下颌骨升支切除后再生1例

患者，女，12岁。主因右下颌升支骨巨细胞瘤术后复发1个月入院。入院查体：全身情况良好，心肺腹未见异常。开口度开口型正常，咬合关系良好，右升支前缘向内外侧隆起圆钝变厚。曲面断层片显示右下颌升支自喙突、髁突至┌7远中呈囊性阴影，喙突轮廓消失，髁突呈一帽状。囊性阴影周缘可见切迹。入院诊断：右侧下颌升支骨巨细胞瘤复发。     

口内进路摘除下颌骨升支囊肿的临床疗效与美学价值

目的探讨和评估口内进路摘除下颌骨升支囊肿的临床效果和美学价值。方法口内进路摘除下颌骨升支囊肿60例,术后常规抗炎、消肿和营养支持治疗,伤口11~15 d拆线。术后半年~3年定期复查和随访,评价临床疗效和美学价值。结果所有病例均未出现感染,无张口受限,未出现周围神经及邻近重要结构损伤症状,无口外切口手术瘢痕;无面神经受损症状;术后半年~3年随访,成功率96.67%,有2例牙源性角化囊肿在术后15个月复发,需行再次手术;其余病例X线片示骨质再生情况良好,未见有囊肿复发。结论口内进路摘除下颌骨升支囊肿具有确切的临床疗效和重要的美学价值。     

下颌升支含牙囊肿一例

患者,女,50岁,患者以反复发作张口困难二年伴左侧面肿就诊。 检查见：两侧面部不对称,左侧耳前区肿大,质中等硬,边界不清,轻压痛,表面皮肤无潮红,张口度5 mm,左侧颌下区轻压痛,颌下腺不肿大,颌下未触及淋巴结肿大。左下颌磨牙缺失,     

下颌骨升支截断式摘除面侧深区肿块的手术体会

面侧深区是指下颌骨升支深面、上颌骨后面、翼外板外侧、腮腺鞘前方的解剖区域，内有颌内动脉及分支、翼静脉丛、腮腺深叶、翼外肌、翼内肌、上颌神经、下颌神经等组织，与颅底诸结构、咽旁诸间隙关系密切，相互贯通。其间肿块组织来源比较复杂，早期症状常不明显，常规检查手段鉴别诊断比较困难，需用CT或MRI扫描作辅助诊断，手术暴露也不理想。根据陈日亭所著的《颌面颈手术解剖》中的描述，笔者对6例局限性面侧深区肿块患者行下颌骨升支截断式以摘除肿块，术中暴露理想，总结报告如下。     

下颌升支血供的血管造影研究

以前的学者就下颌骨,尤其是下颌体的血供作过较多的血管造影研究,但关于下领升支的血供研究较少,对各血供来源在升支内的分     

双侧下颌骨升支矢状劈开截骨术治疗下颌前突畸形

目的探讨口内进路双侧下颌骨升支矢状劈开截骨后退小钛板内固定治疗重度下颌前突畸形的临床疗效。方法9例上颌骨发育正常、下颌骨真性前突、严重反He关系的患者，行术前牙齿正畸治疗后，采用口内进路双侧下颌骨升支矢状劈开截骨后退小钛板内固定，术后正畸治疗，恢复尖窝咬He关系。结果所有病例均取得满意的疗效，获得协调的上下颌骨关系，术后随访1年，未见下颌前突复发。结论重度下颌前突畸形采用口内进路双侧下颌骨升支矢状劈开截骨术及正畸治疗是有效的，值得临床推广应用。     

用组织工程方法预构血管化下颌骨升支的实验研究

目的 观察用组织工程方法再造下颌骨升支，并使之含有知名血管蒂的可能性。方法 体外培养、扩增、诱导兔骨髓基质干细胞（MSCs），将细胞接种于人下颌骨升支外形的多孔珊瑚中，体外培养2d后，值入MSCs供体兔腹壁下动静脉深面，预构血管化的人下颌骨升支。术后2月取材，通过大体标本、扫描电镜检查、组织学检查，观察骨组织的形成情况。结果 在兔体内再造出了腹壁下静脉为蒂的骨组织，并具有人下颌骨升支的解剖形态；X线检查显示有X线阻射影，珊瑚有部分吸收；组织学检查结果证实，在NC表面及孔洞内均有新骨形成。结论 用组织工程方法可预构出具有特定形态的血管化的骨组织。     

下颌升支矢状劈开截骨术后下颌骨短期稳定性的三维分析

目的:本研究利用三维测量方法分析下颌骨在下颌升支矢状劈开截骨术后短期内的复发趋势.方法:收集在北京大学口腔医院接受正颌-正畸联合治疗并行下颌升支矢状截骨手术的患者共49例,分为下颌前徙患者22例,下颌后退患者27例,收集术前4 d(T0)、术后4 d(T1)、术后4～6周(T2)、3个月(T3)的CBCT数据,利用计算...     

双侧下颌升支矢状劈开截骨后退术对下颌骨宽度及形态的影响

目的通过对下颌前突患者行双侧下颌升支矢状劈开截骨后退术前后头颅正侧位定位片硬组织结构变化的洲量分析,评价手术对患者下颌骨宽度及形态的影响。方法选择1997年至2001年在我中心行双侧下颌升支矢状劈开术的下颌前突患者18例,男性9例,女性9例,平均年龄22．22岁,所有患者手术前、术后一周、术后一年拍摄静止位头颅正侧位定位片,在正位片上测量下颌骨宽度(Go-Go),并从头颅正侧位定位片上测量与下颌骨宽度变化有关的参数数值。结果①下颌骨宽度由107．30mm±5．84mm(术前)增加至109．24mm±5．72mm(术后一周)、109．31mm±5．66mm(术后一年),其中有4例宽度减小,1例保持不变。13例增加,②下颌骨宽度术前、术后一用、术后一年的方差分析结果表明差别有显著性。③分析表明下颌骨宽度变化与各参数变化之间没有线性相关。结论①下颌骨宽度在双侧下颌升支矢状劈开截骨术后较术前有轻微增大,但对容貌没有大的影响。②下颌骨宽度变化机制可能与颞下颌关节功能改变有关。     

下颌升支牵张成骨对下颌骨应力分布与位移趋势的影响

目的：应用有限元法建立生物相似性和力学相似性较高的下颌骨三维模型，分析并比较下颌升支部牵张成骨时不同加载方式对下颌骨内部应力分布及位移趋势的影响。方法：以正常青年男性下颌骨为标本，用CT断层扫描技术与计算机软件相结合，在微机上建模。采用受拉杆单元、受压间隙元等模拟肌肉、韧带的边界约束条件，在下颌升支部模拟骨皮质切开。结果：建立了包括下颌骨、颞下颌关节、肌肉和韧带，局部骨皮质断开的三维有限元模型。结论：提高了模型的相似性，为下颌升支部牵张成骨的进一步研究奠定了基础。     

Considerations in correction of mandibular protrusion by intra-oral vertical ramus osteotomy

This case report presents a case that underwent orthognathic treatment with intra-oral vertical ramus osteotomy (IVRO). The patient was a 19-year-old female with mandibular protrusion and severe maxillary anterior crowding. The overbite was +0.5 mm and the overjet −1.5 mm. She had orofacial pain and tenderness of the temporomandibular joints (TMJ) and surrounding muscles. The pre-surgical orthodontic treatment included the extraction of the maxillary right lateral incisor, maxillary right second premolar, maxillary left canine, mandibular left second molar and mandibular right second premolar. After 18 months of pre-surgical orthodontic treatment, the left and right sides of the mandible were set back 8 and 6 mm, respectively, via IVRO to improve mandibular protrusion. The total treatment period was 26 months. The patient showed the backward reaction of the mandible, which occurred after release of the maxillo-mandibular fixation. The usage of the Class II elastics during the post-surgical phase to maintain the overjet made the inclination of the maxillary incisors more lingual.     

Extraoral subcondylar ramus osteotomy for correction of mandibular prognathism: The surgical technique and complications

1178 patients with mandibular prognathism and/or asymmetry, in some cases combined with maxillary retrognathism, were treated by extraoral horizontal or oblique ramus osteotomy during the period from 1939 to 1989. The described percutaneous retromandibular approach is a simple, rapid and reliable technique which can usually be performed under local anaesthesia. Very few complications, particularly neurological, were observed. These aspects justify consideration of this technique when indications for a simple, straight set-back procedure of the mandible exist, and there is no tendency to bite-opening. However, the method demands intermaxillary fixation for 6-9 weeks postoperatively.     

口内入路手术治疗下颌角升支区颌骨囊肿的临床研究

目的 :比较口内和口外 2种入路手术治疗下颌角升支区颌骨囊肿手术效果。方法 :选择 2组位于下颌角升支区的颌骨囊肿病例 (分别应用口内和口外入路手术治疗 ) ,通过病历资料分析和术后复诊 ,调查患者的手术相关情况和术后恢复情况。结果 :口内入路组手术时间短于口外入路组 ,术后下牙槽神经感觉优于口外入路组 ;在术中出血量、术后感染率、术后张口受限发生率、术后面神经下颌缘支损伤率方面两者无明显差异。结论 :口内入路手术治疗下颌角升支区颌骨囊肿可获得与口外入路手术相同的效果 ,值得在临床上推广     

与下颌升支矢状劈开截骨相关的下颌管解剖研究

目的 研究下颌管在下颌骨内的走行和位置关系，为下颌升支矢状劈开截骨手术提供指导。方法 选用30具完整的干燥下颌骨标本，分别在第二磨牙远中的垂直线，磨牙后三角尖至下颌角连线及下颌孔下3mm呈冠状锯开下颌骨，观察测量下颌管的解剖位置。结果 下颌管是下颌骨睁骨松质内较薄的骨密质骨管。下颌管在下颌第二磨牙后缘切面的位置靠内侧型占87％，中间型占13％；在连线切面的住置内侧型占92％，中间型占8％；在下颌孔下3mm平面内侧型占98％，外侧型占2％。越接近下颌孔，烦侧骨皮质越厚。结论 了解下颌管在下颌骨内的位置及比邻关系，可避免下颌升支矢状劈开截骨中下齿槽神经血管束的损伤。     

下颌升支倒L形截骨术结合髂骨移植术矫治成年下颌发育不足畸形

目的 评价应用下颌升支倒L形截骨术结合髂骨移植术矫治成年下颌发育不足畸形的效果.方法 2010年1月—2016年5月11例下颌发育不足患者接受了口内或口外入路的下颌升支倒L形截骨术和髂骨移植术.结果 通过下颌升支倒L形截骨术和髂骨移植术使得所有患者的下颌升支高度和宽度得到有效扩展,面型及咬合明显改善,术后未见严重并发症.结论 下颌升支倒L形截骨术结合髂骨移植术矫治成年下颌发育不足畸形是安全、有效的,是临床上值得考虑和选择的矫治成年下颌发育不足畸形的合理术式.     

下颌前突患者下颌支矢状劈开截骨术后髁突运动轨迹的改变

目的:研究双侧下颌支矢状劈开截骨术对下颌前突患者髁突运动轨迹的影响。方法:采用ARCUSdigma下颌三维运动轨迹描记仪,以髁突运动中心为参考点,研究30例正常受试者、14例下颌前突患者手术前后开口、前伸和左右侧向髁突运动的轨迹。用SPSSV11.0统计软件包进行配对t检验和成组t检验。结果:下颌前突患者术前、术后、正常组左侧髁突的运动轨迹与右侧基本相同,左侧髁突与右侧的开口、前伸和侧方运动范围无显著性差异(P>0.05)。术前组与正常组髁突运动轨迹差别较大,术前开口、前伸和侧方运动范围均小于正常组(P<0.05);术后与正常组髁突运动轨迹接近,术后开口、前伸和侧方运动范围与正常组无统计学差异;术前与术后组髁突运动轨迹差别较大,术前开口、前伸和侧方运动范围均显著小于术后组(P<0.05)。结论:下颌前突患者手术后,随着术后正畸治疗及咬合自我调整,建立了正常的咬合引导关系,使下颌功能运动趋向正常。     

MRI changes in the temporomandibular joint following mandibular setback surgery using sagittal split ramus osteotomy with rigid fixation

Objectives: This study examined the changes in temporomandibular joint dysfunction (TMD) symptoms and investigated the variations in the disc position, disc and condylar morphology following sagittal split ramus osteotomy (SSRO) with rigid fixation in patients with mandibular prognathism. Furthermore, the authors examined the correlation between mandibular setback and TMD symptoms.

Methods: The study included 24 Japanese patients with jaw deformities who were treated using bilateral SSRO and Le Fort I osteotomy. The clinical and magnetic resonance imaging findings in the temporomandibular joint were evaluated preoperatively and at three and six months postoperatively.

Results: The preoperative TMD symptoms were significantly associated with the prevalence of TMD symptoms at six months postoperatively. Anterior disc displacement improved in four joints with slight displacement and with no morphological change. There were no postoperative changes in condylar morphology. There was no significant correlation between mandibular setback and the postoperative TMD symptoms.

Conclusion: Postoperative TMD symptoms may be influenced mainly by preoperative TMD symptoms rather than mandibular setback using SSRO with rigid fixation. Therefore, patients with TMD symptoms require physical examination and MRI for appropriate diagnosis preoperatively.     

Keratocystic odontogenic tumor arising at the mandibular ramus with an impacted tooth: a case report and mimic lesions

Objectives: To consider the biologic behaviors of keratocystic odontogenic tumors (KCOTs) and

ameloblastomas and dentigerous cysts.

Methods: A 63-year-old Japanese man presented with swelling and discomfort in the left cheek during jaw movement. Examination revealed a multilocular lesion within the mandible extending from the left second premolar to the left mandibular ramus and coronoid process; the lesion contained a deviated impacted tooth. The tumor had expanded beyond the bone and was invading the masseter and medial pterygoid muscles. Marginal mandibulectomy with a free iliac bone graft was performed.

Results: No recurrence was observed during a 7-year follow-up.

Discussion: The histopathological diagnosis of the lesion showed it was a KCOT. These tumors usually grow within the bone, causing bone expansion. However, this tumor had expanded beyond the bone and invaded surrounding muscles. Thus, KCOTs can, in rare cases, manifest themselves as described here. Evaluating preoperative images and histopathological findings is important to determine the optimal treatment strategy.     

成人下颌升支应用解剖的研究

目的　研究成人下颌升支后份及髁突的应用解剖。方法　对 16个成人离体下颌升支后缘高度、升支后份厚度 ,下颌孔后缘至下颌升支后缘的距离、髁突高度、髁突颈前后径、内外径测量分析。结果　下颌升支后缘前方 15mm范围内由后向前逐渐增厚 ,部分下颌升支在下颌孔上方 10mm处无松质骨。结论　应用拉力螺钉进行髁突骨折复位固定时应参照以上解剖规律进行。