颌面骨骨折小型接骨板坚强内固定术后并发症20例分析

目的:探讨颌面骨骨折小型接骨板坚强内固定术后并发症类型、原因和防治措施。方法：对82例颌面骨骨折小型钛板坚强内固定术后20例并发症进行临床分析。结果：感染6例，错(牙合)5例，神经损伤4例，钛板外露2例，骨坏死1例，牙损伤2例。结论：掌握小型钛板应用手术适应证；术前、术后适时铺以颌间结扎固定；重视操作技术是防治并发症重要措施。     

颧上颌骨骨折82例临床总结

目的　通过 82例颧上颌骨骨折病人临床资料分析 ,以探讨手术后并发症的发生及治疗方法。方法　 82例颧上颌骨骨折患者 ,72例采用切开复位坚强内固定术 ;6例颌间牵引复位固定术 ;4例未进行任何治疗。结果　所有病例随防 3～ 12个月 ,72例手术患者 6 6例效果满意 ,达到了治疗标准 ,成功率为 91.8%。 4 8例出现面神经颞支损伤 ,术后 6个月 ,4 6例完全恢复 ,仅 2例未完全恢复正常。 12例出现 牙合干扰 ,通过颌间牵引和调牙合后 ,仍有 2例存在牙合干扰。 2例面部塌陷未进行修复 ,6例冠状切口出现瘢痕和瘢痕区无发。结论　治疗颧上颌骨骨折手术复位钛板内固定术效果满意 ,但术后产生并发症的原因及预防措施有待进一步研究 ,对颌面缺损的修复、视力障碍问题有待解决     

下颌角骨折治疗后并发症的临床分析

目的研究下颌角骨折治疗后并发症,分析原因并提出预防方法。方法回顾分析我院206例下颌角骨折患者的治疗及并发症情况,分颌间固定组62例,内固定组120例,颅颌绷带组24例。结果治疗后发生的并发症有骨感染4例,医源性损伤2例,牙合干扰3例,错牙合畸形2例,颞下颌关节功能紊乱病2例。结论下颌角骨折的治疗应首选坚强内固定,应选择正确的手术方案,加强术前、术后抗感染治疗及术后肌功能训练,对骨折线上的阻生齿应尽可能保留,以减少并发症。     

下颌骨骨折术后感染相关因素分析

目的:探讨下颌骨骨折行坚固内固定术后与感染相关的危险因素.方法:设计病例对照研究,收集我院2009年1月—2015年12月期间下颌骨骨折坚固内固定手术患者447例,其中出现术后感染的病例为26例(实验组).从每例发生术后感染的患者入院前2周内,随机选取1例下颌骨骨折坚强内固定术后无任何并发症的患者纳入对照组,共26例.收集整理相关的变量数据,采用SAS9.2软件包在2组间行二变量和多因素Logistic回归分析,确定与术后感染相关的因素.结果:回归分析结果显示,增长的下颌骨骨折严重程度评分(OR=2.509,95％ CI为1.083～5.814)以及患者欠佳的全身健康状态(OR=5.019,95％ CI为1.294～19.472)是导致术后感染的相关危险因素.在二变量检验中,抗生素使用天数与术后感染具有相关性(P＜0.05).结论:骨折的严重程度和患者欠佳的身体健康状态是下颌骨骨折术后感染的危险因素.     

经冠状切口联合下睑缘切口治疗复杂面中部骨折

目的：探讨经冠状切口联合下睑缘切口行复杂面中部骨折坚强固定术的临床应用价值。方法：本组28例患者采用头皮冠状切口联合下睑缘切口行面中部骨折解剖复位，Mini或Micro钛接骨板坚强内固定。结果：28例均一期愈合，面部畸形得到明显改善，咬合关系恢复正常，无面神经的损伤。结论：采用头皮冠状切口联合下睑缘切口的坚强内固定技术大大减少了传统的面中部复杂骨折治疗所带来的复位不准确、固定不可靠、术后遗留面部畸形等并发症，使面中部解剖结构得以重建，提高了骨折固定的稳定性，取得了良好的疗效。     

口内入路坚强内固定术治疗颌骨骨折的护理体会

目的：探讨口内入路坚强内固定术治疗颌骨骨折的术后护理。方法：对93例施行口内入路坚强内固定术治疗颌骨骨折病例,进行术前和术后护理总结。结果：施行口内入路坚强内固定术治疗颌骨骨折的患者经过精心护理均取得满意的治疗效果。结论：对颌骨骨折患者施行口内入路坚强内固定手术配合周密细致的术前术后护理,可以减少并发症,缩短治疗时间,取得满意的治疗效果。     

脱套入路在鼻眶筛区骨折治疗中的应用

目的:探讨面中部脱套入路治疗鼻眶筛区骨折的疗效。方法:选取佛山中医院口腔医疗中心鼻眶筛骨折患者11例,均为单侧一类骨折,其中眶区骨折6例,鼻区骨折5例。所有患者采用面中部脱套入路行骨折复位内固定术或隆鼻术。结果:11例患者术后随访3～12个月,伤口均一期愈合,所有患者均有鼻腔结痂和出血现象,创伤性溢泪1例,眶下区麻木4例,鼻部歪斜1例。结论:面中部脱套入路治疗鼻眶筛区骨折操作安全,术野暴露充分,面部不留瘢痕,无鼻前庭狭窄等并发症发生,值得临床推广应用。     

冠状切口在面中部复杂性骨折中的应用

目的:总结经冠状切口行面中部复杂性骨折复位、坚强内固定术的临床应用及注意事项。方法:本组50例患者采用头皮冠状切口行复杂性面中部骨折解剖复位,钛合金接骨板坚强内固定。结果:除4例出现暂时性神经损伤症状,2例出现头皮麻木和感觉异常,1例感染外,其余的病例均一期愈合,面部畸形得到明显改善,咬合关系恢复正常,X线片显示骨折处对位良好。结论:采用头皮冠状切口的坚强内固定技术,可在直视下开放复位,较好地暴露颧骨、颧弓、上颌骨连接处骨折,使面中部解剖结构得以重建,提高了骨折固定的稳定性,取得了良好的疗效。     

面中部骨折伴发眶底骨折的临床分析

目的探讨面中部骨折伴发眶底骨折的诊治方法。方法对136例面中部骨折伴发眶底骨折患者的治疗进行回顾性研究。136例患者均采用切开复位内固定术进行治疗,其中49例行眶底手术治疗,21例有眶底骨缺损的患者采用自体骨、钛网或多孔高分子聚乙烯进行眶底重建。结果136例骨折患者的面部外形和功能显著恢复,术后未发生永久性严重并发症,仅2例出现切口局部感染,1例暂时失明,经及时治疗后痊愈。结论面中部骨折伴发眶底骨折的首选诊断方法是CT;治疗原则是恢复眶底的解剖形态和眶腔容积,还纳疝入上颌窦的眶内容物,植入修复材料重建眶底。     

颌面部骨折术后并发症的临床研究

目的 探讨颌面部骨折内固定术后并发症的出现原因、防治手段。方法 对南京医科大学附属淮安一院口腔科3年来23例颌面部骨折内固定术后出现并发症患者进行回顾分析,寻找可能原因及解决办法。结果 17例患者出现感染,3例患者出现面神经损伤症状,3例患者出现严重并发症,经对症处理后完全恢复或症状改善。结论 严格掌握手术适应证、手术时机,控制感染,明确内固定板数量、位置,可以有效的预防颌面骨折术后并发症。     

Rigid fixation in reconstruction of craniofacial fractures.

Ninety-four patients had either isolated fractures of the skull or midface, or combined fractures of the skull, periorbit, and/or midface. Thirty-five of these patients were treated by conventional methods, including maxillomandibular fixation (MMF) 4 to 6 weeks postoperatively, wire osteosynthesis, suspension ligatures, or a head frame. The remaining 59 patients were treated with either mini-, low-profile, micro-, or 3-D titanium plate fixation (rigid internal fixation [RIF]) and comprise the patient population for this study. Of the 59 patients, 11 were female and 48 male, ranging in age from 6 to 85 years, with a mean age of 34 years. Six patients had isolated skull fractures, 9 had combined skull and periorbital fractures, 31 had isolated midface fractures, and 13 patients had combined skull and midface fractures. The follow-up period ranged from 3 to 48 months. Patients with midface fractures were placed in MMF intraoperatively, and MMF was released at the completion of the procedure. At 2 to 4 days postoperatively, the occlusion was evaluated. Fifteen of the 38 dentate patients with either midface or combined skull and midface fractures were without MMF postoperatively. Twenty-three patients showed slight occlusal discrepancies and were treated with elastic MMF for 3 to 28 days (mean, 10 days). All reductions were judged to be stable throughout the postoperative course. Based on the results, use of RIF is recommended for primary reconstruction in craniofacial trauma patients whenever possible, thereby achieving three-dimensional stability, sufficient functional and cosmetic results, and often avoiding or reducing the need for MMF.     

牙列重度磨耗伴颞下颌关节紊乱病咬合重建序列治疗临床疗效观察

目的 观察分析牙列重度磨耗伴颞下颌关节紊乱病（TMD）患者咬合重建序列治疗的疗效。方法 选取牙列重度磨耗伴TMD患者11例,检查记录TMD及其相关症状,然后进行咬合重建序列治疗,治疗完成3个月、6个月及12个月后,将治疗后的TMD及其相关症状与治疗前相比较,对相关数据进行统计分析。结果 治疗后11例患者均感满意且咀嚼有力,关节弹响、关节疼痛及咬合干扰治疗前后的比较存在统计学意义( P< 0.05) 。结论 咬合重建后,患者满意度较高,其TMD症状有明显改善,髁突位置在短期内无明显改善。     

青少年错(牙合)患者正畸治疗后动态(牙合)接触特征变化初探

目的 探讨经正畸治疗后获得正常牙列形态的青少年错(牙合)患者矫治结束后12个月内动态(牙合)接触的变化规律,以期为正畸矫治结束前的精细调整提供参考.方法 选择20例正畸矫治后戴用标准霍利保持器的青少年患者,并将20例患者分为(牙合)干扰组与无(牙合)干扰组,其中(牙合)干扰组患者11例,无(牙合)干扰组9例,使用T-ScanⅡ咬合分析系统分别于矫治结束即刻(T1)和矫治结束12个月(T2)时检查患者的动态(牙合)接触,对比分析两个时间点总体与分组情况下患者动态(牙合)接触特征.结果 20例患者的总体情况:T1至T2的前伸、左侧方和右侧方(牙合)分离时间明显减少,从(1.07±0.87)、(0.91±0.47)、(0.76±0.43)s分别降至(0.43±0.25)、(0.67±0.41)、(0.50±0.27)s,两时间点差异均有统计学意义(P＜0.05).其中4例存在(牙合)干扰的患者(牙合)干扰消失.1例出现(牙合)干扰侧咀嚼肌不适症状.无(牙合)干扰组T1至T2的前伸、左侧方和右侧方(牙合)分离时间明显减少,从(1.25±1.11)、(0.84±0.15)、(0.52±0.49)s降至(0.35±0.15)、(0.36±0.15)、(0.33±0.11)s,两时间点差异均有统计学意义(P＜0.05),(牙合)干扰组T1与T2的前伸、左侧方和右侧方(牙合)分离时间的差异无统计学意义(P＞0.05).结论 戴用标准霍利保持器12个月后患者的动态(牙合)接触总体改善,但(牙合)干扰的存在影响了咬合的自行改善进程,矫治器拆除前对动态抬(牙合)接触的评估与精细调整仍是必要的.     

Le Fort Ⅲ型截骨中位牵引成骨治疗成人面中份发育不全

目的:评价中位牵引成骨治疗成人面中份发育不全的疗效。方法:使用自行设计制作的颌骨牵引装置,在全麻手术下LeFortⅢ型截骨,后将牵引钩置入鼻底或梨状孔侧缘,从鼻孔引出,外部装置采用面弓或坚固外固定支架,对8例面中部凹陷畸形成年患者行前牵引,治疗前后拍摄定位头颅侧位片测量分析。结果:上颌中位前牵引治疗后,患者咬合关系和软组织侧貌改变明显,A点水平前移在9～14.5mm之间,面部上中下各部的前后关系协调,鼻梁及鼻下部挺拔,眼球突出度改进明显。结论:经梨状孔中位牵引成骨可有效矫治面中部发育不全,该牵引技术牵引力点适中,能够使面中份骨骼平衡前移;避免对牙齿牵引造成的不利改变。长期效果有待于进一步观察。     

Monobloc distraction osteogenesis in pediatric patients with severe syndromal craniosynostosis

The management of the hypoplastic midface in syndromic craniosynostosis remains a great challenge. Frequently, patients have to be operated on numerous times to achieve a satisfactory end result, partially because of the limited skeletal advancement possible when using traditional surgical techniques. During the last decade, however, methods for gradual midfacial distraction have been presented, whereby greater advancements can be obtained. We present four children aged 17 months to 15 years with severe syndromal craniosynostosis in need of midface advancements because of severe respiratory obstruction or severe exophthalmos. These patients were complex cases with several previous craniofacial surgeries (mean of three times, range of two to six times) that yielded insufficient skeletal advancements. They were operated on with gradual monobloc advancements using the Modular Internal Distraction System. The mean length of operations was 370 minutes (range: 240-455 minutes), and the mean amount of perioperative blood transfusion needed was 1,300 ml (range: 280-2,700 ml) or 66.9 ml/kg (range: 31.1-94.9 ml/kg). The patient with the greatest number of previous operations also had the longest operation time as well as the most blood loss. The average midface advancement obtained was 25 mm (range: 20-30 mm), resulting in cessation or a significant decrease of preoperative respiratory problems, reduced exophthalmos, and improved facial profile. Apart from a local infection in one patient with a connective tissue disorder and several previous wound infections, no major postoperative complications were recorded. Distraction osteogenesis has become a versatile and safe technique that allows for large advancements of the midface.     

Changes in bite force and occlusal contact area after orthognathic surgery for correction of mandibular prognathism

OBJECTIVE: This study examined the long-term changes of bite force and occlusal contact area in patients with prognathous after orthognathic surgery with a newly developed pressure-sensitive sheet (Dental-Prescale; Fuji Photo Film Co). STUDY DESIGN: Fifty-seven patients with prognathous were examined. Bite force and occlusal contact area were measured just before operation and at 2 weeks, 1 month, 3 months, 6 months, 1 year, 2 years, and 3 years after operation. Forty control subjects with normal occlusion were also measured. RESULTS: The bite force and occlusal contact area of the patients were significantly greater than the preoperative level at 1 year, 2 years, and 3 years after operation. However, they were still significantly lower than the control subject level even at 3 years after operation. CONCLUSIONS: This study suggests that orthognathic surgery improves the bite force and occlusal contact area of patients with prognathous. However, at 3 years from the time of operation, patients had not reached control subject levels.     

Distraction osteogenesis of the maxilla and midface using a subcutaneous device: report of four cases

The use of distraction osteogenesis in the hypoplastic maxilla and midface is still controversial. Since the beginning of 1998, 25 patients have been treated with osteodistraction techniques for various reasons. Among them were four patients who were treated by high LeFort I osteotomies and insertion of a newly developed subcutaneous distraction device in the malar region. Distraction osteogenesis was successful in all four cases resulting in a mean sagittal bone gain of 12.0 mm (range 7-14) at the level of distractor fixation. All patients were kept under orthodontic supervision during osteodistraction. The final occlusal relation was satisfactory. Cephalometric measurements after distraction showed an anterior rotational movement of the midface region. As the question of relapse and further growth is still not clear, Delaire masks are used to stabilize the surgical result after removal of the distractor. The importance of long-term follow-up is stressed.     

Midface distraction osteogenesis: internal vs. external devices

This study compares internal and external distraction devices in the treatment of midface retrusion. 20 patients were treated with midface distraction (12 Crouzon, 4 Apert, 4 others); 12 with internal distraction (MID device), 8 with external distraction (Red or Blue device). The two groups were compared regarding operation time, peroperative blood loss and complications. The groups were comparable regarding patient age, sex, weight and diagnosis. In the MID-group, 7 of 12 patients (58%) underwent Le Fort III, 5 underwent 12 monobloc (32%). In the Blue device group, three of eight patients underwent Le Fort II (38%), three of eight underwent Le Fort III (38%), and two of eight underwent monobloc (25%). Operation time was shorter in the Blue device (mean 298 min) than in the MID group (mean 354 min). Peroperative blood loss and complication rates were similar. The internal distraction device is the ‘gold standard’ for treating midface retrusion. The use of an external distraction device in midface distraction osteogenesis is associated with a shorter operation time; peroperative blood loss and complications were similar. An external device affords better 3-dimensional control during the distraction process, so external distraction is preferable in patients who will tolerate this treatment.     

在正颌外科中用钢丝固定和坚硬内固定后并发症的比较研究

对１００例正颌外科病人应用钢丝固定或坚硬内固定的结果进行了回顾性比较，分析了两组病人所有并发症的发生情况．研究中最明显的发现是两种方法的结果基本相同，但在并发症中术后６个月体重过度减轻（≥５ｋｇ）和张口受限（中切牙最大张口度≤３５ｍｍ）两组间有明显差异，钢丝固定组分别为３０％和２４％，明显高于坚硬内固定组的８％和４％，主要是由于应用坚硬内固定的病人可以术后早期进行下颌运动，有利于饮食和咀嚼肌、颞颌关节的功能锻炼，而使术后体重过度减轻和张口受限的比例明显减少．由于坚硬内固定并没有增加正颌外科并发症的发生，而显示许多优点，因此将被广泛接受和应用     

Differences in cephalometric and occlusal outcome of cleft palate patients regarding different surgical techniques.

INTRODUCTION: The purpose of this study was to assess differences of the long-term results following surgical treatment in patients with cleft palate treated by two different surgical concepts. PATIENTS: Fifty-nine adult patients operated on for cleft palate were examined. Thirty palates were closed by a two stage (Widmaier and Veau) and 29 by a single-stage procedure (Veau's pedicled flap). METHODS: Lateral cephalometric and model analysis was performed. In the cephalometric analysis, the vertical and horizontal parameters of the position of maxilla and midface and transverse and sagittal dimensions of the models were compared between the two groups. RESULTS: Model analysis: According to the Bolton analysis the maxillary dental arch was too large in 22 patients in each group. The other patients had mandibular arches that were too large. In 18 patients with two-stage closure and in 9 patients with one-stage closure, a space deficit in the lateral part of the maxilla was observed. Persisting transverse deficits were seen in all patients with two-stage repairs and in 11 patients with one-stage repairs. The deficit was more severe in the molar area in the first group and almost equally severe in the premolar and the molar regions of the second group. A sagittal deficiency was found more often in patients with two-stage repairs while Angle's class I occlusion was seen more often in patients with one-stage surgery. Lateral cephalometry: Similar SNA-angles were seen in both groups whereas the ANB-angle was greater following two-stage repair. In both patient groups a low inclination of the midface was seen. The vertical dimension of the midface in comparison with the lower face was normal in the one-stage group; in the other group a deficiency of the anterior midface height was registered. CONCLUSION: There was a more severe growth impairment of the midface in patients with this type of two-stage palatal repair. The horizontal deficiency was similar in both groups. The long-term occlusal result revealed smaller sagittal and transverse deficiencies in patients with this type of single-stage closure.