腮腺淋巴结结节病一例报告并文献复习

目的：提高对腮腺淋巴结结节病的认识。方法：对1例病理确诊为腮腺淋巴结结节病患者的临床资料进行分析，并结合相关文献进行讨论。结果：结节病是一种原因不明的多系统疾病，以非干酪样坏死性肉芽肿炎症为主要病理特征。临床上大约90％的患者有肺部病变，单发于腮腺淋巴结罕见。该患者术前诊断为多形性腺瘤，手术切除后随访10年未复发。结论：腮腺淋巴结结节病患者易被误诊为肿瘤，病理活检对于结节病的确诊至关重要，手术切除是最有效的治疗方法。     

小腿内侧皮瓣在口腔颌面部术后缺损修复中的应用

目的：评价小腿内侧皮瓣在口腔颌面软组织缺损修复中的价值。方法：对2例累及舌腹部及下颌舌侧骨板的口底鳞癌．行原发灶根治术及保留颏部下缘的颏部截除术：4例舌癌均行原发灶根治术．术中保留下颌舌侧牙龈，未行下颌骨骨段切除术：2例颊部鳞癌患者行保留下颌骨下缘的原发灶根治术；8例患者均行颈淋巴清扫术．术中解剖出面动脉、颈外静脉和颈前静脉，再根据口腔缺损的范围制备相应大小及形状的皮瓣，皮瓣以胫后动、静脉为蒂。将皮瓣的胫后动脉与面动脉吻合，将皮瓣的胫后静脉与颈外静脉（或颈前静脉）吻合．然后将皮瓣与缺损区边缘严密缝合。结果：8例小腿内侧皮瓣均获得成功，口内、外伤口愈合良好，修复效果良好，覆盖于小腿内侧皮肤缺损区的皮片全部成活。结论：小腿内侧皮瓣适用于舌、口底、颊部及面颈部软组织缺损的修复。口腔颌面部肿瘤术后软组织缺损．可利用携带部分比目鱼肌的小腿内侧皮瓣进行修复。     

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目的：评价口腔颌面部脉管畸形的手术治疗的临床疗效。方法对2008年6月至2012年10月中国医科大学口腔医学院口腔颌面外科收治的112例口腔颌面部脉管畸形患者,均采用手术切除治疗,病变切除后直接拉拢缝合83例,邻近皮瓣转移修复19例,中厚皮片移植修复10例。随访观察术后效果。结果术后病理进一步证实,静脉畸形67例、微静脉畸形8例、淋巴管畸形4例、淋巴-静脉畸形24例、动静脉畸形9例。术后1例患者发生皮片感染,化脓部分坏死,患区给予湿敷换药后创面二期愈合。随访6个月至5年,治愈105例,其余7例于术后3～10个月复发,其中1例淋巴-静脉畸形、4例动静脉畸形、2例静脉畸形。复发的静脉畸形患者,病变内注射平阳霉素后均治愈;其他复发患者均再次手术切除后治愈。结论手术切除治疗口腔颌面部脉管畸形在外形和功能上均可获得满意疗效,而且安全。     

腮腺淋巴结结节病一例报告并文献复习

目的：提高对腮腺淋巴结结节病的认识。方法：对1例病理确诊为腮腺淋巴结结节病患者的临床资料进行分析,并结合相关文献进行讨论。结果：结节病是一种原因不明的多系统疾病,以非干酪样坏死性肉芽肿炎症为主要病理特征。临床上大约90％的患者有肺部病变,单发于腮腺淋巴结罕见。该患者术前诊断为多形性腺瘤,手术切除后随访10年未复发。结论：腮腺淋巴结结节病患者易被误诊为肿瘤,病理活检对于结节病的确诊至关重要,手术切除是最有效的治疗方法。     

上颌骨全切除术改良的手术径路

目的　根据上颌骨解剖学上的特点 ,结合各类手术径路的优点 ,设计一种改良的上颌骨全切除术的手术径路 ,旨在改善术后的外形与功能。方法　共有 17例患者采用了该上颌全切除术的手术径路 ,即 :切口设计在下唇 ,沿颏面沟与颌下、腮腺耳前切口连接至同侧发际。切口设计依据为避开上颌区 ,隐蔽切口位于面颌部正常的皮肤皱折区 ,术中对面神经下颌缘支、下颊支、颏神经、腮腺导管以及内眦部等均加以保存。其中行上颌骨全切除 14例 ,次全切除 3例。结果　经 1～ 12个月术后随访 ,疗效满意。其中 11例术后放疗患者均未出现任何皮肤坏死及下颌水肿。因保存了面神经下颌缘支和下唇肌支 ,仅 1例发生轻度口角歪斜畸形。结论　本文提出的上颌骨全切除术改良的径路 ,能充分暴露并完整切除上颌骨肿瘤 ,术后有较满意的外形及功能 ,可作为上颌骨全切除的一种常规手术径路。若病变超过上颌骨区的范围 ,则不应采用本文介绍的手术径路     

隐蔽切口入路内镜辅助颈部肿物切除效果初探

目的探索评价颌面部隐蔽切口入路内镜辅助下颈部良性肿瘤切除的新术式。方法选取2018年1月至2019年8月于山东大学齐鲁医院口腔颌面外科就诊的颈部良性肿瘤患者17例(颏下区3例,下颌下区2例,腮腺后下极9例,胸锁乳突肌上区1例,胸锁乳突肌中区1例,胸锁乳突肌下区1例)。术前行CT检查,评价肿瘤大小、边界、形态、性质,根据肿瘤所在区域设计不同部位隐蔽切口,颏下区及下颌下区肿物选用口内前庭沟入路,腮腺后下极及胸锁乳突肌区肿物选用耳后隐蔽小切口入路。术中采用自制的"口腔手术用造腔装置"辅助牵拉完成颈部"造腔",内镜辅助下将肿物完整摘除,术后每3个月定期随访。结果所有手术均按预期完成,术后3个月复查时,视觉模拟量表平均为9.3分,患者对切口设计及手术整体效果均表示满意,术后1~15个月随访均未见复发。结论采用隐蔽切口入路内镜辅助颈部良性肿物切除是一种切口不明显、具有良好美容效果的手术方法。     

口腔颌面部朗格汉斯细胞组织细胞增生症30例临床分析

目的：探讨口腔颌面部朗格汉斯细胞组织细胞增生症的临床特点及治疗方法。方法：采用病例回顾性研究方法,对30例口腔颌面部朗格汉斯细胞组织细胞增生症病例的临床表现、治疗和预后进行分析。以1997年wH0的临床分型为依据,采用以切除术或刮治术为主的治疗方法,病变累及范围较广者,辅以放疗和（或）化疗。对12例患者的随访结果进行分析。结果：男18例,女12例,中位年龄8岁;66．7％的病例病变累及下颌骨。影像学主要表现为骨组织破坏和软组织侵犯。对病变局限的14例患者采用单纯手术治疗;病变范围较广、累及骨外软组织的6例患者,采用手术加术后放疗;对有明显全身症状的5例患者,采用手术配合化疗。随访的12例患者中,无病生存10例。结论：口腔颌面部朗格汉斯细胞组织细胞增生症有一定临床特点．采取相应的治疗方法．预后较好。     

颌面部脊索瘤伴颈部淋巴结转移1例

脊索瘤起源于胚胎性脊索残留组织，较为少见。最常发生于脊柱两端，如骶尾部、蝶枕部等，手术切除后复发率高，但发生转移较少。作者遇到一例颌面部脊索瘤伴颈部淋巴结转移，报告如下：患者，男性，41岁，主因左腮腺区肿物术后复发于1995年3月14日住院治疗。20年前，患者左耳下长一肿物，约蚕豆大小，有时有针刺样疼痛，未曾治疗。肿物缓慢增大，1年前长至鸡蛋大小，遂在当地医院行肿物切除术。术后2个月肿物复发，生长较快，再次行肿物及面神经切除术（术后病理结果不详）。术后2个月肿物再次复发而来我院治疗。口腔颌面部检查：左腮腺区肿…     

下颌神经多分支切除治疗三叉神经痛疗效观察

目的:为提高三叉神经痛手术治愈率,减少术后复发,采用口腔内手术径路,实施下颌神经切断及多分支切除后,进行术后观察及疗效评估。方法:对16例原发性三叉神经第Ⅲ支痛患者切断下颌神经及对其各分支(包括舌、颊、下牙槽、颏神经)进行切除。结果:术后观察3～5年未见复发,舌、颊、下牙槽、颏等神经分支区域仍有麻木感。结论:对原发性三叉神经第Ⅲ支痛采取下颌神经切断及各分支切除术,可以提高治疗效果。     

口腔颌面部脉管畸形112例手术治疗效果评价

目的 评价口腔颌面部脉管畸形的手术治疗的临床疗效。方法 对2008年6月至2012年10月中国医科大学口腔医学院口腔颌面外科收治的112例口腔颌面部脉管畸形患者,均采用手术切除治疗,病变切除后直接拉拢缝合83例,邻近皮瓣转移修复19例,中厚皮片移植修复10例。随访观察术后效果。结果 术后病理进一步证实,静脉畸形67例、微静脉畸形8例、淋巴管畸形4例、淋巴-静脉畸形24例、动静脉畸形9例。术后1例患者发生皮片感染,化脓部分坏死,患区给予湿敷换药后创面二期愈合。随访6个月至5年,治愈105例,其余7例于术后3～10个月复发,其中1例淋巴-静脉畸形、4例动静脉畸形、2例静脉畸形。复发的静脉畸形患者,病变内注射平阳霉素后均治愈;其他复发患者均再次手术切除后治愈。结论 手术切除治疗口腔颌面部脉管畸形在外形和功能上均可获得满意疗效,而且安全。     

Diagnosis of systemic sarcoidosis prompted by orofacial manifestations: a review of the literature

BACKGROUND: Sarcoidosis is a multifactorial systemic inflammatory disorder of unknown origin characterized by many potential signs and symptoms, as well as by the presence of noncaseating granulomas in the organs involved. Sarcoidosis also may manifest in the oral and maxillofacial region. CASE DESCRIPTION: The authors describe a patient with xerostomia, dysgeusia, oral burning, xerophthalmia and bilateral parotid enlargement. She was diagnosed as having systemic sarcoidosis on the basis of the histologic findings of a biopsy of the labial minor salivary gland, as well as subsequent diagnostic evalutons. CONCLUSION AND CLINICAL IMPLICATIONS: Enlargement of major salivary glands may be the first sign of sarcoidosis in a patient with few other symptoms or clinical findings suggestive of the disease. This case emphasizes the importance of including sarcoidosis in the differential diagnosis of bilateral parotid swelling associated with xerostomia. It also highlights the dentist's potential role in the diagnosis and dental treatment of patients with systemic sarcoidosis.     

面部口腔洞穿性缺损前臂皮瓣折叠修复临床研究

目的：总结前臂皮瓣折叠修复颌面部洞穿性缺损的临床应用及特点。方法：9例恶性肿瘤根治术后,颊部口腔软组织洞穿性缺损5例,颏部皮肤及下唇黏膜缺损3例,颊部、口腔及下颌骨硬软组织缺损1例。应用前臂皮瓣一期折叠修复口腔颌面部的洞穿性缺损,前臂皮瓣的一部分修复口腔黏膜,一部分修复面部缺损。结果：9例前臂皮瓣术后全部存活。术后随访2～48周,颌面部外形恢复及口腔功能恢复满意。结论：前臂皮瓣折叠修复颌面部洞穿性缺损效果可靠,外形满意,值得临床推广应用。     

Localized B-cell non-Hodgkin's lymphoma of oral cavity and maxillofacial region: a clinical study

OBJECTIVE: Non-Hodgkin's lymphomas (NHL) are the third most common group of malignant lesions in the oral cavity and maxillofacial region. Most such lymphomas have been shown to be predominantly of B-lineage. The purpose of the present study is to analyze the clinical signs and symptoms and the clinical staging of B-cell NHL of this region. STUDY DESIGN: Eighteen adults, with B-cell NHL manifestations of the oral cavity and maxillofacial region, were available for this study. The clinical stage according to the Ann Arbor system was assessed by history, physical, and laboratory examination. Hematoxylin and eosin--stained slides and paraffin blocks were available for all cases. Histologic diagnosis was based on the WHO classification of tumors. RESULTS: The mean age of patients at the time of biopsy was 64 years. At the time of the disease presentation, according to the Ann Arbor system, 11 patients were in stage IE, 2 patients in stage IIE, 2 patients in stage IIIE, 1 patient in stage IVE, and 2 patients in stage IV. The typical clinical appearance was a painless local mass lateral or bilateral. Often there is a superficial ulceration of the tumor mass. Tonsillar NHL was the most frequent site occurring in 8 patients followed by NHL of the oral cavity, of the salivary glands, and of the mandible. Grading revealed that most cases were high grade (11 cases), followed by the cases of low grade (5 cases) and intermediate grade (2 cases). All the different histologic types may be observed, but the most frequently encountered is the diffuse large type. CONCLUSIONS: The B-cell NHL may involve both osseous and soft tissues of the oral cavity and maxillofacial region. The favored sites are tonsils, palatal mucosa and parotid glands. The typical clinical appearance is a painless local mass lateral or bilateral. Often there is a superficial ulceration of the tumor mass. According to the Ann Arbor system, the majority of the cases at the time of diagnosis are in stage I or II. Most patients have high grade disease. All the different histologic types may be observed, but the most frequently encountered is the diffuse large type.     

多原发恶性肿瘤合并口腔病变的临床研究

目的 探讨多原发恶性肿瘤患者合并的口腔颌面部恶性肿瘤的临床特点和诊治原则。方法 收集21例合并口腔颌面部恶性肿瘤的多原发恶性肿瘤患者,对其临床资料进行回顾性分析。结果 21例患者共发生44个恶性肿瘤,其中24个位于消化道及呼吸道,10个位于涎腺、乳腺及女性生殖系统,其他10个发生于头皮、耳前区皮肤、甲状腺、膀胱及血液系统。发生于口腔颌面部的恶性肿瘤共25个,主要的病理类型是鳞状细胞癌,其次是腺样囊性癌;常见的发生部位是舌,其次是腮腺、颌下腺、颊黏膜及牙龈。结论 在口腔颌面部,舌及涎腺是多原发恶性肿瘤的好发部位,与消化道、呼吸道密切相关,应对患者进行长期的认真的随访;对于女性患者,乳腺及生殖系统应是检查的重点。定期随访、早发现、早诊断及积极有效的治疗有助于提高患者生存质量。     

Value of gallium-67 scanning in differentiation of malignant tumors from benign tumors or inflammatory disease in the oral and maxillofacial region

OBJECTIVE: The purpose of this study was to evaluate the efficacy of gallium-67 ((67)Ga) scanning in the differentiation of malignant tumors from benign tumors or inflammatory disease in the oral and maxillofacial region.Study design Fifty-two patients with tumors or inflammation in the oral and maxillofacial region underwent (67)Ga scanning. The results were compared with the final pathologic diagnosis. RESULTS: The gallium-67 scanning images for 20 of 21 patients who had malignant tumors were positive (95.23%); images for 3 out of 20 patients who had benign tumors also were positive (15%). There was a significant difference between malignant and benign tumors (P <.001). Images for 2 of 11 patients with chronic inflammatory lesions were positive (18.2%), but, unlike the images of malignant tumors, the image outlines of the inflammatory lesions were indistinct and larger than the actual lesions. CONCLUSION: (67)Ga scanning is a useful adjunct tool for differentiation of malignant tumors from benign tumors or inflammatory disease in the oral and maxillofacial region.     

口腔颌面部结核52例临床分析

目的探讨口腔颌面部结核的发病趋势与临床变化,以提高临床诊治水平.方法回顾分析我院1995年1月～2004年12月间52例口腔颌面部结核的临床资料.结果口腔颌面部结核以单一病灶包块型为主,占38例,主要侵犯淋巴结;溃疡型5例,主要累及口腔粘膜;其它9例.52例中仅4例有结核病史(7.69%).手术加系统性药物治疗40例,以药物治疗为主12例,全部病例痊愈,无并发症,经6个月～2年随访无复发.结论口腔结核的既往典型特征已不明显,临床表现与局部病变密切相关,活检能明确诊断.冶疗以手术加药物治疗相结合;多部位结核、粘膜结核、骨结核以药物治疗为主.     

Cardiac sarcoidosis: an overview of management for the patient requiring oral and maxillofacial surgery.

PURPOSE: The study goal was to present a current definition of sarcoidosis and an overview of cardiac involvement and implications in perioperative management of cardiac sarcoidosis. MATERIALS AND METHODS: Materials included a retrospective review of 4 patients with cardiac sarcoidosis who underwent minor oral surgery. Laboratory data, medical data, and data obtained through monitoring the patient's general condition related to the surgery were critically analyzed. RESULTS: Preoperative understanding of cardiac pathophysiology, evaluation of the patient's general condition, laboratory data, medical records, and physician correspondence were important, as was precise treatment planning against cardiac emergencies that could occur in surgical treatments. It was essential to monitor vital signs, any electrocardiographic changes, blood pressure, and heart rate, starting from the pretreatment period and continuing through the oral and maxillofacial surgery into the post-treatment period. Glucocorticosteroid coverage and prevention of endocarditis were also considered during oral and maxillofacial surgery planning. CONCLUSIONS: Critical issues were identified in the performance of oral and maxillofacial surgery for patients with cardiac sarcoidosis.     

Ultrasonographic study of cystic diseases in the oral and maxillofacial region

Fourteen cases of oral and maxillofacial cysts were evaluated by means of ultrasonography. The pathologic diagnoses were as follows; 5 epidermoid or dermoid cysts, 5 branchial cysts, 3 mucoceles and 1 thyroglossal duct cyst. Epidermoid or dermoid cysts were detected as the solid patterns in the ultrasonographic images. In the cases located submentally, the boundary echoes were not so clear and smooth as those of the branchial cysts, because of the difficulties to differentiate the cyst wall and the surrounding muscle layers. In many cases, strong homogeneous internal echoes were detected, whose echo levels were the same as that of the submandibular gland. All branchial cysts were detected as solid patterns, and in 4 cases homogeneous internal echoes were found, whose echo levels were less than that of the submandibular gland. Mucoceles showed a cystic pattern. For the ultrasonographic diagnosis of the cervical region, the submandibular gland and the mylohyoid muscle play an important role for comparing their echogenecities with the lesions.