65例老年口腔癌患者术后留置人工气道的护理体会

目的：探讨老年口腔癌根治术后留置人工气道的护理。方法：回顾65例老年口腔癌根治术后留置人工气道的护理特点和具体措施。术前做好患者评估,加强术前宣教;密切观察术后留置人工气道患者的生命体征,加强气道湿化,有效落实并发症预见性护理。结果：65例老年口腔癌根治术后留置人工气道患者,1例气管切开患者内套管被血痂堵塞,处理及时。65例均恢复良好,无严重并发症。结论：术前宣教指导和术后有效地护理可减轻患者带管不适,加快术后恢复。     

颌面部缺损修复术后并发症的防治

目的回顾性分析组织瓣修复颌面部缺损术后并发症的原因．为其处理提供正确的方案，减少并发症。方法总结分析2006年以来102例口腔癌根治术后组织瓣修复缺损并发症的种类及原因。结果102例中有15例出现并发症，包括窒息、感染、出血、皮瓣部分坏死等．经处理后患者均顺利出院。结论组织瓣修复颌面部缺损术后正确有效的护理可以提高手术成功率．减少并发症的发生。     

口腔癌联合根治术后并发肺部感染的预防及护理

探讨口腔癌联合根治术后并发肺部感染的防治及护理经验。护理重点包括：（1）完善术前准备,充分做好牙周洁治,处理患牙;（2）术前、术后做好呼吸道的管理,术前进行呼吸功能锻炼,指导患者有效咳嗽咳痰方法;（3）术后加强气道的管理,合理使用抗生素,使用带气囊气管套管,及有效气道的湿化、雾化吸入协助排痰;（4）加强鼻饲护理,防止胃食管返流误吸,加强口腔卫生及全身营养支持治疗。本组131例口腔癌修复重建患者术后5例并发肺部感染,感染率为3.82%,经积极处理后均痊愈出院,无手术相关死亡病例。     

放射粒子植入治疗口腔癌的护理和防护

目的：探讨放射粒子组织间近距离植入治疗口腔癌的护理防护方法及疗效。方法：对48例口腔癌患者实施125I放射粒子植入术。术前对患者进行心理护理，术后进行防护知识的指导。结果：48例手术顺利，无1例发生粒子移位，住院3-5天顺利出院。近期随访3-12个月无1例复发和转移，因时间原因，远期随访尚无结果。结论：系统的术前及术后护理和防护是降低手术并发症，提高疗效的有力保障。     

胸大肌肌皮瓣修复口腔癌术后缺损并发症原因分析

目的:分析胸大肌肌皮瓣修复口腔癌术后缺损出现并发症的原因。方法:对40例晚期口腔癌患者行扩大根治术后采用胸大肌肌皮瓣修复口内组织缺损,对出现并发症的原因进行总结分析。结果:1例皮瓣部分坏死(2.5%),2例术后伤口裂开形成颏下瘘管(5%),2例颈部伤口感染(5%)。结论:细致的手术操作,术中充分止血,术后通畅的引流及口腔护理可有效避免并发症的发生,提高胸大肌肌皮瓣的移植成活率。     

口腔癌患者术前营养风险指数与术后疼痛的相关性分析

目的:分析口腔癌患者术前营养状态与术后镇痛药需求之间的关系。方法:回顾性纳入行口腔癌根治术的593例患者。收集人口学特征、合并症、术前检验结果、手术特点、术中药物的使用以及术后镇痛药的使用等资料。以营养风险指数(nutritional risk index, NRI)来评估患者术前的营养状态。使用Logistic回归对术前NRI与术后镇痛药需求的关系进行分析。结果:纳入患者术前NRI的中位值为94.6,355例患者(59.9%)术前有中重度营养不良风险(NRI≤97.5)。进行多因素Logistic回归分析，分别调整不同的混杂因素来分析口腔癌患者术前NRI与术后镇痛药需求的关系。当NRI以连续变量纳入分析时，患者术后镇痛药需求随NRI的升高而降低(P<0.05);当NRI以分类变量纳入分析时，NRI≤97.5的患者术后镇痛药需求较NRI>97.5的患者高(P<0.05)。结论:术前营养不良在口腔癌患者中比较常见，是患者术后镇痛药需求增加的危险因素。     

老年口腔癌患者手术前后血糖的比较

目的：比较老年口腔癌患者手术前后血糖的变化.方法：对57例70岁以上行口腔癌根治术的患者手术前后空腹血糖进行比较,并与同期其他年龄段行口腔癌根治术患者手术前后空腹血糖进行对比,行统计学分析.结果：所有口腔癌根治术患者术后血糖均较术前升高,而老年口腔癌患者术后血糖升高,较其他年龄段患者血糖升高差异有显著性.结论：胰腺功能和肾功能的减退,是老年口腔癌患者术后血糖升高的主要原因;术后严密的血糖监测和合理,适量的应用胰岛素,是避免老年口腔癌患者术后血糖升高的关键.     

口腔癌伴糖尿病患者围手术期护理体会

目的 探讨口腔癌伴糖尿病患者的围手术期护理要点.方法 总结10例口腔癌伴糖尿病患者的围手术期护理经验.结果 10例患者中7例术后血糖稳定, 2例出现低血糖反应, 1例出现下肢肿胀,对症治疗后均无并发症,痊愈出院.结论 加强口腔癌合并糖尿病患者的围手术期护理可以促进患者的早日康复.     

颏下动脉岛状瓣在口腔癌修复中的临床应用

目的:探讨颏下动脉岛状瓣修复口腔癌术后缺损的可行性。方法 :对我院2010-03—2011-06期间,收治的15例口腔癌病灶切除术后所造成的软组织缺损,设计以颏下动脉为蒂的岛状皮瓣进行修复的病例,进行临床回顾性研究。结果:其中14例皮瓣全部成活,另1例部分成活。术后随访6个月~4年,所有患者对术区外观及功能感到满意。结论:颏下动脉岛状瓣与口腔区邻近、血供可靠、质地柔软、厚度适中、切取方便、制备简单、并发症少,是修复口腔癌术后缺损的理想皮瓣。     

56例合并系统性疾病的口腔癌患者的治疗效果评价

目的: 总结56例合并系统性疾病的口腔癌患者的诊疗经验。方法: 回顾56例口腔癌患者的临床资料,根据口腔癌的特征,分析和制订局部及全身治疗方案,评价治疗效果。结果: 56例患者分别接受手术、放化疗、免疫治疗等。对34例（60.71%）合并高血压患者、11例（19.64%）合并冠心病患者、1例（1.79%）合并严重心律失常的患者提出心血管治疗意见;对23例（41.07%）糖尿病患者提供了合理化控制血糖的方案;对19例（33.93%）合并呼吸系统疾病的患者提出了相应的肺功能检测及术后并发症的治疗方案。结论: 多学科协作对合并系统性疾病的口腔癌患者的诊疗合理、有效,值得完善和推广。     

新型冠状病毒肺炎疫情期口腔颌面外科全身麻醉管理

由于口腔治疗操作的特殊性,治疗过程中会不可避免地产生飞沫和气溶胶等漂浮颗粒,在新型冠状病毒肺炎疫情的防控关键时期内,口腔颌面外科的治疗工作受到很大影响;同时,口腔颌面外科全身麻醉在气道管理过程中极易造成病毒播散,这也为麻醉管理工作带来巨大挑战。本文从专科角度出发,对新型冠状病毒肺炎疫情期口腔颌面外科全身麻醉管理进行论述,以期为疫情期口腔颌面外科全身麻醉实施提供参考。     

The laryngeal mask airway for dental surgery—a review

The ideal airway requirements for oral surgery are the provision of a stable, unobstructed airway, protection of the lungs from aspiration, minimal interference with the surgical field and a low complication rate. Neither the nasal mask nor endotracheal tube meet these requirements. The laryngeal mask airway (LMA), provides a third type of airway for consideration in oral surgery that offers some of the benefits of intubation and avoids many of the associated hazards. It can be inserted without use of a laryngoscope or muscle relaxants, and is designed to produce an airtight seal around the laryngeal inlet. It provides a secure airway suitable for spontaneous or controlled ventilation and acts as an airtight throat pack. Scavenging of waste gases is possible, and it is well tolerated during recovery. A modification, specifically designed for head, neck and dental anaesthesia, has recently become available. The purpose of this article is to provide a brief overview of the LMA with special emphasis on its use in oral surgery.     

Temporary tracheotomy in microvascular reconstruction in maxillofacial surgery: Benefit or threat?

Background

Temporary tracheotomies are often used in oral microvascular flap reconstruction surgery to secure postoperative airway management and avoid emergency tracheotomies. Even when planned electively, a tracheotomy can cause severe and life-threatening complications. The aim of this study was to evaluate the complications of tracheotomies performed on oral cancer patients with microvascular flap reconstructions and differentiated patterns, which could lead to postoperative complications.

Managing complications of radiation therapy in head and neck cancer patients: Part V. Management of mucositis

Head and neck cancer is becoming a more recognizable pathology to the general population and dentists. The modes of treatment include surgery and/or radiation therapy. Where possible, pretreatment dental assessment shall be provided for these patients before they undergo radiation therapy. There are occasions, however, whereby head and neck cancer patients are not prepared optimally for radiation therapy. Because of this, they succumb to complicated oral adverse effects after radiation therapy. The second last part of this series reviews and discusses the management of complication that commonly occur to the oral mucosa, i.e. mucositis.     

Deep space neck infection: principles of surgical management

Knowledge of the management of infections of the deep spaces of the neck is essential to the daily practice of oral and maxillofacial surgery. Timely decisions must be made through the acute course of the disease. Interventions must be performed with the appropriate surgical skill. The surgeon must decide on medical and surgical management, including antibiotic selection, how to employ supportive resuscitative care, when to operate, what procedures to perform, and how to secure the airway. To make these decisions the surgeon must understand the anatomy of the region and the etiology of infection, appropriate diagnostic workup, and medical and surgical management. This article provides a review of these pertinent topics.     

Use of piezosurgery device in management of oral surgery complications: clincal case and clinical experience report

The root displacement into the maxillary sinus could be a complication of oral surgery in the upper jaw. In these cases, the root removal is needed in order to avoid the occurrence of sinus pathologies. Piezosurgery techniques could assure a safer management of such complications, because of the clear surgical visibility and the selective ability of cut. The aim of this article is to present a case of oral surgery complication (root displacement in the right maxillary sinus), in which piezosurgery technique helped for a correct and safe clinical management, allowing to reduce the soft tissue damage.     

Subcutaneous emphysema during third molar surgery: a case report

Extraction of third molars is the most common surgical procedure performed in oral surgery on a daily basis and, despite surgical skills and expertise, complications may occur. Complications observed during or after third molar removal may include pain, swelling, bleeding, infection, sinus perforation and nerve damage. Fortunately, with a proper management and a good surgical technique, the incidence of such events is low. Subcutaneous emphysema associated with dental extraction occurs when the air from the high-speed dental handpiece is forced into the soft tissue through the reflected flap and invades the adjacent tissues, leading to swelling, crepitus on palpation and occasionally spreading through the tissue spaces of the fascial planes. Although rare, iatrogenic subcutaneous emphysema can have serious and potentially life-threatening consequences. Care should be taken when using air-driven handpieces. The access of air into the facial tissues is not limited to tooth extractions, but may also occur through other portals of entrance, such as endodontically treated teeth, periodontium and lacerations of intraoral soft tissues. When subcutaneous emphysema occurs, it must be quickly diagnosed and properly managed to reduce the risk of further complications. This report presents a case of subcutaneous emphysema occurred during extraction of a mandibular third molar extraction with the use of an air turbine handpiece. Case management is described and issues relative to the diagnosis and prevention of this surgical complication are discussed.     

口腔颌面外科全麻手术患者的呼吸道管理

目的：探讨口腔颌面外科全麻手术患者的呼吸道管理。方法：收集8例口腔颌面外科全麻手术发生呼吸道并发症患者的资料，对其病因、措施及救治方法进行分析。结果：呼吸道并发症病因多样，导致后果较为严重，正确分析病因，采取措施，可有效防范呼吸道并发症的发生。结论：在术前、术中、术后妥善管理好呼吸道，是防止发生呼吸并发症，保障医疗安全的关键。     

Perioperative Oral Management Prevents Complications of Heart Valve Surgery

ObjectivesThe effect of perioperative oral management on the prevention of postoperative complications remains unclear in cardiac surgery. Exploratory factor analysis was performed to examine whether a lack of perioperative oral management was associated with postoperative complications of heart valve surgery.Materials and methodsWe retrospectively enrolled 365 patients who underwent heart valve surgery between April 2010 and March 2019. We extracted data on patient characteristics and set postoperative pneumonia and postoperative bloodstream infection as outcomes. A logistic regression analyses were performed to examine the effect of factors on the incidence of postoperative complications.ResultsSignificant risk factors for postoperative pneumonia included dialysis, long operative time, and long-term intubation. Similarly, risk factors for postoperative bloodstream infection were long-term intubation and lack of perioperative oral management. Subsequently, we identified the risk factors for long-term intubation, which were common to both complications, and found they were emergency status, combined valvular disease, long operative time, and lack of perioperative oral management.ConclusionsWe demonstrated that a lack of perioperative oral management could be a risk factor for postoperative bloodstream infection and long-term intubation in heart valve surgery. The results suggest that perioperative oral management is effective in preventing postoperative complications of heart valve surgery.