基于锥形束CT和螺旋CT的成釉细胞瘤影像学表现对比研究

目的    应用锥形束CT（cone-beam CT,CBCT）和螺旋CT（spiral CT,SCT）对比分析成釉细胞瘤的影像学表现及分型,为临床选择合适的影像学检查提供依据。方法    收集2018年1月至2019年12月就诊于南京大学医学院附属口腔医院的49例成釉细胞瘤患者的临床及影像学资料行回顾性分析。根据术前影像学检查方法,将所有患者分为CBCT组（21例）和SCT组（28例）,分析两组影像学表现和分型,记录术后复发情况,并计算影像学分型与病理学分型符合率（以下简称“病理符合率”）。结果    SCT组有单房型7例、多房型（可伴蜂窝）17例、骨外/外周型4例,其与病理学分型完全一致,病理符合率为100% ;CBCT组有单房型10例、多房型（可伴蜂窝）11例、骨外/外周型0例,但单房型中有5例的病理学分型为实性/多囊型,病理符合率为76.19% 。两组病理符合率比较,差异有统计学意义（P = 0.007）。术后2年内,CBCT组有3例患者复发,均为术前影像学分型与病理学分型不一致的行刮治术的患者;SCT组患者均无复发。结论    与CBCT相比,SCT可以对成釉细胞瘤进行更加精准分析和分型,为治疗方案的制定及预后的判断提供更多信息和依据。     

复发性成釉细胞瘤的临床、影像学回顾性分析研究

目的：探讨复发性成釉细胞瘤（Recurrent ameloblastoma,RAB）的临床及影像学表现,为其诊断及治疗提供依据。方法：回顾我院1991～2008年收治的具有完整病例资料的35例RAB病例,进行Gardner分型和初次手术治疗方式的统计学分析;对23例颌骨内RAB的Gardner分型和X线分型进行分析统计;对21例行颌面部CT检查病例的影像学表现进行分析总结。结果：Gardner分型中实质型RAB最多共24例（68.6%）,软组织内RAB有12例（34.3%）;颌骨内RAB最多的X线分型多房伴蜂窝型共8例（22.9%）,CT影像可以清晰的显示成釉细胞瘤的边界、密度、形状、范围及对周围组织的累及情况。结论：成釉细胞瘤的生物学行为及术式是术后复发的主要原因;RAB易出现软组织复发及表现为多囊伴蜂窝型的X线分型;CT对RAB尤其是软组织复发成釉细胞瘤有很好的诊断价值。     

增强CT在口腔颌面颈部多间隙感染中的应用评价

目的：总结口腔颌面颈部多间隙感染在增强CT上的影像学特点,并评估其对诊断和治疗的应用价值。方法：收集2005年12月-2011年12月口腔颌面颈部多间隙感染并行增强CT检查的连续病例227例．对其发病原因、CT表现、累及间隙、治疗结果、随访CT表现进行回顾分析。结果：病因多为牙源性和腺源性,分别有167例和33例;CT主要表现为脓肿、气体积聚和蜂窝织炎;下颌下间隙累及频率最高,为145例,其次为咬肌间隙（73例）、翼颌间隙（50例）和舌下间隙（48例）;出现呼吸道梗阻15例,下行性纵隔炎11例;214例患者治愈,8例失访,5例死亡。结论：增强CT应作为口腔颌面颈部多间隙感染首选的影像学检查．可为术前诊断、指导治疗及判断预后提供有效信息。     

口腔颌面部朗格汉斯细胞组织细胞增生症30例临床分析

目的：探讨口腔颌面部朗格汉斯细胞组织细胞增生症的临床特点及治疗方法。方法：采用病例回顾性研究方法,对30例口腔颌面部朗格汉斯细胞组织细胞增生症病例的临床表现、治疗和预后进行分析。以1997年wH0的临床分型为依据,采用以切除术或刮治术为主的治疗方法,病变累及范围较广者,辅以放疗和（或）化疗。对12例患者的随访结果进行分析。结果：男18例,女12例,中位年龄8岁;66．7％的病例病变累及下颌骨。影像学主要表现为骨组织破坏和软组织侵犯。对病变局限的14例患者采用单纯手术治疗;病变范围较广、累及骨外软组织的6例患者,采用手术加术后放疗;对有明显全身症状的5例患者,采用手术配合化疗。随访的12例患者中,无病生存10例。结论：口腔颌面部朗格汉斯细胞组织细胞增生症有一定临床特点．采取相应的治疗方法．预后较好。     

311例口腔颌面部间隙感染患者的回顾性分析

目的：探讨口腔颌面部间隙感染患者的流行病学分析及诊疗经验。方法：回顾分析311例口腔颌面部间隙感染患者的病案资料。结果：牙源性感染（70.4%）是口腔颌面部间隙感染最常见的病因。56.6%的入院患者病程超过1周。多间隙感染（70.5%）较单间隙感染（29.5%）更常见。60岁以上患者为患病最高的年龄段（38.9%）。血液链球菌是口腔颌面部间隙感染患者细菌培养检出率最高的致病菌（34.2%）。下行性纵隔炎是最常见的危及生命的并发症。78.1%的患者行脓肿切开引流术合并抗生素治疗。结论：口腔颌面部间隙感染患者治疗过程中需明确感染来源,从而指导治疗方案;B超、CT及MR等影像学检查对于间隙感染患者的诊断及治疗有指导意义;经验性抗生素使用合并脓肿切开引流仍是感染患者的首要治疗手段。在控制感染的基础上控制患者基础病的水平,避免可能出现的危及生命的并发症。     

颌面部软组织富血供肿瘤MDCT增强联合CTA多维技术应用价值

目的:应用MDCT增强联合CTA多维技术评价口腔颌面部软组织富血供肿瘤临床影像特征。方法:回顾性分析21例富血供肿瘤影像血供程度及指标,以病理结果作为诊断金标准,评价MDCT平扫及增强联合CTA多维技术对口腔颌面部软组织富血供肿瘤诊断的灵敏度与特异度,并绘制ROC曲线,分析评估效能。结果:21例患者中,MDCT增强联合CTA多维技术诊断准确率为90.48%,静脉期CT值的AUC为0.80,灵敏度为83.30%,特异度为72.73%。结论:MDCT增强联合CTA多维技术可用于术前评估颌面部软组织富血供肿瘤血供程度,其中肿瘤静脉期CT值评价效能最高,为规避颌面部富血供肿瘤术中失血的风险,术前无创性评估肿瘤血供的方法对临床治疗方案制定具有一定指导意义。     

功能性颈清术后胸锁乳突肌形态学变化研究

目的：评估功能性颈淋巴清扫术后胸锁乳突肌形态学改变。方法：口腔颌面部癌瘤患者50例,术前行颈部CT扫描,患者均接受原发病灶同侧的功能性颈清术,术后3月复诊,同时行颈部CT扫描检查颈清术后的胸锁乳突肌的变化并计算其不对称指数。结果：功能性颈清术后胸锁乳突肌不对称指数较术前有显著性差异（P〈0．01）,其形态学变化以胸锁乳突肌下段最为显著。结论：功能性颈清术后胸锁乳突肌产生显著萎缩,其原因可能是因为术中对神经支配、血供或肌肉本身损伤所致。     

累及口腔颌面部的组织细胞增生症X

累及口腔颌面部的组织细胞增生症Ｘ北京医科大学口腔医学院（１０００８１）张万林综述邹兆菊，马绪臣校审１９５３年Ｌｉｃｈｔｅｎｓｔｅｉｎ［１］基于组织病理结构上的相似及各型之间转化的可能，将本病之三种不同表现归于统一分类，命名为组织细胞增生症Ｘ（Ｈｉｓｔ...     

口腔颌面部恶性肿瘤单体素氢质子磁共振波谱的初步研究

目的探讨用单体素氢质子磁共振（^1H MR）波谱诊断口腔颌面部软组织恶性肿瘤的可行性。方法回顾分析42例经^1H MR检查并经病理证实为软组织恶性肿瘤的病例。^1H MR波谱空间定位采用点分辨波谱法，回波时间144ms。以肿瘤内胆碱化合物（化学位移为3．2×10^-6）的检出为评价标准。结果42例恶性肿瘤中，检出胆碱化合物者37例，包括15例鳞状细胞癌，9例涎腺癌，13例肉瘤和恶性淋巴瘤。结论单体素^1H MR波谱能为口腔颌面部软组织恶性肿瘤的诊断提供有益信息。多数恶性肿瘤以含胆碱化合物为特点，其中肉瘤和恶性淋巴瘤内胆碱化合物的检出高于上皮性癌。     

超声造影对口腔颌面部鳞癌颈部转移性淋巴结的诊断价值评价

目的 ：探讨超声造影（contrast-enhanced ultrasound,CEUS）对口腔颌面部鳞癌颈部转移性淋巴结的诊断价值。方法：选择41例接受手术治疗并行颈淋巴清扫术的口腔颌面部鳞癌患者,术前均行常规超声及CEUS检查颈部淋巴结。按术后病理诊断结果分为转移组和非转移组,评价2组淋巴结常规超声和CEUS影像特征的差异,并采用多因素Logistic回归模型分析转移性淋巴结的相关危险因素。应用受试者工作特征（ROC）曲线评价2种检查对口腔颌面部鳞癌颈部转移性淋巴结的诊断价值。数据采用SPSS 25.0软件包进行统计学分析。结果：病理检出17例患者共29个转移性淋巴结,24例患者共28个非转移性淋巴结。转移组常规超声表现为长短径之比（L/S）≤2、形态不规整、淋巴门结构异常、内部回声不均匀、周边型或混合型血流,与非转移组有统计学差异（P<0.05）。转移组与非转移组的灌注模式、灌注类型比较,差异有统计学意义（P<0.05）。常规超声表现为形态不规整、淋巴门结构异常、内部回声不均匀、周边型或混合型血流;CEUS表现为向心型或混合型、有不规则灌注缺损的不均匀增强型或微弱增强...     

颞下颌关节髁突囊样变的多模态影像学分析

目的:分析颞下颌关节髁突囊样变的锥形束CT、螺旋CT、MRI及核素骨显像影像学特点,为其诊疗提供影像学依据。方法:回顾性纳入2018年1月至2020年12月就诊于解放军总医院口腔颌面外科,经锥形束CT影像检查发现髁突囊样变并进行螺旋CT、MRI检查和核素骨显像的患者32例,其中男性12例,女性20例,年龄（33.9±1...     

Characterization of maxillofacial soft tissue vascular anomalies by ultrasound and color Doppler imaging: an adjuvant to computed tomography and magnetic resonance imaging.

PURPOSE: The special imaging and physical properties of ultrasound and color Doppler offer opportunity for continued investigation in oral and maxillofacial surgery. This study prospectively investigated ultrasound and color Doppler in addition to computed tomography (CT) and magnetic resonance imaging (MRI) in the characterization of several vascular or suspected vascular anomalies and assesses the value of ultrasound and color Doppler in their diagnoses. PATIENTS AND METHODS: Six patients with vascular or suspected vascular anomalies seen between 1997 and 1999 composed the study group. All patients were clinically evaluated, imaged by CT with contrast and/or MRI with contrast, ultrasound, and Doppler (including color, spectral, and power). Ultrasound studies were performed in the presence of the referring oral and maxillofacial surgeons to provide consultation on anatomy and differential diagnosis as well as to witness the dynamic study. Three patients were further studied by angiography. The Mulliken/Glowacki classification (Plast Reconstr Surg 69:412, 1982) and designations and the Jackson et al modification (Plast Reconstr Surg 91:1216, 1993) are used in this study. RESULTS: A spectrum of lesions emerged in this small case series. Detailed clinical and imaging findings and a summary of diagnostic impressions allowed general and specific observations and permitted assessment of the value of ultrasound and color Doppler in the diagnosis of these lesions. The diagnostic accuracy of ultrasound and Doppler was equal to or better than that of CT and/or MRI in 4 of 6 cases. In the other 2 cases ultrasound did not specifically diagnose the lesions but did allow assessment of vascularity. In one of these cases the correct diagnosis was made by a combination of CT and angiography, and in the other the diagnosis was made by nonenhanced MRI. An ancillary study showed that the combination of nonenhanced MRI with ultrasound and Doppler provides more information than contrast-enhanced MRI alone and is more cost effective. CONCLUSIONS: 1) A single imaging modality is frequently unable to provide sufficient diagnostic information to allow confident clinical management of a vascular malformation. 2) A team approach and conferencing between imaging specialists and clinicians promote better diagnosis and management. 3) Nonenhanced MRI with ultrasound/color Doppler can be substituted for enhanced MRI to provide the best diagnostic information and at reduced cost. 4) Ultrasound/color Doppler is an important adjuvant to CT and MRI in the diagnosis of vascular or suspected vascular anomalies.     

19例腮腺腺泡细胞癌的MRI影像表现分析

目的: 总结腮腺腺泡细胞癌（acinar cell carcinoma,AciCC）的MRI特征,探讨MR功能成像的诊断价值。方法: 分析269例经手术病理证实的颌面部AciCC的临床资料。其中,19例腮腺AciCC行术前MRI检查（1例平扫,18例增强）,17例行DWI扫描, 15例行DCE扫描。回顾分析19例患者的MRI表现,分析病灶大小、部位、形态、边缘、内部结构、强化方式及功能成像特点。采用SPSS 25.0软件包对数据进行统计学分析。结果: 269例颌面部AciCC中,男108例,女161例,男∶女=1∶1.49。年龄4~89岁,平均年龄（45.95±17.33）岁。84.4%（227/269）的发病部位位于腮腺。MRI表现为78.9%（15/19）病变边界清晰,57.9%（11/19）呈圆形或椭圆形,36.8%（7/19）呈分叶状结节。1例病变形态不规则,且侵犯外周。病灶最大径6~56 mm,平均（24.8±15.3） mm。内部结构为57.9%（11/19）呈囊实性,42.1%（8/19）呈实性,31.6%（6/19）有出血。T2加权像52.6%（10/19）可见包膜结构,15.8%（3/19）内部见低信号分隔;38.9%（7/18）强化均匀,61.1%（11/18）强化不均匀。功能成像显示肿瘤平均ADC值为（1.026±0.194）×10^-3 mm²/s（n=17）,86.7%（13/15）TIC为Ⅱ型。结论: 绝大部分颌面部AciCC位于腮腺。常规MRI显示,AciCC形态学上与良性肿瘤较难鉴别。功能成像ADC值较良性肿瘤低,TIC曲线类型多为Ⅱ型。将形态学与功能成像相结合,可提高该病的诊断准确率。     

The application of magnetic resonance imaging in maxillo-facial region: A comparison with CT

Magnetic resonance imaging (MRI) studies were obtained in 49 cases of various diseases in the maxillo-facial region and the results compared with X-ray computed tomography (CT). Bot MRI and CT scans were performed in 44 cases. In 31 cases (70%), MRI provided similar or superior information to that of CT in the evaluation of various diseases. In 10 cases, MRI was superior to CT in defining the images of diseases, 7 cases of these were carcinomas. CT was superior to MRI in 5 cases, especially in demonstrating calcifications and bony changes. Artifacts caused by prosthetic metals and patient motion disturbed MR images. Our experience with MRI lead us the conclusion that it holds great potential and that it already had some advantages over CT in the maxillo-facial region.     

Orofacial non-Hodgkins lymphoma in Nigerians.

PURPOSE: In this study, we sought to determine the occurrence of primary non-Hodgkins lymphoma (NHL) in the oral and maxillofacial region among Nigerians. PATIENTS AND METHODS: We retrospectively studied hospital records that included radiographs of all patients with a histopathologically confirmed diagnosis of NHL in the Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria, between January 1992 and December 1997. Data were expressed as mean +/- SD or number (%). RESULTS: During the study period, 66 cases of NHL were recorded. Seventeen patients had concomitant extranodal lymphomas involving the gastrointestinal tract, nasopharynx, skin, lungs, kidney, and thyroid, in descending order. Three patients (4.5%) presented primarily with extranodal oral and maxillofacial disease. The ages of these patients ranged from 18 to 50 years (mean +/- SD, 32.3 +/- 16.3 years; median, 29 years). Within the same period, there were 121 cases of Burkitts lymphoma. The onset of lesions varied from 6 to 20 weeks. Two patients had intermediate-grade lesions; the remainder had low-grade lesions. Two presented with stage II disease, and the remainder were stage I. All of the patients had chemotherapy with remission of their lesions but were followed up to 6 months. Most of them did not complete the treatment cycles due to financial and social constraints. CONCLUSIONS: The rarity of primary NHL of oral and maxillofacial region has been aptly shown in this study. The need for the establishment of an effective oncology policy with the active collaboration of voluntary agencies is emphasized. This would ensure ready availability of the required chemotherapeutic agents and hospital care at affordable costs.     

口腔颌面部复发性肿瘤破坏中颅底的CT表现

目的显示口腔颌面部复发性肿瘤侵犯中颅底的ＣＴ表现。方法３７例口腔颌面部复发性肿瘤患者被行以横轴面和冠状面（２６例）ＣＴ检查,所有病变均经病理检查证实。结果ＣＴ上显示的中颅底破坏方式有四种：（１）颅底骨外板吸收（５例）;（２）颅底骨内外板均吸收（２４例）;（３）卵圆孔扩大（３例）;（４）颅底骨硬化和吸收并存（５例）。复发性肿瘤破坏中颅底最多的结构是蝶骨大翼（３６例）。ＣＴ显示病变侵入颅内者共２４例,受累的颅内结构有海绵窦（１６侧）,大脑颞叶（１５侧）和脑垂体（１例）。结论ＣＴ上显示的颅内侵犯与上述中颅底破坏方式密切相关。ＣＴ检查有助于临床上评价颌面复发性肿瘤侵犯中颅底。     

口腔颌面部恶性黑色素瘤的CT表现

目的：评价口腔颌面部恶性黑色素瘤的CT表现。方法：回顾性分析了经CT检查的口腔颌面颈恶性黑色素瘤病例15例(23灶)。CT检查包括平扫(15例,23灶)和增强(12例,19灶)。所有病例均经病理检查证实。结果：22/23灶恶性黑色素瘤在CT检查中呈阳性表现．包括原发病变14灶和颈部淋巴结转移性病变8灶。病变呈软组织肿块者20灶,黏膜增厚者2灶(均为原发灶)。病变边缘不清者18灶,边缘清晰者4灶。增强CT显示：不均匀强化者9灶,均匀强化者5灶,无强化者5灶。病变压迫颈静脉变形3灶,侵犯上颌骨7灶,侵犯下颌骨2灶。结论：口腔颌面部恶性黑色素瘤的CT表现具有多样性。病变多以边界不清并有增强的软组织肿块为特点。     

The pharyngeal mucosal, parapharyngeal, and retropharyngeal spaces

Mass lesions in the deep neck spaces cannot be examined directly but instead require sectional imaging examinations. This pictorial essay reviews cases of mass and/or mass-like lesions in the oral cavity and/or the pharyngeal region that were radiologically diagnosed at our department. The purpose of this paper is to introduce to oral radiologists several key points in the sectional imaging diagnosis of a variety of lesions of the pharyngeal mucosal space, parapharyngeal space, and retropharyngeal spaces. To help readers make full use of CT or MR image findings of lesions in these spaces, we provide actual images of common diseases that occur in either the oral cavity or the neck. By focusing on displacements of fat, vessels, muscles, and bony structures in each space, oral radiologists can narrow the range of possible differential diagnoses. Familiarity with not only the anatomy of these spaces but also with the diseases specific to them and, in turn, their radiological manifestations, can help oral radiologists reach an accurate diagnosis.     

口腔颌面肿瘤侵犯翼腭间隙的CT检查和诊断

为了给治疗提供有益的经验，作者回顾分析了３３例病理检查证实的口腔颌面部肿瘤犯翼腭间隙的ＣＴ表现，结果显示腭间隙区犯的ＣＴ表现主要是软组织肿块的占位和其各壁结构破坏，不同中心部位的口腔颌面部肿瘤对翼腭间隙的侵犯具有不同的ＣＴ表现特点。作战人组织发生和ＣＴ表现两方面对原发性翼腭间隙肿瘤进行了探讨，并提出了ＣＴ诊断标准。ＣＴ对诊断该区的病变具有重要作用。     

Efficacy of a single occipitomental radiograph to screen for midfacial fractures.

PURPOSE: This study evaluated the use of a single 30 degrees occipitomental radiograph as an effective screening procedure for midface fractures. PATIENTS AND METHODS: The emergency room 30 degrees occipitomental films of 105 consecutive patients with suspected midface fractures were examined independently by 2 oral and maxillofacial surgeons (OMFS). They were asked to identify whether a midfacial fracture existed in each case. They also identified those cases in which they believed a computed tomography (CT) scan was indicated for definitive diagnosis of midfacial fractures. These findings and recommendations were then compared with the actual diagnosis and imaging studies for these patients to determine the efficacy of a single occipitomental film, supplemented by CT scans when indicated, in identifying midface fractures. RESULTS: Of the 105 occipitomental films, one oral and maxillofacial surgeon recommended CT scans for 13 of the 105 patients, and the second recommended CT scans for 26 patients. Seventeen patients actually had had CT scanning performed, and a midface fracture was identified in 12 cases. Of these 12 patients, 8 were treated by surgical intervention. One OMFS identified 11 of the 12 fractures that were subsequently identified in the emergency room, including all of the 8 that required surgical treatment, whereas the second OMFS identified all 12 of the fractures seen in the emergency room. CONCLUSION: A single 30 degrees occipitomental radiograph, augmented with CT scans when indicated, can accurately identify all midface fracture requiring treatment. The current practice of obtaining a series of plain radiographs may be unnecessary.