机器人手术在头颈、耳鼻喉区域的发展现状

外科手术机器人具有优秀的可操作性,能为外科医生提供清晰的视野,辅助其在狭小的解剖空间内进行精准、微创的手术,在头颈、耳鼻喉区域具有强大的应用前景.相比于传统的开放手术,机器人手术避免了很多侵入性操作,能够降低手术对颌面部美观与功能的影响,改善患者术后生活质量.本文对近年来机器人手术技术在头颈、耳鼻喉外科的应用进行总结,...     

经口腔机器人手术在头颈外科中的应用

经口腔机器人手术(transoral robotic surgery,TORS)是近年来国际上头颈外科领域引人注目的一大进展,目前已成功应用于头颈-颅颌面肿瘤切除及游离皮瓣重建术。它突破了传统外科医师手术的概念,提高了手术质量,减小了手术创伤,极大地满足了患者的安全与美观需求,在头颈外科中的应用已被初步证实具有可行性和安全性。本文就TORS的组成、优点、应用现状及发展前景作一综述。     

头颈癌颈部治疗失败的临床意义

该文旨在研究颈部转移淋巴结复发的头颈癌患者的生存率。对1988—2007年间47例颈部淋巴结复发的头颈癌患者进行回顾性研究．效果评价方法为淋巴结复发、治疗特异性生存率及总生存率。结果：10例在初诊时淋巴结阳性．患者平均生存时间为14．7个月．5年生存率为5％．颈部救治性手术对颈部复发患者可达最佳效果。结论：颈部救治性手术对头颈癌术后颈淋巴结复发患者可达最佳治疗效果．不管其在治疗初期是否行颈淋巴清扫术。     

功能性与根治性颈淋巴清扫术在早期口腔鳞状细胞癌治疗中的疗效比较

目的:探讨功能性颈淋巴清扫术(functional neck dissection,FND)与根治性颈淋巴清扫术(radical neckdissection,RND)在口腔鳞状细胞癌中的临床疗效.方法:63例口腔鳞状细胞癌患者,分为FND组(n=30)和RND组(n=33),FND组保留胸锁乳突肌、副神经、颈内静脉及耳大神经,术后随访2组患者的肩外展功能、耳大神经功能、颈部是否明显凹陷及颈部复发率.应用SPSS 18.0软件包对数据进行单因素x2检验、两独立样本均数t检验,以及Fisher确切概率检验.结果:FND与RND组之间在年龄、性别、肿瘤部位、T分期、N分期、组织学分化程度、病理学类型、术前化疗及术后化疗等方面无显著差异(P＞0.05).所有患者均为N0或N1期,FND组术后肩关节活动度、耳垂感觉麻木及颈部凹陷改善程度显著优于RND组(P＜0.05);术后随访2年,FND组的颈部复发率与RND组无显著差异(P=1.000).结论:对于N0或N1期口腔鳞状细胞癌患者,FND与RND相比,患者颈部复发率无显著差异,但其并发症显著减少,可明显提高患者术后的生活质量.     

9例经口入路机器人手术在口腔颌面外科应用报道

目的: 总结口腔颌面外科机器人手术的应用经验。方法: 解放军总医院口腔科应用达芬奇机器人手术系统对9例位于口腔深部肿瘤患者行经口入路机器人手术（transoral robotic surgery, TORS）,总结手术经验与体会。结果: 患者均顺利完成手术,摆位及术区暴露用时20~90 min,平均42.2 min;手术时间5~90 min,平均40.9 min。除1例双侧颈淋巴清扫术患者外,其余纯口腔入路患者8例,术后平均住院日3.25 d,术后均顺利出院,平均住院天数7.75 d。结论: 达芬奇机器人手术系统可以独立完成口腔深部肿瘤手术,但在特殊患者如舌根肿瘤手术上仍有一定困难,主要是术区暴露时间较长。     

口腔颌面外科学：麻醉与手术

经鼻盲探插管在小儿困难气管插管中的应用；传统颈淋巴清扫术经典手术入路的反思；机械通气在婴幼儿唇腭裂修复术麻醉中的应用；19例复发性鳃裂囊肿和瘘的手术治疗体会。     

口腔颌面-头颈恶性肿瘤治疗的新策略:放疗联合个体化靶向治疗

抗肿瘤靶向治疗是通过阻断癌细胞上与恶性程度(包括侵袭性、复发转移、生存率下降等)密切相关的特定分子靶点来抗癌的新技术。利用靶向药物减低肿瘤细胞增殖并提高放射敏感性,与放疗联合应用,有可能成为口腔颌面-头颈恶性肿瘤治疗新策略。目前已研制成功并开始在临床应用的分子靶向药物有表皮生长因子受体(epidermal growth factor receptor,EGFR)和血管内皮生长因子受体(vascular endothelial growth factor receptor,VFGFR)的抑制剂。利用分子诊断基因芯片检测肿瘤相关基因表达,可以制定出疗效更好的放疗联合个体化靶向治疗方案,来治疗口腔颌面-头颈恶性肿瘤。     

中华口腔医学会口腔颌面外科专业委员会2015年口腔颌面-头颈肿瘤学术研讨会第一轮通知

由中华口腔医学会口腔颌面外科专业委员会主办,青岛大学医学院附属医院承办的"中华口腔医学会口腔颌面外科专业委员会2015年口腔颌面-头颈肿瘤学术研讨会"将于2015年9月18日-20日在青岛举行。会议将邀请国内著名口腔颌面外科及头颈肿瘤专家作特邀演讲,将针对下颌骨恶性肿瘤外科处理、口咽癌与舌根癌临床研究与治疗进展、口腔癌生存率研究进行专题讨论。同时,本次会议将设置青年医师学术报告比     

2 口咽部鳞状细胞癌经口腔机器人手术：可行性及功能结果的前瞻性研究

Transoral robotic surgery for oropharyngeal squamous cell carcinoma： a prospective study of feasibility and functional outcomes     

Inverted papilloma of paranasal sinuses.

INTRODUCTION: Inverted papilloma (Schneiderian papilloma) is a primarily benign lesion that occurs in the nasal cavity and paranasal sinuses. Clinical problems include a tendency towards local destruction, recurrence and malignant transformation into squamous cell carcinoma. Hence, complete surgical removal is the therapy of choice and a meticulous follow-up is mandatory. STUDY DESIGN: This is a review including a short introduction to the different histological types of nasal papilloma, their pathogenesis and the clinical and histopathological diagnosis. Staging systems, therapeutic approaches, and surgical concepts are discussed. RESULT: The detection and definition of factors that allow a prognosis of recurrence or malignant transformation of inverted papilloma is an active field of research. The results of studies dealing with the definition of prognostic factors, that investigated immunohistochemical methods, virus detection, molecular genetics, and histomorphological studies are discussed including our own results on the prognostic value of histology. A concept for the diagnosis, management, therapy and follow-up of inverted papilloma is proposed.     

Imaging of the paranasal sinuses

Evaluation of the paranasal sinuses is often performed in a purely clinical fashion, without the need for imaging. However, in certain instances imaging may be deemed valuable or even necessary in helping to solve a diagnostic dilemma, confirm a suspected diagnosis, evaluate the extent of a known condition, or assess for an underlying cause of the condition. Computed tomography (CT) and magnetic resonance imaging (MRI) can be useful in confirming a suspected diagnosis or providing additional information regarding causes or complications. CT and MRI play complementary roles in evaluating the rare tumors that may involve the paranasal sinuses.     

Osteomas of the paranasal sinuses

A group of 86 patients with osteomas on the bones of the skull and face, 21 suffered from osteomas of the paranasal sinuses. The mean age of the patients was 50 years, with a predominance of male subjects (2/1). The frontal sinus was the frequently involved (57%), followed by the maxillary, ethmoid and the sphenoid sinuses. Diagnosis was made accidentally in 45% of the cases. The most frequent presenting symptom was headache (57%). Simple excision of the osteoma paranasal sinus was possible in 18 cases. We realize a study of the facts, as well as a review of the literature to know the incidence, diagnosis, indications and surgery technics used in these type of osteomas.     

Microorganisms of the nose and paranasal sinuses

The endogenous normal flora of the nose and paranasal sinuses works to create an environment of homeostasis within the region. This homeostasis can be interrupted by eliminating the anatomic barriers created by the skin, bone, and mucosa, such as after trauma and/or surgery; by altering the atmosphere of the surroundings, such as the creation of an anaerobic environment by obstruction of the sinus ostia or foramina; or by a change in the normal flora of the region. To fully understand the microbiological environment of this region, the normal flora of the nose and paranasal sinuses must be understood.     

Benign cysts and tumors of the paranasal sinuses

To thoroughly understand the biology of any lesion and render the appropriate management, clear and accurate definitions are paramount. For benign cysts and tumors of the oral maxillofacial region, an accurate depiction of these lesions needs to be elucidated to provide both the treating surgeon and the patient with a clear understanding of the course of treatment and the outcome.     

Surgical anatomy of the nasal cavity and paranasal sinuses

The oral cavity and its bony components (maxilla and mandible), along with the nose and its related sinuses, constitute most of the face. Because of their proximity, disease in one may affect the other, whereas trauma of the midface will involve bones common to the oral cavity, nose, and paranasal sinuses. The two serve important life-supporting functions, being the portals for nutrition and respiration. The paranasal sinuses are pneumatic cavities lined by mucous membrane and communicate directly with the nasal cavity. This article presents a brief but relevant view of the surgical anatomy of the nasal cavity and paranasal sinuses.