壳聚糖复合材料修复口腔颌面组织缺损的研究进展

炎症、外伤、肿瘤等原因导致的口腔颌面部组织缺损,常导致诸如进食困难、咀嚼困难、语言障碍等功能障碍.由于解剖位置的特殊性,口腔颌面部组织缺损还会影响美观,长期不修复可能导致患者心理障碍及人格方面的改变.自体组织移植虽然是修复组织缺损的黄金标准,但可供移植的部位有限,且会造成原来健康部位的损伤,这些因素都限制了自体组织移植...     

多种组织瓣在口腔颌面部组织缺损中的应用

目的：总结12种组织瓣整复口腔颌面部软组织缺损的临床应用价值、技术特点及适应症。方法：对68例口腔颌面部大、中型组织缺损的患者，立即用带蒂肌皮瓣和游离组织瓣进行舌、口底、面颊部、腮腺区等部位的修复重建，并对效果进行观察。结果：54块带蒂肌皮瓣成功率为96．3％（52／54），使用最多的是胸大肌皮瓣；17块游离组织瓣成功率为88．3％（15／17），使用最多的是前臂游离皮瓣。所用各类组织瓣修复效果良好。结论：用组织瓣立即整复口腔颌面部组织缺损，可及时恢复口腔颌面部功能，对提高患者生存质量起到积极作用。     

Terminal care for oral cancer patients in hospital dentistry and oral and maxillofacial surgery at a local area

A sequential study concerning suicide of patients with oral cancer, notification of oral cancer, terminal care of patients with oral cancer at home, etc. has been performed in our department. As part of the study, a possible role of hospital dentistry and oral and maxillofacial surgery at a local area was examined recently with reference to the terminal alleviating care provided to three patients with oral cancer at Joetsu General Hospital. The result was as follows: It is natural that most patients want to die at home in the presence of their family. In order to fulfill such a desire, it is considered necessary that a hospital dentistry and oral and maxillofacial surgery must handle terminal alleviating care. However, many problems still remain in managing patients with terminal cancer in a hospital dentistry. But also a cooperation with a university hospital and cooperation with the department of dentistry in other hospitals, education activity concerning oral cancer at local medical treatment including within hospital care, effective utilization of local nursing station, and examination of the home care system, are considered essential.

     

Stem cells in craniofacial and dental tissue engineering

Mesenchymal stem cells (MSC) have been identified in a variety of adult tissues as a population of pluripotential self-renewing cells. Based on their adherence and colony forming properties, a small number of MSC can be isolated from most mesenchymal tissues as well as bone marrow. In the presence of one or more growth factors, these cells commit to lineages that lead to the formation of bone, cartilage, muscle, tendon and adipose tissue; recent studies indicate that stem cells for cementum, dentine and the periodontal ligament also exist. All of these cells can be expanded in vitro, and, embedded in a scaffold, inserted into defects to promote healing and tissue replacement. Increased understanding of the molecular mechanism directing lineage specification and morphogenesis is providing a rational approach for the regeneration of craniofacial tissues and oral structures.     

计算机辅助下的口腔颌面硬组织创伤机制的模拟分析

目的:建立基于CT图像数据的计算机辅助三维立体的口腔颌面硬组织创伤的损伤模拟系统,为手术前进行精确制定手术方案提供可靠依据。方法:运用医学可视化技术和Visual C++编程开发出立体三维重建和损伤模拟软件,模拟口腔颌面部损伤过程,并记录相关数据。结果:通过14例患者的模拟效果与真实效果比较发现,模拟效果有一定的真实性。x2检验结果未见明显差异。结论:该研究建立的口腔颌面硬组织创伤的损伤模拟系统有较高的临床价值。     

成体干细胞在组织工程化牙本质牙髓复合体中的应用研究与展望

牙髓干细胞(dental pucp stem cells，DPSCs)是一种成体干细胞。有关成体十细胞的研究进展，尤其是骨髓基质干细胞(bone marrow stromal stem cells，BMSSCs)的研究，为牙髓干细胞的研究提供了可以借鉴的思路和方法。DPSCs也有相对特异的识别途径和特点，其中重要的特征之一是一定条件下能形成牙本质牙髓复合体。这将为其应用于组织工程中重建牙本质牙髓复合体，展示了巨大的优越性和可行性，也为其在牙髓生理、病理、牙髓病的生物治疗方面的研究提供了重要的应用价值。     

应用细胞片层技术构建组织工程骨修复犬下颌骨缺损的实验研究

目的应用骨髓间充质干细胞（BMSCs）细胞片层构建组织工程骨修复犬下颌骨缺损,探讨细胞片层在成骨中的作用。方法采用密度梯度离心法分离和培养BMSCs,将BMSCs向成骨细胞诱导培养后,制备细胞片层。将细胞片层包裹到聚乳酸羟基乙酸共聚物（PLGA）支架表面,将其植入犬左侧下颌骨全层缺损中,对侧下颌骨植入无细胞片层包裹的支架复合体作同体对照。将16只犬分为4组,每组4只。术后4、8、12、16周分别处死1组,取材行大体及组织学观察。结果实验侧成骨好于对照侧,术后16周,实验侧骨缺损大部分被新生骨替代,舌侧形成与正常骨相似的密质骨,与正常骨断端骨性愈合。实验侧新生骨光密度值大于对照侧,两者差异有统计学意义（P<0.05）。实验侧可见较多哈弗氏系统及红骨髓,大量板层骨;对照侧哈弗氏系统较少。结论利用细胞片层技术可以构建出含板层骨结构的组织工程骨。     

口腔颌面部手术术后谵妄危险因素的Meta分析

目的分析口腔颌面部手术术后谵妄（POD）的相关危险因素,为临床有效预防POD提供依据。 方法检索Web of Science、PubMed、Cochrane Library、EMbase数据库,时间为数据库建库至2018年7月1日,查找关于口腔颌面部手术POD的相关文献,按照纳入、排除标准进行筛选,对纳入的文献进行质量评估,提取关于POD相关因素的数据,采用RevMan 5.3、StataSE 12.0软件进行统计学分析。 结果共纳入11篇口腔颌面部手术POD的相关研究,涉及口腔颌面部手术2429例患者,其中发生POD共415例（发生率17.1%）。研究结果显示,年龄、男性、独居、精神状态、高血压、术前血红蛋白、总蛋白、术中麻醉时间、手术时间、失血量、气管切开术、术后疼痛为口腔颌面部手术POD的危险因素（P<0.05）,而吸烟、酗酒、美国麻醉医师学会（ASA）分级、糖尿病、心脏病、术前血清钠、术前白蛋白、输液量、颈淋巴清扫术、皮瓣转移修复术与POD无明显相关性（P>0.05）。 结论临床上口腔颌面外科医生在术前应密切关注患者的年龄、性别、精神状态、高血压及相关实验室结果（术前血红蛋白、总蛋白）;术中应密切控制麻醉时间和手术时间,减少出血,维持良好通气;术后做好镇痛管理,能有效预防POD发生。     

Preliminary report of the use of a microvascular coupling device for arterial anastomoses in oral and maxillofacial reconstruction

Our aim was to record our preliminary use of a microvascular coupler for arterial anastomoses with free flap transfer in the reconstruction of oral and maxillofacial defects in 45 patients with defects that were repaired with anterolateral thigh, fibular, and radial forearm flaps. The microvascular coupler was used for both the venous and the arterial anastomoses. The site of the defect, type of flap, recipient artery, duration of operating time for the anastomosis, size of coupler, and survival of the flap were recorded and analysed. A total of 45 consecutive patients had microsurgical reconstructions in the head and neck, including 16 radial forearm, 18 fibular, and 11 anterolateral thigh free flaps. The sizes of coupler required ranged from 1.5-2.5 mm, with most flaps (n = 30) requiring a 2.0 mm coupler. The mean (SD) operating time for arterial anastomoses was 7 (2) mins. One arterial crisis occurred during an operation, and required a sutured anastomosis instead. There were no complications related to the technical performance of the coupler. The coupler is reliable for arterial anastomoses of free tissue transfers in reconstructions of the head and neck. With proper selection of vessels and enough experience in using the microvascular coupler, it may be used in an expeditious, safe, and reliable fashion with minimal morbidity. Though not common, the use of the coupler for arterial anastomoses saves a lot of time, and is a viable alternative to a sutured anastomosis.     

应用浓缩生长因子促进干细胞增殖及成骨分化修复口腔颌面部缺损的研究进展

浓缩生长因子（concentrated growth factor,CGF）作为最新一代血小板浓缩物,制备方法简单,来源广泛,安全性能高,含有高浓度生长因子,具有柔软纤薄的纤维蛋白网络结构,能够加速组织再生,被广泛应用于修复口腔颌面部软硬组织缺损,并逐渐成为再生医学及组织工程的研究热点。干细胞是一类具有多向分化潜能的细胞,经诱导后可转化为成骨细胞,进而促进骨组织再生。研究证实,CGF可显著促进干细胞增殖及成骨分化。因此,文章就CGF的发展历史、主要成分及作用、在口腔颌面部缺损修复领域CGF对干细胞增殖及成骨分化的作用和总结展望四个方面进行综述,旨在为口腔颌面部软硬组织修复提供新的治疗思路。     

骨髓基质干细胞片层的制备及其在组织工程骨中应用的初步研究

目的：探讨骨髓基质干细胞（bone marrow stromal cells,BMSCs）片层（cell sheet）的制备方法,并观察其在实验犬体内构建组织工程骨时的成骨作用。方法：密度梯度离心法获取实验犬骨髓基质干细胞,经成骨诱导培养后,利用温度感应性培养皿（temperature-responsive culture dish）制备细胞片层后在体外包裹犬同种异体脱钙骨基质（demineralized bone matrix,DBM）,相差显微镜和扫描电镜观察细胞及片层形态;将复合体植入实验犬背阔肌筋膜下,组织学方法观察术后组织工程骨的骨形成情况。结果：细胞片层成功制备,并与支架材料复合良好,术后16周组织学显示形成类似板层骨的致密骨组织。结论：利用温度反应性培养皿可成功制备BMSC细胞片层,细胞片层包裹支架材料后在实验动物体内可形成具有类似板层骨结构的组织工程骨。     

Regenerative endodontics as a tissue engineering approach: Past,current and future

With the reported startling statistics of high incidence of tooth decay and tooth loss, the current interest is focused on the development of alternate dental tissue replacement therapies. This has led to the application of dental tissue engineering as a clinically relevant method for the regeneration of dental tissues and generation of bioengineered whole tooth. Although, tissue engineering approach requires the three main key elements of stem cells, scaffold and morphogens, a conductive environment (fourth element) is equally important for successful engineering of any tissue and/or organ. The applications of this science has evolved continuously in dentistry, beginning from the application of Ca(OH)₂ in vital pulp therapy to the development of a fully functional bioengineered tooth (mice). Thus, with advances in basic research, recent reports and studies have shown successful application of tissue engineering in the field of dentistry. However, certain practical obstacles are yet to be overcome before dental tissue regeneration can be applied as evidence‐based approach in clinics. The article highlights on the past achievements, current developments and future prospects of tissue engineering and regenerative therapy in the field of endodontics and bioengineered teeth (bioteeth).     

口腔颌面部缺损游离皮瓣修复中血管吻合的技巧及关键点

血管吻合的质量是决定游离皮瓣移植修复术是否成功最为关键的因素。游离皮瓣在修复口腔颌面部缺损的应用中存在血管选择、受区血管相关术中表现和血管吻合技术等方面的诸多特点及技巧。同时,术后对皮瓣危象、并发症进行判断和处理时也有较多的关键点。笔者的团队在近年来开展了大量的口腔颌面缺损游离皮瓣修复,在口腔颌面颈部的血管吻合方面积累了大量的经验。本文针对口腔颌面缺损游离皮瓣修复中动静脉吻合的技巧、血管选择、血管危象的判断及处理等问题进行评述。     

外周血作为骨组织工程种子细胞来源的初步研究

目的：研究外周血作为骨组织工程种子细胞来源的可能性。方法：密度离心法分离兔外周血单个核细胞,冲洗收集长骨内骨髓,将两者在体外进行培养。检测两种来源细胞的表面分子标志物及成脂、成骨能力差异。结果：骨髓原代培养细胞集落形成早,细胞形态均一。传代后CD29阳性,CD34阴性;成脂诱导时脂滴出现早且多;成骨诱导时碱性磷酸酶、Ⅰ型胶原表达早,矿化结节数量多且体积大。外周血原代培养细胞集落形成晚,形态不一,种类多。传代后CD29阳性,CD34弱阳性;成脂诱导时脂滴出现晚且少;成骨诱导时碱性磷酸酶、Ⅰ型胶原表达较晚,有散在的矿化结节和管样结构形成。结论：外周血内含有间充质干细胞、内皮祖细胞等多种干细胞,可以作为血管化组织工程骨的种子细胞来源,但需要进一步优化培养方法。     

Student experiences of professionalism and role models in an oral and maxillofacial surgery internship: A qualitative study

Introduction

Dental students have a clear concept of professionalism and the importance of role models. Our aim was to determine how dental students experience their first oral and maxillofacial surgery internship in terms of their concept of professionalism and their perception of role models.

Methods

From June to August 2020, semi-structured telephone interviews were conducted with 22 dental students in their eighth and ninth semesters at the Medical Faculty of the University of Ulm. The interviews were transcribed and evaluated by qualitative content analysis according to Mayring.

Results

The students' concept of dental professionalism was shaped by the elements of a good approach to patients, professional competence, and manual skills. This perception was not changed by the internship. Having a role model was seen as an important learning strategy, and role models were perceived in both positive and negative ways. Role models were perceived as positive if they corresponded to the student's concept of professionalism and as negative if they did not correspond to this concept, especially with regard to social interaction or the approach to patients. Students' reactions to discrepancies between their own moral values and the role models' behaviour were characterised by passivity and withdrawal. With regard to potential future careers, positive internship experiences supported student goals, whereas negative experiences raised doubts about them.

Conclusion

Supervising dentists may still underestimate the considerable impact of internships, and their awareness of this impact needs to be increased. Students' reactions to conflicts between reality and their own values do not appear to be constructive. One approach to solving this problem may be to include discussions of professional development in curricula.