侧胸部皮瓣修复腮腺区巨大肿瘤1例

侧胸部皮瓣是修复组织缺损的皮瓣之一,近年来在颌面外科修复中得到了应用。本文报道1例应用侧胸部皮瓣修复腮腺巨大肿瘤的患者,并结合文献探讨侧胸部皮瓣的解剖及应用。     

Necrotizing fasciitis.

Necrotizing fasciitis is a relatively uncommon severe soft tissue infection that is characterized by rapid widespread superficial fascial necrosis with undermining of surrounding soft tissue. Recent advances in anaerobic culture techniques have allowed identification of anaerobic organisms, which are now considered to have a vital role in the pathogenesis of this soft tissue infection. Therapy requires both rapid institution of a high level of antibiotics and a radical surgical incision and drainage procedure. All of the aerobic and anaerobic organisms isolated in the reported case of necrotizing fasciitis arising from a periapically infected mandibular third molar demonstrated in vitro sensitivity to penicillin.     

Systematic Review of Soft Tissue Alterations and Esthetic Outcomes Following Immediate Implant Placement and Restoration of Single Implants in the Anterior Maxilla

Background: The aim of this review is to assess the outcome of single‐tooth immediate implant placement and restoration (IPR) in the maxillary anterior region, with a particular emphasis on soft tissue and esthetic outcomes. Methods: An electronic search in Medline, EBSCOhost, and Ovid (PubMed) was performed to identify studies that reported on soft tissue outcomes following immediate placement and restoration of implants in the maxillary esthetic region with a mean follow‐up of ≥1 year. Results: Nineteen studies on single implants inserted immediately into fresh extraction sockets and provisionally restored in the maxillary esthetic region were included. Soft tissue changes were found to be acceptable, with most studies reporting mean gingival recession of 0.27 ± 0.38 mm and mean papillary height loss of 0.23 ± 0.27 mm after follow‐up of ≥1 year. Advanced buccal recession (>1 mm) occurred in 11% of cases. Long‐term follow‐up studies (>2 years) reported that the interdental papillae, in particular, showed a tendency to rebound over time. The few studies that reported on patient‐centered outcomes showed a high level of patient satisfaction with the outcomes of IPR treatment. Conclusions: The IPR protocol resulted in generally acceptable soft tissue and esthetic outcomes, with suboptimal results reported in ≈11% of low‐risk cases. Factors such as preoperative tissue biotype or use of a flap or connective tissue graft did not significantly influence soft tissue and esthetic outcomes. Long‐term prospective controlled clinical trials are necessary to identify factors that may influence the esthetic outcomes associated with IPR.     

Soft‐tissue dehiscence coverage at peri‐implant sites

Soft‐tissue dehiscence at the facial aspect of an osteointegrated implant is a common complication which impacts on the final esthetic result. The etiology and ways of diagnosing this condition are still controversial. Many factors seem to influence the position of the peri‐implant soft‐tissue margin, and some of these have been studied more carefully than others. Various surgical and combination surgical‐prosthetic approaches have been described to treat soft‐tissue dehiscence, with the latter appearing to be more predictable. This paper focuses on the factors affecting peri‐implant soft‐tissue margins and describes the different treatment approaches, reported in the literature, to treat buccal soft‐tissue dehiscence, with more focus on the prosthetic–surgical–prosthetic approach.     

颈部软组织多形性透明变性血管扩张性肿瘤1例

结合1 例右颈部软组织多形性透明变性血管扩张性肿瘤(PHAT)患者的临床资料和文献复习,分析该病的临床表现、影像学表现及其病理学表现,提高对该疾病临床表现及治疗的认识.PHAT是一种中间型有恶性倾向的软组织肿瘤,临床症状轻微且无特征性,影像学检查及术后病理检查有其特异性.治疗方法以局部扩大切除为主,术后应长期随访.     

Adverse soft tissue response to impression procedures: report of case

The use of elastomeric impression materials is routine in the fitting and making of fixed prosthodontic appliances. Occasionally, adverse soft tissue responses to these procedures have been reported. This report of case describes an adverse soft tissue response after the use of vinyl polysiloxane impression material. Suggestions for preventing this problem are also presented.     

Oral hemangioma treated with a sclerosing agent. Report of a case

A case of oral soft tissue hemangioma is reported. The treatment of the lesion with a sclerosing agent is described.     

Predicting soft tissue profile changes concurrent with orthodontic treatment

Two studies related to soft tissue profile change, are reported in this paper. In the first study, 50 adults with normal occlusion were compared to 50 adults with maxillary protrusion. Cephalometric radiographs were obtained for all subjects in two positions: with lips relaxed and lips closed. The amount of lower lip movement increased in relation to the degree of maxillary protrusion. In both groups, thickness of soft tissue pogonion decreased with upward movement of the lower lip. In the second study, 20 posttreatment patients were examined to determine how soft tissue profile is related to the morphologic alterations of treatment. Ten patients were treated for maxillary protrusion and 10 for bimaxillary protrusion. Upper lip retraction was about 40 percent of the maxillary incisor retraction. Cases with maxillary protrusion showed slightly less soft tissue change than cases with bimaxillary protrusion. Lower lip retraction was about 70 percent of the maxillary incisor retraction. With an understanding of pretreatment lip posture and data related to the soft tissue response to treatment, a framework is presented for predicting a patient's posttreatment facial profile.     

Primary oral leiomyosarcoma: A systematic review and update

The aim of this systematic review was to address the clinicopathologic inconsistencies noted with primary oral leiomyosarcoma in the literature by amassing the available data published into a comprehensive analysis. Eligibility criteria included publications of cases with dedicated immunohistochemical work‐up along with radiographs to evaluate location. Based on these criteria, the systematic review compiled 29 cases. Four primary location sites were identified in the reported cases: soft tissue presentation only, soft tissue with bony involvement, bony involvement only, and bony involvement with a soft tissue component. The majority of primary oral leiomyosarcoma cases reviewed showed a soft tissue predilection, which is in contrast to prior reports of jawbones being the most common site. In addition, there was an improved 5‐year survival rate for primary oral leiomyosarcoma limited to the oral cavity and gnathic bones without extension into paranasal sinuses.     

颞下窝软组织外周性角化囊肿1例报告

角化囊肿是口腔颌面部常见的牙源性肿物，多见于颌骨，特别是下颌支和下颌体，罕见在软组织中发生。本文报告1例发生在颞下窝软组织中的外周性角化囊肿，并结合文献，对外周性角化囊肿的组织来源及临床诊断进行了讨论。     

Reconstruction of major forehead soft tissue defects with adjacent tissue and minimal scar formation

Repair and reconstruction of soft tissue defects involving over 50% of the forehead using remaining forehead tissue has not been reported in the literature. The few existing reports mainly concern cases in which less than half of the forehead was involved. The forehead comprises one third of the face and with regard to its prominent position, it is one of the major contributing components to facial beauty. Considering the excellent color, thickness, and quality matching of the adjacent forehead skin, it is considered the ideal substitute for repair of forehead defects. Use of skin graft or free flaps for reconstruction of defects involving 50% or more of the forehead have not reported acceptable results because of the lack of similarity of the donor tissue with the remaining forehead tissue. In this study, we describe successful reconstruction of major forehead soft tissue defects of two thirds to three fourths of the forehead with use of a tissue expander and transverse supratrochlear pedicle flap in four patients who were diagnosed with giant hairy nevus. There were no serious complications such as hematoma, bleeding, infection, or flap necrosis. We recommend this technique for reconstruction of extensive forehead soft tissue defects.     

A rhinolith surrounded by a nasal polyp

Rhinoliths are uncommon mineralized nasal mass in children and adolescents. We reported a case of unilateral rhinolith that presented as a nasal polyp. A 29-year-old woman who had right-sided nasal purulent discharge, nasal obstruction, intermittent epistaxis, and posterior nasal drip for 6 months was admitted to our department. Nasal examination revealed a nasal mass between the inferior turbinate and the nasal septum, presenting as a nasal polyp or a nasal tumor. Paranasal sinus computed tomographic scan confirmed a calcified mass in soft tissue. We removed the rhinolith and the soft tissue that was around it with a transnasal endoscopic approach. Histologic analysis of the soft tissue identified inflammatory nasal polypoid tissue.     

Soft and hard tissue changes after bimaxillary surgery in Chinese Class III patients

Cephalometric studies have shown that the Chinese race tends to have a greater preponderance of skeletal Class III malocclusion. It has also been reported that the soft tissue response to hard tissue movement varies among racial types. The aims of this retrospective cephalometric study were to assess the results of bimaxillary surgery on Chinese subjects presenting with Class III malocclusions and to evaluate the correlation between soft and hard tissue change. The sample consisted of 34 Chinese patients treated with bilateral sagittal split osteotomy and Le Fort I advancement. Lateral cephalograms were taken immediately before surgery and at least six months after surgery. Soft and hard tissue changes were recorded by computer-supported measurements of presurgical and postsurgical lateral cephalograms. Linear regression procedures were used to assess the degree of correlation in terms of soft to hard tissue changes between the two cephalograms. The results showed that there was normalization of the cephalometric variables after surgery. Mandibular soft and hard tissue movements showed a strong correlation in the horizontal direction and a moderate correlation in the vertical direction. Maxillary soft and hard tissue movement showed a moderate to weak correlation in both the horizontal and vertical directions. The ratios of soft to hard tissue movements derived from this study would contribute to the database for planning prediction.     

Peripheral odontogenic keratocyst: report of two cases and review of the literature

The odontogenic keratocyst is a developmental odontogenic cyst most commonly occurring in the jaws. In rare instances, however, this lesion has been reported to occur in the gingival soft tissues. Although most authors have regarded these soft tissue lesions to be peripheral odontogenic keratocysts, others have preferred to regard them as histopathologic variants of the gingival cyst of the adult. We document 2 additional cases occurring in the gingival soft tissues, and we review the existing literature concerning this unusual lesion. Given the distinct microscopic features and possible association with nevoid basal cell carcinoma syndrome, we favor the view that this lesion represents the soft tissue counterpart of the intraosseous odontogenic keratocyst.     

Use of reactive soft tissue for primary wound closure during immediate implant placement: a two-year retrospective study

Sockets with both hard and soft tissue defects present a challenge for immediate implant placement. A modified technique harnessing the reactive soft tissue in the extraction socket for primary closure has been reported to contribute to hard and soft tissue augmentation after immediate implantation. The aim of this study was to evaluate the effects of this novel technique on the hard and soft tissues of sockets with both buccal bone and soft tissue defects (group B) and to compare the outcomes with those obtained for sockets with intact soft tissue but buccal bone dehiscence (group A). Thirty-two implants placed in the posterior region were included: 17 in group A, 15 in group B. The implants were inserted immediately utilizing reactive soft tissue from the socket for primary closure in both groups. The changes in buccal bone dimensions after 6 months were generally comparable between the two groups. A keratinized mucosa reduction of 0.56 mm in group A and keratinized mucosa gain of 0.67 mm in group B were observed at 6 months (P = 0.009). The bone and soft tissue levels were well maintained in both groups after 2 years. This technique may be a potential treatment method for tissue augmentation during immediate implantation in posterior sockets, even when a buccal bony defect and mucogingival recession need to be repaired at the same time.     

Necrotizing soft tissue infection following routine third molar extraction: report of two cases and review of the literature

Necrotizing cellulitis, necrotizing fasciitis, and necrotizing myositis are a constellation of severe soft tissue infections characterized by rapid progression, dusky soft tissue changes, and edema and induration expanding beyond the clinical wound edges. The cases of two female patients with type II necrotizing soft tissue infections occurring after routine third molar extraction are reported here. The patients were treated for the infections at the University of North Carolina Hospitals in 2016. Both were previously healthy. Of particular interest, recent inoculation of group A Streptococcus appears to have contributed to the infection in both cases.     

烟雾病血管搭桥术后颅面软组织缺损游离背阔肌皮瓣修复1例报告

颌面部大面积软组织缺损的修复,需要能提供足够组织量的游离皮瓣。背阔肌皮瓣可达20 cm×15 cm,适用于这类大面积缺损的修复。本文报告1例外伤导致的颅面部大面积软组织缺损病例,颅骨、颧骨、颧弓、硬脑膜暴露,既往有烟雾病病史,曾发生颅内出血,引起神经功能损害及左侧肢体功能障碍,行双侧颅内外血管搭桥手术。该患者面临再次及反复出血的威胁。应用游离背阔肌皮瓣成功修复了颅面部缺损,并避免了颅内严重并发症的发生。     

Intranodal hemangioma of the oral soft tissues: a case report of a rare entity with review of the literature

The presentation of a primary vascular tumor in a lymph node is a rare occurrence. Only 16 documented cases have been reported to date, with none described in the oral soft tissues. This case report presents the first occurrence of an intra-nodal hemangioma of the oral soft tissue in an 11-year-old girl. A review of the literature is also presented.     

Peripheral Odontogenic Myxoma: A Review of the Literature and Report of Two Cases

Two cases of peripheral odontogenic myxoma with a verifiable location in gingival soft tissue and without bone involvement were compared with those reported in the literature. This study showed that they form a distinct albeit rare clinical entity with a potential to grow into large disfiguring lesions. The probability that small peripheral odontogenic myxomas are interpreted as edematous irritation fibromas may contribute to the small number of peripheral odontogenic myxomas recorded in the literature. The differential diagnosis of soft tissue myxoid proliferations is discussed.     

软腭骨瘤1例报告及文献复习

骨瘤是常见的由分化成熟的骨组织构成的良性肿瘤,多来源于邻近骨质,发生于骨膜内层骨母细胞,由成骨性纤维组织、成骨细胞及所产生的新生骨组成。发生于口腔软组织的骨瘤极为罕见,作者报道1例软腭骨瘤病例,结合有关文献对其组织来源、病理分型、鉴别诊断和治疗等进行了讨论。