舌根癌术后舌内剩余肌动力性重建的临床研究

采用新的术式对８例舌根癌患者行舌根癌根治性切除的同时，对所保留的舌前２／３舌剩余肌行舌下神经－舌神经移位移植，并同期修复舌根缺损（３例用前臂游离皮瓣，５例用带蒂胸大肌皮瓣）；皮瓣、肌皮瓣全部成活；舌剩余肌、粘膜除１例部分坏死外，其余均成活，舌剩余肌保留长度４～７ｃｍ。从舌动力性恢复可见：术后早期舌根修复后外形满意，舌体前伸无受限，仅向患侧及上翘时受限；术后６月以后，患侧触压觉、冷热觉恢复。运动神经肌电测定：部分患者术后６月起出现自发肌电；口腔气流压测定：实验组患者的鼓气、吮吸及吞咽气流压值均低于对照组，但术后其恢复率随时间延长不断上升。所有患者近期效果满意     

猕猴舌下——舌神经移位移植的病理学研究

目的 通过猴桃舌下－舌神经移位移植后的病理改变,证实舌神经移位移植后运动神经可以再生,舌肌可以重建其动力功能的临床应用价值。方法 采用ＨＥ常规染色,嗜银,髓鞘特殊染色及免疫酶标记、透射电镜,观察不同时期神经移位移植后舌肌的组织反应及神经重建状况,测定肌纤维中羟脯氨酸的含量。结果 神经移植３月、６月、１２占膜未见萎缩,舌肌间肌纤维萎缩以舌前份较为明显,Ｓ－１００蛋白染色显示肌束及肌纤维间可见神经纤维     

舌神经修复效果及评价方法的初步研究

本研究目的是评价舌神经吻合后舌前２／３感觉和味觉恢复的情况。应用神经外膜吻合修复舌神经损伤１４例，初步研究结果表明：①舌神经重度损伤后，患侧舌前２／３菌状乳头大多萎缩、消失，感觉和味觉严重障碍；②神经外膜吻合修复舌神经，菌状乳头可以再生，术后一年，５０％患者感觉恢复正常，３５．７１％患者味觉恢复正常；③感觉功能检查、味觉功能测定、菌状乳头及其味孔定量观察评价舌神经的损伤和修复，结果是客观、准确、可靠的。     

舌前滑行组织瓣修复半侧舌中份缺损

目的 介绍中份侧缘病变组织切除后，采用舌前部剩余组织瓣向后滑行修复缺损的新方法，方法 在舌侧缘中份正常组织1cm缘切除病变及部分正常组织，将舌前部剩余组织瓣从舌背前正中向后在颏舌肌内向下切开，使舌前部组织与对侧舌前部分成左右两瓣，将切除病变组织后的同侧前部剩余组织瓣向后滑行至缺损区，与切除后的后部剩余组织及对侧创缘缝合，前部创缘对位缝合，结果 3例患者接受此手术，其中2例为舌侧缘中段T2鳞状细胞癌，1例为白斑不典型增生，舌中份侧缘病损切除后，分别形成3cm,6cm和6cm长的缺损，采用舌前部组织瓣向后滑行予以整复，术后3个月复查，语言和吞咽功能良好。结论 该术式特别适应于2-4cm舌病变切除后舌中份组织缺损的修复重建。     

舌再造术后舌部肌电及吞咽压的测定

本实验应用ＳＡＭＰ－ＥＭＧ软件，对１０名正常人及２０名Ⅱ２类舌缺损患者（其中１０例前臂皮瓣修复，７例胸大肌皮瓣修复及３例股薄肌皮瓣修复）作舌背表面肌电测定，计算肌电积分值，并作肌电功率谱分析。此外，还使用液压传导电子测压装置作吞咽压测定。实验结果表明：（１）ＳＡＭＰ－ＥＭＧ软件能较准确地反映出肌电活动情况；（２）正常人舌尖肌电能量最大，舌缘次之，以舌中份能量最弱；（３）各类修复（肌）皮瓣皆未测出有效肌电；（４）患者术后健侧舌部肌电较术前代偿性增强；（５）正常人吞咽压为２１．１±５．７ｋＰａ，舌修复术后较正常值低，股薄肌（ＧＣ）组为１４．６ｋＰａ，胸大肌（ＰＭ）组为１０．８ｋＰａ，前臂皮瓣（ＦＡ）组为１０．３ｋＰａ。     

猕猴舌下神经显微解剖的图像处理与测量分析

目的：揭示猕猴舌下与舌神经间的关系，为临床开展新的术式提供依据。方法：采用显微解剖研究，结合计算机图象处理和测量分析，测量猕猴舌下，舌神经的解剖参数。结果：（１）舌下神经与舌神经之间有二个恒定的联系部位，即舌下神经分支进入舌肌后最初５～１０ｍｍ处和２６～３０ｍｍ处；（２）舌下神经与舌神经最佳吻接部位，我们认为应在舌下神经主干分叉后１０ｍｍ左右；神经直径测量也发现神经直径与舌神经主干和分支直径较为匹配，且此区有利解剖，便于神经吻合；（３）舌下神经分叉之前，在神经干上方距分叉约６～１０ｍｍ处有一较固定分支，参与分布舌肌并与舌神经呈丛状结构。结论：实验结果为舌根切除时将支配舌内肌这一分支与舌经吻合，从而不破坏舌外肌的神经支配这一新术式提供解剖依据。     

舌神经的临床应用解剖学研究

为研究舌神经的临床应用解剖，对３２侧成人尸体头部标本的舌神经及其邻近结构进行了观测。舌神经全长平均为６９．７±７．９ｍｍ，以翼内肌为界将其分为３段，分别测量各段的长度及直径。平均颌下神经节的上下径与横径分别为２．７ｍｍ和２．９ｍｍ，根据它与舌神经的关系将其分为融合型（４６．９％）和游离型（５３．１％）。舌神经及其舌支与颌下腺导管存在两个交叉。着重探讨了舌神经第三段及其与邻近结构的关系和临床意义     

BDNF对端侧吻合面神经再生作用的研究

目的：探讨脑源性神经营养因子（BDNF）对面神经端侧吻合后促进神经再生的作用。方法：30只家兔随机分2组,将双侧离断的面神经上颊支远端与同侧外膜开窗的下颊支行端侧吻合。术后给予BDNF的为实验组,给予生理盐水的为对照组。分别于术后2、4、8周取材,采用电生理,光镜,透射电镜等检测方法。结果：实验组神经传导速度、动作电位、组织学形态学定量分析等指标明显优于对照组。结论：BDNF对面神经端侧吻合后神经再生有明显促进作用。     

电化学治疗对兔舌肌的影响

目的：探讨电化学治疗对兔舌肌组织的影响,为临床治疗舌血管畸形提供参考。方法：40只大耳白兔随机分为正常对照组、2库伦（C）组、3C组、4C组、5C组,每组各8只。正常对照组只置入电极10min而不予电刺激,其他各组分别给予相应电量的电化学治疗。记录术前与术后每天测量体质量的差值,采用SPSS11.5软件包对数据进行SNK-q检验。在术后1、7、14、21d时,各组分别随机抽取一只动物处死,切取舌前2/3组织,进行组织病理学和超微病理学观察。结果：电化学治疗后,实验组兔舌肌均受到一定程度的损伤：电量越大,损伤越严重。在一定时间内,2C、3C组可以观察到兔舌功能的恢复,而4C、5C组兔舌肌无明显恢复（P〈0.05）。结论：兔舌肌应用电化学治疗剂量为3C/cm^3时,无明显影响;超过3C/cm^3时,将产生不可逆损伤。     

静脉桥接治疗面神经缺损

作者采用自体静脉空管移植对２．０ｃｍ～３．０ｃｍ以上面神经缺损的患者进行桥接治疗，共诊治７例，其中颞支１条，颧支４条，上颊支３条，下颊支３条，随访６～１２个月，全部病例肌电图呈恢复性变化。作者认为静脉桥接治疗而神经缺损在临床上有重要的实用价值。     

Analysis of determinants on speech function after glossectomy.

PURPOSE: To determine which of the following factors-type of reconstruction, size of tumor, and site of excision-may influence speech intelligibility after glossectomy. MATERIALS AND METHODS: The speech intelligibilities of 27 tongue cancer patients who underwent glossectomy within the range of the hemitongue were investigated within 6 months after operation with a speech intelligibility test formed by 100 sensitive Chinese sounds. They were compared according to the following factors: type of reconstruction (forearm flap or adjacent flap); size of tumor (T1, T2, T3); and site of excision (anterior, middle, posterior, or hemi part). RESULTS: There was no significant difference in speech intelligibility between the forearm flap reconstructed group and adjacent flap reconstructed group (P > .05). There was a significant difference in the result between the T1 and T3 groups (P < .05). The speech intelligibilities of the patients with tumors in anterior tongue or hemitongue were significantly lower than those with tumor in the middle or posterior tongue (P < .05). Patients with preservation of the tip of the tongue or floor of the mouth had higher intelligibilities (P < .05). CONCLUSION: For the patients after glossectomy within the range of hemitongue, except for the type of reconstruction, the tumor site or excision extent of the tongue followed by the tumor size may be key factors in determining the postoperative articulation intelligibility.     

舌癌患者术后语音功能的影响因素分析

目的：评价舌癌患者手术前、后的语音功能,探讨患者术后语音功能的影响因素。方法：收集2001年10月—2004年6月在上海交通大学医学院附属第九人民医院口腔颌面外科I病区接受手术的舌癌患者27例,所有患者的舌切除范围均在半舌内。根据重建术式分为前臂游离皮瓣修复组（16例）、邻近舌组织瓣修复组（11例）;根据肿瘤大小和分期分为T1组（9例）、T2组（13例）及T3组（5例）;根据肿瘤切除后缺损的部位分为舌前部切除组（5例）、舌中部切除组（6例）、舌后部切除组（12例）和半舌切除组（4例）;根据术后舌活动度分为I度受限（14例）、Ⅱ度受限（7例）和Ⅲ度受限（6例）。采用100个具有代表性的汉字组成的汉语语音清晰度测试字表作为检测手段,对每例患者手术前、后语音清晰度变化情况进行采样,利用SPSS11.5软件包对所获资料进行方差分析,评价原发灶大小、手术切除部位、修复术式、邻近结构保存以及术后舌活动度等因素对患者术后语音清晰度的影响。结果：前臂游离皮瓣组和邻近舌组织瓣修复组间,术后语音清晰度比较无显著性差异（P〉0.05）;对原发灶大小不同的舌癌患者术后语音清晰度的比较表明,T1和T3组间有显著性差异（P〈0.05）;舌前份切除者的语音清晰度显著低于后份切除者（P〈0.05）,保存舌尖和口底组术后的语音清晰度明显高于未保存组（P〈0.05）,保存舌根组和未保存组间的语音清晰度改变无显著差异（P〉0.05）;不同程度伸舌受限者,术后语音清晰度下降有显著差异（P〈0.01）。结论：对半舌范围内行舌切除的舌癌患者,手术切除部位和邻近结构以及舌活动度的保存与否是影响术后语音功能的敏感因素,原发灶大小在一定程度上决定术后语音清晰度的高低,而选择何种修复手段并不是其主要影响因素。     

前臂皮瓣修复舌缺损感觉功能恢复的研究

目的:观察非感觉性游离桡侧前臂皮瓣修复舌缺损术后感觉功能的恢复情况。方法:追踪65例舌癌扩大切除同期行游离前臂皮瓣修复术患者,术后6～12个月复查,检测皮瓣的触觉、两点辨别觉、痛觉(钝锐觉)、方向觉和冷热觉的恢复情况。结果:29例皮瓣(44.6%)至少3/4面积有感觉恢复,32例皮瓣(50%)有部分感觉恢复,4例皮瓣(6.3%)无感觉恢复。结论:非感觉性游离前臂皮瓣修复舌缺损后可自行恢复感觉功能。放疗可能减缓甚至阻碍皮瓣感觉功能的恢复。     

The relationship between lingual and hypoglossal nerve function and quality of life in head and neck cancer

Sensorimotor impairment of the tongue has the potential to affect speech and swallowing. The purpose of this study was to critically examine the effects of nerve preservation and reinnervation after reconstruction of the base of tongue on patient‐perceived outcomes of quality of life (QoL) related to speech and swallowing through completion of the EORTC QLQ‐H&N35 stan‐dardised questionnaire. Thirty participants with a diagnosis of base of tongue cancer underwent primary resection and reconstruction with a radial forearm free flap, which may or may not have included nerve repair to the lingual nerve, hypoglossal nerve or both. Eight QoL domains sensitive to changes in motor and sensory nerve function were included in the analysis. Transected lingual and hypoglossal nerves were associated with difficulty in swallowing, social eating, dry mouth and social contact. There were fewer problems reported when these nerves were either repaired or left intact. There were no significant differences between patient nerve status and QoL outcomes for speech, sticky saliva and use of feeding tubes. This study was the first to examine the impact of sensory or motor nerve transection and reconstruction on health‐related QoL outcomes.     

Evaluation of Neurosensory Disturbance Following Orthognathic Surgery: A Prospective Study

Aim and Objectives

The prospective study was to evaluate the incidence, type of neurosensory disturbance (NSD), grade its severity and monitor its recovery occurring in the lower lip and chin due to damage to inferior alveolar nerve following orthognathic surgery involving mandible.

Materials and Methods

The study included 10 patients who have undergone sagittal split osteotomy, genioplasty, and anterior subapical osteotomy (ASO). All the patients examined preoperatively and post operatively 1 week, 1 and 6 months according to standardized test to clarify the subjective and objective neurosensory status of the injured nerve. Pin prick test, blunt test, two-point discrimator test, brush stoke direction, light touch test, warm and cold test were used bilaterally to lower lip and chin area.

Results

Seven patients underwent bilateral sagittal split osteotomy (BSSO) (70 %), one patient had BSSO with genioplasty (10 %), two patients had BSSO with ASO (20 %). During the operation none of the nerves were transectioned, in 60 % of patients nerve was not visible and in 40 % of patients nerve was seen in distal segment. 70 % of patients underwent setback, 30 % of patients underwent advancement. The subjective evaluation of the patients revealed the incidence of 90 % at 1 week, 30 % at 1 month, 20 % at 6 months and 10 % at 1 year post operatively. The altered sensation reported subjectively was hypoesthesia in 50 % of the patients, anaesthesia in 40 % of the patients. There was 100 % recovery in advancement cases and 93.5 % recovery in setback cases.

Conclusion

There is a high incidence of NSD of the lower lip and chin after BSSO related to advancement, setback, intraoperative nerve encounter and surgical skill. However, recovery of sensation occurs with increasing frequency during the follow-up period. The clinical neurosensory tests are effective guides to study the neurosensory deficit.     

腮腺手术中面神经解剖术式与面神经功能损伤的临床研究

目的:探讨腮腺手术中不同的面神经解剖术式与面神经功能损伤之间的相关性。方法:通过对120例临床腮腺肿瘤患者进行随机分3组,分别采用不同的面神经解剖术式,观察面神经功能损伤的发生率及恢复时间。结果:经面神经总干的顺行法、经颧支或下颌缘支的逆行法面神经解剖术式,其神经功能损伤的发生率及神经功能恢复时间分别是:5%,2.58月;12.5%,2.82月;70%,6.52月。前2种术式之间,神经损伤发生率及恢复时间差异均无显著性,而前2种术式与经下颌缘支的逆行法之间比较,神经损伤的发生率(P<0.01)及恢复时间(P<0.05)差异均存在显著性。结论:经面神经总干及颧支解剖面神经,运用逆行和顺行解剖法相结合,是一种较好的减少面神经损伤的手术方式。     

腹直肌-腹膜瓣修复舌体缺损动物模型的建立

目的 探讨携带神经的腹直肌-腹膜瓣移植修复舌体缺损的可行性。方法 研究选用12只Beagle犬,随机分为3组,制备带神经的腹直肌-腹膜瓣修复舌体缺损的动物模型,其中2组（A、B组）行肋间神经与舌下神经吻合,另一组不行神经吻合。左侧为实验侧,右侧为正常对照侧。术后12周应用激发肌电图,检测舌下神经潜伏期、振幅及传导速度,观察腹直肌-腹膜瓣是否重获舌下神经再支配。结果 12只Beagle犬中9只带神经的腹直肌-腹膜瓣修复舌体缺损的动物模型建立成功,1只雄性犬术后第3天因腹疝死亡,2只雌性犬因动脉解剖与雄性犬差异较大,腹壁下动脉与舌动脉管径相差较大,无法吻合。A、B组舌下神经传导速度分别恢复至正常侧的40%、30%。结论 采用带神经的腹直肌-腹膜瓣移植修复舌体缺损具有可行性,失神经腹直肌-腹膜瓣可重获舌下神经的支配,舌下神经支配功能可部分恢复。     

上颌骨全切除术改良的手术径路

目的　根据上颌骨解剖学上的特点 ,结合各类手术径路的优点 ,设计一种改良的上颌骨全切除术的手术径路 ,旨在改善术后的外形与功能。方法　共有 17例患者采用了该上颌全切除术的手术径路 ,即 :切口设计在下唇 ,沿颏面沟与颌下、腮腺耳前切口连接至同侧发际。切口设计依据为避开上颌区 ,隐蔽切口位于面颌部正常的皮肤皱折区 ,术中对面神经下颌缘支、下颊支、颏神经、腮腺导管以及内眦部等均加以保存。其中行上颌骨全切除 14例 ,次全切除 3例。结果　经 1～ 12个月术后随访 ,疗效满意。其中 11例术后放疗患者均未出现任何皮肤坏死及下颌水肿。因保存了面神经下颌缘支和下唇肌支 ,仅 1例发生轻度口角歪斜畸形。结论　本文提出的上颌骨全切除术改良的径路 ,能充分暴露并完整切除上颌骨肿瘤 ,术后有较满意的外形及功能 ,可作为上颌骨全切除的一种常规手术径路。若病变超过上颌骨区的范围 ,则不应采用本文介绍的手术径路     

Sensory outcomes of the anterior tongue after lingual nerve repair in oropharyngeal cancer

Primary treatment of oropharyngeal cancer often involves surgical resection and reconstruction of the affected area. However, during base of tongue reconstruction the lingual nerve is often severed on one or both sides, affecting sensation in the preserved tissue of the anterior tongue. The loss of specific tongue sensations could negatively affect a person's oral function and quality of life. The aim of this study was to explore the effects of different types of lingual nerve intervention on sensory function for patients with base of tongue cancer as compared to healthy, age-matched adults. Subjects included 30 patients who had undergone primary oropharyngeal reconstruction with a radial forearm free-flap and 30 matched controls. Sensations tested were temperature, two-point discrimination, light touch, taste, oral stereognosis and texture on the anterior two-thirds of the tongue. Results indicated that type of surgical nerve repair may not have a significant impact on overall sensory outcomes, providing mixed results for either nerve repair technique. Sensations for the nonoperated tongue side and operated side with lingual nerve intact were comparable to matched controls, with mixed outcomes for nerve repair. The poorest sensory outcomes were observed in patients with the lingual nerve severed, while all patients with lingual nerve intervention exhibited deteriorated taste sensation on the affected tongue side. Overall, patients in this study who had undergone oropharyngeal reconstruction with lingual nerve intervention exhibited decreased levels of sensation on the operated tongue side, with minimal differences between types of lingual nerve repair.