口腔颌面部火器伤研究进展—火器伤模型与伤情判断

现代战争,由于武器的发展,高速小口径枪和小质量投射物的使用,使得现代火器伤与以往战争火器伤相比,在损伤机制、伤情判断和战伤救治上发生了变化。颌面火器伤在战伤中比较常见,其发生率随着武器的不断改进有增加的趋势。平时的火器伤多由于犯罪伤害引起。1　致伤模型1.1　枪伤模型早期的实验多采用常规的五四式手枪和匹配的制式子弹,手握式目测瞄准法直接射击实验动物,子弹的撞击速度一般小于400m/s,属于火器伤的低速撞击。由于实验稳定性差,现已较少采用;20世纪80年代开始,广泛应用“瑞典模型”,即采用五三式滑膛弹道枪,将其固定于可调式…     

口腔颌面部火器伤机制及创伤救治

本文通过总结口腔颌面部火器伤形成机制和现代创伤学中口腔颌面部分级救治,结合分析战争中卫勤资料,为口腔颌面部火器伤提供救治方案,为我军卫勤力量的人员配置、装备配置提供建议.     

颌面部现代创伤弹道学特点和火器伤救治原则

一、颌面部火器伤流行病学特点颌面部火器伤是战争中常见伤 ,据有关资料报道 ,俄军在阿富汗战争中头面部伤占 13% ,车臣武装冲突中头面部伤占 19% ,有颌面外科医疗小组参加救治。 1991年美军在沙漠风暴军事行动中 ,头面部伤占 17 3% ,颈部伤占 4 3% [1] 。 1996～ 1998年以色列战伤统计中 ,头面部伤占 2 4 % ,颈部伤占12 % [2 ] 。 1998年 7月～ 1999年 3月美军在索马里Mogadishu军事行动中 ,头面部伤占 36 % ,颈部伤占7% ,多数致命伤发生在未受保护的颌面部、颈部、腹股沟等部位[3] 。尽管战伤统计中将颅脑伤和颌面部伤统计于头部损伤中 …     

平时颌面火器伤301例特点及救治体会

目的：探讨平时颌面火器伤的特点和救治经验,以期提高临床救治水平。方法：回顾分析301例颌面火器伤的伤因、伤情和救治,分析总结伤情特点及救治原则。结果：伤员中男女比例为5．1：1。301例火器伤中,枪弹伤占57％。伤情以多发伤为主,占66％。合并伤以颅脑伤最常见（16％）。所有伤员中,共有伤道900余处,多为盲管伤（72％）,发生异物存留者占67％。复合伤主要为烧伤和冲击伤,多见于爆炸伤。救治措施主要为维持生命、早期清创和抗感染。结论：颌面部火器伤因致伤物、致伤方式和解剖因素而多变,救治时应综合考虑,对症治疗。     

Small-vessel pathology and anastomosis following maxillofacial firearm wounds: an experimental study

This experiment was designed to provide a biological basis for early reconstruction of maxillofacial defects caused by firearms using free vascularized flap transfer. The pathologic changes of small-vessel injury, injury mechanism, and the feasibility for early anastomosis of these vessels in the maxillofacial region following high-velocity missile wounds were studied. Dogs' faces were wounded by a steel sphere, weighing 0.7 g and 1.03 g, with an initial velocity of 1,300 m/s or 1,500 m/s. Angiography and high-speed x-ray photography were used to record the effect of injury to blood vessels and other tissues. The pathologic changes in the small blood vessels in the wounds were studied by light microscopy (LM) and electron microscopy (EM). Anastomosis of small vessels in the wound was performed at different times after injury. There were temporary cavity effects and small vascular injury in the wounds. The pathologic changes of the small vessels included microthrombus formation, endothelial loss, breaks in the internal elastic layer, and necrosis. Degeneration of cells was found to end 3 cm from the wound edge. Anastomosis of the vessels performed 3 days after injury provided good short-term patency. These results suggest that the operation for repairing facial defects should be performed 3 days after injury.     

The modern oral and maxillofacial surgery office

The modern OMS office holds unlimited potential for incorporation of many different technologies. The goal, however, should focus on establishing a facility and environment that is inviting to patients and ergonomically designed for safe and efficient care delivery for the surgeon and staff with an overall reduced level of stress. The possibilities in office design and incorporation of emergent technologies, imaging equipment, and media platforms continue to advance, allowing future OMS offices exciting possibilities in day-to-day operation.     

Primary liposarcoma in oral and maxillofacial region

Liposarcoma as one of the most common soft-tissue sarcomas in adults rarely occurs in oral and maxillofacial region. Its rarity makes a systematic and in-depth understanding of these uncommon entities extremely difficult. Here we aimed to characterize and analyze the epidemiology, clinicopathologic characteristics, treatment and prognosis of primary oral and maxillofacial liposarcomas by presenting our experience from a Chinese tertiary referral hospital and literature review. All relevant information was manually collected from medical records from the authors' department (1993-2009) and literature retrieval (Jan.1940-Sep.2009). A total number of 150 patients were identified and included with mean age 49.1 years old and a slight male preponderance. These lesions mostly occurred in tongue (32.0%) followed by buccal region (28.7%) and were diagnosed as atypical lipmatous tumor/well-differentiated (58.45%) and myxoid liposarcomas (27.5%) by pathologic re-evaluation and re-categorization based on 2002 WHO classification scheme. Complete surgical excision with negative margins was the primary treatment modality, while therapeutic utilities of adjuvant radiotherapy/chemotherapy remained controversial. Our data reinforced histopathologic subtype as one of key prognostic factors irrespective of gender, age and primary sites for this malignancy. More importantly, our analysis further revealed that tumor size (especially when larger than 3.6 cm) served as another important prognostic factor suggesting higher rates of disease-related death. Taken together, these findings might for the first time provide comprehensive information regarding the epidemiology, clinicopathologic features, treatment and prognosis of oral and maxillofacial liposarcoma.     

口腔颌面部转移瘤

目的 总结口腔颌面部转移瘤的发病率及原发灶和转移灶情况。方法 回顾总结华西医科大学口腔颌面外科46年间收治的14例口腔颌面部转移瘤病例。结果 口腔颌面部转移瘤占所有该部恶性肿瘤（6813例）的2.05‰。转移灶多数位于颌面骨（9/14）。原发部位有肺、肝脏和上消化道、前列腺等,病理类型以上皮性肿瘤为主（12/14）,尤以腺癌多见（7/12）。结论 口腔颌面部转移瘤的发病率和原发灶的构成与具高转移向恶性肿瘤的发病率和构成比有关。转移灶部位以颌骨多见。     

口腔颌面部地震伤的诊治特点及其救治——四川汶川抗震救灾经验与感想

以华西口腔医院参与5.12四川汶川大地震抗震救灾的具体实践为依据,分析口腔颌面部地震伤的诊治特点和救治措施,希望为未来国家应对大规模灾难性事件中口腔颌面部伤的救治提供参考.