中国口腔颌面外科学科发展调查分析

目的 全面了解中国口腔颌面外科学科发展的现状、发现存在的问题、提出口腔颌面外科可持续发展的策略.方法 设计"口腔颌面外科学科发展问卷调查表",对地市级以上综合医院的口腔科、口腔专科医院、口腔医学院校的口腔颌面外科规模、人力资源、业务范围、医疗工作量、人才培养等项目进行问卷调查,并与5、10年前的状况进行比较.结果 多数医疗机构口腔颌面外科医师人数、病床数、门诊人次增加,业务范围扩大,医疗水平提高.部分基层医疗机构相应医疗指标有下降,超过1/3的医疗机构口腔颌面外科研究生和进修生生源下降.结论 口腔颌面外科在持续发展,但存在基层医疗机构口腔颌面外科力量有所削弱等问题,应采取相应的策略增强学科的竞争力.     

Provision of oral medicine in departments of oral and maxillofacial surgery in the UK: national postal questionnaire survey 2009

We investigated the current provision of oral medicine in oral and maxillofacial (OMF) departments in the UK. We examined the number of specialists in oral medicine in OMF departments, the training given to OMF consultants in oral medicine, and the estimated time dedicated to treating patients with oral medical conditions in outpatient clinics. We also examined the pattern and reasons for onward referrals to departments of oral medicine. A postal questionnaire was sent to 300 OMF consultants and was returned by 183 (61%). Sixteen (9%) of the responding consultants had a registered specialist qualification in oral medicine with the General Dental Council (GDC), 15 (8%) had a degree in oral medicine, and 4 (2%) had a diploma. One hundred and eighteen (64%) consultants had been given formal training in oral medicine during their training as registrars. Time dedicated to oral medicine in outpatient clinics varied between less than 20% and more than 40% of total outpatient time. Sixteen surgeons (9%) referred 1-2 patients/week to departments of oral medicine, and 19 (10%) referred 2-4/month. Reasons for referral included need for specialist expertise, failure of treatment, and lack of time in outpatients. The proposal for a dentally qualified consultant-led oral medicine service was supported by 70 responding surgeons (38%).     

德国口腔颌面肿瘤外科临床技术管窥

介绍作者在德国工作期间所见德国口腔颌面肿瘤外科技术和经验,并将德国经验与国内做法进行比较,分析了德国经验的优点.     

Educational paper: research in oral and maxillofacial surgery

Training in oral and maxillofacial surgery (OMFS) requires undergraduate degrees in both medicine and dentistry. When trainees in other surgical specialties may be pursuing a higher degree in research or education, OMFS trainees will be studying for their second undergraduate degree. It is possibly therefore that the specialty is weak in terms of doubly qualified university academics who have been trained in the full and extended curriculum OMFS. Research is recognised in all applications to United Kingdom and Ireland specialist training programmes, and points are awarded, though many juniors who enter these will have found it difficult to do any research during their careers to date. With changes in specialist training it may become even more difficult to obtain a research degree, although with the introduction of the National Institute for Health Research Integrated Academic Training (academic clinical fellowships/clinical lectureships) there is renewed hope that enthusiasm for academic OMFS will be reignited. In this paper we try to provide an idea of the opportunities available to OMFS trainees in academia and research.     

保留气管插管在口腔颌面外科中的意义

目的探讨气管插管术在口腔颌面外科手术后气道安全维护中的作用,以及与气管切开术比较之优越性. 方法临床分析49例口腔颌面外科病例,实施气管插管术48例,插管期间应用镇静镇痛治疗使病人Ramsay评分维持在2-4级,观察插管留置时间、留置期间血气(SpO2),气管插管保留或拔除后有无手术部位出血、血肿及肺部感染等并发症.结果气管插管平均留置时间为1.56±0.74天,留置期间SpO2>98%(99.76±0.52%)所有气管插管病人无气道损伤,无气道出血,无肺部感染及镇静药物应用后呼吸抑制发生.结论在现代口腔颌面部手术治疗中,气管插管术不仅保障病人呼吸道通畅,对手术的成功起着十分重要的作用,而且具有损伤小,并发症少,减少了病人痛苦,缩短术后恢复时间,提高了病人的生存质量等优势.     

超声骨刀在口腔颌面外科的临床应用进展

超声骨刀引入口腔颌面外科领域已有数十年,已有大量文献对超声骨刀的应用及特点进行了研究。本文回顾近年来关于超声骨刀的文献,对超声骨刀的工作原理、临床应用进展等做一综述,为临床医师提供参考。     

新冠疫情对口腔颌面外科教学模式的影响

目的 :了解并比较口腔医学专业在新型冠状病毒肺炎疫情防控期间在线学习情况,分析在线教学的优势和挑战,为口腔医学教育教学模式的改变提供参考。方法:选择上海交通大学口腔医学院2017级和2018级79名学生作为研究对象,开展在线学习问卷调查。采用SPSS 21.0软件包对数据进行分析。结果:86.08%的同学因疫情防控原因首次接受在线教育;录播和录播+微信群答疑是任课老师多数采用的在线教学形式,分别占51.9%、35.44%;超过70%的同学认为线上教育达到了预期效果,可以应对期末考试。普遍认为(84.28%),增加线上教学可以有效增进理论教学与临床实习的衔接,八年制同学对线上教学的接受程度优于五年制和留学生。结论:线上教学是新型冠状病毒肺炎疫情防控期间维系教学工作的重要途径。正确合理利用信息化技术,将录播、直播和微信答疑群三者结合,可以充分发挥优势,是今后教学改革的可行方向。     

The role of qualitative research in oral and maxillofacial surgery

Oral and maxillofacial research has utilised predominantly quantitative research approaches and qualitative methodologies have been applied with very narrow scope. Although qualitative surgical research is increasing in popularity there is a lack of patient voice within extant research and important aspects of patients’ experiences including preparation, perceptions of well-being, and functional outcomes are potentially overlooked. This provides researchers with significant opportunities to devise approaches that expand our understanding of the social contexts surrounding surgical interventions and associated outcomes and to develop better-informed approaches to research and practice. Reflecting on a novel research project involving OMFS patients this paper seeks to outline some distinct advantages of qualitative research based on researcher reflections. Firstly, we contend that understanding patients as collaborators within the research process helps to establish a research design that reflects the context and complexities of the phenomenon under investigation and increases the precision of the concepts being addressed. Secondly, interactive group-based data collection approaches create a space in which patients are able to explore aspects relating to OMFS. Thirdly, we suggest that patient interaction optimises the quality of data by providing participants with the opportunity to engage in conversation with those who understand the treatment processes. The final advantage concerns the intentional involvement of patients within the data analysis phase. We contend that interactive approaches to data collection and analysis where data are collected, analysed, compared and refined as new data are acquired helps to develop a conceptual explanation for the phenomenon in question that is both significant and relevant to the setting being studied. We conclude with recommendations for future research.     

2018例口腔颌面外科日间手术临床分析

目的:总结中南大学湘雅医院口腔颌面外科开展日间手术的临床经验,探讨日间手术在口腔颌面外科的应用效果与安全性。方法:回顾分析2014年7月—2019年6月在中南大学湘雅医院日间手术中心进行治疗的所有口腔颌面外科患者的临床资料,包括患者年龄、性别、疾病名称、麻醉与手术方式或取消原因、住院时间、延期出院原因、术后并发症发生情况及医疗费用等。选取其中手术量最多的8种疾病,以普通住院病房为对照,比较同类型疾病平均住院时间与医疗费用的差异。采用SPSS 23.0软件包对数据进行统计学分析。结果:在纳入研究期间的5年内,中南大学湘雅医院共完成口腔颌面外科日间手术2018例,疾病类型以口腔颌面部软组织肿物、牙及颌骨病变、唾液腺疾病为主。患者年龄2~77岁,平均34.45岁,男女比例为6:4。手术取消率1.13%,术后并发症发生率0.64%,平均住院时间0.89 d,延迟出院率0.40%。与普通病房相比,同类型疾病住院时间与医疗费用均显著降低(P<0.05)。结论:口腔颌面外科能够实施日间手术的疾病类型多,患者依从性好,住院时间短,医疗资源利用率高。在规范管理的前提下,安全可行,值得进一步推广应用。     

口腔颌面外科患者手术前后甲状腺激素水平的变化

目的:观察口腔颌面外科不同程度手术创伤患者手术前、后甲状腺激素水平的改变,为术后康复治疗提供参考依据。方法:利用放射免疫方法检测60例口腔颌面手术患者(局麻小手术患者30例,全麻手术患者30例)术前及术后第1、4、7天血清中促甲状腺激素(TSH)、甲状腺素(T4)、三碘甲状腺原氨酸(T3)、反-三碘甲状腺原氨酸(rT3)等激素水平的改变。采用SPSS10.0软件包对数据进行单因素方差分析。结果:与术前相比,口腔颌面外科全麻手术患者术后第1、4、7天的T3、T4、rT3水平下降有显著差异(Ρ<0.01),TSH亦显著下降(Ρ<0.05);而局麻小手术患者,术前与术后第1、4、7天的T3、T4、rT3、TSH水平下降均无显著差异(Ρ>0.05)。结论:手术创伤和麻醉种类与患者甲状腺激素水平高低有一定关系。     

Usefulness of measuring plasma cytokines in oral and maxillofacial surgery

We determined the intra- and postoperative plasma concentrations of cytokines (tumor necrosis factor [TNF]-, interleukin [IL]-1, IL-6, and IL-8) in oral surgery patients with procedures ranging in duration from 20 to 375min and investigated their relationship to the intensity of the surgical stress over time. No significant differences from baseline levels were observed in the levels of TNF-, IL-1, and IL-8. By contrast, increased IL-6 levels were noted only on the first postoperative day, when they reached 1500% of the baseline level, after which they decreased to preoperative levels by the third postoperative day and tended to reflect the intensity of surgical stress.     

右美托咪啶对口腔颌面手术苏醒期躁动的作用评价

目的：评价右美托咪啶(简称右美)对口腔颌面手术苏醒期躁动的作用。方法：全麻下行口腔手术患者55例,术后入苏醒室,随机分为右美组28例,使用右美托咪啶0.3μg/kg静脉推注。对照组27例,使用等量生理盐水静脉推注。评估苏醒期发生躁动情况,记录2组入室后拔除气管导管的时间,记录入苏醒室即刻、入室后5、15、30、60、120min时平均动脉压、心率、血氧饱和度、镇静评分。采用SAS9.1软件包对数据进行统计学分析。结果：苏醒期躁动的发生率,右美组(18%)较对照组(70%)显著降低(P<0.05)。入苏醒室后5、15、30、60min,右美组的Ramsay镇静评分显著高于对照组(P<0.05)。入苏醒室后5、15、30、60、120min,右美组患者心率较对照组显著下降(P<0.05),入苏醒室后15、30min,右美组患者平均动脉压较对照组显著下降(P<0.05)。2组患者术后拔管时间无显著差异,术后均无呼吸抑制发生。结论：右美托咪啶0.3 μg/kg一次静脉推注能安全有效地降低口腔手术苏醒期躁动。     

口腔颌面外科围手术期血糖管理专家共识

围手术期血糖水平异常现象是影响患者预后的重要因素。目前,已有较多关于外科手术围手术期血糖管理指南,但对于口腔颌面外科手术围手术期血糖异常情况尚未有规范的管理方案。根据已发表的相关指南、共识及文献,并结合颌面外科的特点及我们的经验,本文主要从术前高血糖的筛查、评估,术中血糖安全管理,术后血糖水平的监测及治疗等方面规范了标准化血糖管理操作规程,为颌面外科围手术期血糖管理提供参考。     

口腔颌面外科日间手术中国专家共识

日间手术是指患者入院、手术和出院在1个工作日内完成的手术,具有加快病床周转、提高医疗资源使用效率、减少院内感染、加速患者康复及降低医疗费用等优点,为部分中、小手术患者提供了一种新型医疗服务。由于同时涉及手术、麻醉及围术期管理等多个环节,日间手术的开展在我国仍处于起步阶段。口腔颌面外科日间手术仅在部分医疗机构初步开展,尚未普及,且缺乏统一的规范化流程。为促进我国口腔颌面外科日间手术的发展,中国日间手术合作联盟和中华口腔医学会口腔颌面外科专业委员会组织全国15所医疗机构相关领域专家,参考国外日间手术的发展经验并结合国情,讨论并制订了本专家共识,以期对我国口腔颌面外科日间手术的开展起到规范和指导作用。     

Regenerative nanotechnology in oral and maxillofacial surgery

Regenerative nanotechnology is at the forefront of medical research, and translational medicine is a challenge to both scientists and clinicians. Although there has been an exponential rise in the volume of research generated about it for both medical and surgical uses, key questions remain about its actual benefits. Nevertheless, some people think that therapeutics based on its principles may form the core of applied research for the future. Here we give an account of its current use in oral and maxillofacial surgery, and implications and challenges for the future.     

自体输血在口腔颌面外科的应用

近年来,自体输血因可以避免传播传染病、输血差错和免疫反应等同种异体输血相关并发症,而在临床上得到广泛应用。自体输血在口腔颌面外科的应用也逐渐开展起来,作者对自体输血的方法、适应证、禁忌证、并发症以及在口腔颌面外科的应用作一综述。     

混合现实技术在口腔颌面外科的应用进展

混合现实(mixed reality,MR)技术是继虚拟现实和增强现实之后出现的新型全息成像技术,在口腔颌面外科领域得到广泛重视。其技术特点相比于以往的三维可视化技术更具优越性,在手术规划、术中导航、操作训练等方面拥有广阔的发展前景。然而,目前MR技术的临床应用存在局限性,主要体现在医学图像处理系统、图像配准精度、定位系统稳定性、人机交互体验方面,因此突破MR技术瓶颈、改善其临床使用体验,是MR技术在口腔颌面外科领域发展的主要方向。     

坚强内固定在口腔颌面外科颌骨骨折实践教学中的应用

对颌骨骨折传统实践教学方法进行改革.学生随机进行分组进行传统骨折实践教学和坚强内固定实践教学.采用项目组针对教学改革制定的评估方法,通过对学生调查问卷的形式获得相关评价.将取得的评分进行统计学分析,学生对坚强内固定用于颌骨骨折实践教学的认可度明显高于传统教学方法(P<0.01 ).坚强内固定技术引入颌骨骨折的实践教学中,是对传统实践教学的一个完善、一个革新,值得在口腔医学的教学实践中推广.     

口腔颌面部严重损伤的控制性外科

损伤控制性外科的主要原则是:先通过简捷的手术控制出血和污染,然后至ICU进行生理性复苏,最后进行二次手术,对所有损伤实施确定性修复。口腔颌面部严重损伤常为多发伤,出血多、生理机能耗竭严重,需要采用损伤控制性外科策略。