动力性肌肉游离移植治疗面瘫的前瞻性研究

作者根据目前吻合神经血管的肌肉游离移植治疗陈旧性面瘫的三种术式，将患者随机分为三组，１组是在健面侧吻合神经血管的超长蒂节段性背阔肌一期跨面移植（一期法），共９例；２组是跨面神经移植和二期肉游离移植（二期法），共７例；３组是在患面侧吻合神经血管的肌催游离移植，共５例。对随访时间在１年以上，资料完整的１６例进行了效果评定，功能恢复优良率达９３．８％。各组之间无显著差异。效果优良者主要分布在４０岁以内年     

背阔肌、前锯肌单蒂双岛肌皮瓣修复上颌骨大型缺损

目的：采用背阔肌,前锯肌单蒂双岛肌皮瓣修复上颌骨扩大切除术后的大型缺损,为此类组织缺损寻求一种理想的外科修复方法。方法：根据胸背血管在背阔肌内行走的解剖部位设计成单蒂双岛肌皮瓣。胸背动脉内,外侧枝的背阔肌肌皮瓣修复口内外或面眶区硬软组织缺损,胸外侧动脉的前锯肌肌瓣插入背阔肌内作为充填上颌骨或颅底缺损的空腔,并详细介绍手术方法。结果：共施手术8例,肌皮瓣全部成活,肤色,质地,形态以及轮廓的恢复均较满意。结论：背阔肌,前锯肌单蒂双岛肌皮瓣修复上颌骨扩大切除术后的大型缺损有其优越性,其充足的肌量对面部轮廓的恢复可起到满意的效果。     

背阔肌、前锯肌单蒂双岛肌皮瓣修复上颌骨大型缺损

目的 :采用背阔肌、前锯肌单蒂双岛肌皮瓣修复上颌骨扩大切除术后的大型缺损 ,为此类组织缺损寻求一种理想的外科修复方法。方法 :根据胸背血管在背阔肌内走行的解剖部位设计成单蒂双岛肌皮瓣。胸背动脉内、外侧枝的背阔肌肌皮瓣修复口内外或面眶区硬软组织缺损 ;胸外侧动脉的前锯肌肌瓣插入背阔肌内作为充填上颌骨或颅底缺损的空腔 ,并详细介绍手术方法。结果 :共施手术 8例 ,肌皮瓣全部成活 ,肤色、质地、形态以及轮廓的恢复均较满意。结论 :背阔肌、前锯肌单蒂双岛肌皮瓣修复上颌骨扩大切除术后的大型缺损有其优越性 ,其充足的肌量对面部轮廓的恢复可起到满意的效果。     

腮腺切除改良术式治疗腮腺良性肿瘤

目的了解腮腺切除改良术式治疗腮腺良性肿瘤的临床疗效。方法采用腮腺切除改良术式共治疗35例腮腺良性肿瘤患者，术式改良内容包括除皱术手术切口、解剖保留耳大神经后支、胸锁乳突肌肌瓣填塞术区、术后负压引流。结果本组35例患者术后出现Frey综合征者2例，发生涎瘘者1例，出现暂时性面神经功能减弱者7例，术侧耳垂和耳廓背部皮肤感觉均暂时性减弱，术后美容效果满意率100％。结论腮腺切除改良术式治疗腮腺良性肿瘤既可取得良好的美容效果，又可降低并发症发生率，值得在临床推广。     

游离背阔肌肌皮瓣在口腔颌面外科的应用

目的　背阔肌肌皮瓣多以带蒂方式用于口腔颌面部软组织缺损的修复,但有一定缺点。本文论述了游离背阔肌肌皮瓣在口腔颌面外科应用的有关问题。方法　我科自1981年以来,所用游离背阔肌肌皮瓣均以胸背血管为蒂,切取肌皮瓣后,创面均直接拉拢缝合,未行植皮。不能直接拉拢关闭者,创面减张缝合后,覆以碘仿纱条,任其二期愈合。结果　应用游离背阔肌肌皮瓣修复口腔颌面部各类缺损45例,成功41例,成功率为91.1%。结论　游离背阔肌肌皮瓣提供的软组织量充足,适用于口腔颌面部某些大型缺损的修复。也可一分为二,修复面部贯通缺损。其缺点是术中需变换病人体位,不利于两组人员同时操作,故应用受到一定限制     

应用背阔肌肌皮瓣重建头颈部

将背阔肌肌皮瓣做为一种可靠而操作简单的游离瓣已引起了人们的注意。过去,有些人将背阔肌做为带蒂瓣或带蒂岛状瓣以重建胸壁、乳房及肩部,具有独特的成效。本文总结了应用背阔肌做为带蒂岛状瓣以重建头颈部的近期经验。解剖背阔肌肌皮瓣是以肩胛下动脉的胸背血管蒂为基准,肩胛下动脉是腋动脉第三部份的一大分支(如右图)。它是一个强而短的动脉,管径约4—5毫米,向后向内走行分出旋肩胛动脉;向下走行进入背阔肌和前锯     

用带蒂肌瓣和小血管吻合游离组织移植修复颜面萎缩畸形(附6例报告)

本文介绍了我科应用带蒂肌瓣和小血管吻合游离组织移植修复6例颜面萎缩畸形的临床经验和体会。术后随访半年至3年,颜面凹陷畸形基本得到矫正,外形恢复较好。作者认为带蒂肌瓣取材方便,手术可一次完成,因有血运,成活率高,抗感染力强,术后萎缩小,背阔肌游离移植组织量丰富,供区隐蔽,尤适用于女性患者。     

背阔肌皮瓣在头颈部整复中的应用

背阔肌皮瓣是一种复合组织瓣,由背阔肌、血管及其表面的皮肤共同组成。它是第一个被详细描述的肌皮瓣。早在1912年D'Este就描述了利用上方带蒂的背阔肌皮瓣立即修复乳房切除术后所造成的缺损。但自1974年以来背阔肌皮瓣已成为整复及再造外科临床应用较广泛的肌皮瓣,在头颈部的重建手术中已显示出无可争议的价值。至1979年背阔肌皮瓣除可用于修复口底、咽部、     

早期外伤性面瘫显微手术治疗的疗效分析

目的探讨早期外伤性面瘫显微手术治疗的临床疗效及其影响因素。方法对22例损伤在1个月以内的面瘫患者实行面神经吻合术，疗效观察以House等提出的面神经功能标准作为疗效判定标准。疗效判定时间平均为12个月（6-24个月）。结果年龄小、进路合理、损伤轻及位置低的病例疗效满意；16例术后疗效达HouseⅠ-Ⅱ级，6例为Ⅲ。结论早期外伤性面瘫显著手术治疗效果确切，外伤性面瘫的病因、部位、程度、范围及手术时机不同因素与疗效关系密切。     

解剖面神经颧支在腮腺切除术中的临床应用

目的：总结解剖面神经颧支在腮腺良性肿瘤切除术中的临床应用。方法：采用经典的面部除皱手术切口,在腮腺嚼肌筋膜下翻瓣,先在耳屏前颧弓下解剖显露面神经的颧支,然后沿该支显露面神经的颞面干及面神经总干,再根据肿瘤的位置沿总干选择性地解剖面神经颈面干及各分支,行肿瘤及腮腺部分切除术。最后采用蒂在上方的胸锁乳突肌肌瓣转移填塞腮腺切除后的凹陷区,避免了常规术式术后耳前区的凹陷畸形。结果：采用该术式对19例患者行腮腺良性肿瘤切除术,所有手术均顺利完成,术后随访3～4年,患者面部疤痕不明显,外形恢复良好,面神经损伤均完全恢复。结论：本术式更易于显露和保护面神经,改善术后面部畸形。     

单侧面肌失神经支配后组织病理学改变的观察

目的：研究单侧面肌失神经支配组织病理学改变。方法：建立单侧面肌失神经支配动物模型,在失神经支配后1、3d,1、2周,1、2、4、6个月制作面肌标本,改良Gomori三然染色观察线粒体变化;酶组化染色检测肌球蛋白（Actin）的表达;吖啶橙染色检测细胞内核酸含量变化。结果：失神支配初期线粒体功能加强、酶活性增高、收缩蛋白质表达增强;2周后,线粒体退化、肌纤维代谢活性降低,收缩蛋白质表达下降;1个月后肌纤维型分别开始转换;6个月组明显型组化,核酸量上升,并出现少量再生的肌纤维。结论：单侧面肌失神经支配后发生典型的失神经萎缩,2－6个月有增殖改变,失神经支配1个月内是对抗肌萎缩的有利时机。     

逆行诱发电位诊断面神经病变的研究现状

面神经逆行诱发电位是刺激面神经干或其外周感受器,其刺激点到大脑皮层某一特定区域出现的特定生物电反应,它可帮助推断面神经病变的部位,为临床上面神经麻痹以及面肌抽搐的定位诊断和预后判断提供信息支持。本文对面神经逆行诱发电位的电生理特点以及在动物实验和临床应用方面的研究成果及争议进行综述.     

面突角对美观侧貌唇突度的影响

目的探讨面突角对美观侧貌唇突度的影响。方法选取侧貌较好的男女成人各一名,描绘其头颅侧位片的侧貌轮廓,制作成剪影图作为标准侧貌,利用图像处理技术改变标准侧貌的颏部位置,各获得5张具有不同面突角（面突角正常、增加5°、增加10°、减小5°、减小10°）的剪影图。在此基础上以E线为参考线,将各剪影图的上下唇分别后移1mm和前移1mm各4次,每张剪影图分别得到9幅具有不同唇突度的侧貌图。选择180名大学生对侧貌图进行审美评价。结果面突角正常时相对后缩的唇突度最受欢迎;随着面突角的增加,人群倾向于喜爱略微前突的唇部位置;而随着面突角的减小,人们则倾向于喜爱更加后缩的唇部突度。结论面突角对美观侧貌的唇突度有显著影响,面突角不同,唇突度的审美标准亦不同。对不同错验类型的临界拔牙患者进行矫治设计时应考虑面突角对唇突度的影响。     

不同疗程直流电治疗创伤性面神经损伤的实验研究

考察不同疗程直流电治疗创伤性神经损伤的效果。方法４０只家兔随机分为常规治疗组，电刺激一疗程组、电刺激二疗程组、电刺激三疗程，分别给予不同程序电刺激治疗，进行组织学观察，神经电图测定、计量病理学研究。结果①电刺激各组对神经恢复均有促进作用，电刺激二疗程、三疗程作用效果明显优于电刺激一疗程。②对于中度神经损伤，电刺激作用时间与神经恢复并不呈线性关系。电刺激三疗与二疗程治疗效果相近。结论地神经中度损伤，     

Understanding the relevance of comprehensive facial injury (CFI) score: Statistical analysis of overall surgical time and length of stay outcomes

Comprehensive facial injury (CFI) score is a powerful and extremely simple scale used to grade the clinical severity of all facial injuries, and is expressed in terms of the overall surgical time needed for definitive treatment. Its statistical validation was previously reported in 2019. The aim of this study was to investigate further the link with duration of surgery, applying the score to a larger sample of patients, and to evaluate the relationship between CFI score and other extremely relevant dependent variables: length of stay (LOS) in high care units (HCU) and in intensive care units (ICU).1406 patients with diagnosis of at least one facial bone fracture, and treated by the same team in two highly specialized trauma centers, were studied. For each patient a specific CFI score is assigned and overall surgical time, length of stay, and presence of associated injuries were recorded. Data were divided into six clusters according to CFI score: (1) 0–5, (2) 6–10, (3) 11–15, (4) 16–20, (5) 21–25, and (6) >25. Regressions between CFI clusters and duration of surgery (minutes), LOS in ICU (days), and in HCU (days) were established. In addition, the presence of associated head and/or somatovisceral injuries was analyzed and related to CFI score.Statistical analysis confirmed linear regression existing between each CFI cluster and overall surgical time (p < 0.00001), with improved significance of the results using median values of surgical duration for each cluster (p = 0.0001). It also demonstrated the existence of linear regression between all CFI clusters and LOS in HCU (p = 0.0001) and between CFI clusters 3–6 and median values of LOS in ICU (p = 0.0001). Finally, associated injuries were observed to be more frequent in high CFI score clusters, occurring in around 90% of patients with a CFI score >25 (p < 0.00001). Association of head and facial injuries play a major role in high LOS in ICU values, whereas coexistence of facial, head and somatovisceral involvement increases LOS in ICU to over twice that for single association.Surgical time and length of stay are outcomes traditionally used to assess the statistical significance of many new proposed trauma score. The strong correlation demonstrated between CFI score and each of these variables confirms its value and reliability.CFI score is proven to be an ideal, simple, informative, and reproducible tool for measuring severity of facial injuries and their clinical impact. It allows correlation with associated head and somatovisceral injuries, focusing attention on the interesting field of reciprocal influences in simultaneous, multidistrectual involvement. None of the previously proposed facial injury severity scales have offered such informative and statistically significant features.     

Extracapsular dissection with a transparotid facial nerve dissection approach versus partial superficial parotidectomy for benign tumours in the tail of the parotid gland: a single-centre retrospective study of 89 patients

The aims of this study were (1) to evaluate the transparotid facial nerve dissection approach (TFND), in which the intraparotid cervicofacial or temporofacial division is identified first through a superficial lobe incision; and (2) to compare extracapsular dissection with a TFND (ECD-TFND) with partial superficial parotidectomy with a retrograde approach (PSP) for benign tumours in the tail of the parotid gland with respect to surgical outcomes. Eighty-nine patients underwent PSP or ECD-TFND for benign tumours in the tail of the parotid gland: 49 were treated surgically with PSP and 40 with ECD-TFND. The mean ( ± standard deviation) surgical time did not differ significantly between the groups: 64 ± 22.4 min for PSP and 59 ± 19.8 min for ECD-TFND (P = 0.302). There was a significant difference in sialocele: 18 (36.7%) patients in the PSP group and four (10%) in the ECD-TFND group (P = 0.002). There was also a significant difference in facial nerve injuries: temporary paralysis was observed in 13 (26.5%) patients in the PSP group and two (5%) in the ECD-TFND group (P = 0.007). It appears that TFND is a viable and safe approach when performing ECD for benign tumours in the tail of the parotid gland. ECD-TFND should be preferred over PSP for benign tumours in the tail of the parotid gland.     

A Clinician’s Role in the Management of Soft Tissue Injuries of the Face: A Clinical Paper

Introduction

Injuries of the facial soft tissues may be due to road traffic accidents, industrial injuries, domestic and interpersonal violence, dog bites, human bites, war injuries etc. They may be described depending on the depth of involvement of the soft tissue and/or region since it gives the clinician the method of treatment. The soft tissue injuries must take into the underlying skeletal injury into account since these injuries if carelessly handled they leave deformed scarring in the most precious and beautiful part of the body.

Materials and Methods

Various patients reporting to the department of Oral and Maxillofacial Surgery, Narayana Dental College and hospital, Nellore were included in the study. Injuries in the various aspects of face at various anatomical areas has been presented with the mode of management.

Conclusion

The maxillofacial surgeon while attending these cases should avoid the need for revision by having a thorough knowledge of the anatomy, physiology of the soft tissues and treat them accordingly after following good clinical and radiological examination.