国际文摘

.1下颌骨方块切除与节段切除对下份口腔鳞癌生存率的影响Influenceofmarginalandsegmentalmandibularresectiononthesurvivalrateinpatientswithsqua鄄mouscellcarcinomaoftheinferiorpartsoftheoralcavity.WolffD,HassfeldS,HofeleC.JCraniomax鄄illofacSurg,-2004,32(5):318-323.该文旨在研究下颌骨根治性切除(节段切除)与保守切除(方块切除)对生存率的影响,回顾性评价了136例因下份口腔鳞癌行下颌骨部分切除的病例,54例行方块切除,82例行节段切除,分别随访(91.1±30.1)个月与(91.5±26.2)个月。结果:方块切除的平均生存率为(63.0±3…     

以带蒂颊脂垫为基础的双层软组织封闭技术修复药物相关颌骨坏死手术后上颌骨缺损的临床应用

目的 探讨以带蒂颊脂垫为基础的双层软组织封闭技术修复药物相关颌骨坏死(MRONJ)手术后上颌骨缺损的临床应用效果.方法 将采用以带蒂颊脂垫为基础的双层软组织封闭技术修复药物相关颌骨坏死手术后上颌骨缺损的10例MRONJ患者纳入研究.患者的手术方式为上颌骨部分切除(部分患者行蝶骨翼突下段切除),去除上颌窦内炎性软组织,保...     

斜方肌骨肌皮瓣在修复半侧下颌骨切除及口腔软组织缺损中的应用

目的：评价斜方肌骨肌皮瓣修复口腔软组织和半侧下颌骨切除术后缺损的可靠性。方法：10例口腔、颌骨恶性肿瘤患者行半侧下颌骨和累及的软组织手术切除，术后缺损采用斜方肌骨肌皮瓣修复。男6例，女4例，年龄45～79岁，平均年龄61．2岁。T4N0M0期3例，T4N1M0期7例。皮瓣大小为（7cm×6cm）～（16cm×8cm）。结果：8例患者皮瓣全部成活。2例患者皮瓣边缘略有坏死。随访观察7～24个月，7例患者生存良好，无复发；1例患者死于肝、肺转移；2例患者术后复发，行二次手术，目前尚存活。结论：斜方肌骨肌皮瓣是一种修复口腔软组织和下颌骨半侧切除遗留的巨大缺损可靠的方法。     

一种新的放射性颌骨坏死的临床分类分期—120例临床分析

目的:探讨颌骨放射性骨坏死的临床特征、治疗方法、分类及分期。方法:采用BS分类及分期,对我院口腔颌面-头颈肿瘤科2003年1月—2013年1月10 a间收治的120例放射性颌骨坏死患者临床资料进行回顾分析。结果:下颌骨发生骨坏死的病例明显多于上颌骨及上、下颌骨,分别为99例、14例及7例。累计放疗剂量区间为35～148 Gy,中位剂量为68.1 Gy, 69(57.5%)例患者剂量大于60 Gy。大多数患者骨坏死发生在放疗后1～2 a内(64.2%),少数发生在放疗5 a以后(20.0%)。按BS分类,Stage Ⅰ期患者为0例;Stage Ⅱ期患者16(13.3%)例,主要采用单纯死骨刮治及单纯死骨扩大切除术(14例);Stage Ⅲ期患者92(76.7%)例,71例患者采用死骨扩大切除术,其中47例同期行血管化组织瓣修复;Stage Ⅳ期患者12(10.0%)例,主要采用死骨扩大切除联合同期血管化组织瓣修复(10例)。结论:放射性颌骨坏死以单侧下颌骨最多见,并以体部及部分下颌支最为好发,大多数患者骨坏死发生在放疗后1～2 a。死骨扩大切除联合同期血管化组织瓣修复是目前最好的治疗方法。     

下颌骨放射性骨坏死伴颌面部组织坏死的临床治疗

目的：探讨较大范围放射性下颌骨骨坏死伴颊瘘的临床手术治疗及下颌骨、面部软组织缺损的修复方法。方法：5例较大范围放射性下颌骨骨坏死,均存在暴露的坏死骨组织和颊瘘,进行下颌骨部分切除和颊部软组织切除,面部组织缺损同期应用腓骨瓣联合前臂皮瓣进行修复。下颌骨缺损平均长度65mm。结果：手术后移植的骨瓣、皮瓣成活,创口Ⅰ期愈合,面部形态及口腔功能恢复。6～12个月复查骨愈合趋正常,未见新的瘘道形成。结论：下颌骨放射性骨坏死伴面部软组织坏死应积极手术治疗,下颌骨的切除手术应在正常边缘上截骨,彻底清除病变坏死组织,方可达到疾病治愈或防止复发,同时行游离腓骨瓣联合前臂皮瓣整复面部组织缺损,能理想地恢复面部的外形及口腔功能。     

腓骨游离皮瓣即刻种植修复下颌骨对头颈部肿瘤放疗近期疗效的初步探讨

目的 探讨腓骨游离皮瓣即刻种植修复下颌骨对头颈部肿瘤放疗近期疗效的初步研究.方法 将2016年2至2019年10月在我院行下颌骨节段切除、腓骨肌皮瓣游离移植下颌骨重建术中即刻牙种植体辅助头颈部肿瘤放疗者17例(种植体修复组)及未即刻植入牙种植体辅助头颈部肿瘤放疗者16例(未种植组).比较2组患者并发症发生率、放疗开始时...     

口底癌9例临床治疗分析

目的：探讨口底癌临床治疗方法和术中缺损的修复。方法：对9例口底癌病例临床资料进行回顾性分析,其中8例进行口底颌颈联合根治术,有3例术创缺损采用前臂游离皮瓣、胸大肌肌皮瓣修复,伴有下颌骨节段缺损病例采用联合重建钛板进行修复。结果：9例口底癌患者中,除1例有肺、肝转移接受化疗外,8例术后下颌部、颈部和口底部等形态及功能恢复良好,前臂游离皮瓣、胸大肌肌皮瓣全部成活,术后随访2月～11年,未见肿瘤复发或淋巴结转移。结论：口底癌对下颌骨的侵犯与否决定下颌骨切除的术式,胸大肌肌皮瓣是修复口底癌术创巨大缺损的理想方法,联合重建钛板可I期修复下颌骨节段性缺损。     

一种新的药物性颌骨坏死临床分期及治疗策略

目的: 通过分析药物性颌骨坏死(medication-related osteonecrosis of the jaw,MRONJ)的病例资料,提出一种用于指导MRONJ临床诊疗的新分期方法。方法: 总结2008—2018年上海交通大学医学院附属第九人民医院收治的74例MRONJ患者的影像学资料及诊疗方式,将下牙槽神经管、下颌骨下缘及上颌窦底等作为划分骨质破坏严重程度的解剖学标志,再根据病损组织是否存在明确的界线,提出了一种新的MRONJ四分期二亚分类法及相应的治疗策略。结果: 根据骨坏死的不同程度将其分为4期,0期(7例),Ⅰa期(18例),Ⅰb期(14例),Ⅱa期(12例),Ⅱb期(15例),Ⅲ期(8例)。治疗后62例患者病情稳定,12例出现骨坏死进展。结论: 新的分期方法及相应治疗策略适用于MRONJ的临床诊疗。     

下颌骨髁突保存对头颈癌患者治疗失败的影响

该文旨在研究保留髁突的下颌骨节段性切除术对头颈癌患者术后肿瘤局部复发的影响，对1994-2003年间54例接受下颌骨节段性切除的头颈癌患者进行回顾性研究，所有患者先前未行治疗，截骨范围自颏孔至下颌骨后方，36例保留髁突及下颌骨的连续性。18例行髁突及下颌支切除，未行下颌骨重建。     

267例舌癌术后相关因素分析

目的　探讨和分析影响舌癌术后生成率的相关因素。方法　对在 1988- 0 4～ 1995 - 12间住院的 2 6 7例舌鳞癌术后病例作 3至 8年的随访 ,然后对记录进行分析。其中男 138例 ,女 12 9例 ,年龄 2 8～ 76岁 (平均 5 4.6岁 ) ; - 期患者有 175例 (6 5 .6 % ) ,舌根癌患者 32例 (11.1% ) ;10 7例患者行单纯舌切除 ,16 0例患者行下颌骨部分切除 ,2 0 5例患者行皮瓣修复。结果　 (1)男性生存率较女性低 ;(2 )舌体癌 3、5、8年生存率明显高于舌根癌 ;(3)原发灶大小与舌癌预后明显相关 ;(4)淋巴结转移者预后明显差于未转移者 ;(5 )舌癌患者的下颌骨切除与否与预后无明显差别 ;(6 )舌癌原发灶切除即刻行皮瓣修复者与不行皮瓣修复者其生存率无明显差异 ,但可增加手术安全缘、减少复发。结论　不论舌癌患者的淋巴结是否转移 ,施行颈淋巴清扫是十分必要的 ;为提高舌癌患者的生存率 ,应早期发现、早期诊断、早期治疗、定期随访。为了提高患者的生命质量 ,应尽可能保留下颌骨连续性及行皮瓣组织的修复     

Combined reconstruction plate fixation and submandibular gland translocation for the management of medication-related osteonecrosis of the mandible

The aim of this study was to summarize the clinical outcomes of patients with stage 3 mandibular medication-related osteonecrosis of the jaw (MRONJ) treated using reconstruction plate fixation and ipsilateral submandibular gland translocation after mandibulectomy. The medical records of patients with stage 3 mandibular MRONJ treated using the above surgical method between September 2014 and July 2019 were reviewed. Of a total of 27 patients included in this study, 23 (85.2%) experienced primary wound healing. The remaining four patients developed wound dehiscence and infection within 1 week after the operation. Three of these patients recovered after the plate was removed, and one patient died of the primary cancer. The follow-up period ranged from 3 months to 5 years, with an average of 12.7 months. The 23 patients with primary wound healing had a symmetrical facial appearance, with normal mouth opening and occlusion. Plate fracture occurred in two patients at 1 year and 3 years after the operation. Radioisotope scanning in 10 patients showed that the function of the translocated submandibular gland was normal at 6 months after the operation. In summary, for patients with stage 3 MRONJ involving the mandibular angle and/or body, reconstruction plate fixation and submandibular gland translocation after segmental mandibulectomy is an effective treatment method.     

Medication-related osteonecrosis of the jaw: An institution’s experience

ABSTRACT

Objectives

This study aimed to evaluate and report the outcomes associated with the management of patients who were treated surgically for medication-related osteonecrosis of the jaw (MRONJ).Methods: Demographic and medical profiles of patients with a diagnosis of MRONJ were created. The type of surgical treatment, complications, and treatment outcomes were identified.Results: Twenty-one patients with an average age of 68.42 years (range 40–90 years) were included. Nineteen patients had only mandible involvement, one patient had only maxilla involvement, and one patient had both mandible and maxilla involvement. Thirteen patients underwent marginal resections. Eight patients underwent segmental resection of the mandible with immediate reconstruction. Nineteen patients healed without any complications. Two patients who had undergone segmental resection of the mandible experienced postoperative complications and needed a second surgery to achieve primary closure.Discussion: Advanced MRONJ can effectively be treated with resective surgery in combination with medical treatment.     

Reconstruction using a submental island flap combined with mylohyoid muscle as a reliable surgical strategy after rim mandibulectomy for the management of stage 3 medication-related osteonecrosis of the mandible

The purpose of this study was to evaluate the clinical outcomes of patients with stage 3 mandibular medication-related osteonecrosis of the jaw (MRONJ) treated using a submental island flap in combination with mylohyoid muscle reconstruction after rim mandibulectomy. The medical records of 12 patients treated between January 2019 and April 2022 were analysed retrospectively. Primary wound healing was assessed as the maintenance of full mucosal coverage without signs of infection at 6 months postoperatively. The follow-up period ranged from 7 to 38 months, with an average of 21.8 months. All 12 patients (100%) experienced primary wound healing, with normal mouth opening and occlusion, and without pathological mandibular fracture or facial aesthetic problems during the follow-up period. Postoperative panoramic images revealed new bone formation in the treated areas of the mandible in four patients. During the follow-up period, one patient continuing bevacizumab and zoledronate administration for the primary cancer developed MRONJ in the same area at 13 months postoperatively and finally died. Hence the total success rate was 91.7%. In summary, for patients with stage 3 mandibular MRONJ treated with rim mandibulectomy, the submental island flap combined with mylohyoid muscle is an effective reconstructive option for wound-healing and possible bone regeneration of denuded bone.     

不同矢状骨面型后牙微种植体植入安全区研究

目的:CBCT探究不同矢状骨面型后牙区植入微种植体的安全区域特征.方法:纳入骨性Ⅰ、Ⅱ、Ⅲ类患者各20名的CBCT数据,运用InVivo 5.0软件重建,选择上下颌第一前磨牙远中至第二磨牙近中区域,分别测量距牙槽嵴顶2、4、6、8、10mm处的近远中向宽度,采用SPSS 19.0对测量结果进行统计学分析.结果:上颌距牙槽嵴高度4～8mm,下颌距牙槽嵴高度超过4 mm根尖间隔区域是安全适宜的微种植体植入部位.上颌第一前磨牙和第二前磨牙根间骨量在骨性Ⅰ、Ⅱ类组＞骨性Ⅲ类组(P＜0.05),其它测量部位各组间无统计学差异.下颌后牙区各根间骨量多数表现为骨性Ⅲ类组＞骨性Ⅰ、Ⅱ类组(P＜0.05).结论:上颌距牙槽嵴高度4～8 mm的第二前磨牙和第一磨牙间,下颌距牙槽嵴高度超过4 mm的第一和第二磨牙间的根尖间隔区域是相对安全的植入部位,不同骨面型存在一定差异.     

Conservative surgical treatment of medication related osteonecrosis of the jaw (MRONJ) lesions in patients affected by osteoporosis exposed to oral bisphosphonates: 24 months follow-up

The purpose of the study was to evaluate the efficacy of conservative surgical treatment of medication related osteonecrosis of the jaw (MRONJ) in patients affected by osteoporosis and exposed to oral bisphosphonates (BPs).Subjects diagnosed with MRONJ and osteoporosis under oral BPs that had undergone conservative surgery and had at least 24 months follow-up were included. All patients received medical-antibiotic therapy and then underwent conservative surgical treatment consisting of sequestrectomy, soft tissue debridement and bone curettage with limited or no extension.A total of 53 patients, mean age of 71.9 ± 10.2 years (range 41–87), were enrolled. Two years after conservative surgical therapy 45 patients (91.8%) showed complete healing. The presence of rheumatoid arthritis (p = 0.003) and a more severe initial MRONJ stage (p = 0.023) were associated with a negative surgical outcome while the presence of bone sequestrum was strongly associated with a positive outcome (p = 0.036).Conservative surgical treatment of MRONJ lesions in patients affected by osteoporosis and receiving only oral BPs may represent a valid therapeutic approach determining a high number of complete healing cases. Conservative surgery should be encouraged at early MRONJ stages and after medical therapy failure.     

常见正颌手术后咬合关系的维护和调整

目的 探讨临床常见的正颌手术后,如何很好的维护和调整上下牙列的咬合关系,为临床提供有益的参考.方法 选择骨性Ⅰ类双颌前突行根尖下截骨后徙术、Ⅱ类下颌后缩行下颌升支矢状劈开前徙术、Ⅲ类骨性反骀行下颌升支骨切开后退及合并上颌前徙术各6例患者,共18例患者.正颌手术后依据分类分别行3种不同的牵引模式进行咬合调整.结果 18例...     

基于颈椎骨龄定量分期法的安氏Ⅱ类Ⅰ分类错畸形患者最佳矫形时机的探讨

目的：基于颈椎骨龄定量分期法（Quantitative Cervical Vertebral Maturation,QCVM）,探讨上颌发育正常的安氏Ⅱ类Ⅰ分类错耠畸形患者的最佳矫形治疗时机。方法：随机选择在武汉协和医院口腔正畸科就诊的上颌发育正常、表现为安氏Ⅱ类Ⅰ分类错殆畸形的患者,根据颈椎骨龄定量分期法（QCVM）,双盲法将患者分为四期：QCVM第Ⅰ期（加速期）、QCVM第Ⅱ期（高峰期）、QCVM第Ⅲ期（减速期）、QCVM第Ⅳ期（结束期）,每期30例共120例患者入选。年龄8．2～16．1岁（平均年龄12．9岁,其中男62例,女58例）。分别利用Twin-block功能矫治器导下颌向前,改善颌骨畸形,疗程约7个月。治疗前后均拍摄x线头颅侧位片,对各参数指标进行测量分析比较。结果：颈椎骨龄不同时期的患者,矫治后面型均有不同程度的改善,在QCVMI期、Ⅱ期和Ⅲ期,SNB、ANB、A卜Gn等骨骼测量参数治疗前后有显著性变化（P〈O．05）,治疗前后参数变化绝对值的顺序依次为：QCVMII期〉QCVMIII期〉QCVMI期〉QCVMIV期。而LI-NB、U1-L1等角度测量参数在QCVMIV期变化较明显（P〈O．05）。结论：颈椎骨龄定量分期法能准确评估在不同的骨龄发育阶段下颌骨的生长发育潜力,在预测下颌骨矫形治疗的最佳时机方面有较好的指导意义。     

Outcomes of sequestrectomy and buccal fat pad reconstruction in the management of medication-related osteonecrosis of the jaws

The aim of the study was to evaluate the effectiveness of buccal fat pad (BFP) in the reconstruction of surgical defects following sequestrectomy in medication-related osteonecrosis of the jaws (MRONJ). A total of ten patients with MRONJ underwent sequestrectomy and reconstruction using BFP. There were 3 males and 7 females. The age range was 20–70 years. Two patients were diagnosed with stage 2, and eight patients were diagnosed with stage 3 disease. Eight defects were present in the maxilla and two in the posterior mandible. Oro-antral communication was present in 8 cases. All patients have undergone sequestrectomy, debridement and reconstruction using BFP under local anaesthesia. Postoperatively, the patients were followed up at 1, 3, 6 and 12 months and evaluated for complete epithelisation of defect, infection, pain and recurrence of the lesion. Complete epithelisation with closure of the defect was achieved in all the cases. None of the patients had residual pain or inflammation at the surgical site. There was no case of postoperative infection. Reconstruction using buccal fat pad is an effective treatment modality to provide symptomatic relief and to prevent further progression of disease in MRONJ patients.

     

晚期药物相关性颌骨坏死的手术治疗

目的 总结晚期（2、3期）药物相关性颌骨坏死（MRONJ）的手术治疗效果。方法 纳入2013年7月—2021年5月就诊于北京大学口腔医学院·口腔医院口腔颌面外科且采用手术治疗的晚期MRONJ患者。回顾性分析患者的临床资料,包括患者的原发疾病、用药情况、病变情况、手术治疗和随访结果等。结果 本研究共纳入104例患者（123处病变）,男性42例,女性62例,平均年龄（64.6±9.1）岁。原发疾病为恶性肿瘤91例,非肿瘤性疾病13例。2期病变43处（35.0%）,3期病变80处（65.0%）。39处（31.7%）病变位于上颌骨,84处（68.3%）病变位于下颌骨。使用唑来膦酸89例（85.6%）,阿仑膦酸钠10例（9.6%）,帕米膦酸钠10例（9.6%）,抗血管生成药物62例（59.6%）。平均药物治疗时长（34.7±25.8）月,平均停药时长（10.1±10.7）月。全部患者均在全麻下完成手术。手术去净死骨后,2期病变以局部黏骨膜瓣关闭创口,3期病变根据具体情况分别采用重建钛板联合下颌下腺转位、血管化腓骨瓣修复、碘仿纱条填塞、带蒂颊脂垫瓣修复等关闭创口。术后随访3个月至6年,81.3%(...     

上颌骨切除术临床分型的探讨

目的　探讨上颌骨切除术临床分型的意义。方法　回顾性分析施行上颌骨切除术治疗肿瘤病例 2 74例 ,根据肿瘤原发部位和侵犯范围将上颌骨切除术分为 4种临床类型 ,分别进行治疗并观察治疗效果。结果　 2 74例中 ,采用Ⅰ型上颌骨切除术 16 1例 ,Ⅱ型上颌骨切除术 5 8例 ,Ⅲ型上颌骨切除术 34例 ,Ⅳ型上颌骨切除术 2 1例。其中采用Ⅲ型和Ⅳ型上颌骨切除术18例 ,同时施行颈淋巴结清扫术 15例和 (或 )眼眶内容物清除术 3例。结论　将上颌骨切除术分成 4种临床类型是一种实用、易于表达手术切除范围的方法 ,并有助于对治疗效果的评价。