舌根部淋巴上皮病1例报告

<正> 患者张××,女,26岁,工人,主诉:舌根部肿块缓慢增大,于1981年2月入院。自觉有异物感,影响吞咽。门诊作~(131)I扫描示甲状腺位于颈部。全身检查无明显异常发现。专科检查:张口及舌运动均正常,舌根部中央见肿物大小约3×1.5×1cm。椭圆形周界清楚。其前缘在舌盲孔前0.5cm,后缘近会厌上端。(?)诊质硬,表面粘膜光滑。双侧颌下各可(?)及一大小约0.5×0.5cm的淋巴结,质软。实验室检查无异常。     

异位甲状腺

异位甲状腺是甲状腺先天发育异常 ,可发生于不同部位 ,由于临床较少见 ,在文献中均有误诊误治的报道 ,作者就异位甲状腺形成的原因、诊断及治疗概述如下。在胚胎发育第 4周时 ,在第 1与第 2咽囊之间的咽腹侧 ,中线部位的内胚层增生 ,形成甲状腺中位始基。该始基随心脏和大血管下降时仍借甲状舌管与咽底 (相当于舌盲孔 )相连。人胚第 7周始基尾断到达气管前面 ,发育成甲状腺峡部及左右两则叶。随后 ,甲状舌管开始退化在胚胎 ,甲状腺下移过程中发生异常 ,是发生异位甲状腺的主要原因。异位甲状腺可发生在颈中线或舌盲孔至胸骨切迹近中线的任何…     

缝扎加点状注射硬化剂治疗舌部血管瘤

<正> 舌根部血管瘤目前主要以手术和硬化治疗为主.近几年来使用缝扎治疗颌面部血管瘤偶见报告.自1989年我们使用缝扎加点状注射硬化剂治疗舌部血管瘤5例。男3例,女2例。其中舌根部血管瘤2例,舌腹部血管瘤3例。瘤体最大为3.5×3×2.5cm,最小2.5×2×1.5cm。本组5例均一次治疗后,观察7个月至2年无复发. 手术方法:全麻或局麻下常规消毒铺巾,根据瘤体大小选择适度圆针丝线,自瘤体边缘(舌腹)正常组织处进针,穿过瘤体的基底部至对侧出针打结。每针打结时应根据瘤体膨隆程度适当收紧打结。针距从前向后缝扎,至舌根最后一针应尽量收紧打结,阻断瘤体血供舌动脉。取注射器抽5％鱼肝油酸钠,以点距1cm,每点0.2ml点状注入缝扎后瘤体组织内:术后常规禁食两天,加强口腔护理及支持疗法,预防使用抗     

舌甲状腺移植手术的口内经路法

<正> 异位甲状腺可发生在舌盲孔至颈前原甲状腺途径的任何部位,但以发生于舌根部的异位甲状腺(简称舌甲状腺Lingnal Thyroid)为多,当舌甲状腺出现梗阻症状时往往需采用手术治疗。以往的手术经路各不相同,但多数主张口外切口的经路。最近我们对1例的舌甲状腺采用口内舌体正中切开的方法,同样达到了手术目的,现予以报道如下:     

两种手术径路在水平阻生牙拔除中的选择

目的:探讨舌侧去骨法与颊侧去骨法用于拔除下颌水平阻生第三磨牙的适应证。方法:中、低位水平阻生患者105例,共160颗牙齿,随机分成2组,每组均为中位阻生齿55颗,低位阻生齿25颗。一组采用舌侧去骨法,一组采用颊侧去骨法。比较2组拔牙花费的时间及术后并发症的严重程度。结果:中位阻生齿拔除所花费时间,舌侧去骨法为(17.31±1.53)min,颊侧去骨法为(18.76±2.45)min,P>0.05。低位阻生齿拔除,舌、颊侧去骨法所用时间分别为(34.40±5.81)min及(42.97±4.77)min,P<0.05。低位阻生齿拔除,舌、颊侧去骨法引起面部水肿的程度分别为(21.25±3.81)%及(30.80±5.04)%,P<0.05。两组间出现疼痛、张口受限、感染、出血、舌或下唇麻木的机会无明显差别。结论:拔除低位水平阻生齿应采用舌侧去骨法,中位水平阻生齿拔除采用颊侧去骨法为宜。     

舌根部巨大淋巴血管瘤1例

<正> 发生在舌根部的淋巴血管瘤较为少见,文献上报道不多,我科曾收治1例舌根部巨大淋巴血管瘤患者,现报告如下。患者李××,女,33岁。住院号:62973。因舌根部肿物2年余要求手术于1986年5月5日入院。2年前自觉舌根部有一肿块,堵塞感,逐渐增大,近2个月来经常自舌根部发现有少量出血,进食时更加明显。体检:全身检查未见异常(略)。颌面外科检     

成都正常人群上颌前牙区鼻腭管相关解剖结构的锥形束CT研究

目的 用锥形束CT(CBCT)分析上颌前牙区鼻腭管及唇侧骨的形态.方法 收集并筛选出712例正常人上颌前牙区CBCT影像,对其鼻腭管、唇侧骨的相关参数进行测量分析.结果 研究对象年龄范围在5～80岁,男306例(43.0％),女406例(57.0％).鼻腭管矢状面平均长度为(13.58±2.22)mm,矢状面平均直径为(3.37±1.58) mm,唇侧骨矢状面平均厚度为(7.63±1.50)mm,鼻腭管直径与唇侧骨厚度相对值为0.46±0.19,长度相对值为0.69±0.10.结论 各年龄段人群之间鼻腭管的直径、长度和唇侧骨厚度存在一定差异.儿童的鼻腭管直径小于成人(P＜0.000 1),唇侧骨厚度大于成人(P＜0.000 1).随着年龄的增长,鼻腭管直径和长度均呈递增趋势,唇侧骨厚度递减.男性的鼻腭管直径、长度和唇侧骨厚度、长度均大于女性.     

阻鼾器治疗前后上气道结构改变与颏舌肌肌电变化的相关性

目的　探讨阻塞性睡眠呼吸暂停综合征 (OSAS )患者治疗前后上气道头影测量值的变化与颏舌肌 (GG )肌电活性改变的相关性。方法　用X线头影测量法比较 31例OSAS和鼾症患者戴用Snoreguard治疗前后 ,上气道及周围结构的形态变化 ,对其中 2 2例患者的形态变化与治疗前后GG肌电活性改变的相关性进行研究。结果　①经Snoreguard治疗软腭后气道增大最显著 ,SPP SPPW由 (9 14± 3 79)mm增加到 (12 36± 3 74 )mm ,舌根后气道TB TPPW由 (10 6 3± 3 71)mm增至 (11 90± 4 33)mm ,软腭与舌体接触长度UC LC由 (2 1 96± 11 0 6 )mm减小至 (10 4 8± 8 5 5 )mm ,舌骨 下颌平面距H MP由 (2 0 6 0± 6 6 5 )mm减小为 (11 0 1± 6 84 )mm。②部分患者戴用Snoreguard时悬雍垂后、舌根后和舌根下气道间隙有减小的趋势 ,但疗效未受影响。这是因为患者清醒状态代偿性增加的GG肌电活性经治疗后显著减小 ,而睡眠状态GG肌电活性无明显改变。结论　进一步证明Snoreguard治疗OSAS和鼾症的机制是机械扩大上气道     

经舌动脉药物灌注化疗的应用解剖及铸型观测

目的 :为临床经舌动脉药物灌注治疗舌癌提供解剖学基础。方法 :解剖观测 15具共 30侧成人头颅标本舌动脉的起源、走行、分支、分布及吻合情况。结果 :舌动脉为颈外动脉的主要分支之一 ,其起点平舌骨大角尖处 ,至颈动脉分叉处距离为 (0 .86± 0 .33)cm ,其起点外径为 (2 .4± 0 .3)mm。舌动脉行经舌骨舌肌深面后分为舌背动脉及舌深动脉终末支。左、右舌深动脉分别行于两侧的舌肌内形成舌粘膜下动脉网 ,不跨越舌正中纤维隔。结论 :舌动脉起点较固定 ,管径较粗 ,行程恒定 ,末梢血管形成舌粘膜下动脉网 ,有利于药物滞留 ,延长药物作用时间 ,是药物灌注治疗舌癌的理想动脉     

采用发射型计算机断层技术评估术后剩余腺体功能

目的保留腮腺主导管腮腺浅叶切除术后,用发射型计算机断层(ECT)技术评估剩余腮腺功能。方法选择一侧行保留主导管腮腺浅叶切除的病例14例,于术后半年行ECT测定,采用术侧和健侧的比值来评定腮腺对99mTcO4摄取和排泄功能。结果剩余腮腺的摄取指数(CI)和分泌指数(SI)分别为(2.66±1.15)和(0.57±0.23),摄取指数率(CIR)和分泌指数率(SIR)分别为(1.09±0.42)和(1.18±0.31)。结论患侧剩余腮腺的腺体均能恢复摄取和排泄基本功能。     

Clinical evaluation of the accuracy of the Evident RCM Mark II Apex Locator.

The accuracy of the Evident RCM Mark II in locating the apical foramen was evaluated in 37 human teeth scheduled for extraction. After extraction, the difference between the position of the apical foramen determined electronically and its real anatomical location was measured under a binocular microscope, using a micrometer mobile in x, y, and z coordinates. The results show that in 86% (n = 37) of the cases, an accurate location +/- 0.5 mm of the apical foramen was obtained.     

Morphometric analysis of implant-related anatomy in Caucasian skulls

BACKGROUND: Sequelae related to implant placement/advanced bone grafting procedures are a result of injury to surrounding anatomic structures. Damage may not necessarily lead to implant failure; however, it is the most common cause of legal action against the practitioner. This study aimed to describe morphological aspects and variations of the anatomy directly related to implant treatment. METHODS: Morphometric analyses were performed in 22 Caucasian skulls. Measurements of the mental foramen (MF) included height (MF-H), width (MF-W), and location in relation to other known anatomical landmarks. Presence or absence of anterior loops (AL) of the inferior alveolar nerve (IAN) was determined, and the mesial extent of the loop was measured. Additional measurements included height (G-H), width (G-W), thickness (G-T), and volume (G-V) of monocortical onlay grafts harvested from the mandibular symphysis area, and thickness of the lateral wall (T-LW) of the maxillary sinus. The independent samples t test, and a two-tailed t test with equal variance were utilized to determine statistical significance to a level of P < 0.05. Multiple regression analyses were performed to determine if each one of these measurements was affected by age and gender. RESULTS: The most common location of the MF in relation to teeth was found to be below the apices of mandibular premolars. The mean MF-H was 3.47 +/- 0.71 mm and the mean MF-W was 3.59 +/- 0.8 mm. The mean distance from the MF to other anatomical landmarks were: MF-CEJ = 15.52 +/- 2.37 mm, MF to the most apical portion of the lower cortex of the mandible = 12.0 +/- 1.67 mm, MF to the midline = 27.61+/- 2.29 mm, and MF-MF = 55.23 +/- 5.34 mm. A high prevalence of AL was found (88%); symmetric occurrence was a common finding (76.2%), with a mean length of 4.13 +/- 2.04 mm. The mean size of symphyseal grafts was: G-H = 9.45 +/- 1.08 mm, G-W = 14.5 +/- 3.0 mm, and G-T = 6.15 +/- 1.04 mm, with an average G-V of 857.55 +/- 283.97 mm3 (range: 352 to 1,200 mm3). The mean T-LW of the maxillary sinus was 0.91 +/- 0.43 mm. CONCLUSION: Implant-related anatomy must be carefully evaluated before treatment due to considerable variations among individuals, in order to prevent injury to surrounding anatomical structures and possible damage.     

Relation of mental nerve with mandibular branch of the facial nerve

The aim of this study is to elucidate the detailed anatomical relation of mental nerve with marginal mandibular branch of the facial nerve. Twenty-three hemi-faces of adult Korean cadavers (11 Male and 7 female) were dissected. All locations of crossing (C) of marginal mandibular branch of the facial nerve and mental nerve were measured below the inferior verge of the lower vermillion (V): a vertical distance (V-Gn) between V and gnathion (Gn) and horizontal distance (V-OC) between V and oral commissure (OC). The mental foramen located at 19.8 +/- 4.4 mm below the inferior verge of the lower vermillion (V) and 34.3 +/- 5.2 mm laterally from the midline. In all specimens there were found interconnections between marginal mandibular branch of the facial nerve and mental nerve. The number of connecting site was 8.26 +/- 2.49. Microscopically, both of the nerve branches had a common epineurium, but the perineurium separated. V-Gn and the vertical distance between V and the connecting point (C) was in the ratio of approximately 2:1, and V-OC and the horizontal distance from V:C was an equal ratio. The proximity of the mental nerve and marginal mandibular branch of the facial nerve to each other draws an attention as operating the mental area.     

Details of the intralingual topography and morphology of the lingual nerve

The lingual nerve supplies the tongue with trigeminal sensory fibers and sensory fibers that originate from the chorda tympani. The aim of this study was to investigate, by dissection, the anatomical features of the lingual nerve at the level of the tongue and to correlate the findings with existing data. Six human adult cadavers dissected bilaterally and 6 specimens of tongue-pharynx-larynx from autopsied adult cadavers were studied. The lingual nerve gives off its terminal branches at the anterior border of the hyoglossus muscle where the anastomotic loops between the lingual and hypoglossal nerves are found. Two morphological types of terminal division of the lingual nerve were seen: a single primary trunk or two primary trunks, a medial one distributed in the middle third of the tongue and a lateral one for the anterior third of the tongue. The primary terminal branches of the lingual nerve were located on the outer surface of the genioglossus muscle, forming a nervous layer over the deep artery of the tongue. The following emerged from the primary trunk(s): thin branches for the ipsilateral mucosa of the ventral surface of the tongue and 4-9 thick secondary trunks, with palisade disposition and translingual courses that followed the outer surface of the genioglossus muscle towards the dorsal mucosa of the ipsilateral part of the tongue, anterior to the circumvallate papillae.     

舌根癌术后舌内剩余肌动力性重建的临床研究

采用新的术式对８例舌根癌患者行舌根癌根治性切除的同时，对所保留的舌前２／３舌剩余肌行舌下神经－舌神经移位移植，并同期修复舌根缺损（３例用前臂游离皮瓣，５例用带蒂胸大肌皮瓣）；皮瓣、肌皮瓣全部成活；舌剩余肌、粘膜除１例部分坏死外，其余均成活，舌剩余肌保留长度４～７ｃｍ。从舌动力性恢复可见：术后早期舌根修复后外形满意，舌体前伸无受限，仅向患侧及上翘时受限；术后６月以后，患侧触压觉、冷热觉恢复。运动神经肌电测定：部分患者术后６月起出现自发肌电；口腔气流压测定：实验组患者的鼓气、吮吸及吞咽气流压值均低于对照组，但术后其恢复率随时间延长不断上升。所有患者近期效果满意     

Horizontal branch of the supraorbital nerve and temporal branch of the facial nerve

The aim of this article is to describe anatomical detail of the course and territory of the horizontal branch of the supraorbital nerve, which connects with temporal branch of the facial nerve. Eighteen hemifaces of Korean cadavers (11 male, 7 female) fixed in 10% formaldehyde solution were dissected. All 18 specimens had horizontal branch of the supraorbital nerve. The horizontal branch emerges out of the supraorbital foramen, runs upward about 12 mm, and then turns laterally at an angle of 104.7 degrees toward the end of the eyebrow. The average number of horizontal branches was 1.7 +/- 0.8. The skin boundary supplied by the horizontal branch was a circle with a diameter of 30 mm. The center was located at 30 mm lateral to the supraorbital foramen and 12 mm above. Grossly, the horizontal branch of the supraorbital nerve connected with the temporal branch of the facial nerve in 8 of 18 (44%) specimens. Microscopically, both nerve branches had common epineurium, but the perineuria were separated. The horizontal branch of the supraorbital nerve is in touch with the temporal branch of the facial nerve, and there are actual connections between them in 44% of cases.     

Topographical evaluation of the major apical foramen in permanent human teeth

Aim To determine the distance from the anatomical root apex to the major apical foramen and the position of the major foramen on the root apex. Methodology Crowns of 926 human teeth were sectioned at the cementum‐enamel junction. Specimens were mounted on microscope slides for measurement parallel to the long axis of the teeth. The major foramen was identified as the largest‐diameter opening at the root apex. A total of 1331 root specimens were evaluated using an optical stereomicroscope to an accuracy of 0.01 mm at 40 × (±10) magnification. The distance from the anatomical apex to the most apical point of the major foramen was measured, and its location (central, buccal, lingual, mesial and distal) was recorded. Results The mean distance between the major foramen and the anatomical root apex was 0.69 mm; the mean distance was larger in posterior teeth (0.82 mm) and smaller in anterior teeth (0.39 mm). A wide range of anatomical apex to major foramen distances were observed in all tooth groups: the greatest distance was in maxillary molars (0.95 mm) followed by mandibular pre‐molars (0.87 mm) and mandibular molars (0.80 mm). The major foramen was at the tip of the root in 40% of teeth. The most frequent deviations of the foramen were to the buccal (20%) and distal (14%). Conclusion In this sample of teeth without apical resorption the distance between the major foramen and the anatomical root apex was always <1 mm. Deviation of the major foramen from the anatomic apex varied widely amongst tooth groups.     

The relationship between lingual and hypoglossal nerve function and quality of life in head and neck cancer

Sensorimotor impairment of the tongue has the potential to affect speech and swallowing. The purpose of this study was to critically examine the effects of nerve preservation and reinnervation after reconstruction of the base of tongue on patient‐perceived outcomes of quality of life (QoL) related to speech and swallowing through completion of the EORTC QLQ‐H&N35 stan‐dardised questionnaire. Thirty participants with a diagnosis of base of tongue cancer underwent primary resection and reconstruction with a radial forearm free flap, which may or may not have included nerve repair to the lingual nerve, hypoglossal nerve or both. Eight QoL domains sensitive to changes in motor and sensory nerve function were included in the analysis. Transected lingual and hypoglossal nerves were associated with difficulty in swallowing, social eating, dry mouth and social contact. There were fewer problems reported when these nerves were either repaired or left intact. There were no significant differences between patient nerve status and QoL outcomes for speech, sticky saliva and use of feeding tubes. This study was the first to examine the impact of sensory or motor nerve transection and reconstruction on health‐related QoL outcomes.     

Anatomic characteristics of the infraorbital foramen: a cadaver study.

PURPOSE: The aim of this study was to document the variability in the position of the infraorbital foramen with relation to the facial midline, infraorbital rim, supraorbital notch, and maxillary teeth. MATERIALS AND METHODS: Forty-seven cadavers (94 sides) were dissected, exposing the infraorbital foramen, supraorbital foramen, and orbital floor bilaterally. Measurements made included (A) distance between the infraorbital foramen and inferior orbital rim; (B) distance of the infraorbital foramen from the facial midline; (C) distance of the supraorbital foramen from the facial midline; (D) distance between the infraorbital foramen and supraorbital foramen. Means, standard deviations, and ranges were determined, and statistical differences were calculated between the left and right orbits and sexes by use of an unpaired sample t-test (P < .05). RESULTS: In men, the mean distance between the infraorbital foramen and the inferior orbital rim was 8.5 +/- 2.2 mm. In women, this was 7.8 +/- 1.6 mm. The distance between the infraorbital foramen from the facial midline was 27.7 +/- 4.3 mm in males and 26.2 +/- 3.2 mm in females. The mean distance between the infraorbital foramen and supraorbital notch in males was 43.3 +/- 3.1 mm and in females was 42.2 +/- 2.4 mm. The average distance of the supraorbital notch from the midline was 26.5 +/- 3.5 mm in males and 26.3 +/- 3.3 mm in females. There were no statistically significant differences between the left and right sides or between sexes. The maxillary tooth most commonly found in the same vertical plane as the infraorbital foramen was the first premolar. Multiple ipsilateral foramina were found in 15% of cadavers. CONCLUSION: These anatomic characteristics may have important implications for surgical and local anesthetic planning.     

Innervation of the temporalis muscle for selective electrical denervation

Bilateral hypertrophy of the temporal muscle can give the impression of an aggressive and violent facial appearance. The authors performed closed selective denervation of the deep temporal nerve using electrocauterization. Before the procedure, precise anatomical knowledge of the deep temporal nerve is mandatory. Sixteen hemifaces of Korean cadavers were dissected. To standardize the position of the anterior division of the deep temporal nerve, we recorded the distance from six anatomical landmarks to the nerve. In 19% (3 of 16) of cadavers, one deep temporal nerve was observed, and in the remainder, two deep temporal nerves were identified. In all our specimens, a mean of three (range: 1-4) temporal branches also arose from the buccal nerve. One temporal branch arising in common with the masseteric nerve was observed in 2 of 15 of our specimens. On the infratemporal crest, the distances from the anterior division of the deep temporal nerve to the posterior division of the deep temporal nerve and to the masseter nerve were 4.7 +/- 0.9 mm (range: 3-6 mm) and 8.3 +/- 1.1 mm (range: 6-10 mm), respectively. On the superior surface of the zygomatic arch, the distance from the most concave point of the zygomatic bone (point A) to the anterior division of the deep temporal nerve was 19.4 +/- 1.2 mm (range: 18-21 mm). On the inferior surface of the zygomatic arch, the distance from the prominent point of the condylar process of the mandible to the anterior division of the deep temporal nerve was 22.3 +/- 1.6 mm (range: 22-25 mm). Great consistency in the position of the anterior division of the deep temporal nerve was shown. The results of this study could provide a basis for closed selective denervation of the anterior division of the deep temporal nerve using electrocauterization. Clinical application is needed.