腮腺切除术中面神经的解剖和观测

为了探讨面神经颅外段的走行,对120例由于各种原因进行保留面神经的腮腺腺叶切除术的患者,在术中对其面神经出颅后的走行、分支及其与邻近组织的关系等进行了解剖测量观察。观测包括面神经主干的长度、宽度以及各个分支发出的部位,各个分支的解剖特点。结果表明:颞支位置深在,分支较多;颧支位置深在,较粗大,分支相对较少,位置恒定;颊支分为①上下颊支型;②融为一支型;③一支再分型三种情况;下颌缘支位置较表浅,较细且走行长,分支多为2～3支。对手术时如何利用邻近解剖关系正确地寻找面神经进行了分析。     

腮腺切除术中面神经的解剖和观测

为了探讨面神经颅外段的走行，对１２０例由于各种原因进行保留面神经的腮腺腺叶切除术的患者，在术中对其面神经出颅后的走行、分支及其与邻近组织的关系等进行了解剖测量观察。观测包括面神经主干的长度、宽度以及各个分支发出的部位，各个分支的解剖特点。结果表明：颞支位置深在，分支较多；颧支位置深在，较粗大，分支相对较少，位置恒定；颊支分为①上下颊支型；②融为一支型；③一支再分型三种情况；下颌缘支位置较表浅，较细且走行长，分支多为２～３支。对手术时如何利用邻近解剖关系正确地寻找面神经进行了分析。     

耳屏周小切口在腮腺良性肿瘤切除中的应用

【摘要】目的评估耳屏周小切口在腮腺良性肿瘤切除术中应用的临床价值。方法30例腮腺良性肿瘤患者,应用耳屏周小切口行浅叶部分切除、保留面神经和耳大神经的腮腺良性肿瘤切除术。术后随访3～24个月,观察耳屏周小切口的美观度及临床疗效。结果所有患者均临床Ⅰ期愈合,术后腮腺功能良好,无涎瘘发生。随访,患者双侧外形对称,无凹陷等畸形,手术切口隐蔽,患者对耳周切口美学效果满意。本研究中出现术后暂时性面瘫患者2例,皮质激素并配合神经营养药物综合治疗后3个月均恢复正常;出现术后耳垂麻木不适患者4例,手术后3～10个月均逐渐恢复。本研究中所有患者均未出现味觉出汗综合征,无肿瘤复发。结论耳屏周小切口隐蔽、瘢痕小、并发症低,术后美容效果理想。     

改良手术切口在腮腺肿瘤中的应用效果及对面神经功能的影响

目的研究改良手术切口在腮腺肿瘤中的应用效果及对面神经功能的影响。方法选取2014年4月至2016年1月到我院就诊的腮腺肿瘤患者118例,按照随机的方法将其分为观察组和对照组,每组59例,观察组采用改良腮腺切除术治疗,对照组采用传统腮腺切除术治疗,观察两组患者手术情况、术后生活质量以及面神经损伤等并发症发生情况。结果观察组的住院时间明显短于对照组,差异具有统计意义(P<0.05)。观察组的面神经损伤率(11.9%)明显少于对照组(32.2%),两组差异具有统计意义(P<0.05)。且观察组患者的并发症发生率为5.1%,而对照组为37.3%,两组比较差异明显,具有统计意义(P<0.05)。术后6个月时观察组患者的生活质量评分(QOL)明显高于对照组,差异有统计意义(P<0.05)。结论改良腮腺切除术治疗腮腺肿瘤疗效显著,并发症少、面神经损伤小、住院时间短,术后生活质量也得到改善,值得临床推广应用。     

耳后入路行腮腺区域性切除的临床效果分析

目的:探讨耳后入路行腮腺区域性切除的可行性及美容效果。方法:对31例腮腺下极浅叶良性肿瘤(多形性腺瘤15例,沃辛瘤11例,基底细胞腺瘤2例,脂肪瘤2例,淋巴管畸形1例)患者,采用耳后入路行腮腺区域性切除。结果:全部患者的腮腺病变被完整切除,切口愈合良好,无面神经下颌缘支麻痹,无涎液潴留、涎瘘发生及Frey征出现。经6个月～5年(平均26个月)追踪复查,肿瘤无复发,切口瘢痕隐蔽,美容效果非常好。术后有2例患者出现耳垂麻木,随访3个月后,麻木消失。结论:经耳后入路切除腮腺良性病损是可行的,可获得较理想的美容效果。     

V形隐蔽切口与局段S形切口SP手术治疗腮腺良性肿瘤的疗效及安全性

目的 探讨V形隐蔽切口与局段S形切口腮腺切除术（SP）手术治疗腮腺良性肿瘤的疗效及安全性。方法 回顾性分析浙江省宁波市北仑区人民医院在2017年6月至2022年6月收治的56例腮腺良性肿瘤的临床资料。根据手术的不同切口分为观察组和对照组两组,观察组28例采用V形隐蔽切口,对照组28例采用局段S形切口。比较两组患者手术指标,包括手术时间、切口长度、引流量、出血量及住院时间;随访3个月,比较两组患者并发症发生率,包括腮瘘、面瘫、耳垂区域麻木、面部凹陷等;采用温哥华瘢痕量表（VSS）表比较两组手术的美容效果及患者对手术满意度。结果 观察组术中出血量、切口长度、引流量、住院时间均低于对照组（P<0.05）,两组手术时间比较无明显差异（P>0.05）;观察组于术后1天出现2例短暂性面瘫,1例腮瘘,2例短暂耳垂区域麻木,对照组出现4例短暂性面瘫,2例腮瘘,4例短暂耳垂区域麻木,经治疗3个月后复查时均恢复,观察组并发症总发生率低于对照组（P<0.05）;观察组VSS评分低于对照组,满意度高于对照组（P<0.05）。结论 V形隐蔽切口相较于局段S形切口治疗腮腺良性肿瘤疗效更显著...     

腮腺美容切口治疗腮腺肿瘤临床效果探讨

目的：探究腮腺美容切口治疗腮腺肿瘤的临床效果。方法：选取2017年1月-2020年2月笔者医院收治的106例腮腺肿瘤患者为研究对象。根据随机数字表法分为观察组(52例)和对照组(54例),对照组采用传统S形切口入路切除术,观察组采用V形切口入路切除术。观察两组手术效果、美学效果、面神经功能、生活质量及并发症情况。结果：观察组手术时间、切口长度、住院时间均短于对照组,术中出血量、术后引流量低于对照组(P<0.05);观察组术后用温哥华瘢痕量表与患者和观测者瘢痕评价量表评分低于对照组(P<0.05),差异有统计学意义。观察组术后H-B面神经功能评分高于对照组;观察组术后生活质量评分高于对照组,差异均有统计学意义(均P<0.05)。与对照组比较,观察组口干、面部凹陷畸形、Frey’s 综合征、暂时性面瘫及术区麻木发生率均较低,差异有统计学意义(P<0.05)。结论：V形切口入路治疗腮腺肿瘤的疗效、美学效果及面神经功能较传统S形切口入路好,有利于提高患者生活质量,改善术后并发症发生情况。     

除皱美容切口在腮腺良性肿瘤手术中的应用

目的:探讨除皱美容切口在腮腺良性肿瘤手术中的临床疗效和美容效果。方法:腮腺良性肿瘤26例,采用美容切口、保留腮腺主导管的区域性切除,并对术后临床疗效和美容效果3~18个月的随访。结果:所有患者均达到I期愈合,无涎瘘和感染发生,术后切口隐蔽、瘢痕不明显,腮腺区外形良好,腮腺分泌功能基本正常。患者对面容和功能的恢复均较满意,肿瘤无复发。结论:应用除皱美容切口的腮腺良性肿瘤切除术既保证了手术的整体质量,又取得了较好的术后美学效果。     

改良S形切口入路腮腺切除术治疗腮腺肿瘤的美学效果研究

目的：探讨改良S形切口入路腮腺切除术治疗腮腺肿瘤的美学效果。方法：选取2018年1月-2021年1月就诊于笔者医院口腔颌面外科并行手术治疗的69例患者,其中34例采用改良“S”形切口入路腮腺切除术作为观察组,35例采用常规腮腺切除术作为对照组。采用视觉模拟量表评估术后美学效果和满意度;记录两组住院时间、手术时间及术中出血量;采用华盛顿大学生存质量问卷(University of Washington quality of life questionnaire,UW-QOL)对患者术后半年的生活质量进行评分;统计两组并发症发生率。结果：观察组美学效果和满意度评分高于对照组,差异有统计学意义(P<0.05)。两组手术时间、术中出血量比较差异无统计学意义(P>0.05);但观察组住院时间短于对照组,差异有统计学意义(P<0.05)。观察组术后情绪、疼痛、唾液、咀嚼、味觉各项生活质量评分均高于对照组,差异有统计学意义(P<0.05)。观察组并发症发生率为8.82%低于对照组的28.57%,差异有统计学意义(P<0.05)。结论：改良“S”形切口入路腮腺切除术可提高...     

美容切口在腮腺良性肿瘤手术中的应用

目的:探讨美容切口在腮腺良性肿瘤手术中的应效果。方法:68例患者随机分为两组,一组采用传统手术切口,另一组采用腮腺美容切口,两组手术方法均应用腮腺部分浅叶切除术、浅叶切除术和全叶切除术,随访观察该切口的美观程度以及临床疗效。结果:腮腺美容切口术后满意度显著高于传统组,手术时间、出血量、引流量、拔管时间、住院期、复发、暂时性面瘫、涎瘘和味觉出汗综合征的发生率比较,两组无统计学意义。结论:美容切口入路隐蔽,美容效果好,术后患者有较满意的面部外形,较传统手术切口有其优越性。     

下颌角区域主要血管、神经解剖学研究及其临床意义

目的：研究下颌角区域主要血管、神经的解剖学特点。方法：选取10例成人头颅标本,对下颌角区域主要血管、神经进行解剖观察和测量。观察内容包括：主要血管、神经的走行及其与下颌角的位置关系。结果：面动、静脉在下颌骨下缘水平距下颌角（30．06±4．25）mm、（27．55±4．02）mm;下颌后静脉距下颌骨升支后缘（3．00±0．56）mm,距下颌角（12．20±1．09）mm;面神经下颌缘支出腮腺位置距离下颌角（10．36±0．41）mm。结论：对下颌角区域主要血管、神经解剖学特点研究,总结一般规律,为下颌角区域手术提供解剖学依据。     

保留胸前神经和肋间臂神经的横切口乳腺癌改良根治术(附40例临床分析)

目的：探讨在乳腺癌改良根治术中采用横切口，并保留胸前神经和肋问臂神经，对术后皮瓣成活、胸大小肌功能、患侧上臂感觉功能的影响。方法：40例乳腺癌均采用横切口乳腺癌改良根治术，清扫时注意保留胸前神经及肋问臂神经。术后检查胸大小肌萎缩情况和患侧上臂内侧的感觉、运动功能变化。结果：术后发生切口皮瓣坏死3例，胸大小肌无明显萎缩，28例保留肋问臂神经患侧上臂内侧皮肤感觉良好，活动自如。结论：保留胸前神经，肋间臂神经的横切口乳腺癌改良根治术减少了术后并发症的发生率，改善了生存质量。     

Safety Profile of Bone Marrow Mononuclear Stem Cells in the Rehabilitation of Patients with Posttraumatic Facial Nerve Paralysis—A Novel Modality (Phase One Trial)

Objectives The objectives of this study were to study the safety profile and role of mononuclear stem cells in the rehabilitation of posttraumatic facial nerve paralysis not improving with conventional treatment.Study Design This is a prospective nonrandomized controlled trial.Study Setting This study is conducted at Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh between July, 2007 and December, 2008.Patients We included eight patients of either sex aged between 18 and 60 years of posttraumatic facial nerve paralysis not improving with conventional treatment presented to PGIMER, Chandigarh between July 2007 and December 2008.Methods All patients underwent preoperative electroneuronography (ENoG), clinical photography, and high-resolution computed tomography (HRCT) temporal bone. All patients then underwent facial nerve decompression and stem cell implantation. Stem cells processing was done in well-equipped bone marrow laboratory. Postoperatively, all patients underwent repeat ENoG and clinical photography at 3 and 6 months to assess for objective and clinical improvement. Clinical improvement was graded according to modified House–Brackmann grading system.Intervention Done All patients of posttraumatic facial nerve paralysis who were not improving with conventional surgical treatment were subjected to facial nerve decompression and stem cell implantation.Main Outcome Measures All patients who were subjected to stem cell implantation were followed up for 6 months to assess for any adverse effects of stem cell therapy on human beings; no adverse effects were seen in any of our patients after more than 6 months of follow-up.Results Majority of the patients were male, with motor vehicle accidents as the most common cause of injury in our series. Majority had longitudinal fractures on HRCT temporal bone. The significant improvement in ENoG amplitude was seen between preoperative and postoperative amplitudes on involved side which was statistically significant (0.041). Clinical improvement seen was statistically significant both for eye closure (p < 0.010) and for deviation of angle of mouth (p < 0.008) at 6-month follow-up in 85% of our patients, far better than the results of previous conventional surgeries.Conclusion Stem cell therapy can be used safely in human beings without any adverse effects on humans, and it appears to be a promising modality for rehabilitation of patients with posttraumatic facial nerve paralysis not improving with conventional surgical treatment but few more clinical series are required for validation.     

Bikini Incision Increases the Incidence of Lateral Femoral Cutaneous Nerve Injury in Direct Anterior Approach Hip Arthroplasty: A Prospective Ultrasonic,Electrophysiological, and Clinical Study

BackgroundLateral femoral cutaneous nerve (LFCN) injury has been widely reported as one of the most common complications of direct anterior approach (DAA) hip arthroplasty. Bikini incision is considered to increase the incidence of this complication.MethodsA prospective randomized study was conducted after including ninety-nine bikini and ninety-six longitudinal incision DAA cases from May to November 2020. The occurrence of LFCN was examined using ultrasound before and after surgery. The recovery of injury symptoms was evaluated by continuous clinical follow-up until six months, and the patients were treated with mecobalamin and/or celecoxib. Sensory conduction velocity and sensory action potential amplitude of the LFCN were measured after surgery in symptomatic patients.ResultsEighty five (43.6%), sixty seven (34.4%), and forty three (22.0%) cases of LFCN were of the anterior trunk, posterior trunk, and fan types, respectively, before surgery. All one hundred ninety five patients completed the follow-up period. Fifty-seven patients had symptoms of LFCN injury, including thirty six and twenty one patients in the bikini group and longitudinal group, respectively, with significantly different incidence rates (36.4% and 21.9%, respectively; P < .05). Of these, thirty two (56.1%), thirteen (22.8%), and twelve (21.1%) cases were of the anterior trunk, posterior trunk, and fan types, respectively. Sensory conduction velocity and sensory action potential amplitude significantly decreased after surgery in both groups (P < .05). Seventeen cases showed reduction of symptoms within three months. Forty six cases showed self-recovery within six months and eleven cases showed persistent symptoms at the final follow-up.ConclusionBikini incision DAA hip arthroplasty may increase the incidence of LFCN injury, and the anterior trunk distribution type is most likely to be affected. (Clinical Trial Registration Number: CHICTR2000035107).     

腓肠神经营养血管皮瓣修复足踝部皮肤缺损

目的 探讨改进腓肠神经营养血管皮瓣修复足踝部皮肤软组织缺损的方法及效果.方法　2003年1月至2011年1月,在腓动脉穿支与腓肠神经营养血供的解剖基础上,根据足踝部皮肤缺损大小,设计腓肠神经营养血管皮瓣,逆行移位修复足踝部皮肤软组织缺损13例.切取皮瓣而积9 cm×8.5 cm～ 28 cm×13 cm,穿支血管蒂长1.7～3.3 cm.结果　本组中11例皮瓣全部存活,2例皮瓣远端边缘坏死,经换药治愈.全部患者随访6～12个月,皮瓣外形及功能满意.结论　腓动脉穿支蒂腓肠神经营养血管皮瓣手术操作简便,血供可靠,切取面积大,适用于修复足踝部大面积皮肤软组织缺损.