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??In recent years??with the development of orthodontic technology??domestic and foreign scholars have done a lot of research on how to accelerate the orthodontic tooth movement. Here we review multiple important factors accelerating the speed of orthodontic tooth movement that has been confirmed??such as hormones and drugs??electromagnetic laser and surgical methods??in order to offer the reference for future clinical treatment.     

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题要：下颌骨作为面下1／3的骨性支架,对维持面型、保持咀嚼功能具有重要作用。颌骨囊性病变及颌骨肿瘤是造成颌骨缺损的主要原因,临床治疗须进行下颌骨重建,方法包括骨移植、牵引成骨技术、骨组织工程技术。本文就下颌骨重建的方法及新材料的研究进展予以综述。     

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目的探讨背阔肌游离肌皮瓣修复口腔颌面部严重组织缺损的临床治疗效果。方法选择2006年11月至2008年11月于中国医科大学口腔医学院颌面外科就诊的颌面部严重组织缺损患者5例,缺损面积最小12cm×8cm,最大20cm×14cm。全部采用背阔肌游离肌皮瓣移植,Ⅰ期修复重建。切取肌皮瓣面积最小13cm×9cm,最大24cm×16cm。结果创口均为Ⅰ期愈合,皮瓣100%成活。术后随访1个月至2年,功能与形态满意。结论背阔肌游离肌皮瓣移植是一种修复重建口腔颌面部较大组织缺损较为理想的方法,具有血供可靠,供瓣面积大、供区隐蔽等优点。     

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??Perforator flaps have increasingly been used to reconstruct oral and maxillofacial-head and neck defects. They offer several advantages over nonperforator-based flaps with lower donor site morbidity and a versatile range of reconstructive options. The lower limb perforator flaps are well used in the head and neck and get a reliable result. The most popularly used perforator flaps in the lower limb were reviewed on their anatomy??clinical applications??and role in head and neck reconstruction. We found that perforator flaps are now mainstream reconstructive options in the head and neck surgeon's armamentarium.     

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??Objective    To investigate the characteristics of indirect injury of periodontal membrane caused by maxillofacial impact injury. Methods    The study was carried out at the laboratory of oral and maxillofacial trauma in Fourth Military Medical University??from November 2013 to January 2014. Totally 18 dogs were divided equally into six groups with random allocation??the right mandible of each dog was impacted by a cylindroid iron cap whose weight was 0.26kg??but teeth were not injured directly??the animals were killed 6 h??24 h??3 d??7 d??2 wk and 4 wk later??respectively??the histopathologic manifestations of periodontal membrane of the fourth premolar of right mandible??the second premolar of right mandible and the second premolar of left mandible were observed. Results    The injury of periodontal membrane of the fourth premolar of right mandible was relatively obvious??but the pathologic changes were reversible??periodontal membrane of the second premolar of right mandible was injured slightly??yet no obvious histopathologic change could be observed in periodontal membrane of the second premolar of left mandible. Conclusion    Maxillofacial impact injury can cause indirect injuries of periodontal membrane of adjacent teeth??but the pathologic changes are reversible??traumatic severity decreases as the distance of the tooth to the wound area increases.     

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??Objective    To observe the effects of lithium chloride pretreatment on cognitive ability of aged rats after oral and maxillofacial surgery. Methods    A total of 48 aged male SD rats??18 ~ 20 months old??weight 550 ~ 700 g?? were bought from the Experimental Animal Center of China Medical University . These rats were randomly divided into three groups??including the normal control group??group C??n=16????surgery and anesthesia group??group O??n=16????and lithium chloride preconditioning group??group L??n=16??.Rats in each group were randomly divided into two parts??one part was given Morris water maze test three days after the surgery and its characteristics of behavior tested. Another part was decapitated 24 h after the surgery and extracted and the hippocampus brain separated at the same time. Test expression content of IL-1β GSK-3β p-GSK-3β??ser9??in the hippocampus by Elisa and Western blotting detection method respectively. Results    Morris water maze test showed that??the first day after surgery??latencies of group L and O were significantly longer than group C??compared with group C in swimming distance?? latency and swim distances of group L were shorter than group O. With the comparison of multiple analysis of variance??differences were statistically significant??P??0.05??. Groups L and O in the second day were slightly shortened compared to the first day??on the third day after surgery it has also improved over the second day. Space exploration experiments in rats showed that??the dwell time of group C was significantly longer in the platform quadrant and the frequency of crossing the platform also increased compared with groups L and O. In addition??group L and group O were higher in IL-β levels than group C??the difference being statistically significant by analysis of variance??P??0.05????but group L was significantly lower compared with group O??the difference being statistically significant??P??0.05??. The content of GSK-3β of three groups were of no significant difference??P > 0.05????but p-GSK-3β??ser9??content was significantly lower in group L and O than in group C. The content of GSK-3β of group L was higher than in group O??the difference being statistically significant??P??0.05??. Conclusion    Pretreatment with lithium chloride in postoperative aged rats can inhibit the expression of inflammatory cytokines and increase GSK-3β phosphorylation in the hippocampus cells??so p-GSK-3β??ser9??upregulates and inhibites  the apoptosis of brain cells??thereby improved cognitive abilities after the cavity and maxillofacial surgery.     

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??There are a lot of methods for condylar reconstruction?? among which?? tissue engineering is a novel technique for condyle regeneration. The aim of the article is to review the research progress in the repair of the defect of condylar cartilage and bone unit by tissue engineering technique.     

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目的 探讨面部不对称畸形患者的三维仿真头模术前设计对其术中上颌骨截骨的指导意义。方法 选择中国医科大学口腔医学院口腔颌面外科2007年1月至2009年1月收治的18例面部不对称畸形患者。所有患者畸形明显并且均伴有竖直方向牙合平面的倾斜。术前制作三维头模,精确测量之后在模型上模拟截断上颌骨,评价截骨的位置及截骨量,再将得到的数据应用到手术中行上颌骨截骨,术后6个月评价手术效果。结果 18例患者手术顺利,无严重并发症出现。所有患者术后效果满意,牙合平面均水平,面部对称。结论 通过三维头模模拟截骨得出的数据可用于精确指导术中的截骨,对于术中上颌骨截骨的位置及截骨量的确定具有重要的指导意义。     

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??The lateral femoral circumflex artery system perforator flaps include anterolateral thigh perforator flap supplied by the lateral descending branch and oblique branch of lateral femoral circumflex artery??anteromedial thigh perforator flap supplied by the medial descending branch of lateral femoral circumflex artery??and tensor fascia lata perforator flap by the ascending branch of lateral femoral circumflex artery. The advantages of these flaps include the low donor site morbidity?? the convenient donor site??the good vascular quality??the large soft tissue volume??the ability to be harvested as a chimeric flap with multiple various tissue components??and being far from the head and neck region which is fit for two-team approach. The lateral femoral circumflex artery system perforator flaps can be flexibly chosen according to the different defects??so as to obtain the best effect in oral and maxillofacial reconstruction.     

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目的    探讨全面部骨折各种手术复位径路的可行性及优缺点。方法    对2002—2009年在宿州市立医院口腔颌面外科救治的资料完整的69例全面部骨折手术病例复位手术径路进行回顾性分析。结果    69例患者中,有47例采用了头皮冠状切口+小切口,22例单纯采取局部小切口。术后随访平均6个月,患者在功能上皆取得了良好的治疗效果,并发症表现各有不同。结论    冠状切口+小切口和单纯局部小切口在不同适应证中均可获得满意的治疗效果,应进一步研究如何减少冠状切口的并发症和如何应用微创切口对全面部骨折进行良好复位。     

右美托咪定对儿童牙科日间全麻手术苏醒期躁动的影响

目的 将右美托咪定用于儿童牙科日间全麻手术的维持,探讨其对苏醒期躁动发生的影响。方法 将拟全麻下行口腔治疗的80例儿童牙科患儿随机分为A组和B组,每组40例。A组在全麻维持期静脉注射1 μg·kg^-1负荷量右美托咪定（生理盐水稀释至10 mL）,然后以0.1~0.4 mL·（kg·h）^-1的速度静脉注射至手术结束前45 min,B组以同样方式注射生理盐水。记录2组患儿的年龄,性别,体重,美国麻醉医师协会病情分级（ASAPS）,不同时间点的心率（HR）、平均动脉压（MAP）、氧饱和度（SpO₂）,舒芬太尼用量,手术持续时间,手术结束到拔管的时间,拔管到清醒的时间、清醒后行为评分（FPAS）,达离院标准的时间等指标,并进行统计分析。结果 2组手术开始、手术10 min、30 min、1 h、2 h及拔管后的HR、MAP均有统计学差异,A组低于B组（P<0.05）;舒芬太尼用量及苏醒期躁动率也有统计学差异,A组低于B组（P<0.05）;2组拔管到清醒的时间及达离院标准的时间为A组长于B组（P<0.05）。其他指标2组均无统计学差异。结论 右美托咪定用于儿童牙科日间全麻手术,能降低苏醒期躁动发生率,术中生命体征更平稳。     

口腔颌面外科手术全麻后苏醒延迟的临床分析

目的探讨全麻术后苏醒延迟的原因及临床处理方法。方法对本院1996—1998年11例口腔颌面外科手术全麻后苏醒延迟的原因及临床处理进行了回顾性分析。结果苏醒延迟的原因主要有低氧、药物过量、脑外伤及严重电解质紊乱等。临床处理以维持呼吸道通畅、血流动力学稳定为原则,必要时采用脑保护措施,适当应用催醒药。结论避免苏醒延迟重在预防。对苏醒延迟患者要正确分析原因,对症处理。     

不同麻醉方式在腮腺肿瘤切除术时面神经监测中的应用比较

目的 比较静吸复合麻醉与全凭静脉麻醉用于腮腺肿瘤切除术时面神经监测的临床效果及安全性。方法 70例接受腮腺肿瘤切除手术的患者,随机分为静吸复合组（S组）和全凭静脉组（V组）（n=35）。麻醉诱导时静脉给予顺式阿曲库铵0.15 mg/kg,气管插管后S组吸入七氟醚复合泵注丙泊酚+瑞芬太尼维持,V组则仅泵注丙泊酚+瑞芬太尼维持。使用肌松监测仪测定拇指内收肌的4个成串刺激（TOF）反应,记录阻滞起效时间、深度阻滞恢复时间（T₁的出现时间）、T₁ 50%及TOF 90%恢复时间。术中采用面神经电生理监测,记录2组患者在T₁ 50%时监测的成功率,比较2组患者术中发生体动与心血管药物使用情况及术后拔管时间。采用SPSS 20.0软件包对数据进行统计学分析。结果 2组患者肌松起效时间无显著差异(P>0.05),S组T1的出现时间晚于V组,但组间差异无统计学意义(P>0.05),S组的T₁ 50%及TOF 90%恢复时间显著延长（P<0.05）。2组患者在T₁ 50%时均能成功获得面神经监测信号。2组均无使用血管活性药物的患者;V组有2例患者术中发生轻微体动。2组患者拔管时间无显著差异（P>0.05）。结论 静吸复合麻醉和全凭静脉麻醉均能满足术中面神经监测的手术要求,全凭静脉麻醉有利于更早地获得面神经电生理信号,而静吸复合麻醉有利于预防术中体动发生。     

两种全凭静脉麻醉维持方法在老年口腔颌面部手术中的比较

目的比较异丙酚麻醉镇静下,瑞芬太尼复合顺式阿曲库铵和芬太尼复合维库溴铵两种麻醉维持方法在老年口腔颌面手术麻醉时临床效果。方法 50例老年口腔颌面部择期手术患者,手术时间在1h～3h,随机分成R和F两组（N=25）,两组术中异丙酚持续输入4mg/kg/h,R组持续泵入瑞芬太尼4ug/kg/h～12ug/kg/h＋顺式阿曲库铵1ug/kg/min～2ug/kg/min;F组持续泵入芬太尼1.5ug/kg/h～2ug/kg/h＋维库溴铵1ug/kg/min～2ug/kg/min,估计在手术结束前10分钟停药。监测指标包括手术开始时,开始后10分钟,开始后30分钟开始后1h,停药时和拔管时的平均动脉压（MAP）,心率（HR）和心输出量（CO）。记录停药后唤名睁眼时间,拔管时间,PACU滞留时间。结果两组患者手术开始时,开始后10分钟的MAP,HR和CO无显著差异;R组手术开始后30分钟HR低于F组（P〈0.05）。R组唤名睁眼时间,拔管时间,PACU滞留时间短于F组（P〈0.05）,R组的苏醒快于F组。结论老年口腔颌面部手术异丙酚全凭静脉麻醉时,瑞芬太尼复合顺式阿曲库铵与芬太尼复合维库溴铵两种维持方法术中均适合,瑞芬太尼复合顺式阿曲库铵维持组意识恢复好,效果优于芬太尼复合维库溴铵组。     

Risks of general anesthesia for the special needs dental patient

The risk of dental rehabilitation under general anesthesia has multiple contributing factors. The literature has addressed the general anesthetic risk of dental general anesthesia and sedation in the operating room and the office settings, but more studies are needed to address the special needs population in particular. There is still a great need for more studies to assess the risk versus benefit for special need population as well as to stratify such risk in order to assist care providers in decision making as well as in sharing such risk concerns with patients, caretakers, and guardians. One recommended approach is to conduct a national retrospective study of patients treated under general anesthesia in the past 10 years in all the various settings and assess the associated risks and complications related to their physical status and the underlying physical and mental disabilities. The product of such a study could be a stratification of risk versus benefit as well as some guidelines for decision making as far as which kind of procedures should be conducted under general anesthesia while weighing the level of risk for the particular patient. Although access to care is not a direct risk factor, it can certainly deter timely treatment and intervention for patients with special needs.     

盐酸戊乙奎醚对接受口腔颌面部手术的老年患者认知功能的影响

目的: 探讨麻醉前应用阿托品以及不同剂量盐酸戊乙奎醚对接受口腔颌面部手术的老年患者术后认知功能的影响。方法: 选择2017年12月—2018年7月于上海交通大学医学院附属第九人民医院择期行口腔颌面部手术的老年患者134例,麻醉诱导前随机接受阿托品0.5 mg（A组,n=32）、盐酸戊乙奎醚0.01 mg/kg（C1组,n=34）、盐酸戊乙奎醚0.015 mg/kg（C2组,n=33）、生理盐水（NS组,n=35）作为术前用药。比较4组患者术前焦虑评分、术前认知功能评分、用药后生命体征变化、口腔腺体分泌程度、手术时间、失血量、苏醒时间、术后疼痛评估、术后认知功能评分。采用SPSS 18.0软件包对数据进行统计分析。结果: A组患者用药后心率变化较其余3组显著升高（P<0.05）,A组、C1组、C2组患者用药后在准备室需要吸引口腔内分泌物次数较对照组显著减少（P<0.05）,C2组苏醒时间较其余3组显著延长（P<0.05）,MMSE评分显著下降（P<0.05）。结论: 麻醉诱导前应用小剂量（0.01 mg/kg）盐酸戊乙奎醚,不延长苏醒时间、不增加术后认知功能下降风险,同时其抑制口腔腺体分泌效果好,对老年患者心肺系统影响较小,是老年口腔颌面部手术患者理想的术前用药。     

全身麻醉下儿童牙齿治疗技术在我国应用现状及展望

国际上开展全身麻醉下儿童牙齿治疗已经有60多年历史,其技术越来越成熟,效果也得到了广泛肯定。我国从90年代末期开始一些医院相继开展此项技术,近年来有了长足发展,许多医院已开始或准备开展全身麻醉下儿童牙齿治疗,大部分开展此项技术的医院都出现了患者排队数月甚至更长时间的情况。该文将介绍全身麻醉下儿童牙齿治疗的国内外情况,适应证和禁忌证、风险防范和规范制定以及未来展望。     

Providing deep sedation and general anesthesia for patients with special needs in the dental office-based setting

This article discusses the issues of morbidity and mortality associated with deep sedation and general anesthesia specifically in the dental office-based setting for patients with special needs (PSN). A focused review of a particular environment and patient population was challenging as it was difficult to identify articles that discuss the unique scope of this subject. During the review of the literature, no article was identified that discussed this exact topic. There were articles that discussed the delivery of general anesthesia for PSN in an outpatient setting and associated issues of morbidity and mortality. There were also articles and sources of information that discussed the delivery of general anesthesia for other patient populations in the office-based setting. In an effort to support the scope of this article, some of these articles are discussed as they pertain to the subject of this article. In addition, an analysis of the author's practice over a 4-year period is discussed in an effort to present relevant data per the scope of this article. After reviewing the literature and the author's clinical practice, it appears that the incidence of mortality for PSN in the dental office-based setting is minimal and the incidence of morbidity for this same population is limited to relatively minor events. Ultimately, it was concluded that the delivery of general anesthesia for PSN in the dental office-based setting can be considered a very safe and successful procedure.     

bFGF雾化吸入对全麻下口腔颌面外科术后咽喉痛的疗效观察

目的:观察重组人碱性成纤维细胞生长因子(bFGF)雾化吸入对全麻下口腔颌面外科术后咽喉痛的疗效.方法:将全麻下口腔颌面外科术后拔除气管导管的40例患者随机分为治疗组和对照组;治疗组给予bFGF 35000IU+生理盐水20 mL,压缩雾化吸人、每天1次,每次20 min,连续3d;对照组给予生理盐水5 mL+地塞米松5 mg+庆大霉素8万U+糜蛋白酶4000 U,压缩雾化吸人、每天2次,每次20 min,连续3d.分别记录2组术后12 h咽痛发生情况及咽痛(吞咽时)12、24、48、72 h视觉模拟评分(VAS),采用SPSSl4.0软件包对数据进行统计学分析.结果:治疗组术后12 h咽痛发生率显著低于对照组(P＜0.01);治疗组术后12、24、48和72 h咽痛(吞咽时)VAS均显著低于对照组(P＜0.05).结论:bFGF雾化吸入能降低口腔颌面外科气管插管全麻术后咽痛发生率及咽痛程度.