A comparison of imaging techniques with surgical experience in orbital injuries: A prospective study

The aim of the study is to compare the effectiveness of computerised tomography (CT) and magnetic resonance (MR) imaging in diagnosing herniation and entrapment of orbital soft tissues in orbital fractures. 15 consecutive patients with clinical signs and symptoms of medial orbital wall injury were examined with CT and MR. The data were subsequently compared with the findings of the surgical exploration with regard to the extent of the wall fractures, the presence of soft tissue herniation and its entrapment. CT and MR were equally accurate in demonstrating or excluding orbital wall fractures but both modalities slightly underestimated their incidence. CT and MR underestimated the actual incidence of soft tissue herniation and entrapment when compared with the surgical findings but the extent of soft tissue herniation and entrapment were demonstrated more clearly by MR than by CT scanning. MR imaging when available should therefore be used as the initial imaging modality and CT held in reserve for confirmation as positioning in the MR unit is easier and more comfortable for recently injured patients who may well have other injuries.     

Clinical-laboratory techniques making for adaptation to complete removable plate dentures of elderly patients with unfavorable clinical conditions in oral cavity

Positive results of prosthetic treatment of 52 edentulous patients (29 women and 23 men) of the age interval from 60 to 89 years with unfavorable clinical conditions in oral cavity were received. The authors summarized clinical-laboratory techniques making for adaptation of such patients to complete removable plate dentures.     

Classification and surgical management of orbital fractures: experience with 111 orbital reconstructions

Orbital skeletal injuries are frequently associated with other significant injuries and require a substantial surgical effort to correct. The use of a unified classification of orbital injury may better predict the surgical effort required to correct such injuries and help with future comparisons of results. In an attempt to summarize the principles of reconstruction of the orbital skeleton following trauma and introduce a unified classification system for orbital injuries, a retrospective review of all consecutive orbital reconstructions in a tertiary care teaching hospital was conducted. The nasoethmoidal region was involved in 32%, the zygomatic complex in 50%, and the frontal region in 28% of orbital fractures. Of the orbital walls, four walls were involved in 5%, three walls in 17%, two walls in 30%, and one wall in 53%. Associated ocular and neurologic injury was encountered in 33% and 57% of patients, respectively. Regions of fixation ranged from one to eight. Bone grafts were used in 20% and titanium mesh in 34% of the orbits. In general, the authors recommend an aggressive approach to orbital injuries, addressing all associated injuries simultaneously.     

Post-traumatic orbital reconstruction: anatomical landmarks and the concept of the deep orbit

Dissection deep within the orbit is a cause for concern to surgeons because of the perceived risks of injuring critical structures such as the contents of the superior orbital fissure and the optic nerve. Although "safe distances" (those distances within which it is considered safe to dissect within the orbit) have been described, these are of limited value if the orbit is severely disrupted or is congenitally shallow. In addition, traumatic defects in the orbital floor, in particular, often extend beyond these distances. Reliable landmarks based on the relations between anatomical structures within the orbit, rather than absolute distances, are described that permit safe dissection within the orbit. We present the concept of the deep orbit and describe its relevance to repair of injuries.     

2种不同舒适化技术在60例高血压患者阻生牙拔除术中的应用评价

目的:比较氧化亚氮/氧吸入镇静镇痛、右美托咪定联合氟比洛芬酯辅助镇静镇痛2种舒适化技术在高血压患者阻生牙拔除术中的效果.方法:将60例高血压阻生牙拔除术患者随机分为2组(n=30),X组(氧化亚氮/氧吸入镇静镇痛组)和Y组(右美托咪定联合氟比洛芬酯辅助镇静镇痛组).记录T0(术前)、T1(局部麻醉)、T2(手术操作)、...     

C-modified osteotomy for bilateral advancement of the orbital rim in Graves orbitopathy: a technical note

The authors present a modification of the classical three-wall orbital decompression for the treatment of Graves' orbitopathy. It consists of two 'C' osteotomies for the bilateral projection of the superolateral, lateral and inferolateral orbital rims, associated with the removal of the lateral orbital walls. This technique is performed following a coronal approach. Ultrasound cutting instruments were used for the osteotomies. They avoided lesion of surrounding soft tissues, such as the duramater and the periorbital tissues. Stabilization of the advanced structure was achieved by interposition of autologous bone graft obtained from the outer cortex of the calvaria. An extreme advancement of the orbital rim with resolution of diplopia, ocular pain and eyelid incompetence was obtained. Using this procedure, a good functional and aesthetic outcome was achieved.     

Stability of the mandible following advancement: a comparison of three postsurgical fixation techniques

This study examines short-term stability of the mandible following mandibular advancement surgery by means of three standard techniques of postsurgical fixation. Twenty-two adult female rhesus monkeys (Macaca mulatta) underwent sagittal ramus advancement osteotomy of approximately 4 to 6 mm. Six animals had dental maxillomandibular fixation alone. Six animals had dental plus skeletal maxillomandibular fixation with circummandibular wires connected to pyriform aperture wires. Ten animals had rigid internal fixation with bicortical bone screws between the proximal and distal segments without maxillomandibular fixation. Radiographic cephalograms with the aid of tantalum bone markers and dental amalgams were analyzed during the first 6 postoperative weeks to evaluate skeletal and dental stability. Rigid internal fixation and the use of dental plus skeletal maxillomandibular fixation were both equally effective in the prevention of postsurgical relapse. However, in the animals in which only dental maxillomandibular fixation was used, statistically significant changes (relapse) occurred when compared with either of the other groups.     

Ten-year experience in oral implant rehabilitation of cancer patients: treatment concept and proposed criteria for success.

Between 1988 and 1997, 18 irradiated patients (group 1, 83 implants) and 22 nonirradiated patients (group 2, 92 implants) received resection of the cancer-involved mandible and floor of the mouth and subsequently underwent mandibular rehabilitation with endosseous implants. Implant-supported prostheses were placed in 26 patients, while 13 patients received implant-tissue-supported prostheses. Between 1988 and 1991, patients were restored with implant-tissue-supported prostheses (based on 2 to 4 implants). This strategy was later changed because of the development of denture-related lesions. Since 1992, group 1 patients have been restored exclusively with implant-supported prostheses on 5 to 6 implants; group 2 patients have been rehabilitated alternatively with implant-tissue-supported prostheses on 4 implants. Special criteria for determining the success of implant-supported maxillofacial prostheses were developed. With a mean follow-up period of 37 months, 160 implants (91%) were clinically osseointegrated. Both types of restorations provided sufficient oral rehabilitation. However, only completely implant-supported prostheses avoided soft tissue ulcers. The cumulative success rate was approximately 75% after 7 years for group 1 patients and about 86% after 10 years for group 2 patients. The success rates for implants placed after the change in strategy were approximately 86% (group 1) and 94% (group 2) after 5 years. Based on these experiences, it is suggested that irradiated patients should be restored with exclusively implant-supported prostheses, without any mucosal contact.     

Evaluation of bone gain in horizontal ridge augmentation using titanium mesh in combination with different flap advancement techniques: a randomized clinical trial

The aim of this study was to investigate and compare the clinical and radiographic bone gain in guided bone regeneration with titanium mesh, for four different advancement techniques: periosteal releasing incision (PRI), double flap incision (DFI), modified periosteal releasing incision (MPRI), and coronally advanced lingual flap (CALF). Forty patients with a partially edentulous mandible were allocated randomly to four study groups (PRI, DFI, MPRI, CALF; 10 patients in each). Clinical bone gain (primary outcome) and radiographic bone gain were evaluated. In addition, correlations between study variables (clinical and radiographic bone gain, flap advancement, mesh exposure area and percentage exposure, pain, and swelling) were explored. CALF exhibited the highest mean clinical bone gain (4.12 ± 1.37 mm) and PRI the lowest (2.60 ± 1.36 mm); the mean clinical bone gain differed significantly among the groups (P < 0.001). The highest mean radiographic bone gain was seen in the CALF group (3.54 ± 1.65 mm) and the lowest in the PRI group (2.06 ± 1.11 mm); the mean radiographic bone gain also differed significantly among the groups (P < 0.001). The correlation analysis revealed positive correlations between flap advancement and radiographic bone gain (P = 0.003) and between swelling and pain (P = 0.007). An inverse correlation was found between flap advancement and swelling (P = 0.049), mesh exposure area and clinical bone gain (P = 0.022), and mesh exposure percentage and clinical bone gain (P = 0.017). In summary, the highest clinical and radiographic bone gain was observed for CALF, while the lowest was observed for PRI.     

自制“V”形支架在眶内侧壁骨折复位术中的应用

目的 探讨鼻内镜下自制“V”形支架在眶内侧壁骨折复位术中的应用效果。方法 回顾性分析15例眶壁骨折患者,均在鼻内镜辅助下经鼻窦入路整复,并以“V”形支架进行支撑,观察临床疗效。结果 15例手术患者均成功整复到位,术后随访3~12个月,全部患者无并发症发生,临床疗效满意。结论 在眶壁骨折复位治疗中,应用自制“V”形支架,可以取得满意疗效。     

Direct access to a frontal sinus osteoma and reconstruction of the orbital roof displaced by the lesion by titanium mesh

Osteomas are the most common benign tumors of the paranasal sinuses. They are usually localized in the frontal sinus and less often in the other paranasal sinuses. In this article, we report the surgical treatment of an unknown frontal sinus osteoma discovered after an acute exophthalmos. We have chosen an external approach to obtain a radical excision of the tumor, but we prefer a direct frontal incision following a horizontal wrinkle to the classic bicoronal flap to avoid an unsightly scar because of patient's hair loss. We discuss the surgical approach, the reconstruction of the roof of the orbit involved, and patient's satisfaction.     

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目的评价老年人牙齿缺失后固定义齿修复的临床效果。方法对2004—2010年河南省濮阳市油田总医院口腔科收治的60例行固定桥修复的老年患者的75件固定义齿修复体进行随诊观察,通过主观评价和临床检查进行综合评价分析,临床检查主要从修复体的完整性、边缘密合性、基牙及牙周的健康状况等方面进行检查。结果 75件修复体经过0.5～5年的观察随访,主观评价满意72件,满意率为96%;临床检查成功66件,失败9件,成功率为88.0%。结论针对老年人缺失牙的特点,正确选择适应证,合理设计,老年人固定义齿修复的效果是满意的。     

PET在头颈部肿瘤诊断与治疗中的应用进展

正电子放射断层显像(PET)作为一种功能成像新技术,可以观察人体组织和器官在分子水平的新陈代谢情况。相比于CT、MRI等传统解剖结构成像方法,PET在肿瘤的早期发现、鉴别原发与转移或复发病灶,以及肿瘤分期和放化疗疗效判断等方面具有独特的优势和重要的临床价值。该文介绍目前PET技术在头颈部肿瘤的临床应用现状和诊断效果,并探讨了PET在头颈部肿瘤诊断和治疗的未来发展趋势。     

颞下颌关节MRI技术的应用和进展

颞下颌关节疾病是较为常见的头颈部疾病之一。目前,磁共振成像(magnetic resonance imaging,MRI)已成为检查颞下颌关节的首选方法之一。本文简要介绍了应用于颞下颌关节解剖和疾病诊断的常规及特殊MRI方法(包括增强MRI、MR关节造影、动态MRI和三维MRI),并简述了这些技术的研究进展状况。     

Correlation between increased orbital volume and enophthalmos and diplopia in patients with fractures of the orbital floor or the medial orbital wall

Fractures of the orbital floor and medial orbital wall (blowout fractures) are common midface injuries. Diagnostic methods and treatment options have improved over recent years, due to threedimensional image processing and the use of patient-specific implants. Nonetheless, the indications for orbital reconstructive surgery are still controversial. Previous authors have reported a linear correlation between post-traumatic increases in orbital volume and enophthalmos and diplopia. Post-traumatic increases in orbital volume are often considered to be predictive of long-term symptoms; therefore, it is commonly recommended that orbital volume increases be treated as an indication for early reconstructive surgery. However, the results of this study did not show any statistically significant long-term linear correlation between increased orbital volume and enophthalmos or diplopia, and the performance of orbital volume as a predictor of ocular symptoms was poor. Hence, we do not consider increased post-traumatic orbital volume to be particularly useful for predicting late enophthalmos or diplopia. However, a statistical correlation between fractures of the anterior and medial thirds of the orbital floor and double vision was found. As such, fractures of the middle and anterior third should be regarded as problematic, and surgical reconstruction should be considered in these cases.     

Stability of the chin after advancement genioplasty using absorbable plate and screws with template devices

PurposeThe purpose of this study was to compare the stability of the chin between absorbable plate and screws with a template device and titanium plate after advancement genioplasty in class II patients.Patients and methodsThe subjects consisted of 22 Japanese class II patients who underwent genioplasty advancement in combination with bi-maxillary surgery. After genioplasty horizontal osteotomy, the template plate and screws were fixed at the central region of the chin temporarily. Then, two absorbable bi-cortical screws (uncalcined and unsintered hydroxyapatite and poly-l-lactic acid: uHA/PLLA) were used and fixed bilaterally. After removal of the template plate and screws, one absorbable plate and screws were added to fix the segment in the advancement genioplasty (n = 14). The remaining 8 patients underwent genioplasty advancement surgery with the conventional titanium plate.For all patients, lateral cephalograms were obtained pre- and immediately after surgery and at 1 year after surgery. Change in the Pogonion (Pog) and Menton (Me) points and the corresponding soft tissue points (PogS and MeS) were evaluated.ResultsAlthough there were no significant differences in the change from before to immediately after surgery between the absorbable and titanium groups, there were significant differences in the Pog (Y) (P = 0.0379) and PogS (Y) (P = 0.0379) from immediately after surgery to after 1 year between both groups.ConclusionThis study shows that predicted advancement of the chin in the absorbable group could be achieved by using a template and screws, and likewise in the titanium group. However, this study suggested that vertical relapse to the inferior site or resorption at the antero-superior edge of the segment could occur in the absorbable group.