开放手术治疗髁状突纵形骨折

目的 总结分析髁状突纵形骨折的发病、诊断和治疗方法。方法 共收治１１例１４侧髁状突纵型骨折的患者,经过病史、体格检查、Ｘ线片、ＣＴ及三维ＣＴ诊断,选择开放性手术。结果 所有总例在咬合关系、张口度、颞下颌关节区疼痛、弹响、下颌骨运动时偏斜、伤口愈合等方面均获得良好疗效。结论 髁状突纵型骨折虽然较为少见,但必须引起足够重视。正确诊断、精准复位及良好固定是保证开放手术成功的关键。     

双侧升支矢状劈开截骨后退下颌术中去骨的评估研究

目的:评估双侧升支矢状劈开截骨后退下颌术中去除的颊侧骨皮质形状与垂直截骨线的方向和前牙覆变化间的关系,指导临床去骨操作。方法:在头影测量侧位描记图的下颌体部设计3种不同方向的垂直截骨线,用头影测量裁剪预测方法先旋转再后退下颌到术前设计位置,分析最终垂直截骨线与初始垂直截骨线间的角度关系,运用几何学原理计算此角度的大小。评价后退下颌时所需要去除骨皮质大致形状同初始垂直截骨线方向及前牙覆变化间的关系。结果:近心骨段不发生矢状向移位情况下,最终垂直截骨线与初始垂直截骨线间的角度大小与上下颌平面交角保持一致,与初始截骨线的方向和下颌后退的距离大小无关。去除的骨皮质形状与前牙覆变化相关。结论:近心骨段去骨形状与前牙覆变化密切相关,与截骨线方向和下颌后退的距离大小无明显相关。     

Condylar Hyperplasia and Facial Asymmetry: Report of Five Cases

Condylar hyperplasia of mandible is overdevelopment of condyle, unilaterally or bilaterally, leading to facial asymmetry, mandibular deviation, malocclusion and articular dysfunction. This is a series of five such patients managed at our centre.     

头颈部大型神经纤维瘤病手术治疗难点的探讨

目的:探讨头颈部大型神经纤维瘤病(neurofibromatosis, NF)治疗中棘手问题的临床应对措施。方法:对3例头颈部巨型NF的临床资料及治疗过程进行回顾性总结,评估手术安全性、手术原则、手术时机及手术次数。结果:3例头颈部巨型NF经分次手术,病灶均被大部分切除,术中出血量控制好,头颈部外形改善满意,受累眼睛、耳廓、口唇的保留及修复效果均满意。结论:正确把握巨型NF治疗原则、谨慎处理好治疗中的棘手问题可达到满意的效果。     

永生化髁突软骨细胞的血清依赖性生长实验

目的 研究永生化髁突软骨细胞（Immortalizedmandibularcondylarchondrocyte,IMCC）的血清依赖性生长特征。方法 将IMCC和原代培养的躲突软骨细胞（Mandibularcondylarchondrocyte,MCC）接种于96孔板,用MTT法比较两种细胞在无血清培养基,含5％、10％和20％血清培养基中的生长情况。结果 IMCC和MCC均不能在无血清培养基中生长,但可在含5％血清的培养基中生长,其增殖速度明显低于在10％和20％两种血清浓度中细胞的生长速度,而10％和20％两种血清浓度中细胞的生长速度则较接近。IMCC的生长速度快于MCC。结论 IMCC保留了MCC的血清依赖性生长特性,其增殖速度快于MCC,不属于恶性转化细胞。     

髁突矢状骨折继发颞下颌关节强直31例临床分析

目的:探讨髁突矢状骨折继发创伤性颞下颌关节强直的临床特点。方法:回顾性分析2001～2010年武汉大学口腔医院口腔颌面外科收治的31例、48侧继发于髁突矢状骨折的颞下颌关节强直患者的相关临床资料。结果:31例颞下颌关节强直患者平均外伤年龄15.6岁,其中23例(74.2%)外伤年龄小于16岁。病程3月~20年,平均病程6.5年。42侧强直关节的关节盘发生移位,6侧强直关节的关节盘完全破坏。强直关节标本镜下观察:内侧髁突骨折块发生废用萎缩性改变,外侧骨球区见软骨细胞呈灶性增生成骨,关节盘纤维结构紊乱、玻璃样变性。结论:青少年髁突矢状骨折易发生颞下颌关节强直,关节盘的移位损伤是颞下颌关节强直发生的重要条件。创伤性颞下颌关节强直首先发生在关节外侧,融合骨赘的组织病理学表现为软骨化生、成骨。     

Subjective perception of paraesthesia of the lower lip after bilateral sagittal split osteotomy at a district general hospital

Our aim was to assess patients’ perception of paraesthesia of the lower lip after bilateral sagittal split osteotomy (BSSO) at a district general hospital. Patients who had BSSO between August 2013 and August 2014 (n = 46) were asked to score their perception of numbness between 0–10 (0 = normal sensation. 10 = complete loss of sensation/total numbness) one day postoperatively and then weekly for seven weeks, and at three months, 6 months, and one year. Data was collected on score sheets and by regular contact by telephone. Of the 46 operated on, 31 were female and 15 male. Data were available one year postoperatively for 43 patients. Ten of the 92 sides were reported as feeling normal on day 1 postoperatively, three-quarters as feeling normal at six months, and 79 at one year. On multivariate analysis there was no significant difference in postoperative sensation at one year between sides operated on by the registrar (left) and consultant (right) operated (p = 0.76). Our results compared favourably with the limited data available in similarly designed studies.     

Evaluation of condylar surface CT values related to condylar height reduction after orthognathic surgery

This study was performed to evaluate the relationship between condylar height reduction and changes in condylar surface computed tomography (CT) values in jaw deformity patients following orthognathic surgery.Mandibular advancement by sagittal split ramus osteotomy (SSRO) with Le Fort I osteotomy was performed in class II patients, and mandibular setback by SSRO with Le Fort I osteotomy was performed in class III patients. The maximum CT values (pixel values) at five points on the condylar surface and the condylar height, ramus height, condylar square, ramus angle, and gonial angle in the sagittal plane were measured preoperatively and 1 year postoperatively. Disc position was classified as anterior disc displacement (ADD) or other types by using magnetic resonance imaging (MRI).Ninety-two condyles of 46 female patients were prepared for this study. Their temporomandibular joints (TMJs) were divided into two groups based on class (46 joints in class II and 46 joints in class III) and two groups based on the findings (25 joints with ADD and 67 joints with other findings). ADD with and without reduction was observed in two joints in the class III group and in 23 joints in the class II group. The distribution of ADD incidence had not changed 1 year after surgery. Condylar height decreased 1 year after surgery in both class II patients (mandibular advancement) (p < 0.0001) and class III patients (mandibular setback) (p = 0.0306). Similarly, condylar height decreased 1 year after surgery both in patients who showed ADD (p = 0.0087) and those with other types (p = 0.0023). Significant postoperative increases at all angle sites on the condylar surface were found in the class II (p < 0.05) and ADD (p < 0.05) groups.This study showed that an enhanced condylar surface CT value might be one sign of condylar height reduction related to sequential condylar resorption, in combination with ADD.     

Sagittal mandibular development effects on the dimensions of the awake pharyngeal airway passage

Objective:To test the hypothesis that sagittal mandibular development has no effects on the dimensions of the awake pharyngeal airway passage.Materials and Methods:Ninety-one subjects (age 15–25 years) with a normal vertical growth pattern of the mandible, normally positioned maxilla, and various sagittal mandibular developments were divided into three groups based on the sagittal mandibular development. Group I included 37 subjects who had a normally positioned mandible (76° ≤ angle between ‘S,’ ‘N,’ and ‘B’; it represents the antero-posterior position of the maxilla in relation to the anterior cranial base [SNB] ≤ 82°), Group II included 31 subjects in whom the mandible was retrognathic (SNB < 76°), and Group III included 23 subjects in whom the mandible was prognathic (SNB > 82°) in relation to the anterior cranial base. Lateral cephalograms were traced manually to evaluate the pharyngeal airway passage.Results:The length of the soft palate was significantly smaller in mandibular prognathism subjects than in subjects with mandibular retrognathism (P < .01). The thickness of the soft palate was significantly greater among subjects with mandibular prognathism than in subjects with normal (P < .01) and retrognathic (P < .001) mandibular development. The sagittal mandibular development had no effect on the dimensions of the nasopharyngeal and hypopharyngeal airway passage. The depth of the oropharynx was comparable among the subjects with normal and retrognathic mandibles but was greater (P < .001) among subjects with mandibular prognathism.Conclusions:The hypothesis is rejected. Sagittal mandibular development had significant effects on the dimensions of the awake pharyngeal airway passage.     

Comparative evaluation of stress distribution and transverse displacement of novel designs of miniplates for sagittal split ramus osteotomy in 10 mm advancements: a finite element analysis

The aim of this study was to evaluate the stress distribution and displacement values of six different miniplate systems in large mandibular advancement after sagittal split ramus osteotomy (SSRO) with finite element analysis (FEA). A three-dimensional model of a mandible was created and a 10 mm advancement SSRO was simulated. The model was fixed using a four-hole miniplate, a six-hole miniplate, a newly designed six-hole miniplate and their curved versions. Maximum principal stress values for bone, von Mises stress values for osteosynthesis materials, and the amount of displacement between segments were measured. The highest von Mises value was observed in the curved version of the newly designed six-hole miniplate; the lowest value was detected in the four-hole curved miniplate. The lowest value of maximum principal stress in the bone was found in the curved version of the novel design six-hole miniplate. The least displacements between segments were also recorded in the new design of straight miniplate; therefore, for large mandibular advancement surgery, this novel six-hole miniplate may be a promising option with positive biomechanical characteristics.     

弹性牵引治疗上颌骨腭骨正中骨折29例报告

目的 :探讨上颌骨腭骨正中骨折的治疗措施。方法 :对29例上颌骨腭骨正中骨折所形成的裂缝,采用橡皮圈牵引复位术+牙弓夹板颌间牵引复位术(或牵引钉颌间牵引复位术),辅以颅颌固定联合治疗。结果:术后纵向裂口逐渐缩小,骨缝基本拉拢,1月左右CT片显示骨折复位愈合情况良好,拆除全部牵引装置,3月后复查CT显示骨折全部Ⅰ期愈合、咬合关系正常。结论:橡皮圈牵引复位术+牙弓夹板颌间牵引复位术(或牵引钉颌间牵引复位术)辅以颅颌固定联合治疗上颌骨腭骨正中骨折,有利于骨折的复位愈合,能较好地恢复硬腭的形态结构,获得良好的咬合关系,恢复咬合功能。是一种价廉物美、值得推广的好方法。     

下颌下进路行上颌骨切除术3例报道

目的 探讨下颌下进路切除上颌骨与肿瘤的可行性。方法 采用经下颌下进路对3例侵及上颌骨的恶性肿瘤行上颌骨次全切除术。结果 1例行保留眶底的上颌骨扩大切除术，2例行保留部分上颌骨的次全切除术。术后10－14d，创口均一期愈合，无术后并发症；随访3－9月，无肿瘤复发。结论 采用下颌下进路行上颌骨切除要，经临床实践是可行的，尤其适用于侵及上颌骨后份的肿瘤的治疗，具有切口隐蔽，翼腭窝区术野显露好，能保留部分上颌骨等优点，符合肿瘤外科与功能外科的手术原则和要求。     

下颌骨髁突软骨瘤5例报告

发生于下颌骨髁突的软骨瘤罕见，临床报道极少。作者结合1989-2004年间收治的5例髁突软骨瘤患者的临床资料，对该病的临床特点，病理表现，诊断与治疗进行讨论。     

下颌绞链运动轴点稳定性及位置的探讨

本研究的目的在于探讨下颌绞链运动轴点的位置是否恒定以及它是否位于髁突中心点。采用新型的三维下颌运动轨迹描记仪ＭＴ－１６０２测量了１４名健康人在４次重复性实验中，下颌小张闭口运动绞链轴点的稳定性及其与髁突的位置关系。结果表明，下颌后退位的小张闭口运动所测得的绞链轴点位置不恒定，存在瞬间绞链轴点。双侧绞链轴点基本均匀地分布于髁突四周，其距髁突中心点的平均距离为８．８３±５．６５ｍｍ。这一结果对临床正确使用架有直接的参考价值。     

髁突骨折498例临床分析

目的:对本院1984-2003年20a间498名髁突骨折患者进行临床流行病学回顾性研究。方法:研究20年 间498名髁突骨折患者年龄、性别、致伤原因、骨折特点以及合并损伤情况。结果:髁突骨折男性多于女性,发病 年龄高峰为21-30岁,原因以交通事故居多,占47.99％。髁突颈部是最常见骨折部位,骨折片成角移位达56. 03％,下颌骨颏部是伴发髁突骨折最常见的部位。结论:髁突骨折中男性好发,交通事故是首要原因,髁突颈部最 易发生骨折。     

Nonsurgical Management of Internal Derangements: A Report of Three Cases

There is much difficulty involved in prescribing appropriate treatment for patients with internal derangements of the temporomandibular joint. This article presents three case histories in which the patients have well-documented TMJ disk displacements with and without perforations. None of these cases showed adequate response to extensive nonsurgical treatment, and all had come to the point of referral for surgical correction. While the doctors involved felt surgery to be the next step for relief, none of the patients actually went on for surgery. However, within a few months each showed significant improvement. Two to four years later the patients are still managing well without active treatments. These cases underscore the need to improve understanding of the course of internal derangements and of the efficacy of various treatment methods.