口腔颌面部结核12例临床分析

目的：总结口腔颌面部结核的临床特征和误诊原因。方法：对2005．2—2010．12桂林市第三人民医院和广西壮族自治区南溪山医院收治的经病理确诊的12例口腔颌面部结核病例进行全面分析。结果：本组12例口腔颌面部结核表现为单个淋巴结结核（8例），单个口腔黏膜溃疡（3例），结节增生并溃疡（1例）。其中2例合并活动性肺结核。对5例淋巴结结核仅行手术完整切除，另7例采用手术切除及规范抗结核治疗。结论：口腔颌面部结核的临床表现不典型，全身症状少见，误诊率高，依靠病理学诊断，以手术及规范的抗结核药物治疗为首选。     

一岁内婴儿口腔颌面部肿瘤临床特点分析

口腔颌面部肿瘤是常见多发病 ,可发生于任何年龄 ,文献报道中多以成人病例为主[1,2 ] ,鲜见有关儿童口腔颌面部肿瘤的报道[3 ] 。目前尚未查见有关 1岁内婴儿口腔颌面部肿瘤发病情况的分析报道。作者现将婴儿口腔颌面部肿瘤的发病情况、临床特点报道分析如下。1　临床资料将湖北医科大学口腔医学院和同济医科大学同济医院近 4 0年收治并有病理诊断的 1岁内婴儿口腔颌面部肿瘤6 6例 ,男婴 4 5例 (6 8 2 % ) ,女婴 2 1例 (31 8% ) ,男女之比为2 1∶1。按月龄、性别、肿瘤分类、部位、治疗等进行分析。2　结　　果1岁内婴儿口腔颌面部肿瘤发病…     

口腔颌面部慢性自发性血肿

目的 探讨口腔颌面部慢性自发性血肿的临床和病理特点。方法 收集1987年1月～1999年12月,发生在口腔颌面部自发性血肿39例,分析临床表现、阳性体征及病理形态学特点。结果 全部病例经手术治愈,病理诊断:肌间或灶性出血20例,机化血块10例,机化血栓9例。39例中有血管增生或扩张17例,血管畸形有血管瘤形态改变8例。临床误诊率达84.6％。结论 血肿部位存在着血管增生和扩张及动静脉和毛细血管畸形,与颅脑部的慢性自发生血肿有着相同的病理形态学基础。     

腓骨肌皮瓣修复6岁儿童创伤性口腔颌面部缺损：1例报告及文献复习

临床上造成口腔颌面部缺损的原因主要有肿瘤、瘢痕切除和创伤等,但很少有切割伤导致口腔颌面部软、硬组织大面积缺损的报道,儿童更为罕见,在治疗上具有极大的难度与挑战。本文报告1例制备游离血管化腓骨肌瓣带有巨大皮岛修复重建6岁儿童口腔颌面部软、硬组织重度缺损的病例,并对相关文献进行复习。     

血管内皮生长因子在口腔扁平苔藓及鳞癌组织中的表达

目的探讨血管内皮生长因子在口腔扁平苔藓癌变及发病机制中的作用。方法采用免疫组化法,检测10例正常口腔黏膜、25例口腔扁平苔藓、11例口腔扁平苔藓伴不典型增生及14例口腔鳞癌,上皮组织中血管内皮生长因子的表达水平。结果血管内皮生长因子在24例口腔扁平苔藓标本中阳性表达2例,阴性表达22例,阳性表达率明显低于其它3组（P〈0.05）。扁平苔藓伴不典型增生及口腔鳞癌中血管内皮生长因子的阳性表达率均高于正常黏膜（P〈0.05）。结论血管内皮生长因子的表达异常可能在口腔扁平苔藓的发生发展及癌变的过程中起作用。     

健康人口腔黏膜Ki-67与Cox-2的表达及其意义

目的评价健康人口腔黏膜的组织学状况及其Ki-67和Cox-2的表达。方法采集50例健康志愿者口腔黏膜和10例存档口腔白斑标本,进行组织学观察和Ki-67与Cox-2的免疫组织化学研究。结果 50例受检健康人口腔黏膜肉眼观察均为红润、柔软;组织学观察发现其中10例为正常口腔黏膜的组织学表现,另40例表现为不同程度的黏膜增生水肿,其组织学改变与黏膜白色水肿极其相似。10例黏膜白斑表现为上皮增生,表面过度正角化。免疫组织化学观察发现,Ki-67表达在正常口腔黏膜（5.24%）与增生水肿的口腔黏膜（14.41%）和黏膜白斑（12.08%）之间,差异有显著性（P〈0.05）;而增生水肿的口腔黏膜和白斑之间,差异无显著性（P〉0.05）。Cox-2表达从正常口腔黏膜（0）到增生水肿的口腔黏膜（55.0%）和白斑（70.0%）之间,逐渐增高。正常口腔黏膜Cox-2阴性表达与增生水肿的口腔黏膜和白斑之间,差别有显著性（P〈0.05）;而增生水肿的口腔黏膜和白斑之间,差别无显著性（P〉0.05）。结论本研究中,约80%的受检健康人口腔黏膜存在组织病理学改变。     

口腔颌面部游离组织瓣移植91例临床分析

目的:分析口腔颌面部游离组织瓣移植的临床效果及可能发生的问题。方法:2001年1月-2005年6月应用前臂皮瓣、背阔肌皮瓣及腓骨肌皮瓣3种游离组织瓣修复口腔颌面部组织缺损91例,总结其成活情况、患者外形、功能恢复情况及术后的各种并发症,并分析影响成功的各种因素。结果:91例病例中有7例组织瓣坏死,组织瓣总体成活率为92.3%。绝大多数组织瓣成活的病例均达到了术前所预测的功能与外形,患者满意率达92.8%。影响其成功的主要因素为术后血管危象及术后感染,前者与血管吻合技术、血管情况、组织瓣及血管蒂的放置处理密切相关;其他疾病如高血压、冠心病、糖尿病与组织瓣的成活情况无明显关系。结论:3种组织瓣的移植整体上是安全可靠,且效果良好的,对口腔颌面部游离缺损的修复有很大应用价值。     

以口腔表征为首发的血液系统疾病500例临床分析

目的： 探讨以口腔表征为首发症状的血液系统疾病的临床特点,为早期诊断,防止漏诊误诊提供依据。方法： 回顾近5年因口腔症状首诊于上海交通大学医学院附属第九人民医院口腔相关科室（口腔黏膜病科、牙周病科、牙体牙髓病科和口腔颌面-头颈肿瘤科）的500例血液系统疾病患者的临床资料,分析其口腔表征的多样性及分布情况。结果： 500例首诊于口腔各科的血液系统疾病患者的口腔表征有口腔黏膜和牙龈出血、牙龈增生、口腔黏膜溃疡、口腔黏膜感染及口腔颌面部肿块。其中以口腔颌面部肿块症状首诊者数量居首,占19.8%。血常规、凝血机制和口腔病理活检对血液系统疾病的初步筛查与确诊至关重要。结论： 多种血液系统疾病都可能在疾病初期就出现口腔表征,正确认识血液系统疾病多样性的口腔表征,结合血常规和凝血机制检查以初步筛选血液系统疾病;对表现为口腔颌面部肿块的患者进行肿块活检,可在临床上更早地对血液系统疾病进行诊断和鉴别诊断,从而避免误诊和漏诊。口腔表征的治疗以针对血液系统疾病为主,口腔局部对症治疗为辅。     

游离组织瓣修复口腔颌面部缺损的临床分析

目的 研究游离组织瓣修复口腔颌面部肿瘤术后缺损的临床效果及可能发生的问题.方法 应用游离前臂皮瓣、游离腓骨肌皮瓣修复口腔颌面部肿瘤术后组织缺损23例,分析血管吻合方式和技术、皮瓣成活情况、患者外形、功能恢复情况,并分析影响皮瓣成活的各种因素.结果 23例游离组织瓣成活21例,术后发生血栓4例,抢救成功2例;受区和供区共7例发生并发症.手术失败的主要原因为术后血管危象,其与血管吻合技术、血管情况、组织瓣及血管蒂的放置处理及早期的头部制动、呼吸道护理、围手术期用药密切相关.结论 游离前臂皮瓣和游离腓骨肌皮瓣在口腔颌面部肿瘤术后缺损的修复中具有较大的灵活性,其制备简便,安全可靠,效果良好.     

先天性腭裂患儿伴发腭部错构瘤1例报告

错构瘤是一种多成分肿瘤,是正常组织在通常所在位置过度增生形成的瘤样肿块。口腔颌面部发生错构瘤并不多见,腭裂伴发错构瘤在临床上更为罕见。作者报道1例不完全性腭裂患儿同时伴发腭部错构瘤的病例,为小儿口腔颌面部肿瘤的诊断提供借鉴。     

Complicating mucosal reactions in patients receiving radiation therapy for head and neck cancer

Radiation mucositis is characterized by erythema, pseudomem-branes, and ulceration of mucosa in the irradiated field. We present two cases of oral mucosal changes in patients treated with radiotherapy in the head and neck region, which included mucosal erythema and ulceration outside of the radiated fields. One case was confirmed as herpes virus infection, and the other was diagnosed as Sweet's syndrome. When mucositis extends beyond the radiation fields, the clinician should consider other causes of mucosal inflammation and erythema in order to begin appropriate management.     

口炎清颗粒防治鼻咽癌患者放射性口腔炎的疗效观察

目的 观察口炎清颗粒对鼻咽癌患者放射性口腔炎的防治效果。方法 将60例鼻咽癌行适形调强放疗患者随机分为2组,口炎清组（30例）于放射治疗开始给予口炎清颗粒口服至放射治疗结束,对照组（30例）在放射治疗过程中出现2级及以上放射性口腔黏膜炎时,给予0.9%氯化钠注射液、利多卡因、地塞米松、维生素B12与维生素B2配制成漱口液含漱。采用全美放射肿瘤治疗协作组急性放射性黏膜炎的分级标准比较2组患者放射性口腔炎发生的时间、程度以及疼痛分级情况。结果 口炎清组和对照组放射性口腔炎出现的时间分别为（12.40±2.74）、（9.46±1.39） d,二者间差异有统计学意义（t=5.241,P<0.001）。口炎清组患者的疼痛分级、放射性口腔炎的分级比较均明显低于对照组,差异有统计学意义。结论 口炎清颗粒可延迟放射性口腔炎的发生时间,降低放射性口腔炎的严重程度,减轻患者疼痛,改善患者临床症状,有效防治鼻咽癌放疗引起的放射性口腔炎。     

Oral Candida isolates in patients undergoing radiotherapy for head and neck cancer: prevalence, azole susceptibility profiles and response to antifungal treatment

Oral pseudomembranous candidiasis and mucositis were assessed in 39 patients receiving a total dose of 39-70 Gy radiotherapy for head and neck cancer. Mucositis was scored using the Radiation Therapy Oncology Group criteria, and oral candidiasis was diagnosed on the basis of clinical evaluation and quantitative laboratory findings. Radiation-induced mucositis was observed in 9/39 patients. Only 3/39 patients discontinued radiotherapy due to acute severe mucosal effects. Candidiasis (colony-forming units 35 to > or = 60/lesion) associated with mucositis was diagnosed in 30/39 patients: the most frequent aetiology of the infection was Candida albicans (n = 23), followed by Candida glabrata (n = 3), Candida krusei (n = 2), Candida tropicalis (n = 1) and Candida kefyr (n = 1). Patients with confirmed oral pseudomembranous candidiasis were treated with either fluconazole 200 mg/day or itraconazole 200 mg/day for 2 weeks. Clinical improvement and concomitant negative Candida cultures (mycologic cure) were the criteria determining a response to antifungal treatment. Etest revealed very low voriconazole MICs (0.004-0.125 microg/ml) for all isolates, and fluconazole resistance for eight C. albicans strains (MIC > 64 microg/ml) and for the C. krusei isolates (MIC > 32 microg/ml). The same strains showed itraconazole susceptibility dose dependence (MIC 0.5 microg/ml). Despite the itraconazole susceptible dose dependent MIC readings, all patients with oral pseudomembranous candidiasis caused by these strains responded to antifungal treatment with 200 mg/day itraconazole. Oral mycologic surveillance of patients undergoing radiotherapy for head and neck malignancies and susceptibility testing of isolates may be indicated in cases with mucositis-associated confirmed oral pseudomembranous candidiasis to ensure prompt administration of targeted antifungal treatment. On the basis of the low MIC values found, clinical evaluation of voriconazole is indicated for management of oral pseudomembranous candidiasis refractory to other azoles.     

放化疗性口腔黏膜炎动物模型研究进展

由放疗和(或)化疗诱发的口腔黏膜炎症,可能导致患者疼痛、说话吞咽困难、局部和全身感染风险增高,甚至中断抗癌治疗,严重影响患者生活质量。放化疗性口腔黏膜炎的发病机制复杂而且防治较为困难,而动物模型在探究放化疗性口腔黏膜炎的发病机制以及探索更好的防治方法中发挥了重要作用,本文就以现有的放化疗性口腔黏膜炎动物模型的复制及评估方法予以综述。文献复习结果表明,国内外采用小鼠、大鼠、金仓鼠等动物来复制动物模型;放疗诱发的口腔黏膜炎的诱导方法有仅采用X射线设备对动物进行局部单剂量照射或局部分割照射,或照射时辅助使用化疗药物5 氟尿嘧啶或顺铂,也可以采用137铯作为放射源进行局部照射;单纯使用化疗药物5 氟尿嘧啶诱发的口腔黏膜炎一般症状较轻,因此多采用5 氟尿嘧啶联合机械刺激或乙酸进行诱导;评估放化疗性口腔黏膜炎的方法主要为大体样本观察及组织病理学观察。     

Chemotherapy‐induced oral mucositis and associated infections in a novel organotypic model

Oral mucositis is a common side effect of cancer chemotherapy, with significant adverse impact on the delivery of anti‐neoplastic treatment. There is a lack of consensus regarding the role of oral commensal microorganisms in the initiation or progression of mucositis because relevant experimental models are non‐existent. The goal of this study was to develop an in vitro mucosal injury model that mimics chemotherapy‐induced mucositis, where the effect of oral commensals can be studied. A novel organotypic model of chemotherapy‐induced mucositis was developed based on a human oral epithelial cell line and a fibroblast‐embedded collagen matrix. Treatment of organotypic constructs with 5‐fluorouracil (5‐FU) reproduced major histopathologic characteristics of oral mucositis, such as DNA synthesis inhibition, apoptosis and cytoplasmic vacuolation, without compromising the three‐dimensional structure of the multilayer organotypic mucosa. Although structural integrity of the model was preserved, 5‐FU treatment resulted in a widening of epithelial intercellular spaces, characterized by E‐cadherin dissolution from adherens junctions. In a neutrophil transmigration assay we discovered that this treatment facilitated transport of neutrophils through epithelial layers. Moreover, 5‐FU treatment stimulated key proinflammatory cytokines that are associated with the pathogenesis of oral mucositis. 5‐FU treatment of mucosal constructs did not significantly affect fungal or bacterial biofilm growth under the conditions tested in this study; however, it exacerbated the inflammatory response to certain bacterial and fungal commensals. These findings suggest that commensals may play a role in the pathogenesis of oral mucositis by amplifying the proinflammatory signals to mucosa that is injured by cytotoxic chemotherapy.     

光动力治疗口腔黏膜癌及癌前病变的临床进展

口腔癌是发生在口腔的恶性肿瘤之总称,严重影响人类生命和生活,发病率高,致残率和病死率高.许多口腔癌由癌前病变发展而来,最常见的是口腔黏膜白斑、扁平苔藓等.目前针对口腔癌一线治疗方案分为:手术切除、放射线治疗、化学治疗以及联合治疗.特别是高龄口腔癌症患者,传统治疗尚有一定的局限性和毒副作用.针对癌前病变常用药物和手术治疗...     

Mucosal secretion changes during radiotherapy in the oral cavity

Mucositis in the oral cavity is a serious complication during radiation therapy for head and neck cancer, causing local discomfort and pain. In severe cases, hospitalization and interruption of radiotherapy may be necessary. The pathogenesis of this mucositis is not clear. With the purpose of getting more understanding of the pathogenesis of the mucositis, we examined the mucosal secretion from ten patients during radiotherapy with an imprint technique. In the secretion we studied the cellular composition and cellular function. In eight of ten treated patients the numbers of granulocytes increased in the secretion after 2 weeks of radiation therapy. The granulocytes, however, did not show any signs of phagocytosis. The patients all developed mucositis. We propose that the granulocytes in the secretion might play an important role in the development of mucositis during radiotherapy.     

Oral mucosal injury caused by cancer therapies: current management and new frontiers in research

This invited update is designed to provide a summary of the state‐of‐the‐science regarding oral mucosal injury (oral mucositis) caused by conventional and emerging cancer therapies. Current modeling of oral mucositis pathobiology as well as evidence‐based clinical practice guidelines for prevention and treatment of oral mucositis are presented. In addition, studies addressing oral mucositis as published in the Journal of Oral Pathology and Medicine 2008–2013 are specifically highlighted in this context. Key research directions in basic and translational science associated with mucosal toxicity caused by cancer therapies are also delineated as a basis for identifying pathobiologic and pharmacogenomic targets for interventions. This collective portfolio of research and its ongoing incorporation into clinical practice is setting the stage for the clinician in the future to predict mucosal toxicity risk and tailor therapeutic interventions to the individual oncology patient accordingly.     

Effect of low level laser therapy in the reduction of oral complications in patients with cancer of the head and neck submitted to radiotherapy

The aim of this study was to assess the effect of low level laser therapy on reducing the occurrence and severity of oral complications in patients with head and neck cancer undergoing radiotherapy. Sixty head and neck cancer outpatients from a cancer hospital receiving radiotherapy were selected and randomly assigned into two groups. The laser group was irradiated with an InGaAlP laser and the control received sham laser. The assessment of complications (oral mucositis, pain) was carried out one week after starting radiotherapy, and at the fifteenth and thirtieth sessions of radiotherapy. All patients from both groups showed some degree of oral mucositis. Better outcomes were observed in the laser group when compared with the control in the follow‐up sessions, indicating lower degrees of oral mucositis, pain and higher salivary flow (p < .05). These findings support the use of laser therapy as an adjuvant treatment for the control of oral complications.     

A Convenient Method for Guarding Against Localized Mucositis During Radiation Therapy

Metal restorations, such as full gold crowns and dental implants, can cause forward and back scatter radiation during radiation therapy with a dose enhancement to adjacent tissues. Mucositis, one of the most common complications of the radiation treatment of oral, as well as other head and neck malignancies can result. A method for constructing a buccolingual guard in the clinical setting using hydroplastic material is described. The guard can be easily oriented and adapted to an existing radiation stent, adding positional stability and patient comfort. When adequate thickness of material is used, the guard can attenuate forward and back scatter radiation, separate the adjacent tissues from metal restorations, and protect the oral mucosa from localized incidents of mucositis.