33例口腔颌面部损伤伴休克的急救处理

目的探讨各种口腔颌面部损伤并休克的急救方法。方法收集33例口腔颌面部损伤并休克住院患者临床资料,分析损伤原因、类型、诊断、急救方法及疗效。结果33例中有20例为交通事故所致,31例为失血性休克,27例合并颅脑损伤、四肢骨骨折等全身合并伤。32例抢救成功且口腔颌面部软硬组织损伤恢复或基本恢复,1例因脾破裂死亡。结论合并休克的口腔颌面部损伤患者首先应明确诊断,积极抢救生命,在此基础上尽可能恢复口腔颌面部功能及外观。     

颌面部损伤患者265例的临床护理体会

目的　总结颌面部损伤患者临床护理要点。方法　对 2 6 5例颌面部损伤患者的临床资料进行回顾性分析。结果　应根据颌面部损伤患者的特点 ,做好 4项重点护理。结论　把握好抢救时机 ,做好急救处理 ,严密观察伤情 ,重视整体护理 ,对使患者转危为安 ,获得良好的预后和康复非常重要     

老年口腔颌面部损伤救治320例临床分析

目的:探讨老年口腔颌面部损伤的急救经验。方法:回顾性分析2003年3月-2011年12月我院收治320例62-83岁老年口腔颌面部损伤患者的临床资料。结果:320例老年口腔颌面部损伤患者经抢救及综合治疗,2例患者因重度颅脑损伤及伴心脏疾病抢救无效死亡外,其余均救治成功,治愈率99.4%。2例患者因面部瘢痕明显影响外貌,行二期整形修复,术后恢复满意;109例颌面部骨折术后随访6个月-4年,术后面部形态恢复满意,咀嚼功能良好,张口度≥3 cm,咬合关系恢复正常,X线片显示骨折断端对位良好,未见骨愈合不良、钛板排异反应、伤口感染、神经损伤等并发症。结论:以抢救生命为原则,多科协作,在保障患者生命的前提下,尽早对不同类型的颌面部损伤采取相应的治疗措施,创造手术条件,术中、术后严密监测,发现问题并及时处理,并存心脑血管等系统疾病的老年颌面部损伤患者,能够较顺利的度过围手术期,取得满意的临床效果。     

508例颌面部骨折的急救处理

５０８例颌面部骨折的急救处理广东省茂名市人民医院口腔科（５２５０００）吴克志颌面部骨折临床上比较常见，急救处理较为复杂。自１９８７年至１９９７年作者参与抢救５０８例颌面部外伤患者，其中１５７例伴颅脑损伤，现总结报告如下。临床资料一般资料：本组男性３１...     

口腔颌面部创伤并发呼吸道梗阻急救50例

目的:探讨口腔颌面部创伤并发呼吸道梗阻的急救。方法：对1988～2002年收治的50例口腔颌面部创伤并发呼吸道梗阻的患者，抢救治疗总结分析。结果：50例患者全部抢救成功：结论：口腔颁面部创伤并发呼吸道梗阻应分为吸人性梗阻、肿胀性梗阻、组织移位性梗阻，根据不同梗阻分别处理、及时救治，必要时应紧急气管切开或预防性气管切开，才能提高呼吸道梗阻急救成功率。     

5762例非住院颌面部外伤患者回顾分析

目的: 了解颌面部外伤非住院患者的流行病学特点,为预防和治疗颌面部外伤提供参考。方法: 选取2014年1月—2017年12月于中国医科大学附属盛京医院就诊的5762例非住院颌面部外伤患者进行流行病学统计分析。结果: 非住院颌面部外伤患者中,男性多于女性,男女比例为1.736∶1。发病年龄高峰为学龄前儿童（3~6岁,28.55%）,其次为婴幼儿（0~3岁）。未成年患者（0~17岁）占非住院颌面部外伤患者的68.7%。摔伤（72.9%）为最主要的损伤原因,其次分别为交通事故伤（9.2%）和暴力伤（7.5%）。第3季度（30.1%）及9月份（12.9%）为发病高峰。软组织伤中,额部（37.24%）为最常见的损伤部位,其次为颊部（19.04%）及唇部（18.67%）。结论: 非住院颌面部外伤患者以男性多见,3~6岁组为发病高峰。摔伤及额部是最常见的损伤原因及损伤部位。     

颌面部损伤伴复合伤76例临床分析与治疗

目的探讨颌面部损伤伴常见复合伤的伤情特点、救治原则及处理要点。方法对76例颌面部损伤的患者进行回顾性临床分析。结果颌面部损伤高发年龄段为20~40岁,占60%,致伤原因以交通事故居首位,占64%。患者经过及时、综合、多科联合治疗,除1例颌面部损伤并发颅底骨折、硬脑膜下血肿及另1例并发颈椎脱位而死亡,其余患者均获得渐愈或治愈。结论在颌面部损伤患者的诊治过程中要做到及时抢救,全面检查,联合治疗。     

颌面部复合伤的综合处理

目的　提高颌面部及其复合伤的抢救综合治疗水平。方法　总结近十年来收治有颌面部合并其他部位复合 1 2 1例的救治经验 ,并进行病种 ,伤情和伤因的分析。结果　颌面部外伤占创伤发病率的首位 ,与其它部位复合伤的发病率高 ,抢救成功率 96%。结论　颌面部复合伤伤情判断 ,急救和早期处理 ,相关并发症和后遗证的处理原则与经验 ,对正确抢救此类患者有重要意义。     

老年患者颌面部创伤83例临床分析

目的：研究老年口腔颌面部创伤的临床治疗方法及效果。方法：对赤峰学院附属医院口腔科2008年8月至2013年8月期间收治的83例老年口腔颌面部创伤住院病人的病历资料进行统计和分析,并与同期的随机抽取的90例非老年组患者进行比较。结果：83例老年颌面创伤患者男女比例为2.9∶1。交通事故49.39%在致伤原因中居首位。下颌骨骨折发生率最高。在合并伤中,以颅脑损伤6例（42.86%）最多见。经过及时治疗,83例患者生命体征平稳,面部形态恢复满意,咀嚼功能良好,张口度≥3 cm,咬合关系恢复正常。结论：颌面部损伤治疗应以抢救生命,保护功能,恢复面容为原则,及时进行急救和固定处理。     

伴有全身多发性损伤的颅颌面骨折同期与延期手术的疗效比较

目的：探讨颅颌面部骨折伴有全身其他部位多发性损伤的患者采用同期或延期手术治疗的临床效果差异。方法85例颅颌面部骨折伴有全身其他部位多发性损伤的患者，根据患者本人、家属意愿及实际情况，将患者按照颅颌面部骨折与全身其他部位是否同期治疗分为2组，同期组48例行同期手术治疗；延期组37例行延期手术治疗。比较2组伴有颅脑损伤患者的神经功能缺损程度、术后咬合、张口度、住院时间及术后并发症的差异。结果根据神经外科评分标准，2组术后3个月的格拉斯哥预后评分（Glasgow outcome scale，GOS）分布差异无统计学意义（Z=?1.545，P=0.122）；术后同期组患者的咬合优良率（93.75%）高于延期组患者（75.68%）（c2=5.630，P=0.018）；术后同期组患者的张口度（34.5±3.6）mm高于延期组（28.9±3.3）mm （c2=7.370，P<0.001）；同期组住院时间（28.5±5.2）d，短于延期组（40.1±5.7）d（c2=9.778，P<0.001）；术后同期组手术并发症发生率为8.33%，低于延期组24.32%（c2=4.124，P=0.042）。结论在患者创伤严重程度适宜的情况下，对于颅颌面部骨折伴多发性损伤患者可以采取多科室联合手术治疗，可缩短住院时间、有利于患者颌面部外观及功能恢复。     

Prospective study of facial nerve function after surgical procedures for the treatment of temporomandibular pathology.

PURPOSE: The aim of this prospective study was to report facial nerve injury following surgical procedures for the treatment of temporomandibular pathology, using the House-Brackmann facial nerve grading system (HBFNGS) as a means of classifying and measuring the degree and type of injury. PATIENTS AND METHODS: The sample consisted of 32 patients who underwent temporomandibular joint (TMJ) surgery. A total of 50 approaches were carried out. Surgical procedures consisted of TMJ reconstruction, gap arthroplasty, eminectomy, bone plates for the treatment of chronic mandibular luxation, and disc plication. Facial nerve function of all patients was evaluated preoperatively and 24 hours after surgery. Patients who presented postoperative facial nerve injury were likewise examined using the HBFNGS at 24 hours, 1 week, 1 month, and 3 months. RESULTS: Of the 32 patients, 12.5% (ie, 8% of the 50 approaches) showed signs of facial nerve injury after TMJ surgery. The prevalence of postoperative facial nerve injury was significantly greater in the patients who had ankylosis (P = .014) and in those submitted to gap arthroplasty (P = .011). At 24 hours, none of the patients showed total nerve paralysis or severe dysfunction, only a moderately severe dysfunction (50%), or moderate dysfunction (50%). The forehead was the most affected area measured. At 3 months, all patients had recovered their normal facial nerve function. The overall improvement in facial nerve function was 40% for the patients classified initially with moderately severe dysfunction and 60% for those with moderate dysfunction. CONCLUSION: The frequency of facial nerve injury was related to the diagnosis of the temporomandibular pathology and surgical procedures. Facial nerve impairment was shown to be of a temporary nature. Moreover, there is a need to standardize the reporting of facial nerve recovery.     

周围性面神经损伤患者对侧神经支配的研究

目的　通过测定面神经损伤患者组及大学生志愿者组面神经各分支对侧神经支配率 ,探讨周围性面肌瘫痪恢复过程中面神经对侧代偿支配的问题。方法　分别测定大学生志愿者 2 2例( 2 2侧 )及 10 8例面神经损伤患者的面神经电图对其对侧神经支配率进行分析其中损伤组又按发病原因不同 ,分为医源性损伤组、Bell氏面瘫组和创伤性损伤组 ,测试损伤支数为Ⅰ支 76支 ,Ⅱ支 81支 ,Ⅲ支 88支 ,Ⅳ支 6 6支。结果　①损伤组 3组间对侧支配率差异无显著性 (P >0 0 5 ) ;②损伤组Ⅰ、Ⅱ支对侧支配率明显高于志愿者组 (P <0 0 0 1) ;③损伤组Ⅰ支对侧支配率明显高于Ⅱ支(P <0 0 0 1)。结论　面神经损伤后 ,存在对侧神经支配功能增强的表现     

Prevalence of cervical spine injuries in patients with facial trauma

OBJECTIVE: Injuries to the spine may accompany facial trauma. By using a large computerized database the goal of this case control study was to assess the association between facial and cervical spine injuries among patients sustaining facial trauma. STUDY DESIGN: During a period of 4 years (1995 to 1998) 3083 patients, 10 years or older, with facial injuries were admitted to the University Hospital of Innsbruck's Department of Oral and Maxillofacial Surgery for facial trauma. Records were analyzed for cause of injury, age and gender distribution, frequency and type of injury, and frequency of cervical spine injuries in relation to facial trauma and concomitant injuries. Two hundred six (6.7%) of these patients had experienced a concomitant cervical spine injury (case group). All other patients (2877) were assigned to the control group of facial trauma only. RESULTS: Facial trauma patients with concomitant cervical spine injuries were significantly older (mean age, 42 vs 34 years); no difference existed for the female/male ratio of 30:70. Sports trauma was the main cause of facial trauma in the control group (37.4%), yet traffic accidents accounted for 43.7% of combined facial and cervical spine injuries in the case group. Central mid face fractures dominated in the case group and lateral mid face fractures in the control group. In the case group cervical spine fractures and dislocations occurred in 19.2%. None of them showed evidence of paralysis. Concomitant brain injuries occurred in 21.6% of the case group and 8.8% of the control group. For patients sustaining facial trauma, logistic regression analysis revealed reduced risks for additional cervical spine injuries in younger patients, female patients, absence of brain injury, and in patients with facial soft tissue lesions alone (58.2%) or dental trauma alone (77.5%). CONCLUSION: The results of this study underline the importance of proper clinical and computed tomographic evaluation in cases of facial fractures for recognition of additional cervical spine trauma. Detection of cervical spine trauma can be missed, especially when pain or symptoms from other parts of the body dominate. The typical patient with concomitant neck and facial trauma is male, 40 years old, and usually involved in a traffic accident.     

面神经损伤182例临床资料回顾性分析

目的 分析颌面部外周性面神经损伤后功能恢复的规律和相关影响因素.方法 回顾分析182例面神经损伤患者的病历资料,分析损伤部位、损伤方式、损伤后治疗时间及治疗方式对于面神经功能恢复结果的影响.结果 口腔颌面部面神经损伤以分支损伤为主.神经损伤方式、部位、患者年龄、修复时间等因素均对面神经功能恢复结果有影响.随访至最终有完整记录的解剖性损伤49例中,45例(92%)在6个月内完全恢复;断裂损伤59例中,53例(90%)于6个月内开始恢复;12个月内,神经吻合35例中33例(94%)面神经功能开始恢复;8例神经移植病例中5例(62%)完全恢复.结论 口腔颌面部手术中应尽量降低对神经的损伤,尽早修复受损神经,这样能够更好地保存面神经功能.     

腮腺手术中面神经解剖术式与面神经功能损伤的临床研究

目的:探讨腮腺手术中不同的面神经解剖术式与面神经功能损伤之间的相关性。方法:通过对120例临床腮腺肿瘤患者进行随机分3组,分别采用不同的面神经解剖术式,观察面神经功能损伤的发生率及恢复时间。结果:经面神经总干的顺行法、经颧支或下颌缘支的逆行法面神经解剖术式,其神经功能损伤的发生率及神经功能恢复时间分别是:5%,2.58月;12.5%,2.82月;70%,6.52月。前2种术式之间,神经损伤发生率及恢复时间差异均无显著性,而前2种术式与经下颌缘支的逆行法之间比较,神经损伤的发生率(P<0.01)及恢复时间(P<0.05)差异均存在显著性。结论:经面神经总干及颧支解剖面神经,运用逆行和顺行解剖法相结合,是一种较好的减少面神经损伤的手术方式。     

Facial soft tissue injuries as an aid to ordering a combination head and facial computed tomography in trauma patients.

PURPOSE: While the trauma computed tomography (CT) head scan is frequently ordered during resuscitation of multiply injured patients, determining when also to order facial CT in these situations can be difficult. Consequently, facial fractures are commonly missed on initial imaging evaluation. In acute trauma situations, facial soft tissue injury markers are often used to aid in this decision. A study was undertaken to identify exactly which facial soft tissue injuries correlate with facial fractures and which did not. The aim of our research was to compare the facial soft tissue injury patterns of patients receiving a combination head and facial CT who had facial fractures versus those who had no facial fractures. PATIENTS AND METHODS: A retrospective trauma registry review was performed for a 5-year period at Legacy Emanuel Hospital, a level 1 trauma center. The trauma team saw a total of 9,871 trauma patients and 49.9% required head CT as part of their initial evaluation. A total of 777 (15.7%) patients had a combination head and facial CT in which 477 (61.4%) had a facial fracture and 300 (38.6%) had no facial fracture. Statistical significance was established using Bonferroni corrected P values less than .05. RESULTS: Lacerations occurring in areas of the lips, nose, and intraorally, as well as wounds leading to periorbital contusion and subconjunctival hemorrhage, were significantly prevalent in the fracture group. Conversely, scalp lacerations and scalp contusions were significantly higher in the nonfracture group. Other injuries such as lacerations of the tongue, chin, forehead, cheek, ear, eyelid, and eyebrow were indistinguishable between both groups. CONCLUSIONS: Our data demonstrate that there are certain facial soft tissue injury zones that correlate with facial fractures in trauma patients who obtain head CT. We would like to propose that the acronym LIPS-N (Lip laceration, Intraoral laceration, Periorbital contusion, Subconjunctival hemorrhage, and Nasal laceration) be used in conjunction with a physical examination when assessing if a trauma patient who is getting head CT should also get facial CT.     

West of Ireland facial injury study. Part 1

The pattern, presentation, and volume of facial injury in the west of Ireland are subjectively different from that in the United Kingdom. We know of no prospective regional study of facial injury in Ireland to date, and nationally there is no system in place to collect data on injury. The epidemiology of facial trauma has important implications for the development of health services, the education and training of clinicians, workforce planning, prevention of injury, and promotion of health. Over one week we did a multicentre prospective data collection study involving all emergency departments in the west of Ireland. All patients who attended with facial injuries were included, and those with injuries solely of the scalp and neck were excluded. The proforma recorded patients' characteristics, details of injury and presentation, treatment and follow-up. It also included relation with sport, alcohol, assault, and animals. During the study period 325 patients were injured (5% of attendances at emergency departments in the region). The mean was 29.8%, and 68% were male. Falls caused 39% of injuries, sport 27%, and assault 14%. Sixteen percent of patients were treated in oral and maxillofacial surgery departments, and 16% in plastics, and ear, nose and throat (ENT) departments combined. There were 166 serious injuries. The busiest 24h were from Saturday at 09:00. Forty-five percent presented between 1 and 2h after injury. Different approaches and methods may be needed to prevent injury because of differences in aetiology, and staff in emergency departments will need training in this area, given the large proportion of facial injuries in the region.     

Correlating facial fractures and cranial injuries.

PURPOSE: This study retrospectively evaluated individuals with traumatic injuries from different mechanisms and tried to determine if there is any relationship between various isolated or combined fractures of facial skeleton and cranial injuries. MATERIALS AND METHODS: We retrospectively studied hospital charts of all patients who reported to the trauma center at Kasturba Hospital in Manipal with facial fractures and suspected cranial injuries during a 5-year period (January 1, 1995 to December 31, 1999). These patients were admitted to the Department of Neurosurgery or the Maxillofacial Unit of Kasturba Hospital, Manipal. The complete medical record of each patient was reviewed, recording the following in a standard format: age, gender, cause of injury, type of facial fractures, type of cranial bone fracture, concussion, intracranial injury, cerebrospinal fluid (CSF) rhinorrhea, CSF otorrhea, and the Glasgow coma scale. RESULTS: The study data were collected as part of retrospective analysis. A total of 12,329 patients reported to the trauma center of the study hospital during a 5-year period with various injuries. A total of 772 patients had facial fractures (6%). A total of 108 patients with a combination of cranial injuries and facial fractures were identified within this group (14%). Gender predilection was seen to favor males (90%) more than females (10%). The ratio was seen to be nearly 9:1. The ages of the patients ranged from 7 to 70 years with mean age being 32 years (standard deviation [SD] = +/-12). Central midfacial bone involvement was found to be more commonly associated with head injury. CONCLUSIONS: There is a correlation between midfacial injuries and CNS trauma. A more exhaustive multicentric case-control study with a larger sample and additional parameters will be essential to reach definite conclusions regarding the spectrum of head injuries associated with facial fractures.     

逆行面动脉瓣修复口腔颌面部肿瘤术后缺损12例报道

目的:探讨逆行面动脉瓣修复口腔颌面部肿瘤缺损的效果。方法:选择2008年5月—2011年1月在中山大学孙逸仙纪念医院口腔科就诊的发生于上颌、软腭、颊部等口裂以上的12例肿瘤患者,肿瘤根治术同期采用逆行面动脉瓣修复组织缺损。结果:12例患者中,皮瓣成活11例(91.7%),完全坏死1例。术后随访8～36个月,局部、颈部肿瘤复发各1例。下颌下区切口均一期愈合,无裂开。2例患者术后出现面神经损伤。结论:逆行面动脉瓣制备简单,血供可靠,适合修复口腔颌面部口裂以上的缺损。     

两种颌后入路治疗下颌骨髁突骨折方法的研究

目的:探讨两种颌后入路治疗下颌骨髁突颈骨折的治疗方法及效果。方法:64例成人下颌骨中低位髁突颈骨折患者,随机分为A、B两组,经颌后入路,分别采用腮腺前缘入路及横断腮腺入路,解剖复位髁突骨折行坚强内固定术。结果:64例患者均取得良好解剖复位,咬合关系恢复良好,无关节强直出现。A组2例出现面神经麻痹。B组2例出现涎瘘,4例出现面神经麻痹症状。结论:颌后入路可有效治疗髁突骨折,且腮腺前缘入路较横断腮腺入路减少了手术并发症的发生。