老年口腔癌患者合并系统性疾病的治疗体会

目的：探讨老年口腔癌患者合并系统性疾病的特点及治疗体会。方法：收集本院口腔颁而外科经冶的老年口腔患者59例，对其合并系统性疾病及围手术期处理，进行回顾性分析。结果：经围手术期处理后，58例患者安全渡过围手术期，完成口腔癌的手术治疗。结论：积极处理纠正老年口腔癌患者的合并症，提高手术耐受力，加强术后的监测和护理，合并系统性疾病老年口腔痛患者可取得满意的治疗效果。     

Multidisciplinary team model for patients with oral cancer and systemic diseases: an expert consensus

近年来,随着双向转诊、分级诊疗和医联体的建立,大型综合医院承担急危重症和疑难疾病诊疗的功能定位日益凸显,来诊的口腔癌患者常伴有全身情况复杂的系统性疾病,传统的单一诊疗模式难以达到医疗需求。为此,多学科协作诊疗（MDT）模式应运而生并在实践中应用,取得了良好的临床效果。为了进一步规范口腔癌患者的MDT,组织专家制订了本专家共识,对诊疗流程、常见系统性疾病的诊治等给出了规范化建议,供临床医师参考。     

口腔癌患者的心理困扰及生存质量研究

目的: 探讨口腔癌患者的心理现状及其影响因素,以及与生存质量相关的因素。方法: 使用心理困扰温度计（distress themometer,DT）和华盛顿大学生存质量量表（University of Washington Quality of Life Questionnaire,UW-QOL）对郑州大学第一附属医院2016年10月—2017年9月收治的250例口腔癌患者进行问卷调查。应用SPSS20.0软件包对数据进行统计学分析。结果: 发放问卷250份,实际回收有效问卷239份。在239例口腔癌患者中,DT分数≥4分139例（58.2%）,UWQOL量表平均得分53.3±17.1;<4分的患者100例（41.8%）,UWQOL量表平均得分52.8±17.4,DT总平均得分4.56±2.18。单因素分析结果显示,心理困扰与年龄、文化程度、收入水平、病理分期、颌骨切除、复发6个因素有关（χ²值分别为5.12、21.31、34.2、10.69、31.3和7.84,P<0.05）。Logistic回归分析显示,年龄、颌骨切除、复发是影响口腔癌患者心理困扰的危险因素（OR值分别为4.06、5.12和5.79,P<0.05）。Spearman相关分析显示,UWQOL量表中疼痛、娱乐、情绪、焦虑4个条目得分与心理困扰得分呈负相关（r分别为-0.58、-0.84、-0.66和-0.69,P<0.05）。结论: 口腔癌患者的心理困扰发生率较高;年龄越小、做过颌骨切除、复发的患者心理困扰程度更严重。对口腔癌患者施行个体化的治疗方案、术后护理及心理疏导,可能会减轻患者的心理困扰程度。     

新型冠状病毒肺炎疫情下口腔癌患者诊疗及康复策略

2019年末，新型冠状病毒肺炎（COVID-19，简称新冠肺炎）疫情在中国蔓延，对全国医疗卫生活动带来了巨大的影响和挑战。口腔癌是需要限期治疗的恶性肿瘤，新冠肺炎疫情下如何实现及时诊治是亟待解决的难题。中山大学附属口腔医院在新冠肺炎疫情严密防控基础上，通过院前严格筛查、治疗方案调整、线上复诊及居家功能康复等策略，坚持对口腔癌患者的及时救治。现将我院疫情期间口腔癌患者诊疗及康复策略进行总结，供同行及患者参考。     

369例口腔癌患者汉语普通话语音数据库的建立与初步评价

目的 ：收集口腔癌患者手术前、后语音样本,建立口腔癌患者汉语普通话语音数据库,为口腔癌的临床诊治和康复提供数据平台。方法：收集在中山大学附属口腔医院口腔颌面外科就诊及术后定期复诊的口腔癌患者,利用多种语音测试工具对患者进行语音评估,在安静环境下录音,纳入非恶性肿瘤病变患者和健康人作为对照组。所有音频样本经统一预处理、分割、标注、匿名化处理,生成标准化语音数据集。结果：2017年7月—2021年4月纳入481位独立发音人,男274例（57.0%）,女207例（43.0%）,平均年龄（46.98±16.34）岁。口腔癌患者369例（76.7%）,健康人79例（16.4%）,非恶性肿瘤患者33例（6.9%）。口腔癌患者中,病变位于舌及口底258例,术前进入评估队列202例,T1、T2、T3、T4分别为35例（17.3%）、68例（33.7%）、41例（20.3%）、58例（28.7%）。所有发音人的中位随访（评估）时间为术后219 d(IQR:87.5～587 d),共计1 100人次。共得到73 008份独立语料音频,所涉及的语料种类包括元音（6,1.30%）、下颌轮替运动音节（7,1.5...     

口腔癌患者生存质量的影响因素及医学应对方式分析

目的 评价口腔癌患者术后生存质量的影响因素并对患者的应对方式进行分析。方法 采用第4版华盛顿大学生存质量量表（UWQOL）和医学应对问卷（MCMQ）分别对符合纳入标准的131例口腔癌术后患者进行调查,了解患者生存质量的影响因素及应对方式与生存质量之间的相关关系。结果 共回收有效问卷126份,回收率为96.18%（126/131）。单因素分析显示年龄、婚姻状况、文化程度、其他系统性疾病、个人收入水平、牙齿缺失、手术次数、辅助放疗、分期、颈淋巴清扫术、复发及颌骨切除等因素对口腔癌患者生存质量有不同程度的影响（P<0.05）;多重回归分析显示,牙齿缺失、分期、复发及颌骨切除主要在生存质量总得分上的差异有统计学意义（P<0.05）。口腔癌术后患者应对方式中的面对维度得分为（17.54±4.97）分,回避维度得分为（17.79±2.19）分,屈服维度得分为（12.97±5.70）分,与常模比较,差异具有统计学意义（P<0.05）,相关分析表明,面对和回避维度与患者生存质量呈正相关,屈服维度与患者生存质量呈负相关（P<0.05）。结论 年龄、婚姻状况、文化程度、其他系统性疾病、个人收入水平、牙齿缺失、手术次数、辅助放疗、分期、颈淋巴清扫术、复发及颌骨切除在生存质量各方面均有不同程度的影响,而牙齿缺失、分期、复发及颌骨切除是影响患者整体生存质量的主要因素,应加强个性化治疗及护理,全面提高患者的生存质量,改变患者的不良应对方式。     

术前全身合并症情况及营养状态对老年口腔鳞癌患者预后的影响

目的：探讨老年口腔癌患者术前全身合并症情况及营养状态对预后的影响。方法：收集2010年1月—2012年12月间手术治疗的老年（年龄≥60岁）口腔鳞癌患者的相关病史资料,回顾分析合并症指数（Charlson、HNCA、ACT指数）以及营养指数（nutrition index, NI）对术后生存率的影响。采用SPSS 17.0软件包对数据进行统计学分析。结果：465例患者中,死亡170例,Charlson、HNCA以及ACT指数与患者预后（总生存率OS）无相关性（P=0.747、0.530、0.869）,术前营养状态与预后相关,营养指数是老年口腔癌患者预后的独立危险因素（P<0.001）,得分越高,预后越差。结论：对于老年口腔鳞癌患者,术前全身系统性疾病并不是影响预后的独立因素,术前营养状态越差,生存率越低。     

311例口腔颌面部间隙感染患者的回顾性分析

目的：探讨口腔颌面部间隙感染患者的流行病学分析及诊疗经验。方法：回顾分析311例口腔颌面部间隙感染患者的病案资料。结果：牙源性感染（70.4%）是口腔颌面部间隙感染最常见的病因。56.6%的入院患者病程超过1周。多间隙感染（70.5%）较单间隙感染（29.5%）更常见。60岁以上患者为患病最高的年龄段（38.9%）。血液链球菌是口腔颌面部间隙感染患者细菌培养检出率最高的致病菌（34.2%）。下行性纵隔炎是最常见的危及生命的并发症。78.1%的患者行脓肿切开引流术合并抗生素治疗。结论：口腔颌面部间隙感染患者治疗过程中需明确感染来源,从而指导治疗方案;B超、CT及MR等影像学检查对于间隙感染患者的诊断及治疗有指导意义;经验性抗生素使用合并脓肿切开引流仍是感染患者的首要治疗手段。在控制感染的基础上控制患者基础病的水平,避免可能出现的危及生命的并发症。     

198例老年颌面部骨折患者临床分析

目的 了解老年颌面部骨折患者的临床特征。方法 对2010年7月—2017年10月收治的198例老年颌面部骨折手术患者的临床资料进行回顾,分析创伤原因、骨折部位、合并伤、系统性疾病、治疗方法等临床特征。结果 198例老年颌面部骨折患者,男女比3.95︰1,平均年龄66.15岁;交通事故伤（78例,39.39%）、摔伤（49例,24.75%）、高坠伤（33例,16.67%）是老年人颌面部骨折的主要原因;下颌骨是最常见的骨折部位（120例）;60例患者同时伴发颌面部以外的创伤,四肢损伤最多（28例）;66例患有系统性疾病,最常见的是心血管疾病（50例）。198例患者的治疗方法主要是小型或微型接骨板切开复位坚强内固定。结论 坠跌伤和交通事故伤是老年颌面部骨折的主要原因,应采取有效的预防和干预措施。     

食物嵌塞双轴分类法及序列诊疗方案的临床效果观察

目的 探究食物嵌塞双轴分类法及序列诊疗方案的临床应用效果。方法 采用食物嵌塞双轴分类法对272例食物嵌塞患者进行分类,并按序列诊疗方案进行治疗。在治疗结束当天、1月、3月、6月和12月时,根据患者的主观感受进行疗效评价。结果 在治疗结束当天、1月、3月、6月和12月时,患者的主观感受评分分别为2.00、1.93、1.59、1.20、0.98,各时间点的患者主观感受评分均存在差异（P<0.05）;治疗有效率分别为87.17%、81.70%、73.21%、55.80%、44.59%。结论 食物嵌塞双轴分类法及序列诊疗方案可有效地指导食物嵌塞的治疗。     

Treatment outcomes of proton beam therapy combined with retrograde intra-arterial infusion chemotherapy for locally advanced oral cancer in the elderly

The aim of this study was to evaluate the therapeutic efficacy and safety of proton beam therapy combined with retrograde intra-arterial infusion chemotherapy in elderly patients with locally advanced oral cancer. Between February 2009 and October 2019, 42 oral cancer patients aged ≥75 years were treated with this therapy. Median age was 80 years (range 75–90 years) and the median follow-up duration was 39 months (range 2–106 months). Of the 42 patients, 34 (81%) were diagnosed with stage IV cancer. The 3-year overall survival, local control, progression-free survival, and disease-specific survival rates were 56%, 69%, 32%, and 67%, respectively. Regarding acute toxicities, grade 3 neutropenia was observed in six patients (14%), anaemia in five (12%), acute kidney injury in one (2%), and oral mucositis in 18 (42%). Late toxicities of grade 3 were observed in seven patients: dysphagia in six (14%) and osteonecrosis of the jaw in one (2%). This study showed that proton beam therapy combined with retrograde intra-arterial infusion chemotherapy was effective for elderly patients with oral cancer, and toxicities were tolerable and manageable. The study findings suggest that this therapy is a potential treatment option for elderly oral cancer patients with difficulty in surgery and systemic chemotherapy.     

Radiographic manifestation of 68 cases with various systemic diseases

Oral radiographic findings often provide important clues that lead to early recognition and diagnosis of systemic diseases. The purpose of this study was to identify and analyze the oral radiographic manifestations of various systemic diseases. Conventional radiographs (panoramic, Waters' and dental radiographs) were evaluated in 68 patients with systemic diseases to assess abnormalities retrospectively. Furthermore, high-resolution CT and 3D-CT reformations were available in 2 cases. Various oral radiographic manifestations were present in 36 patients (52.9%): 22 patients with congenital, developmental and hereditary abnormalities; 7 patients with endocrine disturbance, a patient with blood disease and 6 patients with other diseases. The oral radiographic appearance of systemic diseases is considered to provide valuable information for the diagnosis and treatment planning of systemic diseases, especially with regard to abnormalities of the teeth and jaw bones. Furthermore, by using modalities such as CT, further detailed findings can be obtained.     

口腔外科门诊突发医疗紧急事件的回顾研究

目的:分析口腔外科门诊出现突发医疗紧急事件的种类、原因,探讨口腔医护人员对口腔科突发医疗紧急事件的预防。方法:对2003～2010年间于第四军医大学口腔医学院口腔外科门诊出现突发医疗紧急事件的病例进行回顾研究。结果:在口腔外科门诊进行治疗的患者、患者陪人和医护人员中共有63例出现突发医疗紧急事件;其中心血管疾病(44.44%)和肾上腺素反应(15.87%)最为常见;突发医疗紧急事件易于在患有全身系统疾病的患者(71.43%)和高龄患者(58.73%)的治疗过程中发生。结论:突发医疗紧急事件的发生与多种因素有关,患者自身系统疾病的存在是最主要的内在因素,治疗过程中患者情绪紧张、疼痛、麻药注射等刺激是最常见的诱因,口腔医护人员必须做好对口腔科突发医疗紧急事件的预防。     

多种胸锁乳突肌瓣与游离皮瓣修复口腔癌缺损的效果比较

目的 通过比较胸锁乳突肌瓣与常用游离皮瓣用于不同年龄、原发灶大小及部位、颈部淋巴转移及全身情况的口腔癌患者的信息,为胸锁乳突肌瓣临床适应证的选择提供依据。方法 选择2015年9月—2018年3月由青岛大学附属医院同一术者手术的口腔癌患者58例,其中鳞状细胞癌53例,腺样囊性癌4例,下颌骨肉瘤1例。应用胸锁乳突肌瓣28例、游离皮瓣30例对口腔癌缺损进行同期修复。采用SPSS 22.0软件包分析2种皮瓣患者的基本信息、手术信息及术后功能状况。结果 与游离皮瓣相比,应用胸锁乳突肌瓣的患者原发灶面积多属T1~T2期,部位集中于舌、下牙龈、口底、舌根或口咽,平均年龄较大,术前合并全身疾病较多,手术费用低,手术时间短,术后住院天数少,气管切开率低（P<0.05）。术后随访提示,2组患者术后功能恢复相仿（P>0.05）。结论 口腔癌患者手术缺损选用胸锁乳突肌瓣或游离皮瓣修复,应综合考虑患者的年龄、原发灶大小及部位、颈部淋巴转移及全身情况等多种因素。对于高龄、原发灶较小、合并全身疾病较多的患者,建议多采用胸锁乳突肌瓣修复缺损。     

Oral lichen planus: causes,diagnosis and management

Oral lichen planus (OLP) is a chronic inflammatory disease of unknown etiology. In this paper we review the clinical and histological features of OLP, process of OLP diagnosis, causes of OLP, management of OLP patients and medical treatment of OLP lesions. Approximately 0.2 per cent OLP patients develop intra-oral carcinoma each year compared with approximately 0.005 per cent Australian adults. Possible mechanisms of increased oral cancer risk in OLP patients are presented. The aims of current OLP therapy are to eliminate mucosal erythema and ulceration, alleviate symptoms and reduce the risk of oral cancer. Patient education may improve the outcomes of OLP therapy and further reduce the risk of oral cancer in OLP patients. Although OLP may be diagnosed clinically, appropriate specialist referral is required for: (i) histological diagnosis; (ii) assessment of causative/exacerbating factors, associated diseases and oral cancer risk; (iii) patient education and management; (iv) medical treatment; and (v) long-term review and re-biopsy as required.     

Effect of local antifibrinolytic treatment with tranexamic acid in hemophiliacs undergoing oral surgery

The objectives of the present clinical investigation were to examine the effects in hemophiliacs of local antifibrinolytic treatment with tranexamic acid on the incidence of postoperative bleeding after oral surgery and on the amount of replacement therapy needed to control bleeding. The study compared three groups of patients. The patients in group A received high doses of factor concentrate and systemic antifibrinolytic treatment with tranexamic acid. In group B local antifibrinolytic treatment with tranexamic acid was added to the treatment received by group A. Group C received replacement therapy to raise factor levels to approximately 10% of the normal value perioperatively, combined with systemic and local antifibrinolytic treatment (mouth rinse) with tranexamic acid. The study demonstrated that local antifibrinolytic therapy with tranexamic acid as a supplement to the currently used systemic therapy significantly reduces the incidence of postoperative bleeding. The results of the study further suggest that replacement therapy can be reduced during oral surgery in the hemophilic patient provided that local and systemic inhibition of fibrinolysis is instituted.     

Burning mouth syndrome: a review and update

Burning mouth syndrome (BMS) is characterized by the presence of burning sensation of the oral mucosa in the absence of clinically apparent mucosal alterations. It occurs more commonly in middle‐aged and elderly women and often affects the tongue tip and lateral borders, lips, and hard and soft palate. In addition to a burning sensation, the patients with BMS may also complain unremitting oral mucosal pain, dysgeusia, and xerostomia. BMS can be classified into two clinical forms: primary and secondary BMS. The primary BMS is essential or idiopathic, in which the organic local/systemic causes cannot be identified and a neuropathological cause is likely. The diagnosis of primary BMS depends mainly on exclusion of etiological factors. The secondary BMS is caused by local, systemic, and/or psychological factors; thus, its diagnosis depends on identification of the exact causative factor. When local, systemic or psychological factors are present, treatment or elimination of these factors usually results in a significant clinical improvement of BMS symptoms. Vitamin, zinc, or hormone replacement therapy has been found to be effective for reducing the oral burning or pain symptom in some BMS patients with deficiency of the corresponding factor. If patients still have the symptoms after the removal of potential causes, drug therapy should be instituted. Previous randomized controlled clinical trials found that drug therapy with capsaicin, alpha‐lipoic acid, clonazepam, and antidepressants may provide relief of oral burning or pain symptom. In addition, psychotherapy and behavioral feedback may also help eliminate the BMS symptoms.     

Implant survival in mandibles of irradiated oral cancer patients

OBJECTIVE: The aim of this study was to analyze long-term implant survival in the mandible after radiotherapy and radical surgery in oral cancer patients. STUDY DESIGN: Between 1990 and 2003, 71 patients (15 females, 56 males; average age 57.8 years, range 16-84.1 years) were treated with dental implants after radiochemotherapy and ablative surgery of oral cancer. Radiation therapy was delivered in daily fractions of 2 Gy given on 25 days (total dose of 50 Gy). Oral defects were reconstructed microsurgically with jejunal, iliac crest or radial forearm grafts. Thereafter 316 dental implants were placed in the non-irradiated residual bone (84; 27%), irradiated residual bone (154; 49%) or grafted bone (78; 25%) at various intervals (mean interval 1.41 (+/- 1.01) years, range 0.34-6.35 years). RESULTS: The mean follow-up time after implant insertion was 5.42 (+/- 3.21) years (range 0.3-13.61 years). The overall 2-, 3-, 5-, and 8-year survival rates of all implants were 95%, 94%, 91% and 75%. Forty-four implants were lost in 21 patients during the observation period. Irradiation of the mandibular bone showed significantly (P = 0.0028) lower implant survival compared with non-irradiated mandibular bone. The 8-year survival rate in the non-irradiated residual bone (two loss), irradiated residual bone (29 loss) or grafted bone (13 loss) were 95%, 72% and 54%, respectively. Time of implantation after irradiation showed no statistically significant influence. Implant brand, length or diameter or the incidence of resective surgery on the mandible and gender of patients had no statistically significant influence on implant survival. CONCLUSION: Radiation therapy with 50 Gy was significantly related to shorter implant survival in mandibular bone. Survival was lowest in grafted bone. Time of implant placement had no statistically significant influence on survival under the conditions of this study. Although implant survival is lower in irradiated mandibles, implants significantly facilitate prosthodontic treatment and enhance outcome of oral rehabilitation in cancer patients.     

口腔癌患者手术前后外周血免疫指标的检测及其临床意义

目的 探讨口腔癌患者手术前后免疫功能状态变化及其临床应酬意义。方法：采集口腔癌患者手术前后的外周静脉血，流式细胞仪检测CD3 总T淋巴细胞、CD4 辅助性T细胞、CD8 杀伤，抑制性T细胞、CD4 ，CD8 比值、CDl9 总B淋巴细胞、CDl6 /CD56 NK细胞。酶联免疫吸附法(ELISA)检测外周血肿瘤坏死因子-α(TNF-α)和可溶性白细胞介素-2受体(sIL-2R)的表达。采用配对t检验进行统计学分析结果：口腔癌术后外周静脉血CD8 杀伤／抑制性T细胞显著减少，CD4 ／CD8 细胞比值显著升高，CDl9 总B淋巴细胞明显升高．CDl6 /CD56 NK细胞显著减少．TNF-α的表达明显减少，其余变化无显著性差异：结论：手术虽然影响口腔癌患者的免疫功能，但减轻肿瘤患者的免疫抑制状态。术后辅助治疗尤其是免疫治疗．对口腔癌患者具有重要意义，     

伴全身多系统创伤颌面伤患者的综合救治

目的:研究伴发身体其他部位创伤的颌面伤患者综合救治中专科确定性手术时机和适应证。方法:回顾性统计4所大型综合医院口腔科病房近20年收治的4 869例口腔颌面部创伤患者的临床资料,分析伴发身体其他部位创伤状况和专科手术时机。结果:4 869例患者中,面骨骨折3 364例,软组织伤1 505例。伴发其他部位创伤1 524例(占31.3%),其中颅脑伤570例(37.4%),肢体伤545例(35.8%),胸部伤170例(11.2%),眼创伤151例(9.9%),脊柱伤54例(3.3%),腹部伤34例(2.2%)。74%的颅脑伴发伤患者伤后4周内、76.2%的眼伴发伤患者伤后7d内进行了面骨骨折手术治疗。而肢体、脊柱、胸腹部伴发伤患者,面骨骨折手术均有不同程度延误。结论:伴发多系统创伤的颌面伤患者的救治需要多学科间的合作,在患者呼吸系统、循环系统等全身状况稳定的情况下,大部分颌面多发伤患者可以同期或早期进行专科处理。