MRI诊断口腔鳞癌颈淋巴结转移的临床研究

目的研究磁共振成像（MRI）用于诊断口腔鳞癌病例是否存在颈淋巴转移的应用价值。方法选用中山大学附属第一医院口腔颌面外科2000～2005年首诊收治并经病理检查证实的口腔鳞癌病例48例，术前均行颈部淋巴结MRI检查及临床触诊检查。对照术后病理结果，计算MR／检查及临床触诊检查对颈部转移淋巴结检出的敏感率、特异率及准确率等。对两种方法进行比较。结果术前MRI对本组口腔鳞癌病例颈部淋巴结转移情况检查的敏感率、特异率及准确率均高于临床触诊，对口腔鳞癌颈淋巴结转移的术前评估具有较高的诊断价值。     

颈部恶性肿瘤转移淋巴结与炎性淋巴结的MRI鉴别诊断

ＭＲＩ（磁共振成像）用来鉴别恶性肿瘤转移的淋巴结和炎性淋巴结，尚未有一个明确的标准。本研究对２４例颈部肿瘤转移淋巴结和１４例颈部炎性淋巴结行ＭＲＩ检查。结果表明：颈部恶性肿瘤转移淋巴结的ＭＲＩ上，Ｔ１加权为均匀略低和等信号，Ｔ２加权表现为不均匀的略高信号与高信号混合。转移淋巴结轮廓清晰，周围可出现不完全环状脂肪增生带，而炎性淋巴结在Ｔ１和Ｔ２加权上分别为：等信号和略高信号，且周边欠清晰，边缘脂肪模糊。至目前为止，ＭＲＩ可被视为鉴别上述两者的一种有效方法。     

口咽鳞癌颈淋巴结临床触诊、B超和MRI检查的对比分析

目的：比较临床触诊、B超和磁共振（MRI）诊断口咽鳞癌颈淋巴结转移的准确性,分析B超、MRI在口咽鳞癌颈淋巴结转移术前评估中的临床价值。方法：对20例口咽鳞癌患者的100个颈部分区行术前临床触诊、B超和MRI检查,以术后病理诊断为金标准,双盲法分析临床触诊、B超和MRI所见,将其结果在SPSS13.0软件中分别采用χ2检验或Fisher确切概率法进行统计学处理。结果：术后病理证实16个区存在淋巴结转移,临床触诊检出其中的7个区（敏感度43.8%,特异度96.4%,准确度88.0%）;B超确诊其中的10个区（敏感度60.0%,特异度97.6%,准确度92.0%）,可以发现33.3%的临床触诊隐匿性转移区;MRI确诊其中的13个区（敏感度81.3%,特异度96.4%,准确度94.0%）;可以发现66.7%的临床触诊隐匿性转移区。B超联合MRI检出其中的13个区（敏感度81.3%,特异度95.2%,准确度93.0%）。结论：B超或MRI评价口咽鳞癌颈淋巴结转移的敏感度、准确度均优于临床触诊,B超联合MRI的可靠性并不优于单独使用MRI,但两者存在互补性。     

头颈部恶性肿瘤颈淋巴结隐匿性转移的MRI诊断

目的：确定磁共振（MRI）诊断口腔癌的颈淋巴结隐匿性的效果。方法：41例临床触诊检查颈部淋巴结转移阴性的头颈部恶性肿瘤病人,术前行MRI颈部扫描,了解颈淋巴结转移阳性和阴性的情况,并在术后同病理诊断对照。结果：41例病人被手术切除的颈淋巴清扫标本内有12例经病理证实为颈淋巴结转移,其中MRI发现9例,其敏感性为75％,特异性为87％,3列假阴性,主要是转移的淋巴结体积小,形态无明显的变化,其内部信号变化不明显,结论：MRI技术可作为临床诊断颈淋巴结隐匿性转移的有效手段之一。     

口腔颌面部肿瘤的MRI诊断

口腔颌面部肿瘤的ＭＲＩ诊断孙大熙磁共振（ＭａｇｎｅｔｉｃＲｅｓｏｎａｎｃｅ）简称ＭＲ是一种核物理现象。１９４６年美国Ｆ．Ｂｌｏｃｈ和Ｅ．Ｍ．Ｐｕｒｃｅｌｌ首先发现了ＭＲ现象之后，主要用来研究分子结构。１９７３年美国Ｐ．Ｃ．Ｌａｕｔｅｒｂｕｒ发表了磁共...     

口腔颌面部鳞癌颈淋巴结转移的超声诊断标准

颈部淋巴结转移是决定头颈癌患者预后和选择治疗方案的重要因素,常用的诊断方法包括触诊、CT、MRI和超声(US)检查。触诊的准确率低,结果不可靠。CT及MRT可发现临床不能触及的淋巴结及隐匿转移,但其花费昂贵,难以重复应用。US具有花费低、可反复使用的优点,能发现小淋巴结,诊     

PET/CT在诊断口腔颌面部肿瘤颈淋巴结转移中的价值

目的:通过与MRI检查比较,评价PET/CT(integrated PET-CT system)在诊断口腔颌面部肿瘤颈部淋巴结转移中的临床价值.方法:前瞻性分析2008-2011年47例口腔颌面部肿瘤患者,于术前2周内分别进行PET/CT、MRI检查.分别获取PET/CT影像和MRI影像.以病理结果为金标准,分析2种方法判断颈部淋巴结转移的敏感度、特异度及准确率方面的差异.采用SPSS13.0软件包对数据进行x2检验.结果:PET/CT、MRI判定颈淋巴结转移的敏感度分别为89.5％和73.7％(P＜0.05);特异度分别为89.3％和78.6％(P＞0.05);准确率分别为89.4％和76.6％(P＜0.05).结论:PET/CT在口腔颌面部肿瘤颈部淋巴结转移判定中的敏感度及准确率均优于MRI,差异具有统计学意义;PET/CT在口腔颌面部肿瘤颈淋巴结转移判定中作为一种辅助诊断方法,具有重要的临床价值.     

阻塞性睡眠呼吸暂停综合征矫治后的上气道磁共振影响改变

目的探讨阻塞性睡眠呼吸暂停综合征（ｏｂｓｔｒｕｃｔｉｖｅ ｓｌｅｅｐ ａｐｎｅａ ｓｙｎｄｒｏｍｅ，ＯＳＡＳ）患者戴用口腔矫治器后，其上气道磁共振（ｍａｇｎｅｔｉｃ ｒｅｓｏｎａｎｃｅ ｉｍａｇｉｎｇ，ＭＲＩ）影像发生的改变。方法 选择１１例有治疗前后多导睡眠图评价、磁共振影像资料完整的ＯＳＡＳ患者，用于研究矫治器对上气道的形态学改变；另选１１名性别、年龄配比的无睡眠呼吸障碍者，作为ＭＲＩ三维形态     

正电子发射体层摄影术诊断头颈部恶性肿瘤颈部淋巴结转移的临床价值探讨

目的 与CT、MRI和临床触诊比较,评价正电子发射体层摄影术(positron-emission tomography,PET)在判断头颈部恶性肿瘤颈部淋巴结转移中的应用价值.方法 40例头颈部恶性肿瘤患者于术前两周分别进行PET、CT或MRI检查,分别获取①PET影像;②CT或MRI影像;③临床触诊的淋巴结状况.以病理结果 为金标准,分析3种方法 判断颈部淋巴结转移的敏感性、特异性及准确率方面的差异.结果 PET在判定淋巴结转移的敏感性方面较CT、MRI和临床触诊高14.3%(P=0.648);特异性比CT或MRI和临床触诊分别高15.4%(P=0.188)和7.7%(P=0.482).PET、CT或MRI和临床触诊的准确率分别是85.0%、70.0%和75.0%.结论 PET在头颈癌颈部淋巴结转移判定中的敏感性、特异性及准确率方面略好于CT、MRI和临床触诊.虽然结果 差异无统计学意义,但PET在头颈癌淋巴结转移判定中作为一种辅助方法 有其重要的作用.     

量子点荧光探针检测cNO舌鳞癌颈淋巴结微转移的研究

目的：应用特异性量子点荧光探针检测临床颈部淋巴结阴性（cN0）舌鳞癌颈部淋巴结微转移情况,比较其与免疫组化和HE染色标记转移灶的精确度。方法：用量子点荧光探针、免疫组化染色和HE染色3种方法检测39例舌鳞癌患者的586枚颈淋巴结标本,分析其微小转移灶检出率。结果：量子点荧光探针、免疫组化染色和HE染色检测颈淋巴结微转移阳性率分别是33．33％（13／39例）、25．64％（10／39例）和10．26％（4／39例）,量子点免疫荧光法检出率明显高于其他两法,差异有统计学意义（P〈O．05）。结论：量子点探针荧光检测技术可应用于舌鳞癌颈部淋巴结微转移的检测。     

三种营养状况评价法在口腔颌面恶性肿瘤患者中的比较

用营养状况综合评价法（ｃｏｍｂｉｎｅｄｓｕｂｊｅｃｔｉｖｅａｎｄｏｂｊｅｃｔｉｖｅｎｕｔｒｉｔｉｏｎａｌａｓｓｅｓｓｍｅｎｔ，ＳＮＡ）、营养状况简捷评价法（ｃｏｎｃｉｓｅｎｕｔｒｉｔｉｏｎａｌａｓｓｅｓｓｍｅｎｔ，ＣＮＡ）、营养状况综合评分法（ｇｅｎｅｒａｌｎｕｔｒｉｔｉｏｎａｌｓｔａｔｕｓｓｃｏｒｅ，ＧＮＳ）及营养状况主观评价法（ｓｕｂｊｅｃｔｉｖｅｇｌｏｂａｌａｓｓｅｓｓｍｅｎｔｏｆｎｕｔｒｉｔｉｏｎａｌｓｔａｔｕｓ，ＳＧＡ）分别对１２７例口腔颌面恶性肿瘤患者进行营养状况评价。以ＳＮＡ作为标准诊断方法，对ＣＮＡ、ＧＮＳ、ＳＧＡ进行比较研究。结果显示：①ＣＮＡ的总符合率（８８．２％）明显高于ＧＮＳ（７８．０％）与ＳＧＡ（７８．７％）；②ＣＮＡ的假阳性率（９．９％）和假阴性率（１５．２％）低于ＧＮＳ（１７．３％，３０．４％）与ＳＧＡ（１４．８％，３２．６％）；③ＣＮＡ的诊断指数（７４．９％）高于ＧＮＳ（５２．３％）与ＳＧＡ（５２．６％），这种差异具有显著性（Ｐ＜０．０５）；④ＣＮＡ的评价指标均由仪器测试，避免了人为误差。结论：ＣＮＡ是评价口腔颌面外科患者临床营养状况的最佳方法     

Protection of short-time enamel erosion by different tetrafluoride compounds

OBJECTIVE: This in vitro study aimed to analyse the protective effect of differently concentrated titanium (TiF(4)), zirconium (ZrF(4)) and hafnium (HfF(4)) tetrafluoride on enamel erosion. METHODS: Polished enamel surfaces of 36 bovine crowns were covered with tape leaving 4 enamel windows each 3mm in diameter exposed. The crowns were randomly assigned to six groups (each n=6) and pretreated with 4% TiF(4), 10% TiF(4), 4% ZrF(4), 10% ZrF(4), 4% HfF(4) or 10% HfF(4) for 4 min (first window), 10 min (second window) or 15 min (third window). The fourth window of each crown was not pretreated and served as control. Erosion was performed stepwise with 1% HCl (pH 2) in five consecutive intervals of each 15 s (total 75 s). Enamel dissolution was quantified by colorimetric determination of phosphate release into the acid. For each tooth, cumulative phosphate loss of enamel pretreated with one of the tetrafluoride compounds was calculated as percentage of the respective control and statistically analysed using two-way ANOVA. RESULTS: Enamel erosion was significantly reduced by TiF(4), ZrF(4) and HfF(4) application. Cumulative phosphate loss (mean % of control, 75s erosion) after 4-15 min application was significantly lower for 4% ZrF(4) (7-11%), 10% ZrF(4) (2-6%), 4% HfF(4) (11-9%) and 10% HfF(4) (12-16%) compared to 4% TiF(4) (42-27%) and 10% TiF(4) (54-33%). Only for 4% and 10% TiF(4), phosphate loss decreased with increasing duration of application, but also increased with increasing acid intervals. CONCLUSION: TiF(4), ZrF(4) and HfF(4) might protect enamel against short-time erosion, but protection was more enhanced by ZrF(4) and HfF(4) compared to TiF(4) application overtime.     

Techniques for dissection of the facial nerve in benign parotid surgery: a cross specialty survey of oral and maxillofacial and ear nose and throat surgeons in the UK

We investigated techniques of dissection of the facial nerve currently being used in parotid surgery for benign disease in oral and maxillofacial (OMF) and ear, nose and throat (ENT) surgery. A postal questionnaire was sent to 300 OMF and 300 ENT consultants and 49% were returned(171(57%) OMF and 123 (41%) ENT. The antegrade technique was used routinely by 209 surgeons (87%), the retrograde technique by 9 (4%), and both techniques combined by 21 surgeons (9%). The antegrade technique was used by 135 surgeons (56%) for revision parotidectomy, by 193 (81%) for limited superficial parotidectomy, by 173 (72%) for obese patients with large tumours and by 75 (31%) for injury to the facial nerve. The retrograde technique was used by 21 surgeons (9%) for revision parotidectomy, by 22 (9%) for limited superficial parotidectomy, by 15 (6%) for obese patients with large tumours and by 29 surgeons (12%) for injury to the facial nerve. A combination of techniques was chosen by 83 surgeons (35%) in revision parotidectomy, by 24 surgeons (10%) in limited superficial parotidectomy, by 51 surgeons (21%) in obese patients with large tumours and by (56%) surgeons 135 for injury to the facial nerve.     

黏膜下腭裂的腭咽闭合状态及语音表现分析

目的 通过分析黏膜下腭裂患者腭咽闭合模式、腭咽口各部分的收缩运动状况和语音表现,进一步探究黏膜下腭裂的病理特征规律。方法 回顾2008—2016年于四川大学华西口腔医院唇腭裂外科就诊的黏膜下腭裂患者的病历资料,分析其术前腭咽功能、辅音构音表现,采用鼻咽内镜观察腭咽闭合模式以及软腭、咽侧壁和咽后壁的运动情况。结果 共纳入353例黏膜下腭裂患者,其中术前腭咽闭合完全（VPC）者138例（39.09%）,腭咽闭合不全（VPI）者176例（49.86%）,边缘性腭咽闭合不全（MVPI）者39例（11.05%）; 268例患者接受了鼻咽内镜检查,167例（62.31%）为环状闭合,89例（33.21%）为冠状闭合,12例（4.48%）为矢状闭合;派氏嵴参与了45.51%（76/167）的环状闭合和13.48%（12/89）的冠状闭合。353例患者中137例（38.81%）构音正常,124例（35.13%）表现为辅音省略,51例（14.45%）有代偿性构音,36例（10.20%）有辅音弱化,25例（7.08%）有辅音替代,36例（10.20%）有2种以上的构音错误。结论 环状闭合是黏膜下腭裂患者最主要的腭咽闭合模式,压力辅音省略是最常见的构音障碍。随着腭咽闭合程度的降低,发生2种以上构音错误的患者明显增加。     

Oral mucosal lesions in a representative cross-sectional study of aging Germans

OBJECTIVES: To determine prevalence of oral mucosal lesions in a cross-sectional study among aging Germans. METHODS: Three specially trained dental teams examined adults (35-44 yrs, Group 1) and senior individuals (65-74 yrs, Group 2) in 90 sample points of which 60 were located in the former West and 30 in the former East part of Germany. The spectrum comprised 28 different oral lesions with subforms. RESULTS: 655 individuals in Group 1 (35-44 yrs) and 1367 individuals in Group 2 (65-74 yrs) were studied. 33.8% (Group 1) and 33.9% (Group 2) were without any pathology of the oral mucosa. Several lesions were not recorded in both Groups like oral hairy leukoplakia and gingival hyperplasia (Group 1 and two) and xerostomia (Group 1). In Group 1 history for labial herpetic lesions (31.7%), Fordyce granules (26.6%), history for recurrent aphthous ulceration (18.3%) and lip and/or cheek biting (10.1%) were recorded. In Group 2 Fordyce granules (23.7%), history of labial herpes (20.0%), plicated tongue (19.0%) and denture stomatitis (18.3%) were those lesions most frequently recorded. Leukoplakia was seen in 1.8% (West) and 0.9% (East) respectively; men were more often affected than women (2.3% versus 0.0% P<0.05, Group 1; 2.3% versus 0.9%, Group 2. There was association between the prevalence of leukoplakia and a lower (3.3%) or higher educational level (0.5%). Denture associated lesions were seen in 18.3% (Group 2) compared to 2.5% (Group 1) (P<0.001). Other age-related lesions were lip and/or cheek biting being more prevalent in Group 1 10.1% versus 1.9% (P<0.001), plicated tongue 19.0% in Group 2 versus 3.8% in Group 1 (P<0.001). CONCLUSIONS: The present study has shown prevalence to be comparable to other relevant Western European studies. Since the spectrum of oral mucosal lesions changes with age and increases with general morbidity, routine examinations of oral cavities of the aging are mandatory particularly to detect early precancerous and other mucosal lesions.     

Mandibular fractures in Townsville, Australia: incidence, aetiology and treatment using the 2.0 AO/ASIF miniplate system

In 1995 a total of 114 patients presented with 154 mandibular fractures at the Townsville General Hospital, Australia. Fifty-eight (51%) were white, 50 (44%) aboriginal, and six (5%) of other or unknown race. One-hundred-and-twenty-four of the fractures (81%) occurred in male and 30 (19%) in female patients. Most fractures (n= 128, 83%) resulted from fights. The rest being a result of road traffic accidents (10%), falls (3%), accidents caused by falling objects (3%) and sport accidents (2%). The mandibular angle (n= 66, 43%) and the symphyseal area (n= 40, 26%) were the most common fracture sites. Combined fractures were found in 30% patients (26%). Of all angle fractures, 97% were related to third molars. One-hundred-and-five patients had open reduction by an intraoral approach and stabilization by 2.0 AO/ASIF titanium miniplates and nine closed reduction. Complications included temporary sensory deficit of the mental nerve (3%), minor malocclusion (2%) and infection or dehiscence (5%). We conclude that osteosynthesis of mandibular fractures by the 2.0 AO/ASIF titanium miniplate system is reliable.     

The effect of a deproteinized bovine bone mineral on bone regeneration around titanium dental implants®

The aim of the present experiment was to test the effect of a deproteinized bovine bone mineral (Bio-Oss) on guided bone regeneration (GBR) in dehiscence defects around implants. The first 2 molars and all premolars were extracted on both sides of the mandibles of 3 monkeys (Macaca fascicularis). Three months later, 2 titanium plasma-coated cylindrical implants were placed in all quadrants of each monkey. During the surgical procedure, standardized dehiscence defects were produced buccally and lingually, measuring 2.5 mm in width and 3 mm in height. Four different experimental situations were created: 2 sites in each monkey were covered with an ePTFE membrane (M), 2 were filled with the graft material (DBBM), 2 were filled with the graft material and also covered with a membrane (M + DBBM), and 2 control sites were neither grafted nor covered (C). The flaps were sutured to allow for primary healing. Linear measurements of bone height and width were calculated on histological specimens obtained 6 months following surgery. In addition, values for bone density and for surface fraction of graft to new bone contact were measured. Vertical bone growth along the implant surface of 100% (SD 0%) for M + DBBM, 91% (SD 9%) for M, 52% (SD 24%) for DBBM, and 42% (SD 35%) for C was measured. The width of the regenerated bone 1.5 mm above the bottom of the original defect, i.e. at the 50% mark of the vertical extension of the defect, in relation to the width at the bottom of the defect amounted to 97% (SD 2%) for M + DBBM, 85% (SD 9%) for M, 42% (SD 41%) for DBBM, and 23% (SD 31%) for C. Assessment of bone density within the confinement of the regenerated bone resulted in an increase of 30% (SD 11%) for M + DBBM, 45% (SD 20%) for M, 33% (SD 20%) for DBBM, and 22% (SD 23%) for C. The values for graft to new bone contact within this compartment amounted to 80% (SD 15%) for M + DBBM and 89% (SD 14%) for DBBM. In conclusion, Bio-Oss exhibited osteoconductive properties and hence can be recommended for GBR procedures in dehiscence defects with respect to vertical and horizontal growth of bone.     

Retrospective clinical investigation and survival analysis on ceramic inlays and partial ceramic crowns: results up to 7 years

This study retrospectively evaluated the clinical performance of 287 all-ceramic restorations placed during routine patient care in the University setting in the past 7 years. All patients (n = 106) with ceramic inlays or partial ceramic crowns (PCC), placed during 1988–1994 (n = 327) by five experienced dentists were asked to take part in a clinical investigation, and 92 patients with 287 restorations (232 inlays, 55 PCC) agreed to do so. The following ceramics were used: 44 (15.3%) Dicor (Dentsply), 126 (43.9%) IPS-Empress (Ivoclar), 82 (28.7%) Mirage II, 33 (11.5%) Cerec-Vita-Mark I (Vita), and 2 (0.7%) Duceram LFC (Ducera) restorations. The restorations were placed using the following luting composites: 73 (25.4%) Dual Cure Luting Cement (Optec), 81 (28.3%) Variolink high viscosity (Ivoclar), 32 (11.1%) Microfill Pontic C (Kulzer), 51 (17.8%) Dual Zement (Ivoclar), 40 (13.9%) Dicor Light Activated Cement (Dentsply), and 10 (3.5%) Vita Cerec Duo Cement (Vita). Restorations were evaluated according to the modified USPHS criteria. Kaplan-Meier analysis was used to calculate the probability of survival. Of the 287 restorations 270 (94.2%) were still in function without any need of intervention. Fourteen restorations (4.8%) had failed before starting the clinical investigation, and in three a fracture was found during the investigation. These 17 failed restorations consisted of 14 PCC and 3 ceramic inlays. The results of the clinical investigation revealed 59.2% Alpha-ratings for marginal adaptation. Only one restored tooth showed recurrent caries. The probability of survival (95% confidence interval) for 7 years was 98% (97.99–98.01%) for ceramic inlays and 56% (46–66%) for PCC. Our findings show that ceramic inlays can be regarded as an acceptable alternative to cast gold restorations within the methodological limitations of the present study. For PCC further experience with more recent ceramics is warranted. Received: 6 August 1998 / Accepted: 26 September 1998     

Effect of bioresorbable fibres (Polyfibre) and a bioresorbable foam (Polyfoam) on new bone formation. A short term experimental study on the rabbit skull

The aim of the study was to evaluate two bioresorbable polylactic acid (PLA) filler materials in a guided bone regeneration (GBR) model system. The first was Polyfibre, a fibrous PLA filler material. Polyfoam, the second material tested, consisted of a spongy PLA filler material. In each group there were eight rabbits. In test rabbits a flap was raised uncovering the calvaria. A hemispherical PLA dome was filled with Polyfibre or Polyfoam material and periphereal blood and anchored onto the calvaria. Eight rabbits with the same domes, filled with blood alone, served as controls. The rabbits were sacrificed at 1 or 2 months. Histomorphometric measurements of regenerated total tissue volume, bone height and bone volume were carried out in undecalcified sections under a light microscope. At 1 month the totally filled volume attained 87% (range 82-91) in the fibre group, including 25% (23-27) fibres, 87% (85-95) in the foam group, including 15% (15-16) foam, and 55% (16-100) in the controls. The volume of mineralized bone was 12% (7-15) in the fibre group, 15% (12-18) in the foam group and 6% (1-11) in control domes. Bone height attained 48% (27-79) in the fibre group, 37% (31-58) in the foam group and 45% (14-67) in the control group. At 2 months, tissue volume attained 86% (85-87) including 26% (22-29) fibres, bone volume attained 13% (7-21) and bone height attained 56% (42-78) in the Polyfibre group. In the Polyfoam group, they were 83% (55-99) including 18% (15-19) foam, 13% (7-24) and 49% (29-74). In control domes, tissue volume was 82% (35-100), bone volume 20% (9-27) and bone height 86% (60-100). The Polyfibre and Polyfoam material was excellently integrated. No adverse reactions were found in the surrounding tissues. Direct bone apposition was observed onto the material. In conclusion, Polyfibre and Polyfoam material had a positive effect on initial bone and tissue formation but was a hindrance to increasing tissue volume, bone volume or bone height at 2 months compared to control specimens. The Polyfibre and Polyfoam material provoked no adverse reactions in the surrounding tissues and allowed for extensive angiogenesis.