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??This article summarized the experiences of the author in management of dental diseases of pregnant patients?? interdisciplinary cooperation with obstetricians and oral health educations for pregnant patients in the past years. In combine with textbooks and research literatures home and abroad?? it gave professional opinions upon hot issues dental treatment for pregnant patients?? including basic principles?? harm of dental diseases during pregnancy?? dental radiological exam in pregnancy?? safety of local anesthetic techniques and drugs?? etc. The author hopes through the cooperation and efforts of dentists and obstetricians?? a guideline in this field could be developed and more and more professional could give attention in this field.     

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??Traumatic dental injuries are caused by a collision that can generate enough mechanical energy to produce the injury. Injuries involve the hard dental tissues?? the pulp and the periodontal tissues. Crown fractures and luxations of permanent teeth occur most commonly in all dental injuries. Proper diagnosis?? treatment planning and follow-up are important for improving a favorable outcome. The study highlighted Chinese dentists’ need for continuing education in order to improve current knowledge in emergency management of teeth injuries. The International Association of Dental Traumatology??IADT??Guidelines for management of fractures and luxations of permanent teeth represent the best current evidence based on literature search and professional opinion. Guidelines should assist dentists and other health care professionals in decision making in order to provide the best care effectively and efficiently.     

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??Peri-implantitis represents a clinical condition that includes the presence of an inflammatory lesion in the peri-implant mucosa and loss of implant bone. Several surgical treatment methods have been proposed for the management of peri-implantitis??including peri-implant surgical debridement??resective therapy?? implantoplasty and regenerative therapy. The way we choose to work on the patients should be based on clinical evidence along with full discussions with patients themselves.     

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随着口腔正畸学的发展与成熟,口腔正畸医生和颌面外科医生通过良好的合作,有效地将口腔正畸学与颌面外科学紧密地结合起来,形成口腔正畸-正颌外科联合治疗骨性错耠畸形的治疗手段。正颌外科对于颌面部和牙弓形态学的改善已经得到学术界的普遍认可,并且获得越来越多患者的接受。正颌手术治疗后,患者颌骨和牙齿均有移动,打破了原有的口颌系统,重建咬合平衡。近些年来,关于患者正颌手术治疗后口颌系统功能改变的研究一直受到广泛关注并存在很多争议。本文就近年来正颌手术治疗后口腔生理功能变化的相关研究进展做一综述。     

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目的比较高速涡轮钻法和传统劈冠法在下颌低位近中水平阻生牙拔除中的临床效果,评价涡轮钻法的优越性。方法对2006年7月至2008年7月中山大学光华口腔医学院附属口腔医院口腔颌面外科收治的140例下颌低位近中水平阻生牙患者,随机分成2组,每组70例。一组采用高速涡轮钻法(试验组),另一组采用传统劈冠法(对照组)。比较2组拔牙时间和疼痛、肿胀、张口度和第二磨牙松动度等并发症的发生情况。结果试验组的拔牙时间明显少于对照组,术后疼痛、张口度、第二磨牙松动度等并发症的发生率也较对照组少,两组间差异有统计学意义(P<0.01),但肿胀并发症的发生两组间差异无统计学意义(P>0.05)。结论运用高速涡轮钻法拔除下颌低位水平阻生牙,创伤轻、术后并发症少、手术时间短、患者对手术的恐惧感少,与传统劈冠法相比具有较好临床疗效。     

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目的评价传统下牙槽神经阻滞麻醉(直接麻醉)、Akinosi法麻醉与Gow-Gates法麻醉对下牙槽神经阻滞麻醉效果。方法2007年3月至2008年12月在山西医科大学第一医院口腔颌面外科对需拔除下颌智齿患者420例。分别施行直接麻醉、Akinosi法麻醉或Gow-Gates法麻醉,比较其麻醉成功率和优缺点。结果直接麻醉法A级118例(占84.3%);Gow-Gates法A级136例(占97.1%);Akinosi-Vazirani法A级133例(占95%)。直接麻醉法有23例注射麻药前回抽有血,经改变方向后重新注射;Gow-Gates法与Akinosi-Vazirani法无回抽有血病例。结论Gow-Gates法和Akinosi-Vazirani法均可替代直接麻醉方法。其中Akinosi-Vazirani法尤其适用于张口受限和精神紧张患者。     

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随着微创外科技术的发展,减少手术创伤的治疗方法日益受到口腔颌面外科医生的重视。目前,在颧骨骨折的治疗中,微创一方面体现在小切口或经皮径路在颧骨骨折治疗中的应用更为广泛;另外一方面则是体现在以影像辅助、内镜辅助、计算机辅助为代表的新技术应用在颧骨骨折治疗中的兴起,后者使手术创伤进一步减小。本文介绍了小切口或经皮径路微创术以及影像辅助、内镜辅助、计算机辅助的微创技术在颧骨骨折治疗中的应用。     

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目的探讨正畸治疗对成年安氏Ⅱ类高角型错患者颞下颌关节的影响。方法对2007年10月至2001年10月到云南省第二人民医院口腔正畸科就诊的21例成年安氏Ⅱ类高角型错患者,采用自锁托槽矫治技术进行正畸治疗,分别于治疗前、后,利用16层螺旋CT,进行颞下颌关节扫描,然后通过多层面重建(multiplanarreformation,MPR)技术对颞下颌关节进行三维重建及参数测量,并对结果进行统计学分析。结果治疗后有27侧髁状突处于关节窝内中性位,占57.2%(27/42),与治疗前比较,差异无统计学意义(P>0.05);而处于关节窝前位和后位的髁状突构成比分别为33.3%(12/42)和9.5%(4/42),与治疗前比较,差异均有统计学意义(均P<0.05)。髁状突前斜面倾角测量值在治疗后平均增大1.64°,与治疗前比较差异有统计学意义(P<0.05);关节结节后斜面斜度,关节窝前后径、内外径和关节窝高度的测量值与治疗前比较,差异无统计学意义(P>0.05)。结论正畸治疗能使成年安氏Ⅱ类高角型错患者的髁状突位置前移及髁状突前斜面适应性改建,但不会对颞下颌关节骨性结构和功能产生不利影响。     

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(牙合)是咀嚼系统功能的枢纽,口腔修复治疗除了满足美观和功能要求,还应确保通过修复体传导到机体的负荷有利于咀嚼系统健康.由于支持方式的差别,不同类型修复体对于(牙合)关系的要求有所不同.(牙合)关系设计制作应该参照个体的生理性(牙合),尽量准确复制有关的静态和动态因素,控制误差,使修复体与个体的(牙合)型达到协调.     

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口腔疾病患病率和发病率特别高,是主要的公共卫生问题之一。特别在社会低收入人群中,口腔疾病已经成为主要的疾病负担之一。本文就我国口腔流行病学资料,对我国目前口腔疾病的现状、改变的趋势、发展及对策做一论述和探讨。     

舌鳞状细胞癌颈淋巴结转移的特点和评估处理

舌鳞状细胞癌位居口腔癌首位,颈淋巴结转移妨碍其治疗.颈淋巴结转移分为微转移和包膜外转移,前者与肿瘤预后较差相关,后者对患者的生存率影响更大.舌鳞状细胞癌的淋巴结转移多为Ⅰ～Ⅲ区,原发灶浸润深度对颈部隐匿性淋巴转移有较高的预测价值.舌鳞状细胞癌颈淋巴结转移存在着一定的规律性,与其病理分级、神经和血管侵犯、浸润深度等多方面因素相关.颈淋巴结转移的临床评估除需借助B超、CT、磁共振成像、正电子发射断层摄影术等影像学辅助检查技术外,还需借助细胞细针吸取活检和前哨淋巴结活检来确认.迄今有关舌鳞状细胞癌的颈淋巴结处理仍无定论,临床选择上存在着仁者见仁智者见智的现象.目前,舌鳞状细胞癌的颈淋巴结处理主要为颈淋巴结清扫和随访观察两种方式,早发现、早诊断、早治疗仍是解决其问题的主要方式.     

Sublingual lymph node metastasis of early tongue cancer: report of two cases and review of the literature

Sublingual lymph node metastasis of early stage squamous cell carcinoma of the tongue (SCCT) is seldom reported. Lymphatic tissue in the floor of mouth, which intervenes between the tongue and neck, will be left behind by a primary tumour resection with discontinuous neck dissection. The authors present two cases of early stage SCCT with sublingual lymph node metastasis, review the literature, and discuss the management of the floor of mouth for early stage SCCT. The authors suggest that more attention should be paid to possible sublingual lymph node metastasis for T1/T2 SCC of the ventral tongue with deeply endophytic infiltration.     

舌癌患者非前哨淋巴结转移的预测因素

目的探讨舌鳞癌患者非前哨淋巴结（non-sentinel lymph node,nSLN）转移的预测因素。方法回顾性分析采用单光子发射计算机断层成像术和螺旋CT融合显像技术及蓝染法示踪定位前哨淋巴结（sentinel lymphnode,SLN）活检中存在转移的38例患者,对nSLN进行常规HE染色和CK免疫组化检查,研究nSLN转移与各种临床病理因素的关系。结果当SLN（＋）转移灶最大直径大于2 mm时,nSLN转移率为64.7%（11/17）;当SLN（＋）数目为1时,nSLN转移率为64.3%;当SLN（＋）数目为2时,nSLN转移率为20.0%;当SLN（＋）数目大于等于3时,nSLN转移率为11.1%。nSLN转移率随着肿瘤原发灶浸润深度的增加而增大。结论 nSLN是否转移与SLN（＋）转移灶最大直径、SLN（＋）数目和肿瘤原发灶浸润深度有关。     

口腔颌面癌瘤的颈淋巴结转移及颈淋巴清扫术的临床研究

目的 探讨口腔颌面癌瘤颈淋巴结转移的部分规律及其与颈淋巴清扫术间的关系。方法 对250例行颈淋巴清扫联合根治术的口腔颌面癌病例进行回顾性研究。结果 口腔颌面癌颈淋巴结转移率为18．8％，其中鳞癌的颈淋巴结转移率为23．4％，腺上皮源性癌颈淋巴结转移率为9．6％，颈淋巴结转移临床诊断与病理诊断符合率为58．4％，漏诊率为9．1％。结论 鳞状上皮细胞癌比腺上皮源性癌更易发生颈淋巴结转移；临床诊断阳性的颈淋巴结应实施颈淋巴清扫术，对N0期颈淋巴结应采取适时监测，当其转为阳性时可再行手术治疗。     

cN0早期舌体鳞癌的颈部处理探讨

目的 通过对临床早期舌体鳞癌患者的回顾研究,探讨预防性颈淋巴结清扫和严密观察2种治疗方式的合理应用.方法 收集132例cN0早期舌体鳞癌病例,根据颈部处理方案分为颈清组(71例)和观察组(61例),统计分析临床、病理和随访资料.结果 颈清组和观察组的3年生存率分别为87.3％、83.4％.颈清组T1、T2病例的3年生存...     

cN0早期舌体鳞癌的颈部处理探讨

目的通过对临床早期舌体鳞癌患者的回顾研究,探讨预防性颈淋巴结清扫和严密观察2种治疗方式的合理应用。方法收集132例cN0早期舌体鳞癌病例,根据颈部处理方案分为颈清组（71例）和观察组（61例）,统计分析临床、病理和随访资料。结果颈清组和观察组的3年生存率分别为87.3%、83.4%。颈清组T1、T2病例的3年生存率分别为89.3%、83.3%,观察组T1、T2病例的3年生存率分别为89.6%和58.3%。T2以3.0 cm为界,观察组T2b生存曲线较T2a下降趋势明显。低分化病例的生存曲线较高分化和中分化显著下降。结论T1期的cN0舌体鳞癌颈部可严密观察;小于3.0 cm的T2病例仍可采用严密观察,如果病理分化差可考虑预防性颈淋巴结清扫;大于3.0 cm的T2病例应采用预防性颈淋巴结清扫。     

The prognostic significance of the lymph node ratio in oral cancer differs for anatomical subsites

The aim of this study was to validate the prognostic significance of the lymph node ratio (LNR) in patients suffering from oral squamous cell carcinoma in regard to different anatomical subsites. A cohort of 430 patients was investigated to determine the rates of primary metastasis and local and regional disease recurrence. Correlation analysis of the LNR with relevant clinical and pathological parameters was performed. Receiver operating characteristic (ROC) curve analysis was conducted to evaluate the prognostic impact for different subsites. Significantly differing rates of primary metastasis and loco-regional disease recurrence were found for cancer of different anatomical subsites of the head and neck. Furthermore, ROC curve analysis suggested that LNR has prognostic relevance in subsets of cancer (tongue, P <  0.001; alveolar process, P =  0.04; maxilla, P =  0.03; buccal mucosa, P =  0.02). The LNR of cancer located in the soft palate (P =  0.6) and floor of the mouth (P =  0.11) showed little or no association with the clinical outcome. There is the need for a more sensitive consideration of the LNR as a factor in the assessment of risk and the treatment decision, as the anatomical subsite plays a crucial role in its impact on the clinical outcome.     

Usefulness of intra‐oral ultrasonography to predict neck metastasis in patients with tongue carcinoma

Objective: To assess tissue characterization relating with neck metastasis of invasive tongue cancer, we investigate the usefulness of intra‐oral ultrasonography (US). Materials and methods: The patients with squamous cell carcinoma of the tongue (n = 110) were preoperatively evaluated with intra‐oral US. The US images were compared with histological sections. The histological and ultrasonographic parameters were evaluated for their correlation with neck metastasis. Results and conclusion: High‐quality ultrasonic images were obtained, and all lesions over 1 mm thickness by histology were detected. There was a significant correlation (P < 0.0001) between measurements of tumor thickness by US and histology. Univariate analysis showed that the histological parameters influencing neck metastasis were mode of invasion (P = 0.0006), muscular invasion (P < 0.0001), stromal reaction (P = 0.0002), and tumor thickness (P = 0.0004). Of the ultrasonographic parameters, shape of margin (P = 0.019), pattern of margin (P = 0.033), internal echo signal (P = 0.035), and tumor thickness (P < 0.0001) showed a significant correlation with neck metastasis. Ultrasound images of oral tongue cancer reflected the histological structures. Tumors with diffuse invasive mode shows an irregular and unclear tumor margins on US image. Thickness of 8 mm by ultrasound is useful as a cut‐off point of predicting risk of neck metastasis of tongue cancer. Intra‐oral US is a reliable tool in objectively predicting subclinical neck metastasis in tongue cancer.     

Sampling of jugulo-digastric lymph nodes in oral cancer

A modified method of histologic sampling involving multiple blocks has been applied to 37 jugulo-digastric nodes dissected from freshly submitted neck dissection specimens from patients with oral squamous cell carcinoma (SCC). Seventeen of these nodes had been found to be free from tumor following standard sampling. The method was also applied to a further 29 jugulo-digastric nodes that had been previously reported as being free from metastatic tumor. Only one of the 46 nodes previously reported as negative was found to contain secondary tumor following more extensive sampling.