系列数字化导板在腓骨肌皮瓣修复下颌骨缺损中的初步应用

目的:将系列数字化导板用于腓骨肌皮瓣修复下颌骨缺损,实现下颌骨缺损的个体化精确修复。方法:10例腓骨肌皮瓣修复下颌骨缺损的患者,男性7例,女性3例,均行术前规划,并3D打印系列数字化导板,术中应用数字化导板精确重建下颌骨,术后利用图像融合技术评价术后效果。术后所有病例未出现相关并发症。结果:系列导板术中就位顺利,重建钛板及髁状突位置准确,面型及咬合关系恢复良好。术后图像融合显示,剩余下颌骨与患侧髁状突术后位置与术前相比误差<2 mm。结论:系列数字化导板在重建下颌骨形态、保证髁状突的位置、恢复咬合关系、减少手术时间方面具有优越性。     

数字化导板引导髁突巨大骨软骨瘤手术切除1例报告

髁突外生型骨软骨瘤常采用手术切除,但切除范围多基于术者经验,易导致肿瘤复发或神经血管损伤。本文报道髁突巨大外生型骨软骨瘤1例,采用计算机辅助设计技术（Proplan 1.3软件）术前确定瘤体与髁突关节面边界,模拟设计手术入路、截骨平面及瘤体取出路径,并利用快速成型技术制作数字化截骨导板,于术中应用。该数字化导板可精确指导髁突巨大外生型骨软骨瘤切除并保护未受累髁突软骨面,避免神经血管损伤,节约手术时间。     

改良数字化导板技术在下颌骨缺损腓骨肌皮瓣修复中的应用评价

目的:探讨改良数字化导板技术在下颌骨节段切除及腓骨肌皮瓣修复重建术中的临床应用效果.方法:选择2016年1月-2020年1月在南京医科大学附属口腔医院及阜阳市人民医院口腔科行下颌骨节段性切除同期行血管化腓骨肌皮瓣修复的16例患者,均为良性病变,随机分为常规导板技术组(常规组)和改良数字化导板组(改良组),每组各8例.常...     

体内预成血管化骨在下颌骨重建中的应用

下颌骨肿瘤患者,由于术后瘢痕的存在及术后化疗造成的局部低血管化常使骨移植下颌骨重建的成功率降低。而自体血管化骨移植必然引起供区骨缺损,供区骨组织常与受区骨组织存在外形不匹配的问题。新近有学者采用内源性组织工程学技术在体内利用骨形成蛋白复合载体在体内预成血管化移植骨用于下颌骨重建,获得了较好的效果。本文就该技术的研究进展作一综述。     

异位预成血管化骨在下颌骨缺损重建中的应用

先天畸形、创伤、炎症和肿瘤等所致的下颌骨缺损重建在临床上仍是一个难题。单纯游离骨移植在肿瘤放疗患者受区条件差的情况下有较大的局限性,血管化游离骨移植也会造成其供区创伤和继发畸形。近来,异位预成血管化骨移植为下颌骨缺损重建提供了新的途径。下面就血管化骨异位预成的方法、所需条件、优点及其研究进展作一综述。     

数字化耠板在儿童颞下颌关节强直合并颌骨畸形同期治疗中的应用：附2例报告

目的：探讨数字化验板在儿童颞下颌关节强直合并颌骨畸形同期治疗中的应用效果。方法：2例儿童单侧颞下颌关节强直合并颌骨畸形患者,术前采用SurgiCaseCMF5．0软件进行颌骨畸形的三维测量．模拟骨球截除后摆正下颌骨,制作数字化袷板,术中应用,行肋骨一软骨移植关节重建。术后进行CT扫描二三维测量,评价应用效果。结果：2例患者术中袷板戴入顺利,术后CT三维测量与术前设计吻合度高。结论：数字化袷板在儿童颞下颌关节强直合并颌骨畸形的同期治疗中节省了手术时间,提高了手术的准确性,具有较好的临床应用前景。     

钛网结合异体骨移植和人骨形成蛋白在上颌前牙种植前牙槽嵴骨增量中的应用研究（附1例报告）

编者按：本刊特邀美国德克萨斯健康研究中心牙学院Bing-Yan Wang副教授介绍1例在上颌前牙牙槽骨严重缺损区实现骨增量的病例。在拔牙同期用异体骨和Bio-Mend延展膜进行引导骨再生术后未获得满意骨量的情况下,无法进行种植手术,术者用钛网结合异体骨移植材料和人骨形成蛋白在种植体植入前修复上前牙区部分牙缺失部位的牙槽骨缺损,最终获得成功。通过这种方法扩大了在上前牙牙槽骨严重骨缺损区种植的适应证,为患者提供了除自体骨移植以外的另一个选择。     

Inferior alveolar nerve preservation during resection and reconstruction of the mandible for benign tumors as a factor improving patient's quality of life

This prospective study aimed to evaluate neurosensory disturbance and quality of life in patients who underwent mandibular resection for benign tumors and whose inferior alveolar nerve (IAN) was either preserved or sacrificed. Mandibular resection was indicated owing to the presence of osteoradionecrosis in 25 patients and ameloblastoma in 15 patients. Resection was unilateral in 24 patients and bilateral in 16 patients.The authors assessed the inferior alveolar nerve's sensory dysfunction by measuring the electroexcitability of skin receptors using an electro-odontometer. Study participants' quality of life was estimated with the oral health impact profile (OHIP)-14 and short-form (SF)-36 questionnaire. All the patients in whom the inferior alveolar nerve was sacrificed experienced persistent numbness in the area of innervation with mental nerve on the affected side. The average pain threshold reached preoperative levels (point 1–22.7 ± 2.5, p-value = .025; point 2–25.8 ± 2.7, p-value = .023) 6 months after the operation in patients in whom the IAN was preserved (point 1–23.7 ± 2.3, p-value = .022; point 2–25.4 ± 2.8, p-value = .025). The results of the OHIP-14 and SF-36 showed that patients with preserved IANs had a significantly better quality of life than the patients in whom the IAN was sacrificed. The results of OHIP-14 twelve months after the operation in unilateral resection: control group - 16.0 ± 1.6, p-value = .029; study group - 8.0 ± 0.8, p-value = .029, and in bilateral resection: control group - 26.0 ± 3.2, p-value = .044; study group - 9.0 ± 0.7, p-value = .027. The possibility of sparing the inferior alveolar nerve should not be ignored when planning mandibular resection and reconstruction.     

磁共振成像显示犬下牙槽神经的实验研究

目的 探讨磁共振成像显示犬下牙槽神经的方法及意义.方法 对犬分别于下牙槽神经离断前后进行磁共振三维磁化准备快速梯度回波序列扫描,采用最大信号强度投影、薄层最大信号强度投影、多平面重建等进行图像后处理,观察磁共振成像图像重建显示下牙槽神经情况.结果 磁共振成像结合图像后处理技术可清晰显示犬下牙槽神经离断前后情况.结论 磁共振图像重建可以清楚的显示犬的下牙槽神经,对临床上判断下牙槽神经状况及术中保护下牙槽神经有较大指导价值.     

Risk assessment of inferior alveolar nerve injury for immediate implant placement in the posterior mandible: A virtual implant placement study

Objectives

To investigate the prevalence and morphological parameters of lingual concavity, and whether these factors are related to a higher risk of inferior alveolar nerve (IAN) injury when performing an immediate implant surgery in posterior mandible region.

Methods

The CBCT images from 237 subjects (1008 teeth) were analysed the shape of the mandibles (C, P, U type), dimensional parameters of lingual concavity (angle, height, depth), and its relation to inferior alveolar canal (IAC) (A, B, C zone), RAC (distance from root apex to IAC) and probability of IAN injury. Multiple logistic regression modelling to determine the odds ratio of variables that made an important contribution to the probability of IAN injury and to adjust for confounding variables.

Results

The U type ridge (46.7%) and the most concave point located at C zone (48.8%) are most prevalent in this region. The mandibular second molar presents highest risk for IAN injury than other tooth type (p < 0.001), which were 3.82 times to occur IAN injury than the mandibular second premolar. The concave point located at A zone and B zone were 7.82 and 3.52 times than C zone to have IAN damage, respectively. The probability of IAN injury will reduce 26% for every 1 mm increase in RAC (p < 0.001).

Conclusions

The tooth type, morphological features of lingual concavities, and RAC are associated with risks of IAN injury during immediate implant placement.

Clinical significance

Pre-surgical mapping of the IAC and identification of its proximity relative to the lingual concavity in the posterior mandible regions may avoid unpleasant complications, specifically when performing immediate implant procedures.     

正畸牵引法辅助拔除接触下牙槽神经管的埋伏阻生牙1例报告

阻生下颌第三磨牙拔除是口腔颌面外科的一种常见手术.由于低位阻生的下颌第三磨牙牙根位置常与下牙槽神经(inferior alveolar nerve,IAN)关系密切,神经损伤是该手术的严重并发症之一.目前,国际上主要有3种避免IAN损伤的方法:截冠法、部分牙冠切除术和正畸牵引法.本文报告1例下颌第三磨牙近中斜位低位阻生的患者,采用改良正畸牵引法,分两步将牙根牵离神经管,牵引完成后顺利拔除患牙.     

下颌骨牵引延长后下齿槽神经功能的评价

目的 采用三叉神经体感诱发电位（trigeminal somatosensory evoked potential,TSEP)检查恒河猴下颌骨牵引延长术对下齿槽神经功能的影响。方法 健康青年恒河猴7只，行下颌角部完全骨截开术，右侧或双侧安放牵引器。截骨间隙平均牵引距离为13．5mm。于术前、牵引完成时、牵引完成后4周分别进行下齿槽神经SEP检查。结果 术前下齿槽神经SEP各波的潜伏期测量值，两侧对比检验差异无显著性。牵引术完成时SEP各波的潜伏期较术前均有不同程度延长（P＜0．01，P＜0．001），波幅显著下降（P＜0．001）。术后4周各波潜伏期及波幅均有恢复，但多数差别仍有显著性。结论 TSEP检查提示下颌骨牵引延长术对下齿槽神经功能有一定影响，术后4周其功能有部分恢复。     

Neurosensory alterations and function of the temporomandibular joint after high oblique sagittal split osteotomy: an alternative technique in orthognathic surgery

The current most common technique for repositioning of the mandible, bilateral sagittal split osteotomy (BSSO), was first described by Obwegeser and Dal Pont in the early1960s, and has since been modified several times. However, there is always a risk of damaging the inferior alveolar nerve. We have studied 50 consecutive patients who had high oblique sagittal split osteotomy (HSSO) as an alternative to avoid damage to the nerve. The patients were evaluated for sensory alterations and function of the temporomandibular joint (TMJ). Healing of both wound and bone were complete and uneventful in all 50 patients. Mean (SD) sagittal movement of the mandible was 6.6 (2.9) mm and length of the osteotomy line was 11.0 (3.1) mm. No patient had either temporary or permanent alteration in sensitivity. Pinprick tests showed no significant changes between the preoperative and postoperative readings (p > 0.16) or in the chronological results (p > 0.23). No disorders of the TMJ developed. Mean (SD) mouth opening 6 months postoperatively was 41.6 (8.6) mm. The lateral excursion increased postoperatively by 1.86 mm to the left and by 0.76 mm to the right. Protrusion increased by 0.66 mm. HSSO is therefore a suitable alternative to BSSO as it avoids injury to the inferior alveolar nerve without compromising the TMJ. Ossification was uneventful though bony attachment was less than with the classic BSSO.     

Perineural infiltration of the inferior alveolar nerve in mandibular ameloblastomas

Our aim was to evaluate the histological association of mandibular solid and multicystic ameloblastoma with the inferior alveolar nerve, both in situ and in segments of the nerve that had been removed separately, to assess the feasibility of preserving the nerve during resection of mandibular ameloblastomas. In this prospective histological examination of 13 resected hemimandibulectomy specimens, we studied the proximity of tumour cells to the inferior alveolar nerve. In group 1 (n = 8) this association was examined with the nerve still within the mandibular segment after resection, while in group 2 (n = 5) the nerve was removed from the resected tumour and examined separately. Perineural and intraneural involvement of the ameloblastoma with the nerve was confirmed in 5 cases in group 1 and 2 cases in group 2. Tumour cells abutted the nerve directly in group 1. In group 2 tumour was removed with, and found within, the nerve. On this evidence we cannot recommend preservation of the inferior alveolar nerve during operation for large, advanced, mandibular ameloblastomas.     

下颌支矢状劈开术不同固定方式对下牙槽神经结构的影响

目的：对比观察下颌支矢状劈开术（sagittal split ramus osteotomy，SSRO）2种内固定方式术后不同时期下牙槽神经（inferior alveolar nenre，IAN）结构的改变，为临床SSRO手术选择内固定方式提供实验依据。方法：选用成年恒河猴12只．全麻下行SSRO后退双侧下颌骨，左、右侧分别行双皮质螺钉固定及单皮质微型夹板固定。术后4、12周时各随机处死6只恒河猴，制作双侧IAN半薄和超薄切片，光镜和透射电镜下观察其结构变化。另选取2只成年恒河猴作为正常对照。应用SPSS11．5统计软件包进行方差分析，组间比较采用q检验。结果：术后4周，所有动物的IAN均出现轻中度Wallerian变性（P=0．000），但同时发现神经轴突再生。在2种固定方式中，术后4周双皮质固定组IAN的病理改变较单皮质固定组重（P=0．02），且单皮质固定组显示出更早和更快的神经再生现象。结论：SSRO结合坚强内固定术对IAN的结构形态均有一定影响，但单皮质固定较双皮质固定对IAN的影响较小，受损神经的恢复再生速度更快。     

下牙槽神经阻滞麻醉后失声1例

下牙槽神经阻滞麻醉是口腔科门诊常用的局部麻醉方式,但麻醉后出现失声国内外文献鲜有报道。本文报道1例下牙槽神经阻滞麻醉后失声的患者,并结合文献进行讨论。     

Perforation of the inferior alveolar nerve by the maxillary artery: An anatomical study

The infratemporal fossa is a clinically important anatomical area for the delivery of local anaesthetic agents in dentistry and maxillofacial surgery. We studied the infratemporal fossas in white cadavers, and in particular the topographical relations of the inferior alveolar nerve and the maxillary artery. In 3 of the 50 fossas dissected the maxillary artery passed through the inferior alveolar nerve, splitting it into superficial and deep divisions. Entrapment of the maxillary artery may cause numbness or headache and may interfere with injection of local anaesthetics into the infratemporal fossa.