘤细胞，界限不清，核分裂像多见；免疫组化示CKpan全部阳性（13／13），Vim部分阳性（3／13），SMA部分阳性（2／13）；8例MLEL可随访资料中，术后1例死于复发，1例死于其他疾病，1例局部复发，5例未见复发或转移，随访3．5个月-4a。BLEL的病理学特点为腺实质萎缩，间质淋巴细胞浸润及形态温和的腺肌上皮岛；免疫组化示CKpan19例阳性，LCA17例阳性。UCHL-1、L2616例阳性。CK10 10例阳性．S-1002例阳性；12例可随访的BIEL中，2例术后复发诊断为MLEL，其余健在，随访3个月～6a不等。3例MT中。1例术后6个月复发，经再次手术并化疗后缓解；免疫组化L26、LCA、CD79、CD43均阳性；UCHL-1、CKpan、EMA均有2例阳性。结论：MLEL好发于腮腺，且女性多见，来源于唾液腺导管上皮。对已发生颈淋巴结转移的患者行原发灶一颈联合根治，术后放疗，少数MLEL可在BLEL基础上发生，故BLEL局部切除后应长期随访；MT为B细胞淋巴瘤，手术切除辅以适当化疗可获较好疗效。术中冷冻切片是本病目前最可靠的术中诊断手段。     

92例上颌骨成釉细胞瘤不同手术方式的效果评价

目的:探讨上颌骨各型成釉细胞瘤合适的手术治疗方法.方法:回顾分析92例上颌骨成釉细胞瘤患者的临床资料,所有患者病理诊断明确,术后随访3～8年,定期拍摄颌面部CT、全景片,观察手术治疗效果.采用SPSS 22.0软件包对数据进行统计学分析.结果:上颌骨成釉细胞瘤男女比例为3∶1,男性较多,平均年龄为45.77岁.92例患...