口腔颌面部恶性肿瘤治疗指南

口腔颌面部恶性肿瘤约占全身恶性肿瘤的3%～5%,其组织病理学类型多样,以鳞状细胞癌最多见,约占90%以上。由于解剖部位特殊,口腔颌面部恶性肿瘤不仅影响外观,而且造成咀嚼、吞咽、呼吸和语音等功能障碍,严重降低患者的生存质量,并危及生命。手术、放疗和化疗是治疗口腔颌面部恶性肿瘤的3大治疗手段,免疫治疗、生物治疗对某些类型的肿瘤和晚期患者是必要的补充和辅助措施。早期患者以手术治疗为主,晚期患者则提倡综合序列治疗,并鼓励患者参加临床试验。口腔颌面部恶性肿瘤患者的5年总生存率在65%左右,晚期患者的5年生存率不足30%。为了规范口腔颌面部恶性肿瘤的治疗,进一步提高患者的远期生存率,中华口腔医学会口腔颌面外科专业委员会肿瘤学组牵头,组织国内从事口腔颌面部恶性肿瘤治疗的知名专家,参考国内外文献,尤其是2009年美国NCCN指南中的相关内容,撰写了《口腔颌面部恶性肿瘤治疗指南》,希望对口腔颌面部恶性肿瘤的规范治疗起到指导作用。随着医学科学技术的发展,新的技术、方法、药物会不断出现,本指南将及时予以更新,以反映和纳入最新的研究成果,为广大患者提供最新的治疗方案。     

头颈部恶性肿瘤化疗期间镇吐治疗临床分析

剧烈的恶心和呕吐是化疗中常见的副作用之一。众所周知 ,长期以来 ,各种镇吐治疗的效果及安全性 ,直接影响病人治疗期间的生活质量及化疗效果 [1]。作者通过三组不同的镇吐治疗效果比较 ,并对照使用安慰剂 ,分析其优缺点 ,现报告如下。1　材料和方法1 .1　研究对象40例口腔颌面部恶性肿瘤患者 ,以头颈部鳞癌、低分化癌、鼻咽癌及恶性淋巴瘤为主 (见表 1 )。年龄 2 0～ 60岁 ,男∶女为 1 .5∶ 1 ,随机分为 4组 ,每组 1 0人。所有患者此前未曾接受过放化疗 ,无临床可检出的远端转移 ,无严重的胃肠道疾病和严重的全身系统性疾病 ,没有毒品瘾。…     

口腔颌面-头颈部静脉畸形诊治指南

静脉畸形是常见的良性病变,约40%发生于头颈部,严重影响患者的容貌和功能,甚至可并发大出血或呼吸道梗阻而危及生命。目前采用的治疗方法有手术、激光、硬化剂注射等。小而浅表的静脉畸形治疗较为简单,效果良好;而累及多个解剖分区的深部、广泛病变治疗困难,是临床上面临的一大挑战。对于复杂病例,单一治疗方法的效果欠佳,需根据患者的病情和医疗机构的技术条件,制定个体化治疗方案,采用综合序列治疗,以期获得最佳疗效。本文参考国内外相关文献和诊治经验,制定口腔颌面-头颈部静脉畸形诊治指南,希望对临床规范治疗起到指导作用。本指南将及时予以更新,以反映和纳入最新研究成果,为广大患者提供最好的治疗方案。     

头颈部恶性肿瘤颈淋巴转移的MRI诊断

MRI成像技术。由于其良好的软组织分辨率。对头颈部恶性肿瘤颈部淋巴结转移的诊断有独特的优点及相当高的准确率。远远超过传统的颈部触诊。因此。MRI可指导头颈部恶性肿瘤的临床分级、分期、放疗和化疗和疗效评估。帮助选择较佳的颈淋巴清扫的术式、作者就MRI的技术特征。颈部转移性淋巴结的MRI特征表现及颈部淋巴结MRI的诊断价值等方面的最近进展进行了综述报道。     

头颈部恶性肿瘤颈淋巴结隐匿性转移的MRI诊断

目的：确定磁共振（MRI）诊断口腔癌的颈淋巴结隐匿性的效果。方法：41例临床触诊检查颈部淋巴结转移阴性的头颈部恶性肿瘤病人,术前行MRI颈部扫描,了解颈淋巴结转移阳性和阴性的情况,并在术后同病理诊断对照。结果：41例病人被手术切除的颈淋巴清扫标本内有12例经病理证实为颈淋巴结转移,其中MRI发现9例,其敏感性为75％,特异性为87％,3列假阴性,主要是转移的淋巴结体积小,形态无明显的变化,其内部信号变化不明显,结论：MRI技术可作为临床诊断颈淋巴结隐匿性转移的有效手段之一。     

非编码核糖核酸与头颈部恶性肿瘤

非编码核糖核酸是一类具有重要生物学功能的核酸分子.目前,学术界仅对少数非编码核糖核酸的特性及其在细胞内的调控作用等有一定的认识,而对其他更多种类的非编码核糖核酸及其具体的生物学作用依然不甚明了.下面就非编码核糖核酸的主要分类、生物学意义和功能,以及非编码核糖核酸参与头颈部恶性肿瘤的发生及其在头颈部恶性肿瘤诊断、治疗中的应用作一简要综述.     

头颈部恶性肿瘤患者治疗后张口困难的研究进展

头颈部恶性肿瘤严重威胁患者的身心健康,以手术为主的综合序列治疗常造成面部畸形、咀嚼吞咽困难和语音不清等多种并发症,而张口困难是头颈部恶性肿瘤患者综合治疗后最为常见的并发症之一,严重者可出现牙关紧闭、进食困难,进而导致患者出现营养不良甚至恶病质,不仅影响患者生存质量,甚至危及生命,同时也会带来了严重的社会及经济负担.如何...     

“口腔颌面部恶性肿瘤治疗指南”发布

<正>《中国口腔颌面外科杂志》2010年第2期全文发表了由中华口腔医学会口腔颌面外科专业委员会肿瘤学组牵头制订的"口腔颌面部恶性肿瘤治疗指南"(通信作者:张陈平、郑家伟,作者:郑家伟、李金忠、涂文勇、张陈平、郭传瑸、李龙江、孙沫逸、韩正学、廖贵清、潘潮斌、张文峰、季彤)。     

“口腔颌面部恶性肿瘤治疗指南”发布

近日出版的《中国口腔颌面外科杂志》全文发表了由中华口腔医学会口腔颌面外科专业委员会肿瘤学组牵头制订的“口腔颌面部恶性肿瘤治疗指南”（通信作者：张陈平、郑家伟,作者：郑家伟、李金忠、涂文勇、张陈平、郭传殡、李龙江、孙沫逸、韩正学、廖贵清、潘朝斌、张文峰、季彤）。     

Mood and malignancy: head and neck cancer and depression

Head and neck cancer patients have been reported to show high rates of depression. However, it is important to differentiate between depressive symptoms and a depressive disorder. This review critically examines the relationship between head and neck cancer and depression. There appears to be little evidence for depression leading to an increased risk of developing cancer and although depressive symptoms in head and neck cancer patients are common, very few studies have investigated depressive disorders. The studies that investigated the incidence of a comorbid depressive disorder report a prevalence very close to that of the general population, implying that major depression is not a normal response to cancer. Finally, the evidence suggests that comorbidity of depression with cancer has a negative impact on morbidity and mortality. Both psychosocial and biological factors could account for this. Dysregulation of the stress hormone axis and increased inflammation are common in depressive disorders and have been suggested as underlying pathological mechanisms and are both markers of poor prognosis in cancer. This evidence suggests that a relatively small number of patients develop a depressive disorder following a diagnosis of cancer, but for those that do it may have a substantial impact on their prognosis.     

头颈部脉管畸形的超声诊断

超声检查以其无创、便捷的独特优势,被越来越多地应用于头颈部脉管畸形的辅助诊断、术前评估和随访病情变化。本文根据国际脉管疾病研究学会（ISSVA）提出的脉管疾病新分类,总结头颈部脉管畸形的超声检查方法,包括灰度成像、彩色多普勒成像、频谱多普勒成像,并回顾相关的临床和超声特征包括葡萄酒色斑、静脉畸形、动静脉畸形和淋巴管畸形,为临床诊疗提供参考。     

头颈部粘膜性恶性黑色素瘤的诊疗现状

头颈部粘膜恶恶性黑色素瘤临床上多表现出起病隐匿、发展快、易转移的特点，因而预后较差。目前对此病主要采取手术，免疫、化疗等综合治疗方案。本文综述了该病诊断及治疗方面的国内外现状，并指出应进一步开展的研究工作。     

Development of a tracheostomy scoring system to guide airway management after major head and neck surgery

The use of elective tracheostomy in major head and neck surgery is well established, although practice varies between units. There is no published method that reliably predicts the need for tracheostomy. This paper describes the development of a surgical scoring system designed to achieve that aim. The system was devised using data obtained retrospectively from 148 consecutive major head and neck procedures. These procedures were grouped according to the airway management plan in place at the end of the procedure: elective extubation (group E, 52 procedures, 50 patients); elective overnight ventilation via an endotracheal tube (group ETT, 55 procedures, 52 patients); and elective overnight ventilation via a tracheostomy (group T, 41 procedures, 41 patients). 8 patients from group ETT required a late tracheostomy for either medical or surgical indications. Using statistical methods, a threshold score was defined above which the high risk of upper airway obstruction should prompt consideration of an elective tracheostomy.     

Multidisciplinary approach to the differential diagnosis of facial, head and neck pain

Pain in the region of the head and neck is one of the most common complaints that bring patients to the dentist. Because of the complexity of the anatomy as well as the vagueness of presenting symptoms, head and neck pain often is a diagnostic problem. Many different specialists may ultimately be consulted to make a comprehensive diagnosis and institute effective therapy. It is up to the one who coordinates the diagnostic sequence to have an understanding of the various pathologic conditions that can be manifested as pain in the head and neck. Although a comprehensive knowledge of all disciplines is not necessary, an overall understanding of the various disciplines of medicine as they relate to head and neck pain is valuable. The primary provider should establish a group of specialists to whom patients can be referred for further diagnosis and treatment when necessary to provide optimum care.     

Head and neck teratoma: From diagnosis to treatment

IntroductionHead and neck teratoma is a rare entity. Its prognosis mostly depends on the risk of neonatal respiratory distress, its extension and potential malignancy. Surgical management must be as complete as possible to avoid recurrences and malignant transformation. The authors present a retrospective analysis of 6 cervicofacial teratomas and a review of the literature. The aim of the study was to analyse prenatal, neonatal and postnatal management of teratoma.Materials and methodsCharts of children presenting with a head and neck teratoma, managed by our maxillofacial and plastic surgery unit, were analysed and antenatal, clinical, biological, radiological and pathological characteristics were collected. Surgical treatment, recurrences and surgical outcomes were analysed.ResultsSix patients were included: 2 with a cervical teratoma, 2 with a facial teratoma and 2 with intraoral teratomas. In 2 cases, the lesions were diagnosed antenatally and both patients required neonatal resuscitation. All the patients underwent early surgery, and 3 with complete excisions. All patients with an initial incomplete excision eventually presented a recurrence and therefore second look surgery. No malignant transformation was noted.ConclusionEarly prenatal diagnosis is crucial to neonatal care. Early surgery and meticulous follow-up are critical in the long-term favourable outcome.     

Nutrition during treatment of head and neck cancer

The importance of nutrition during the treatment of head and neck cancers has been discussed in relation to oral health. The side effects of surgery, radiation therapy, and chemotherapy are described as well as their effects on nutrition. Common presentations of therapy-induced malnutrition are presented. Parameters for nutritional assessment are listed and an instrument is proposed to assist with the monitoring of nutritional status and to aid in organizing interventions that support adequate nutrition. The practitioner who is capable of recognizing and helps to prevent nutritional deficiencies in patients with head and neck cancers provides a valuable service that increases the comfort of the patient and improves the prognosis for successful therapy.