发育性下颌骨不对称畸形的美容外科治疗

下颌骨不对称畸形在颜面不对称畸形中较为常见,通常伴有上颌骨畸形,软组织畸形,咬合关系异常,颞下颌关节功能障碍等。可由一侧发育过度,也可由一侧发育不良引起,常造成两侧颜面不对称及牙颌关系紊乱,影响患者容貌、咀嚼、发音功能。对于此类伴有牙颌关系紊乱,咬颌平面偏斜的下颌骨不对称畸形患者的治疗比较复杂。需要正颌及整形外科手段联合治疗,     

正畸-正颌联合治疗下颌骨性偏颌畸形

目的:偏颌畸形(oral facial asymmetry)是以颜面不对称、咬合关系紊乱为主要特征的疾病,严重影响患者容貌、咀嚼和发音等功能,给患者造成严重的心理负担。通过病例总结并探讨正畸-正颌联合治疗下颌骨性偏颌畸形的治疗效果及相关注意事项。方法:对一例下颌骨性偏颌畸形之形成机制、正畸-正颌联合治疗方法及疗效进行分析评估。结果:患者下颌偏斜情况得到明显改善,面部基本对称,张闭口过程中下颌向左偏摆情况消失;上下颌牙齿排列整齐,前牙覆牙合、覆盖及后牙咬合关系良好。结论:正畸-正颌联合治疗能够大大改善骨性偏颌畸形患者的面貌、取得协调稳定的咬合关系,并有利于口颌系统平衡及其功能的发挥。     

活动斜面导板在成人安氏II类下颌后缩深覆牙合治疗中的应用

目的:探讨活动斜面导板在矫治安氏Ⅱ类下颌后缩深覆牙合成人患者中的应用。方法:在临床上选择12例安氏Ⅱ类下颌后缩深覆牙合的成人错牙合患者,应用斜面导板分次前移下颌矫治下颌后缩,并纠正深覆牙合。恢复磨牙Ⅰ类关系。通过临床观察、模型测量及X线头影测量来评价其疗效。结果:12名患者中10名在戴用活动斜面导板6～12个月后,咬合关系明显改善;侧貌协调;前牙覆牙合覆盖正常,无颞颌关节症状。结论:只要病例合适,方法运用得当,活动斜面导板治疗安氏Ⅱ类下颌后缩深覆牙合的成人患者具有良好的疗效。     

发育性偏颌畸形患者颈椎姿势特征的研究

目的：探讨发育性下颌偏颌患者的颈椎姿势特征，为改善患者体态提供新的思路。方法：对20例恒牙列下颌偏颌患者及39例正常咬合者拍摄头颅定位后前位、侧位、颈椎标准正、侧位X线片及直立时的面颈和全身照片。结果：偏颌畸形患者颜面明显不对称，直立时一侧胸锁乳突肌肌张力较对侧强、头向一侧偏斜、双肩不等高。矢状面内头颈呈前倾、前伸痊。颈椎正位X片显示颏部及第4、5、6颈椎棘突偏离中线程度大于对照组；颈椎侧位X线显示颈椎曲度小于对照组。结论：偏颌畸形影响颈椎姿势，矫治颌面畸形的同时应注意对异常颈椎姿势的矫治。     

活动斜面导板在成人安氏Ⅱ类下颌后缩深覆(牙合)治疗中的应用

目的探讨活动斜面导板在矫治安氏Ⅱ类下颌后缩深覆(牙合)成人患者中的应用.方法在临床上选择12例安氏Ⅱ类下颌后缩深覆(牙合)的成人错(牙合)患者,应用斜面导板分次前移下颌矫治下颌后缩,并纠正深覆(牙合).恢复磨牙I类关系.通过临床观察、模型测量及X线头影测量来评价其疗效.结果12名患者中10名在戴用活动斜面导板6～1 2个月后,咬合关系明显改善;侧貌协调;前牙覆(牙合)覆盖正常,无颞颌关节症状.结论只要病例合适,方法运用得当,活动斜面导板治疗安氏Ⅱ类下颌后缩深覆(牙合)的成人患者具有良好的疗效.     

正颌外科和正畸联合治疗发育性下颌骨不对称畸形

目的 发育性下颌骨不对称畸形是常见的牙颌面畸形之一，临床治疗难以取得满意疗效。通过对发育性下颌骨不对称畸形治疗的回顾性研究，探讨正颌手术和正畸联合矫治对于提高疗效、减少复发的临床意义。方法 按术前正畸-正颌手术-术后正畸的模式，对58例发育性下颌骨不对称畸形患者进行矫治，行单颌手术、双颌手术、颌骨整形、颏成形术、牵引成骨术共计82例次，设计三级疗效评定标准对手术效果进行评价。结果 经过正畸、正颌联合矫治的发育性下颌骨不对称畸形58例，满意53例(91．4％)，基本满意4例(6．9％)，不满意1例(1．7％)，该例经二次手术得以矫正。结论 发育性下颌骨不对称畸形的矫治必须坚持正颌与正畸的紧密配合，通过严格的术前术后正畸，可达到改善面形，恢复合关系、提高矫治效果，减少畸形复发的目的。     

牵张成骨联合正颌外科治疗成人严重小下颌畸形伴重度阻塞性睡眠呼吸暂停低通气综合征

目的:探讨牵张成骨术联合正颌外科的方法治疗小下颌畸形患者下颌骨严重发育不足伴重度睡眠呼吸暂停综合征(OSAHS)的效果。方法:对2例继发于颞下颌关节强直的小颌畸形患者首先采用牵张成骨技术进行治疗。手术在全麻下行双侧下颌角处截骨,安置牵引器,延长下颌升支及下颌体矫正小颌畸形及OSAHS。第二期在拆除牵引器的后行正畸治疗,继而采用正颌外科方法矫正颌面畸形及咬合关系,术后进一步正畸治疗矫正咬合关系排齐牙列。结果:2例患者均顺利完成治疗。下颌骨最小牵引距离25mm,最大牵引距离30mm,牵引区成骨良好。后气道间隙由治疗前的平均3.25mm增加到11.5mm;SNB角由术前平均67°增加到术后80°,OSAHS得以治愈。联合正颌外科及正畸治疗后小颌畸形得以矫治,面型及咬合功能均获得满意的效果。术后经过2年随访,未见复发。结论:牵张成骨技术联合正颌外科治疗成人严重小颌畸形伴重度OSAHS可以获得满意的效果。不仅可有效治疗伴发的OSAHS,而且能很好地矫治小下颌畸形引起的牙颌面畸形。     

功能矫治器治疗儿童下颌后缩的颜面美学变化

目的　分析经Activator、Frankel等功能矫治器治疗后的安氏Ⅱ类 1分类下颌后缩患者 ,面部侧貌软组织的变化量及其与颌面部硬组织变化的相关性 ,以揭示下颌前伸后引起颜面美观变化的因素。方法　选取生长发育高峰期下颌后缩患者 32例 ,采用Activator、Frankel等功能矫治器矫治至磨牙达中性或中性偏近中关系 ,前牙覆盖 <4mm。采用Holdaway、Pancherz等方法 ,分析矫治前后X线头侧位片上的软硬组织变化量 ,并进一步分析它们之间的相关关系。结果　除了面角和上唇基厚度 ,下颌平面角 (MP SN)和上颌基骨位置 ,其余软硬组织指标治疗后都发生了明显变化 (P <0 .0 5 ) ;下列软硬组织的变化存在相关性 :唇颏高和后面高 (r =0 .5 4 ) ,颏部软组织厚度和前上面高 (r =0 .5 5 ) ,上唇长度和下切牙位置 (r=0 .5 2 ) ,颏唇沟深度和下切牙 (r =0 .6 0 )、下颌基骨的矢状位置及上下基骨的矢状关系 (r =0 .4 7)相关。结论　功能矫治器矫治安氏Ⅱ类 1分类错牙合 ,明显改善了患者的颜面美观 ,而软组织侧貌的变化 ,主要源于下切牙位置的改变、下颌前伸及由此引起的面高和上下颌骨矢状关系的改变。     

活动斜面导板在成人安氏Ⅱ类下颌后缩深覆He治疗中的应用

目的：探讨活动斜面导板在矫治安氏Ⅱ类下颌后缩深覆He成人患者中的应用。方法：在临床上选择12例安氏Ⅱ类下颌后缩深覆He的成人错He患者，应用斜面导板分次前移下颌矫治下颌后缩，并纠正深覆He。恢复磨牙Ⅰ类关系。通过临床观察、模型测量及X线头影测量来评价其疗效。结果：12名患者中10名在戴用活动斜面导板6～12个月后，咬合关系明显改善；侧貌协调；前牙覆He覆盖正常，无颞颌关节症状。结论：只要病例合适，方法运用得当，活动斜面导板治疗安氏Ⅱ类下颌后缩深覆He的成人患者具有良好的疗效。     

上颌快速扩弓联合多曲方丝技术矫治年轻成人骨性反（牙合）伴下颌偏斜畸形

目的评价上颌快速扩弓（rapid maxillary expansion，RME）联合多曲方丝技术（multi—loop edgewise arch wire。MEAW）矫治年轻成人骨性反[牙合]伴下颌偏斜畸形的临床疗效。方法选择成年安氏Ⅲ类骨性错[牙合]伴下颌偏斜患者9例，年龄16．2～18．8岁，采用上颌快速扩弓纠正单侧后牙反[牙合]，多曲方丝技术配合颌间牵引调整咬合关系，纠正下颌及中线偏斜。矫治前后拍摄头颅侧位片和正位片，并进行X线头影测量分析。结果（1）矢状方向上，SNA增大（1.4±1.7）°，SNB减少（0．7±0．9）°，ANB增加（2．1±0．9）°，颌骨前后向不协调减轻；U1-SN，L1-MP矫治前后分别增加（2．7±3．7）°和减少（5．4±2．9）°，前牙覆盖减少（3．8±1．0）mm。（2）垂直方向上，MP-SN和MP-FH分别增加（1．9±2．0）°和（1．1±2．6）°，矫治前后差异均无统计学意义。（3）矫治前后Maz—Maz’增加（2．6±2．8）mm，Um-Um’增加（6．2±5．9）mm，后者矫治前后差异具有统计学意义。（4）矫治前后，ACd-Me和ACd-Go分别减少（3．7±2．1）mm和（2．8±1．6）mm；ManDP-MSL和Me-MSL分别减少（3．8±2．3）mm和（3．6±2．5）mm，矫治前后差异均具有统计学意义。结论上颌快速扩弓联合多曲方丝技术可以有效地矫治年轻成人轻、中度骨性反[牙合]伴下颌偏斜畸形，纠正异常咬合关系，改善颜面部不对称畸形。     

骨性安氏Ⅲ类错患者行正颌手术后其口腔功能间隙的改变

目的:探讨骨性安氏Ⅲ类错患者行正颌手术后,口腔功能间隙面积的改变,了解口腔功能间隙与牙颌畸形发生的关系,为正颌临床诊断治疗提供有益的参考。同时研究口腔功能间隙的改变对术后保持与防止复发提供理论依据。方法:对在我院就诊的共20例骨性安氏Ⅲ类错患者进行研究,采用定位X线头影测量分析的方法,通过患者治疗前后的对照,比较正颌术后口腔功能间隙的改变。结果:骨性安氏Ⅲ类错患者行正颌手术后较术前1周口腔功能间隙减小(P<0.05),有统计学差异。下颌后退量与口腔功能间隙减少量存在明显的正相关性。结论:骨性安氏Ⅲ类错患者,经正颌治疗后,口腔功能间隙矢状向面积有所减小,其直接原因可能是正颌手术后退下颌骨造成的,并且口腔功能间隙变化量与下颌骨后退距离存在正相关性。     

数字化技术配合模型制作种植导板在牙缺失患者口腔种植修复中应用效果

探讨数字化技术配合模型制作种植导板在牙缺失患者口腔种植修复中的应用效果。方法 选 取2020年1月-2023年1月于西安宝石花长庆医院口腔科就诊的100例牙缺失患者为研究对象，按照随机数字 表法分为对照组与观察组，每组50例。对照组选择传统种植修复治疗技术，观察组选择数字化技术配合模 型制作种植导板，比较两组临床疗效、种植体位置偏差情况、牙周健康指标及并发症发生情况。结果 观察组治疗优良率为96.00%，高于对照组的80.00%（P ＜0.05）；观察组种植体位置深度偏差、角度 偏差、根部偏差、顶部偏差数值均低于对照组（P ＜0.05）；观察组治疗后GI、SBI、PLI评分均低 于对照组（P ＜0.05）；观察组并发症发生率为8.00%，低于对照组的16.00%，但差异无统计学意义 （P ＞0.05）。结论 数字化技术配合模型制作种植导板技术便于降低种植体偏差，可有效保证牙缺失患 者的牙周健康水平，治疗效果及安全性均较高，值得临床应用。     

Combined maxillary and mandibular osteotomies

In certain patient categories single-jaw surgery will not result in the optimal outcome that can be achieved through bimaxillary surgery. These include patients with asymmetrical facial deformities (usually mid and lower face), long face deformity with vertical maxillary excess and significant mandibular retrognathism, and bimaxillary protrusion or retrusion. To correct such deformities a well-planned and orchestrated orthodontic preparation followed by bimaxillary orthognathic surgery is necessary. An interim occlusal splint will guide the surgeon in moving the maxilla, and the final splint will position the mandible. Precise attention to detail throughout the operative course is essential to an optimal outcome. Rigid fixation will minimize the need for traditional intermaxillary wiring.     

Importance of chin evaluation and treatment to optimizing neck rejuvenation surgery

The chin is the keystone linking the aesthetics of the face and neck but is often neglected in the analysis. Procedures related to the chin play an important role in defining neck anatomy. Alloplastic implants can provide the illusion of a longer jaw line in a patient with retrogenia. Even greater anatomic changes to the neck result when a sliding genioplasty is performed. This effect is primarily due to the digastric attachments from the mentum and mastoid. Advancing the mentum may have a more direct effect of elevating the position of the hyoid, which sharpens the angle between the jaw and neck. Finally, the diagnosis of a witch's chin is also discussed for the patients who present for aging neck surgery.     

Osteonecrosis of jaw in patient with hormone-refractory prostate cancer treated with zoledronic acid

Intravenous bisphosphonates are widely used in the management of metastatic bone disease, as well as osteoporosis. Recent published reports have documented a possible link between treatment with intravenous bisphosphonates and osteonecrosis of the jaw. We report a case of osteonecrosis of the jaw in 1 patient with prostate cancer receiving both chemotherapy and intravenous zoledronic acid (Zometa). Bisphosphonates have been demonstrated to alter the normal bone microenvironment and appear to have direct effects on tumors as well. These changes may contribute to the development of osteonecrosis of the jaw, particularly after tooth extractions or other invasive dental procedures.     

自制导萌装置联合闭合式开窗术在替牙期埋伏阻生前牙牵引中的应用

目的：评价自制导萌装置牵引上颌埋伏阻生牙的临床疗效,并探讨其机制和使用方法。方法：临床选择8～11岁上颌埋伏阻生牙患者13例,应用自制导萌装置联合闭合式开窗术进行埋伏阻生牙的牵引导萌治疗,并在治疗前后拍摄X线片辅助评价疗效。结果：通过应用自制导萌装置,13例患者的上颌埋伏阻生牙均顺利萌出至理想位置,疗效满意,疗程8～15月,平均12个月。结论：应用自制导萌装置牵引上颌埋伏阻生中切牙可取得令人满意的临床效果。     

Aesthetic aspects of composite oromandibular cancer resection and reconstruction

Disfigurement after oromandibular cancer surgery is as much feared as the tumor itself. A deviated jaw, collapsed neck and muffled speech are external markers that may prevent normal life. Yet such stigmata are not necessary. For two years we have used an immediate reconstruction that avoids these problems. In 12 patients we used a pectoralis musculocutaneous flap plus a stainless steel shaped bridging bone plate placed under or through the flap. The flap reconstructs the floor of the mouth, while the bridging bone plate preserves mandibular continuity. A McFee incision avoids vertical scarring, and the muscle pedicle duplicates the missing neck contents. Meticulous lip closure completes the procedure, which often does not necessitate tracheotomy scarring. Our patients have maintained a highly satisfactory appearance of face and jaw, with normal swallowing and clear speech. In treatment of oromandibular cancer, aesthetic considerations are essential.     

The Impact of Wearing a Face Mask during the COVID-19 Pandemic on Temporomandibular Joint: A Radiological and Questionnaire Assessment

Aim  Several health problems have been reported to be triggered or facilitated by prolonged mask usage during the coronavirus disease 2019 (COVID-19) pandemic. While wearing a face mask, people tend to push their jaws forward and downward in a repetitive manner to hold their masks in the right position; these jaw motions may induce temporomandibular joint disorder (TMD). In this study, we aimed to investigate these repetitive jaw movements while wearing face masks and their effects on TMD. Patients and Methods  Patients who applied with TMD signs between June 2020 and May 2021 were evaluated prospectively. A survey using a questionnaire was conducted to define patients with TMD that caused only by mask-related repetitive jaw movements. Demographic data (age and gender), mean duration of daily mask usage, mask type, and magnetic resonance imaging results were recorded. Results  Prolonged daily mask usage (≥8 hours/day) was significantly higher in patients with mask-related habits (group a) with a rate of 40.4% ( p ≈ 0.001). Also, in this group, the disc displacement with reduction rate (54.6%) was higher compared with other groups ( p ≈ 0.010). On the contrary, patients with no underlying risk factor (group c) showed an unexpected high osteoarthritis rate ( p ≈ 0.029). Conclusions  In this study, we demonstrate that correcting the position of a face mask by repetitive jaw movements can increase the occurrence of TMD. Informing individuals wearing face masks about the risk of TMD and the importance of choosing the appropriate mask size according to the face shape are important issues to be addressed in the near future.     

A simple jaw splint for minimally displaced mandible fractures with undisplaced occlusion

A 35-year-old patient presented with a minimally displaced jaw fracture with normal occlusion. She was treated conservatively with a soft diet and told to avoid doing things that hurt to prevent movement at the fracture site. She had the most difficulty with pain generated by walking, driving on bumpy roads and waking up with an unfavourable jaw position during her sleep. She created a simple Velcro (Velcro Industries BV, USA) splint, that removed all of her pain with walking, driving and sleeping and went on to heal her fracture uneventfully. The occupational therapist easily fabricated this splint for a second patient, who also found it very helpful.     

85例根管再治疗的临床分析

目的:探讨根管再治疗的原因及技术方法。方法:2010年5月~2012年5月完成根管再治疗患者中,选择其中术后18个月随访了的73例(85颗),统计其需要再治疗的原因,针对原因分别进行再治疗,统计其成功率。并对预后影响因素进行统计学分析。结果:85颗患牙中,59颗完成了根管再治疗并获得了临床成功,成功率达69.4%。在预后影响因素统计学分析中,其中除牙位及临床应用类型组间差异有统计学意义外,其余如性别、年龄、有无窦道组间差异均无统计学意义。结论:通过分析原因及针对性治疗,大部分根管再治疗病例能取得较满意效果。病例选择和规范化操作是手术成败的关键。