下斜方肌皮瓣和肩胛背动脉皮瓣在头颈重建中的应用

Baek等于1980年首次将下斜方肌肌皮瓣（lower trapezius myocutaneous flap，LTMF）应用于头颈部重建，随后该组织瓣逐步得到了推广和应用，并成为头颈重建常用的带蒂组织瓣之一。传统的LTMF是以颈横动脉的浅支作为血管蒂，后来的研究证实了颈横动脉的深支（肩胛背动脉）在LTMF血供中的作用，并提出了术中将该动脉包含在LTMF内的意义。晚近又出现了单纯以肩胛背动脉为血管蒂的扩展斜方肌皮瓣（extended lower trapezius myocutaneous flap，ELTMF）或肩胛背动脉皮瓣（dorsal scapular artery flap，DSAF）。ELTMF优于传统LTMF的是其皮岛设计位于斜方肌的更远端，因而有更长的血管蒂，而且组织瓣制备时无需切断斜方肌的上部肌纤维，从而大大改善了患者术后的肩功能。本文对LTMF及DSAF作一简介。     

下斜方肌肌皮瓣修复颌面部缺损的临床应用

目的:观察应用下斜方肌肌皮瓣修复颌面部组织缺损的临床效果.方法:在对斜方肌及其血供进行显微外科学研究的基础上,利用颈横动脉浅降支设计下斜方肌肌皮瓣用于颌面部组织缺损修复.结果:5例患者斜方肌肌皮瓣全部成活,颌面外形及功能恢复基本满意.结论:应用下斜方肌肌皮瓣是修复颌面部缺损的较好方法.     

带颈横血管上斜方肌肌皮瓣即刻修复舌癌术后缺损21例报道

目的：研究以颈横动脉为蒂的上斜方肌肌皮瓣修复舌癌术后舌缺损的临床效果。方法：1994年9月-2004年4月期间，对21例经病理确诊的舌癌患者均行根治性颈清术，术中采用以颈横血管为蒂的上斜方肌肌皮瓣同期修复舌缺损。供区创面直接拉拢缝合，未行植皮。结果：21例皮瓣全部成活，仅1例出现部分坏死。术后早期再造舌外形和功能都较差，3个月-1a后，形态上出现黏膜化，语言、咀嚼和吞咽功能逐渐改善。结论：以颈横动脉为蒂的上斜方肌肌皮瓣是修复舌缺损的优良皮瓣之一．     

应用下蒂型斜方肌皮瓣修复放射性骨坏死致口腔面颈部软组织缺损

目的:采用下蒂型斜方肌肌皮瓣修复放射性骨坏死致口腔面颈部软组织缺损,评价其临床效果。方法:在对斜方肌及其血供进行显微外科解剖学研究的基础上,利用颈横动脉浅降支为蒂,设计下蒂型斜方肌皮瓣,皮瓣转移修复因放射性骨坏死致口腔、颌面及上颈部软组织缺损9例,共11侧。术后随访1～6个月,观察皮瓣生长情况和患者张口度的变化。结果:临床应用该肌皮瓣修复口腔、颌面及颈部组织缺损9例,其中2例采用双侧肌皮瓣转移修复,除1块皮瓣远端部分表皮坏死外,其余皮瓣均完全成活,且术后患者张口度最大者增加2.5cm。结论:下蒂型斜方肌皮瓣修复口腔、颌面及上颈部组织缺损的效果良好,成功率高,方法可靠,操作简单,是一种治疗颌骨放射性骨坏死的理想方法。     

延长垂直下斜方肌岛状肌皮瓣修复颅颌面软组织缺损

目的：探讨延长垂直下斜方肌岛状肌皮瓣修复颅颌面巨大软组织缺损的临床效果。方法：对4例累及颅底的颌面部恶性肿瘤患者(男3例,女1例,年龄36～63岁,平均51岁)行颅面根治术,颅面软组织缺损用颈横动脉供血的延长垂直下斜方肌岛状肌皮瓣修复,皮瓣蒂长为32～34cm,皮岛长8～12cm,宽5～7cm。结果：除1例皮瓣远端小部分坏死外,其余皮瓣全部成活,供区皮肤直接拉拢缝合,无明显肩臂功能障碍。术后随访3～12个月(平均7．3个月),1例术后6个月肿瘤复发,1例术后12个月死于肺转移。结论：延长垂直下斜方肌肌皮瓣制作较简单,效果可靠,瓣足够大,可用于颅面根治术后大面积软组织缺损的修复。     

斜方肌肌皮瓣联合肩胛骨肌皮瓣修复晚期头颈肿瘤术后下颌骨贯穿性缺损6例报道

目的：评估斜方肌肌皮瓣联合肩胛骨肌皮瓣重建下颌骨洞穿性缺损的效果。方法：对6例复发性晚期头颈恶性肿瘤患者进行挽救性手术,均通过基于颈横血管系统（TCVs）的斜方肌肌皮瓣和肩胛骨骨肌皮瓣修复肿瘤根治术后下颌骨洞穿性缺损。结果：所有患者均具有骨组织和广泛的软组织缺损,其中下颌骨缺损类型包括4例H型,1例LCL型和1例C型缺损,挽救性手术后存在洞穿性软组织缺损。所有肿瘤均可被整块切除,无严重并发症。其中2例出现轻微并发症：1例出现口内皮瓣轻微坏死,1例皮瓣供区的部分伤口裂开。所有患者不需要鼻饲饮食,面部和颈部外观均令人满意或可接受,未表现出上肢运动严重受限。随访10~18个月,5例患者无复发迹象。结论：基于颈横血管系统（TCVs）的斜方肌肌皮瓣和肩胛骨骨肌皮瓣可作为重建颅面部洞穿性缺损的有效方法,修复晚期头颈部肿瘤患者挽救性手术的术后缺损,可达到令人满意的功能和美学效果。     

锁骨上动脉岛状瓣的应用解剖

目的:为临床应用锁骨上动脉岛状瓣提供解剖学依据。方法:在10例20侧经锁骨下动脉灌注氧化铅-明胶溶液的成人尸体标本上,对颈横动脉和锁骨上动脉的分支情况、起始位置、行程、长度和管径进行观测,观察其回流静脉情况,并在尸体标本上模拟皮瓣制备。结果:颈横动脉由甲状颈干或锁骨下动脉分支而来,在锁骨中1/3上方分为深支和浅支。锁骨上动脉由颈横动脉浅支发出后行向后外,越过斜方肌浅面和锁骨的肩峰端,走行于三角肌筋膜的浅面,并逐渐发出细小分支穿过深筋膜,进入锁骨上和肩部的皮肤和皮下组织。颈横动脉起点至锁骨上动脉起点距离平均为(4.31±0.64)cm,锁骨上动脉起点至其发出分支穿深筋膜点的距离平均为(3.62±0.42)cm。颈横动脉起点处外径平均为(2.71±0.33)mm,锁骨上动脉起点处外径平均为(1.10±0.17)mm。2条锁骨上动脉伴行静脉分别回流入颈横静脉和颈外静脉。结论:以锁骨上动脉为营养血管的锁骨上动脉岛状瓣,适于转移修复口腔颌面颈部组织缺损,也可以颈横动脉为吻合血管,制作游离皮瓣。     

冠突颞肌瓣联合血管化腓骨肌皮瓣修复全上颌骨缺损

目的：探讨冠突颞肌瓣联合血管化腓骨肌皮瓣修复全上颌骨缺损的手术方式及临床价值。方法 ：收集2例上颌骨全切术后面中部缺损畸形（James BrownⅢb类）患者,采用冠突颞肌瓣联合血管化腓骨肌皮瓣行全上颌骨重建,术前应用Surgicase 5.0（Materialise,Belgium）软件进行手术规划,对手术方式及术后效果进行预测分析。术中以冠突颞肌瓣旋转修复眶底,冠突大小分别为3.5 cm×1.5 cm及4.0 cm×1.6 cm;以2段式腓骨塑形修复牙槽突,腓骨长度分别为32.51 mm、27.36 mm及71.82 mm、38.74 mm;以腓骨肌皮瓣携带皮岛修复面中部软组织缺损。结果：术中检查冠突颞肌瓣血供良好,术后腓骨肌皮瓣均成活,创口一期愈合。分别随访5个月和6 a,无复视、睑外翻及眼球突出,无涎瘘、下唇麻木等并发症,开口度正常。CT检查眶底及牙槽突重建形态良好。结论：冠突颞肌瓣联合血管化腓骨肌皮瓣发挥了不同组织瓣的优势,是全上颌骨缺损重建的良好选择。     

延长垂直下斜方肌岛状肌皮瓣修复重建大型头颈部缺损

颈横动脉供血的延长垂直下斜方肌岛状肌皮瓣(extended vertical lower trapezius island myocutaneous flap,eVLTIMF)用于修复重建大型头颈部缺损安全可靠。该瓣制备较简单,成活率高。供区较隐蔽,可直接关闭缝合,并发症少,肩部运动受影响较小;还可制备成折叠瓣,合并其他带蒂瓣或合并肩胛骨骨肌皮瓣修复特大洞穿性缺损或下颌骨缺损。eVLTIMF在头颈部大面积缺损修复,尤其是在晚期复发性头颈部肿瘤挽救手术后巨大缺损修复重建中起着重要作用。本文对斜方肌的临床应用解剖、 eVLTIMF瓣制备及其在颅颌面、口腔颌面和颌颈区缺损修复中的应用作一阐述。     

舌骨下肌皮瓣血管灌注的应用解剖研究

运用新鲜尸体头颈区整体血管灌注法,对5具标本进行显微外科解剖。发现舌骨下肌群各块肌肉各有来自甲状腺上动脉的肌支动脉,这些肌支动脉在各块肌肉外上缘分支呈两层血管网,包绕该肌之深浅两面。甲状腺上动脉的颈阔肌支与胸锁孔突肌支是该肌皮瓣的另一血供来源。舌骨下肌皮辮的静脉回流有深浅两套系统,其间有交通支,甲状腺上静脉是主要回流静脉,回流方式分三型。研究结果证明舌骨下肌皮辦是一种血运好,安全可靠,厚薄适宜,具有一些独特优点的肌皮瓣。     

Oral cancer: molecular technologies for risk assessment and diagnosis

Purpose: The effective biomarkers related to diagnosis, metastasis, drug resistance and irradiation sensitivity of oral cancers will help the pathologist and oncologist to determine the molecular taxonomy diagnosis and design the individualization treatment for the patients with oral cancers.     

柠檬精油对牙周致病菌抑制作用及其安全性初步研究

目的:探讨柠檬精油对牙周致病菌的体外抗菌活性及对细胞增殖的影响。方法:采用微量液体稀释法测定柠檬精油对Pg、Fn、Aa、Pi的最小抑菌浓度(minimal inhibitory concentration,MIC)及最小杀菌浓度(minimum bactericidal concentration,MBC);以较低浓度的MIC为标准稀释LEO作为实验组,采用MTT法测定柠檬精油对HUVECs的毒性作用,明确抑菌浓度下LEO的安全性。结果:柠檬精油对牙周主要致病菌均有抑菌作用,Pg、Fn、Aa、Pi的MIC分别是9.0 g/L、4.5 g/L、4.5 g/L、9.0 g/L,Aa、Fn的 MBC是9.0 g/L,Pg、Pi的MBC未测得。1/2MIC、1/20MIC浓度的LEO能够抑制人脐静脉内皮细胞的生长,而低于1/200MIC浓度的LEO则对人脐静脉内皮细胞的生长没有影响,其中1/200MIC浓度的LEO作用明显优于0.02%的CHX。结论:体外环境中,柠檬精油对牙周致病菌Pg、Fn、Aa、Pi具有抗菌活性,低浓度应用对机体相对安全。     

Stimulated whole saliva components in children with Down syndrome

The authors report on the components of stimulated whole saliva from children with Down syndrome—including pH, flow rate, sialic acid and protein concentrations, and amylase and peroxidase activity. Saliva samples were collected from 35 children aged 6–10 years. Of the participants, 17 had Down syndrome and 18 did not. To stimulate saliva production, the children chewed a piece of parafilm for 10 minutes before the sample was collected. Soon after collecting the saliva sample, the authors measured pH using a portable pH-meter. Sialic acid levels were determined with a thiobarbituric acid assay. Protein content was determined with Folin's phenol reagent. Amylase was assayed and the authors measured the maltose produced by the breakdown of starch and peroxidase using ortho-dianisidine.
No statistically significant difference was observed in levels of sialic acid (free and total) between the two groups. Protein concentration was about 36% higher in the group with Down syndrome. However, the salivary flow rate, pH, and amylase and peroxidase activities were lower among the children with Down syndrome.     

Computer-assisted planning for maxillofacial prosthodontic rehabilitation

Computerized tomography (CT) planning and the use of CT derived surgical templates for implant placement have shown promise for restoring function within months after surgical reconstruction of acquired post-oncologic defects.     

牙髓再生的研究现状

目前,根管治疗术在临床上已得到了广泛的应用并成功的保存了患牙,但其仍有许多术后并发症。随着组织工程技术在口腔领域的应用,构建一种组织工程化牙髓进行牙髓-牙本质复合体的再生治疗成为可能。近年来国内外已有很多关于牙髓再生的研究,并且已经取得了一定成果。本文将对目前国内外牙髓再生的研究进展现状作一综述。     

Effect of Pingyangmycin on human venous malformation endothelial cells

Purpose: Venous malformations are common vascular anomalies with a propensity of the head and neck. Intralesional injection of Pingyangmycin (PYM, bleomycin A5 hydrochloride) is a widely used sclerotherapy method for the treatment of venous malformation.     

拔牙位点保存用复合温敏凝胶的构建及体外表征

目的:制备多壁碳纳米管/羟基磷灰石/壳聚糖复合温敏凝胶,探讨其作为拔牙位点保存材料的理化性能。方法:采用原位沉积方法制备多壁碳纳米管/羟基磷灰石(MWNT/ HA简称HAC)复合无机材料,将其分散至壳聚糖温敏凝胶中,制备壳聚糖/多壁碳纳米管/羟基磷灰石(CS /MWNT/HA简称CS/HAC)复合温敏凝胶,以成胶时间、孔径、孔隙率、机械强度及降解性能为指标优化配方设计,并表征复合温敏凝胶的微观形貌及理化性能。结果:以10 g/L的HAC作为补强成分加入到壳聚糖溶液中,能够在不影响成胶并保证一定孔隙率(84%)的前提下,提高材料的机械性能(抗压强度0.441 MPa),所获复合温敏凝胶具有适宜的临床操作时间(12 min),并具有可控的降解速率。结论:负载HAC的复合温敏凝胶具有良好的成型性,并具有较好的机械性能,在拔牙位点保存领域具有良好的应用前景。     

Oropharyngeal dysphagia in amyotrophic lateral sclerosis alters quality of life

Dysphagia is one of the most important complications encountered in amyotrophic lateral sclerosis (ALS). Our aim was to determine whether oropharyngeal dysphagia impacted the quality of life (QoL) of patients with ALS. Thirty consecutive patients were recruited (31–82 years, 18 men). Swallowing function was evaluated using a standardised videofluoroscopic barium swallow. All the patients completed a specific questionnaire on quality of life in dysphagia (SWAL‐QoL) immediately after the videofluoroscopy. The results of dysphagia outcome severity scale separated 14 patients with oropharyngeal dysphagia and 16 with normal swallowing function. There was no difference in the average age, weight and body mass index of the two groups (dysphagic patients: 68 ± 11 kg versus non‐dysphagic patients: 69 ± 14 kg). Most of the dysphagic patients had a bulbar affection based on their Norris scores which determine the importance of cranial nerves illness (20 ± 8), significantly lower than those of the non‐dysphagic patients (35 ± 5) (P < 0·0001). There was no difference in the neurological peripheral symptoms evaluated by Amyotrophic Lateral Sclerosis Functional Rating Scale scores (dysphagic patients: 26 ± 7 versus non‐dysphagic patients: 27 ± 8) (ns). The swallowing quality of life questionnaire revealed that the dysphagic patients had significant burden (P < 0·001). They were affected by the necessity to applied a food selection (P < 0·01), by the increase in eating duration (P < 0·05) and described a decrease in eating desire (P < 0·05). They complained of fear regarding the risk of dysphagia (P < 0·05). They also described difficulties with oral communication (P < 0·001). All of those complained about dysphagia which impacted directly mental health (P < 0·05) and social life (P < 0·05). In conclusion, oropharyngeal dysphagia is a common symptom accompanying ALS, which alters the patient's QoL, especially social health.     

替牙期骨性Ⅲ类错牙合患者颞下颌关节特征的锥形束CT研究

目的:采用锥形束CT(CBCT)研究替牙期骨性Ⅲ类错牙合患者颞下颌关节的影像学特征,探讨Ⅲ类功能状态下,颞下颌关节的生长、改建机制。方法:从就诊于昆明医科大学附属口腔医院正畸科的患者中选取符合纳入标准的替牙期骨性Ⅲ类错牙合患者及骨性Ⅰ类错牙合患者各20名,使用NNT viewer 5.3图像处理软件进行三维重建及线距和角度的测量,并进行统计学分析。结果:替牙期骨性Ⅲ类错牙合患者组和替牙期骨性Ⅰ类错牙合患者组对比结果为:矢状面双侧关节前间隙偏小、双侧关节上间隙偏小、双侧关节结节斜度偏小;冠状面双侧关节内间隙偏小,双侧关节上间隙偏小,双侧关节外间隙偏小,右侧髁状突角度偏小;横截面右侧髁状突前后径偏小。结论:替牙期骨性Ⅲ类错牙合患者颞下颌关节发育不充分,呈现髁状突,关节窝深度,关节结节斜度;冠状面关节内、外间隙均较小的特征。骨性Ⅲ类错牙合患者髁状突在关节窝中处于前置近关节窝顶位置。骨性Ⅲ类错牙合患者颞下颌关节影像学特征与其功能状态相适应。