CT对颌面颈部金属异物定位的临床评价

ＣＴ对颌面颈部金属异物定位的临床评价广州军区广州总医院口腔科（邮５１００１０）朱光第，梁桂生，牛书铭，汪维健，秦义雄临床资料本组１６例；男１２例，女４例。年龄：１．５岁１例，５～１５岁５例，１６～２９岁１０例。伤后就诊时间最短１天，最长３个月。异物种...     

口腔颌面部金属异物取出术53例报告

目的：探讨口腔颌面部金属异物取出的方法。方法：回顾分析2000～2006年期间诊治的口腔颌面部金属异物53例取出术的经验。结果：53例63枚口腔颌面部金属模具碎片异物均顺利取出,未发生伤口感染。结论：金属异物取出应根据准确的X线片或三维CT定位诊断,根据异物位置及与周围组织的关系,酌情选用手术入路方法或经X线透视下取出。     

口腔颌面部金属异物取出61例临床总结

目的:探讨口腔颌面部金属异物最佳手术取出途径。方法:将我科1999—2008年口腔颌面部金属异物61例诊治情况进行分析总结。结果:61例中的65个口腔颌面部金属异物都顺利取出,没有发生伤口感染,创口均愈合良好。结论:口腔颌面部异物应用平板探测器X线数字成影(DDR)线片,必要时可行三维CT重建准确定位,在明确诊断后,尽量沿着原创口选择手术途径,如明视下手术取出困难可在X线透视下取出。     

颈部金属异物取出7例报告

目的:探讨颈部金属异物取出的手术方法。方法:回顾性分析7例颈部金属异物的临床资料。异物种类为气枪子弹3例,铁屑3例,弹片1例。结果:颈部金属异物均经手术取出,无1例出现并发症。结论:颈部金属异物需手术取出,术前定位及术式的选择极为重要。     

光学导航技术在口腔颌面深部间隙异物取出术中的应用

目的:探讨光学导航技术应用于口腔颌面深部异物留置取出术的适应条件和临床价值。方法:对5例口腔颌面部外伤后异物留置于深部间隙的患者在导航辅助下行异物取出术,术前进行三维CT和数字减影血管造影检查,对异物进行空间定位,并将CT的Dicom数据导入STN导航系统中,用于术前手术规划和术中导航。术中观察导航系统的实时性和精确性,评价导航技术对口腔颌面部深部间隙异物取出的有效性。结果:在光学导航技术辅助下,5例留置的异物均能通过微创入路顺利定位和取出,术中未发现神经、血管损伤,术后亦未发现感染、呼吸困难等并发症。术后随访3～12个月,患者主诉症状均缓解,功能和面型取得了满意的效果。结论:光学导航技术在口腔颌面深部间隙异物取出术中的应用,尤其在解剖位置复杂和危险的区域,可以提高手术的精确性、微创性和安全性。     

特大金属异物锥形束CT的影像重建1例报道

患者,32岁,主诉2009年3月28日,当地人用枪击中右侧耳屏前,当时短暂的昏厥史,随入我院口腔颌面外科门诊就诊。自主体位,神志清楚,查体合作,颈静脉正常,气管居中,四肢活动自如。颌面部两侧不对     

颌面颈部异物伤20例诊治分析

目的：探讨颌面颈部异物伤的诊断和治疗方法。方法：总结20例颌面颈部异物伤病例,对诊断、定位和手术方法进行分析,观察治疗效果。结果：20例异物伤病例明确诊断后均成功手术取出异物,术后恢复良好。结论：颌面颈部异物伤手术风险大,术前明确诊断,准确定位,结合术者良好的手术技巧和责任心是异物取出的关键。     

颌面部金属异物在X线屏下取出10例

由于各种原因所造成的口腔颌面部异物比较常见，我科自2001年以来共接治颌面部异物患者20例，其中10例颌面部金属异物是在X线透视电视屏下取出的，取得了较好的效果。     

5例下颌升支前缘纵切口在翼颌间隙异物取出术中的应用

下颌阻生智齿拔除术为门诊常见的困难手术之一 ,因拔牙方法不正确、拔牙器械不合适或对局部解剖不熟悉 ,术中发生断根或完整牙齿移位于舌侧骨板外进入翼颌间隙者并非罕见。作者工作中曾遇此病例 5例 ,均在术中行下颌升支前缘纵切口 ,将舌侧软组织翻瓣后在直视下将异物顺利取出 ,现报道如下。1　临床资料5例病例中 ,男性 2例 ,女性 3例。 2例完整牙齿均为单根牙 ,其中 1例根端肥大。 3例断根者 1例为锥形根 ,2例为远中舌侧根。2　治疗方法及效果对于移位于舌侧软组织内的断根或完整牙齿 ,先试用手指从舌侧粘膜外将其推回牙槽窝内。如未成功 ,…     

口腔颌面部异物36例临床分析

目的:探讨口腔颌面部异物伤的诊断与治疗及影像学诊断的重要性。方法 :选择2003-01—2010-12期间收治的,影像和病历资料完善的口腔颌面部异物存留伤36例。分析异物类型,并对临床疗效进行评估。结果:36例异物存留伤患者中,金属异物12例,非金属异物24例。择期异物取出26例;需要急诊清创者10例,而清创术可一期取出异物者6例,4例延期取出。30例经常规X线片检查后,需经CT或三维CT检查进一步定位,评估手术取出的可行性及风险。其中26例经手术取出,4例保留并观察。结论:三维CT在非金属异物存留伤诊疗中起到重要的作用;必须根据异物大小、部位及与周围大血管的毗邻关系,患者全身情况等综合因素判定是否手术及手术时机。     

Removal of a large number of foreign bodies in the maxillofacial region with navigation system

The removal of a large number of foreign bodies in the maxillofacial region can be complicated and challenging. In this case report, a specific strategy for removal of multiple foreign bodies in the maxillofacial region is presented. A girl diagnosed with 24 foreign bodies in her left lower face and neck underwent the surgery using a computer‐assisted navigation system. A specific strategy was used in this case, which included from one sub‐region to the next and from the easiest to the most difficult. This strategy is recommended for the removal of a large number of foreign bodies in the maxillofacial region with a navigation system.     

增强现实联合导板治疗颌面部多发异物1例报告

随着社会经济的发展,颌面部创伤的致伤因素越来越多,并伴随着创伤,异物残留的情况也常有发生,除了可能损伤重要解剖结构以外,残留的异物还可能会造成感染、疼痛等二次损伤[1-3]。对于颌面外科医生来说,要在尽可能保证颌面部美观的前提下完成异物取出手术也是一个挑战,因此颌面部异物的诊疗一直是口腔颌面外科领域中的难题。     

应用显微超声技术清除根管内罕见异物的病例分析

目的 研究4例,临床上罕见的根管异物病例(2例缝被针及指甲,2例牙科用钻针)的临床清除过程.方法 应用根管显微镜,超声器械ET40松解异物旁根管壁牙本质,振松清除异物.结果 异物完全清除,完善根管治疗,患牙得以保存.结论 鉴于根管异物清除的复杂性,临床医生应具备正确识别根管异物的能力,通过准确定位并采用合适的方法,以达...     

颌面部非金属微小异物的超声定位及手术治疗

目的:应用超声对颌面部非金属微小异物进行诊断定位并引导手术摘取异物。方法:采用超声对18例患者7个解剖部位的8种微小非金属异物进行探查定位及手术引导。结果:18例颌面部非金属微小异物在超声定位引导下均顺利取出,未发生并发症。手术时间10～80min。7例从外伤伤口中取出,其余11例从手术切口中取出。结论:应用超声对颌面部非金属异物探查定位并引导颌面部手术摘除异物,简便易行,值得推广。     

口腔颌面部异物临床分析

对第四军医大学口腔医学院近10年收治106例口腔颌面部异物取出的适应证、异物定位、手术入路及方法等进行了讨论,着重讨论了大血管周围或已伤及大血管的异物存留处理方法,重型颌面损伤中异物存留的处理。认为一般情况下口腔颌面部异物均应力争取出,但异物小而深在,患者年龄较小、临床无症状、取出过程可能伤及重要的血管神经或者与严重伤情无直接关系的异物可暂不取出。     

Features of cranio-maxillofacial trauma in the massive Sichuan earthquake: Analysis of 221 cases with multi-detector row CT

Objective

In a massive earthquake, cranio-maxillofacial trauma was common. The present study was to determine the features of cranio-maxillofacial trauma sustained in the massive Sichuan earthquake by multi-detector row computed tomography (MDCT).

Methods

The study included 221 consecutive patients (123 males and 98 females; age range, 1–83 years; median age, 35 years) with cranio-maxillofacial trauma in the Sichuan earthquake, who underwent cranio-maxillofacial MDCT scans. The image data were retrospectively reviewed focusing on the injuries of the cranio-maxillofacial soft tissue, facial bones and cranium.

Results

All patients had soft tissue injuries frequently with foreign bodies. Ninety-seven (43.9%) patients had fractures (1.5 involved sites per patient, range from 1 to 8) including single cranial fractures in 36 (37.1%) cases, single maxillofacial fractures were seen in 48 (49.5%) and cranio-maxillofacial fractures in 13 (13.4%). Single bone fracture was more common than multiple bone fractures (p < 0.05). Nasal, ethmoid bones and the orbits were the most commonly involved sites of the craniofacial region. Thirty-eight (17.2%) patients had intracranial injuries, the commonest being subarachnoid haemorrhage and the commonest sites were the temporal and frontal regions. Coexisting intracranial injuries were more common in patients with cranial fractures than in patients with maxillofacial fractures (p < 0.05).

Conclusion

Our results indicate that the cranio-maxillofacial trauma arising from the massive Sichuan earthquake had some characteristic features, and a significant number of individuals had the potential for combined cranial and maxillofacial injuries, successful management of which required a multidisciplinary approach.     

Foreign body in the apical portion of a root canal in a tooth with an immature apex: a case report

Aim To describe the successful retrieval of a foreign object located in the apical portion of an immature root canal by simple orthograde techniques, avoiding the need for surgery or intentional reimplantation. Summary A radio‐opaque foreign object lodged in the apical portion of an immature root canal was discovered on radiographic examination of a patient with a complicated crown fracture. Attempts to retrieve it resulted in displacement into the periapical area. Eventually, the object was retrieved by a simple technique, followed by successful apexification, root canal filling and jacket crown placement. Key learning points ? Foreign bodies in root canals should be carefully evaluated to determine their nature, position, size and the degree of difficulty that may be encountered during retrieval. ? Patience, care and appropriate techniques may be helpful in retrieving foreign bodies and avoiding periapical surgery. ? Complicated crown fractures should be managed promptly, and prolonged open drainage avoided in children if the risks of foreign body impaction are to be minimized.     

口腔手术显微镜联合锥形束CT辅助治疗上颌第一前磨牙遗漏远颊根管1例报告

遗漏根管是根管治疗失败的常见原因,避免根管遗漏对提高根管治疗成功率至关重要。上颌第一前磨牙根管解剖形态变异较大,多为颊腭双根管或单根管,极少存在三根管[1]。研究表明,汉族人上颌第一前磨牙三根管的发生率为0.2%~1.8%[2-4]。如何识别可能存在的遗漏第三根管是上颌第一前磨牙根管治疗过程中的难点。本文报道了1例口腔手术显微镜联合锥形束CT(CBCT)辅助治疗上颌第一前磨牙根管治疗中远颊根管遗漏的病例,以期为临床治疗提供参考。     

开窗刮治术治疗24例下颌骨实性成釉细胞瘤效果观察

目的 观察下颌骨实性成釉细胞瘤一期刮治开窗术结合二期刮治术的临床效果,探讨该术式治疗下颌骨实性成釉细胞瘤的可行性。方法 筛选24例下颌骨单房或多房实性肿瘤患者,术中明确诊断为成釉细胞瘤后,进行一期开窗刮治。术后定期随访颌面部CT、全景片,适时行二期刮治。观察囊腔变化,分析治疗效果。结果 24例患者中,无肿瘤进展、范围增大病例,均未出现开窗口早闭、局部感染或骨髓炎症状。其中病情稳定6例,部分缓解10例,完全缓解8例,总有效率为75.0%。20例患者经二期刮治术,术后随访12~24个月,未见肿瘤复发。结论 开窗刮治治疗下颌骨实性成釉细胞瘤具有可行性,但应严格掌握手术适应证。