621例颅颌面骨折临床分析

目的:通过对本院621例颅颌面骨折患者回顾分析,了解本地区颅颌面骨折患者的流行病学特点.方法:对上海交通大学医学院附属第九人民医院颅颌面外科、眼科、耳鼻咽喉科、神经外科、整形外科2015年7月--2016年8月期间收治的621例颅颌面骨折患者的年龄、性别、病因、骨折部位分布等信息进行分析.采用SPSS 22.0软件包对单发及多发骨折的病因差异进行x2检验.结果:621例颅颌面骨折的男女比为2.18:1;平均发病年龄为(34.7±15.5)岁,19～29岁(28.3％)为骨折的高发年龄段;交通事故在致伤原因中居于首位(49.0％);在骨折部位中,眼眶骨折319例(51.4％),发生率最高,其次分别为颧骨、颧弓(292例,47.0％)、下颌骨(247例,39.8％).结论:骨折发生的数量、部位等与致伤原因、受力性质及相应部位的解剖结构有关.建立完善的交通事故救治体系及相关法律,是亟须解决的问题.     

复杂陈旧性颅颌面骨折的临床特征及处理

复杂颅颌面骨折常因合并颅脑损伤而延误早期治疗 ,从而造成口颌系统的功能障碍及颜面畸形。作者对该类患者选择性采用脑外科、正颌外科、种植外科等技术进行治疗 ,疗效好 ,现报道如下。1　材料和方法1.1　临床病例收集 1997年 5月～ 2 0 0 2年 5月就诊于第二军医大学长海医院口     

颅颌面部生长的预测

颅颌面的生长预测是正畸临床治疗学的重要内容 ,而掌握颅颌面生长的规律则是进行颅颌面生长预测的基础。严格的生长预测应包括高度、深度和宽度三维方向的内容 ,但由于颅颌面组织的差异性生长 ,其宽度生长完成较早。因此 ,矫治期间的颅颌面生长改变主要是在侧面的二维方向上。从正畸临床的角度看 ,颅面生长的预测主要是对侧面二维方向上的变化进行预测。颅颌面部的生长规律是颅面生长预测的基础 ,而个体面部的生长预测 ,首先要明确其生长的方向 ;其次要对面部高度和深度的生长变化量进行合理的估计 ,这是决定生长预测的两大基本因素。另外 ,…     

34例髁突骨折伴发外耳道骨折临床分析

目的: 探讨髁突骨折与外耳道骨折的关系及同期手术的必要性。方法: 230例320侧髁突骨折根据骨折线位置不同分为矢状（Ⅰ型）、头部 （Ⅱ型）、颈部 （Ⅲ型）、髁突下（Ⅳ型）4种类型, 随访髁突与外耳道骨折同期手术与否的预后差异。采用SPSS 20.0软件包中的χ²检验,比较不同类别髁突骨折伴同侧外耳道骨折之间的差异。结果: 230例320侧髁突骨折伴外耳道骨折34例46侧,Ⅰ~Ⅳ型分别为12侧、16侧、7侧、5侧,另有6侧外耳道骨折无髁突骨折。Ⅲ型髁突骨折伴同侧外耳道骨折发生率显著低于另外3型（P<0.05）;Ⅰ型髁突骨折伴外耳道骨折的发生率显著高于Ⅳ型（P<0.05）,其他各型之间两两比较无显著差异。22例30侧随访至受伤后6个月,5例8侧在排除外耳道脑脊液漏的情况下,同期行髁突及外耳道骨折治疗,术后6个月外耳道无狭窄,听力无下降;另17例22侧均出现不同程度的外耳道狭窄,其中4例5侧出现严重听力障碍（均为外耳道粉碎性骨折）。结论: 髁突颈部骨折伴外耳道骨折的概率较低,而髁突矢状骨折较基底部骨折更易导致外耳道骨折。治疗颌面部骨折,应早期发现、治疗外耳道骨折,积极预防外耳道狭窄、听力下降等并发症。     

颅颌面部组织的测量研究进展

<正>人类的牙颌、颅面形态结构存在着种族地区差异。因此,在正畸、颌面、整复等医学领域,对不同种族地区背景的个体进行颅颌面畸形的诊断治疗时,必须以其本民族地区的正常人群形态特征作为参考依据。多年来,学者们通过各种测量方法对其进行了     

240例颌面部骨折的回顾性研究

目的 :分析颌面部骨折的致伤原因及流行病学特征。方法 :对 2 40名颌骨骨折病例进行回顾性研究 ,对伤者的年龄、性别、致伤原因、骨折类型、事故发生时间等进行分析。结果 :本组病例以男性居多 ,主要年龄段为2 1-3 0岁 ,多于周六及节假日发生 ,交通事故为致伤的主要原因 ,与其他致伤原因间差异有统计学意义 ( p <0 .0 5 )。结论 :交通事故是造成颌面部骨折的主要原因 ,且以男性居多 ,多发生于 2 1-3 0岁 ,主要发病时间为周末     

颅颌面联合切除术在颌面部恶性肿瘤治疗中的应用

颅颌面联合切除手术是对已侵犯到颅底或颅骨的原发于颌面部的晚期恶性肿瘤,以及原发于颅底下组织的癌瘤的一种治疗方法。早在30多年前,Ketcham和Terz就分别进行了颅前凹、颅中凹的颅颌面联合切除术,并作出了初步评价。以后被推广用于临床,促成了颅颌面联合切除术在晚期颌?..     

颅颌面联合切除术治疗颌面部晚期恶性肿瘤

目的 研究颅颌面联合切除术治疗晚期恶性的临床意义。方法 对１９７８年６月至１９９７年１２月的２０年间在我科行颅颌面联合切除术的４６例患者进行评价。切除颅骨范围 ：颅前窝、颅中窝、有窝和颅中窦联合切除,其中１８便同时行眶内的摘除,１４例有硬脑膜侵犯,行局部硬脑切除术。结果 ３年与５年生存率分别为４８．８％和３５．１％,１０年生存率为２０．０％。结论对晚期头颈部恶性肿瘤患者行颅颌面联合切除术具有一定的     

胚胎颅颌面部发育中的电生理学研究进展

脊椎动物的胚胎有稳定电势差,不同部位和胚胎发育时期的皮肤电势差不同.肢体发育早期就存在生理性电场,正常极性和大小的内源性电场参与神经系统和其他组织的正常发育和空间结构的形成.纤维细胞、神经细胞和大多数上皮细胞都有朝向阴极的趋电性,肌细胞对电场的反应则与其他细胞不同.内向整流钾离子通道Kir2.1在胚胎的颌面部发育中起重...     

Associations between condylar fractures and external auditory canal fracture: A 7-year retrospective study

The study aimed to investigate whether the incidence rate of external auditory canal (EAC) fracture varies among different clinical types of condylar fracture. A retrospective cohort study was conducted in single hospital of China. Eligible patients diagnosed with mandibular condylar fractures were retrospectively reviewed. Among all patients with condylar fractures (318 cases and 437 sides), 45 cases and 59 sides (59/437 sides, 13.5%) were found with EAC fracture, including 17(17/38, 44.7%) sides of sagittal fracture of condyle (Type I), 21(21/59, 35.6%) sides of intracapsular condylar fracture (Type II), 8 (8/306, 2.6%) sides of condylar neck fracture (Type III), and 6 (6/34, 17.7%) sides of condylar base fracture (Type IV). Type III condylar fracture had a significant lower rate of EAC fracture than all other three types (all p<0.001). Type I condylar fracture had a higher rate of EAC fracture compared to Type IV (p=0.014). The incidence rates of EAC fracture in combined Type I+Type II group (38/97, 39.2%) was significantly higher than Type III (8/306,2.6%, p<0.001) and Type IV (6/34,17.7%, p=0.002). A total of 35 sides (27 patients) with combined fractures were followed up for 6 months after treatment, among whom 11 sides (7 patients) were operated for both fractures simultaneously. Neither EAC stenosis nor hearing loss was observed. Meanwhile, for 24 non-operated ears from 20 patients, all EACs showed different degrees of stenosis. In conclusion, oral and maxillofacial surgeons should pay more attention to EAC fracture combined with condylar fracture, especially for patients diagnosed with condylar head fracture. Maxillofacial fractures should be accompanied by early treatment of EAC fractures, in order to prevent EAC stenosis, hearing loss, and other complications.     

A spectrum of auditory canal injuries ensuing from direct or indirect trauma to the temporomandibular joint: A 2-year prospective study

This study aimed to assess various auditory canal injuries in patients with direct or indirect temporomandibular joint (TMJ) trauma, and, in collaboration with an otolaryngologist, evaluate the need for intervention. A prospective study was conducted at the institution. Patients who had sustained trauma to the TMJ were assessed for auditory canal injury through clinical and CT scan examination. All the patients were cross-consulted by an otolaryngologist for diagnosis and eventual management of any auditory canal injury. A close 3-month follow-up was carried out for all patients. Out of 32 cases (64 sides) of TMJ trauma, the following auditory canal injuries were documented: five cases (six sides) with tympanic plate fracture; five cases (five sides) with soft-tissue injury to the EAC; two cases (two sides) with tympanic membrane (TM) perforation; and one case (one side) with external auditory canal (EAC) hematoma (all p < 0.001). Corroborative results for the diagnosis of auditory canal injuries between the oral and maxillofacial surgeon (OMFS) and ENT surgeon were found to be statistically significant (p < 0.001). One case of tympanic membrane perforation required tympanoplasty and the rest were treated by conservative management. No complications were seen after 3 months of follow-up. To conclude, maxillofacial surgeons should perform a thorough bilateral ear examination to rule out any auditory canal injury in all the cases presenting with direct or indirect trauma to the TMJ. Timely management of such injuries should be undertaken by an otolaryngologist before TMJ trauma management to avoid any complications.     

Bisphosphonate-associated osteonecrosis of the auditory canal

Only rare cases of osteonecrosis of the auditory canal associated with bisphosphonates, have been published. Our results confirm that similar reports can also be encountered in databases of adverse drug reactions.     

西帕依固龈液治疗牙龈炎引起的牙龈出血的疗效观察

目的观察西帕依固龈液治疗因牙龈炎引起牙龈出血的效果,为临床治疗提供参考。方法选取2008年6月～2009年3月因刷牙出血来我科就诊的患者,诊断为牙龈炎者125例,男72例,女53例,年龄18～60岁。主要症状为牙龈炎症,探诊出血,牙周袋≤3mm,无附着丧失。将患者随机分成2组,实验组64例,使用西帕依固龈液含漱,对照组61例,使用口泰含漱液;使用方法均为每日3～5次,每次3～5ml,含漱1min,漱后均不再用清水漱口,漱口0.5h内勿饮水和进食;使用4周复查,记录龈沟出血指数情况。评定疗效。采用卡方检验进行统计学分析。结果实验组64例,有效56例,无效8例,有效率为87.5%;对照组61例,有效46例,无效15例,有效率为75.4%。组间有效率差异无统计学意义（P〉0.05）。结论西帕依固龈液对治疗因牙龈炎引起的牙龈出血有一定的疗效,具有较好的临床推广价值。     

获得性凝血因子XIII缺乏症致牙龈出血的临床分析

获得性凝血因子XIII缺乏症极罕见,笔者在临床工作中发现1例以牙龈出血为首发症状的获得性凝血因子XIII缺乏症。对此症进行分析,并对相关文献进行了复习。     

不同方法修复薄弱根管的疲劳抗折性能比较

目的 比较根管重塑后纤维桩核系统及传统铸造桩核修复薄弱根管前磨牙的疲劳抗折性能.方法 将16颗实验牙截冠后制备成薄弱根管,随机分为2组,A组根管重塑+预成纤维桩+树脂核修复;B组传统铸造桩核修复.所有样本全冠修复并进行5000次冷热水循环及30万次循环加载,再以3mm/min的速度静加载至折裂发生,记录2组试件折裂发生时的加载强度、折裂模式.结果 抗折载荷分别为A组1.79±0.26KN和B组2.35±0.22KN,差异有统计学意义.A组多见可再修复性折裂,B组多见破坏性折裂.结论 在本实验条件下,根管重塑后纤维桩核系统修复薄弱根管的疲劳抗折强度不及传统铸造桩核修复,但其折裂模式更有利于牙根的保护.     

Obliteration of the pulp canal caused by mandibular distraction: a case report

We present a 16-year-old boy with a history of ankylosis of the temporomandibular joint (TMJ) who had been treated with a costochondral graft and mandibular distraction. The distraction seems to have caused pulp canal obliteration of the lower right second premolar and lower right first molar on radiographic examination. To our knowledge this is the only reported instance of such damage related to mandibular distraction. We aim to highlight the risks of this complication and the importance of discussing it with patients as part of the process of informed consent.     

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一个成功的根管治疗包括正确的诊断、充分的根管预备和完善的根管充填,而这些步骤成功的基础是对根管形态的充分掌握。变异根管的错误诊断和治疗以及根管遗漏是造成根管治疗失败的主要原因。本文对根管解剖形态、根管数目的确定方法、临床常见的变异根管形态及根管形态研究方法的发展进行简要介绍。