��ǻ��״��86���ٴ����������

目的探讨口腔疣状癌的病因、临床表现、鉴别诊断、组织病理学特点及治疗。方法回顾分析中国医科大学附属口腔医院1990-2012年收治的86例经组织病理确诊的口腔疣状癌患者的临床资料,总结其临床症状、病灶区影像学表现、病理学表现、治疗方案及术后随访情况。结果86例患者中44例于肿物边缘外1．0～1．5cm单纯行病灶扩大切除,21例除行病灶扩大切除外均同期行临近瓣转移修复术,11例行病灶扩大切除及功能性颈淋巴结清扫术,9例行病灶扩大切除及颌骨部分切除术,1例行病灶扩大切除＋右侧颌下腺摘除＋颌下腺导管改道术。对术后患者随访调查,单纯行手术切除的患者术后5年内复发3例（其中包括同期行临近瓣修复患者1例）,余来见复发。对复发病例再次行肿物扩大切除,未见复发。结论疣状癌的诊断需靠临床表现、镜下形态以及生物学行为判断,外科根治性手术为首选治疗方案,术后应定期复查、随访。     

���۹�ȱ���޸������������ƶ�ʱ��̽��

??Objective    To investigate the effect of tooth movement at different time after the repair of alveolar bone defects. Methods    Defective alveolar bone model was established on one side in forty white rabbits??which were filled with bone meal and attached with Bio-Gide membrane as experiment sides. The other side was performed routine tooth extraction as control. Track the mandibular second molar in both sides respectively in 1 week??1 month??2 months and 3 months after operation. One month later??the distance between the mandibular second molar and third molar was measured with electronic vernier caliper in the experiment side and control side. The mandibular tissue was made paraffin section and hematoxylin eosin staining. Three views of the periodontal ligament in a third place of the mesial roots of the second molar was randomly chosen to count the total number of osteoclasts. Paired-t test analysis was made to evaluate the displacement of the mandibular second molar in experiment and control side??and to evaluate the number of osteoclasts in two side. Results    In Group 1w and Group 1 m??the displacement of the mandibular second molar in experiment group was smaller than that in the control side??P??0.05??. There was no statistical significance in Group 2 m and Group 3 m. The number of osteoclasts in the experiment side was less than the control group in Group 1 w and Group1 m??P??0.05??. No statistical significance in Group 2 m and Group 3 m was found. Conclusion    Orthodontic treatment can be performed two months after the repair of alveolar bone defects.     

����ؽ�ǿֱ���ƽ�չ

?? Temporomandibular joint ankylosis is characterized by mouth opening limitation?? and is likely to cause jaw deformity and OSAHS. It is refractory and tends to recur. This paper is to review the development of treatment for temporomandibular joint ankylosis.     

Is early diagnosis of oral cancer a feasible objective? Who is to blame for diagnostic delay?

Oral Diseases (2010) 16 , 333–342 Worldwide, oral cancer has one of the lowest survival rates and poor prognosis remains unaffected despite recent therapeutic advances. Reducing diagnostic delay to achieve earlier detection is a cornerstone to improve survival. Thus, intervention strategies to minimize diagnostic delays resulting from patient factors and to identify groups at risk in different geographical areas seem to be necessary. The identification of a ‘scheduling delay’ in oral cancer justifies the introduction of additional educational interventions aimed at the whole health care team at dental and medical practices. The access to and the kind of healthcare system in a particular country are also relevant in this context, particularly the referral system. The design of a simple, clear, fail‐safe, fast‐track referral scheme for those suspected with cancer may diminish greatly the length of the delay. Moreover, there is a need for future investigations, which are methodologically adequate, that consider cultural and geographical aspects and use patient survival as the final outcome, that are able to recognize the agents/factors responsible for diagnostic delay by patients as well as healthcare providers and those attributable to the healthcare systems.     

Exploring the reasons for delay in treatment of oral cancer

BACKGROUND: Oral cancer continues to be diagnosed and treated at a late stage, which has a negative effect on outcomes. This study identified and quantified delays in diagnosis and treatment. METHODS: The authors conducted a study that included all new patients seen in the Department of Oral and Maxillofacial Surgery, University of California, San Francisco, between 2003 and 2007 who had a diagnosis of squamous cell carcinoma of the oral cavity. They identified the time intervals for six stages, beginning with the time at which patients first became aware of symptoms and ending with the time at which definitive treatment began. RESULTS: The total time from patients' first sign or symptoms to commencement of treatment was a mean of 205.9 days (range, 52-786 days). The longest delay was from the time symptoms first appeared to the initial visit to a health care professional (mean time, 104.7 days; range, 0-730 days). CONCLUSIONS: Health care professionals need to place greater emphasis on patient education to encourage early self-referrals. CLINICAL IMPLICATIONS: Patients should be encouraged to visit a health care professional when signs or symptoms of oral cancer first develop.     

Assessing oral cancer early detection: clarifying dentists' practices

Objective: This study explores new methods for assessing in greater detail what dentists do when they perform oral cancer early detection examinations. It clarifies practice behaviors and opens opportunities to identify factors that facilitate thorough early detection examinations by clinicians and to assess the relative effectiveness of different examination procedures. Methods: A 38‐item survey instrument was e‐mailed to dentists in a western US, multistate dental practice group. Questionnaires were received by 241 dentists, and 102 responded. An Oral Cancer Knowledge scale (0 to 14) was generated from correct responses on oral cancer general knowledge. An Oral Cancer Examination Thoroughness scale was calculated from the two dimensions of reported usage and frequency of procedures in oral cancer examinations. Results: Nearly all responding dentists were in general practice (90%), with a median year of graduation from dental school of 1994. The Oral Cancer Knowledge scores ranged from 5 to 14 with a mean of 10.4. The mean Thoroughness of Examination score was 11.34 (range 0 to 20). The two scales were not statistically correlated (r = ?0.015, P = 0.883). Statistically, recency of continuing education was significantly associated with knowledge (P = 0.0284) and appears to be marginally associated with thoroughness (P = 0.075). Conclusions: This study documents considerable variability in dentists' knowledge and thoroughness of examinations. The scales provide tools for future studies for improving understanding of early detection of oral cancer in clinical practice.     

Compliance following referral in the early detection of oral cancer and precancer in Sri Lanka

An innovative approach for the early detection of oral cancer and precancer within the context of the primary health care system has been field tested in Sri Lanka. The overall compliance in accepting this particular PHC approach for cancer screening, as estimated by arrival at a referral centre manned by consultant staff, was 54.1%. Nearly 80% of those who turned up without needing an additional reminder, did so within the first 2 weeks of case finding. There was a variation in the degree of compliance depending on the primary health care worker who did the screening and referral. Compliance was greater when the screening area was nearer to the referral centre and in subjects who were diagnosed as having a more advanced stage of the disease. Certain practical considerations that contributed to noncompliance were identified. Postal reminders were seen to increase overall compliance by 10.9%.     

Knowledge of oral cancer and screening practices of primary care providers at Federally Qualified Health Centers

OBJECTIVES: Primary care providers (PCPs) who worked in Federally-Qualified Health Centers (FQHC) in Michigan were surveyed to assess their knowledge level and practices related to screening and preventing oral cancer. METHODS: A questionnaire was developed with the assistance of dental and medical experts, and revised through focus groups. The questionnaire included one case scenario describing a suspicious oral lesion in a 55-year old female patient, followed by questions assessing PCPs' knowledge level, attitude, opinion, and screening practices for oral cancer. This mail survey was conducted in 2003. RESULTS: Survey response rate was 56.4%. Over 70% of the respondents reported that they screen patients for oral cancer during a routine physical examination. Forty-four percent of PCPs had high knowledge level, based on the scenario questions. Those who had high knowledge level were more likely to be physicians, males, and more likely to perform screening for oral cancer than those with low knowledge level. There was no difference in age and race/ethnicity between high and low knowledge groups. Perceived barriers included (1) lack of education; (2) lack of specialists to refer patients; and (3) lack of reimbursement. CONCLUSIONS: The majority of PCPs in this survey had positive attitudes about performing screening for oral cancer. To involve PCPs in screening for oral cancer, oral health programs should focus on providing up-to-date education, setting up a referral system, and providing proper reimbursement.     

甲苯胺蓝活体染色在口腔癌早期诊断中的临床价值

对８４例早期口腔病损患者用１％甲苯胺蓝染色，观察着色情况，与病理结果对照。结果显示甲苯胺蓝对口腔癌诊断的敏感性９７．３％，特异性为４１．２％，假阳性率４２．２％，假阴性率５．０％；白斑癌变及上皮异常增生性白斑的染色阳性率明显高于上皮单纯增生性白斑；４３例溃疡病变都呈阳性染色，炎性溃疡染色，周界与恶性溃疡无显著性差异。     

Reconstruction of huge oral cancer defect versus early detection and screening of oral cancer

Oral cancer is the fifth most common cancer in the world and is associated with chronic irritating factors such as tobacco, smoking, alcohol, and BQ use.     

Comparison of early telescope loading of non-submerged ITI implants in irradiated and non-irradiated oral cancer patients

OBJECTIVE: To compare early dental implant loading in irradiated and non-irradiated oral cancer patients in order to accelerate masticatory function improvement and quality of life. PATIENTS AND METHODS: One hundred and fourteen non-submerged interforaminal ITI implants were early loaded in 30 patients after 3 weeks in situ (telescoped overdenture). Nineteen patients received 72 implants (63%) after local irradiation; 11 non-irradiated patients received 42 implants (37%) with a 24-month follow-up. RESULTS: At 24 month follow-up, one early failure had occurred in an irradiated patient (=99% functioning implants in situ). Peri-implant bleeding and plaque index were similarly high in both groups (40 to 68% average).The Results of other measured parameters were as follows (values for mean; irradiated; non-irradiated patients with respective standard deviations; significance of comparison): bone loss (0.9+/-0.9; 1.4+/-0.9; 0.4+/-0.5 mM; P<0.01); Periotest score (-2.7+/-2.7; -2.4+/-2.2; -3.1+/-3.3; P<0.2); gingival recession (0.6+/-0.7 mM; 0.8+/-0.9 mM; 0.4+/-0.5 mM, P<0.02); and peri-implant probing depths (3+/-1.2; 2.6+/-0.6; 3.4+/-1.7 mM; P<0.002). CONCLUSION: The results suggest reliable non-submerged implantation and early loading. However, bone loss in irradiated mandibles, combined with higher average Periotest values and gingival recession in an oral environment of altered saliva quantity, quality, microflora and local scarring, requires extended follow-up.