老年人原发性三叉神经痛改进撕脱术治疗的临床疗效观察

目的:探讨改进的三叉神经周围支撕脱术治疗老年人原发性三叉神经痛的临床疗效.方法:在三叉神经周围支撕脱术的基础上,采用局部骨碎块填塞神经孔治疗32例老年原发性三叉神经痛患者,其中第Ⅱ支17例,第Ⅲ支10例,第Ⅱ、Ⅲ支5例,均为单侧病变.结果:本组术后随访观察最长6年,最短5个月,显效12例,有效16例,无效4例,有效率87.5%.术后患者撕脱神经所支配区域的面部遗有不同程度的感觉麻木,无其它并发症.结论:改进撕脱术是一种治疗老年人原发性三叉神经痛简单、安全而有效的方法.     

Transient loss of power of accommodation in 1 eye following inferior alveolar nerve block: report of 2 cases

Unintended intravascular injection from inferior alveolar nerve blocks can result in frustrating distant complications affecting such structures as the middle ear and eyes. Possible complications affecting the eyes include blurring of vision, diplopia, mydriasis, palpebral ptosis and amaurosis (temporary or permanent). In this article, we present a complication that has been reported only rarely. Two patients developed transient loss of power of accommodation of the eye resulting in blurred vision after routine inferior alveolar nerve blocks on the ipsilateral side. Clear vision returned within 10-15 minutes after completion of the blocks. The possible explanation for this phenomenon is accidental injection into the neurovascular bundle of local anesthetic agents, which were carried via the blood to the orbital region. This resulted in paralysis of a branch of cranial nerve III, the short ciliary nerves that innervate the ciliary muscle, which controls accommodation.     

表面陶瓷化钛种植体与骨组织结合的界面表征及机制探讨

目的:通过对种植体-骨组织界面表征的研究,评价和分析新型表面陶瓷化钛种植体(Bio-Ti implant)的骨结合情况及机制.方法:制作犬下颌牙列部分缺损模型,设计制作相应的钛种植体,经过表面陶瓷化处理后,植入犬下颌骨,分别于3、6、12周处死动物,利用SEM对种植体表面矿物质沉积情况进行观察,同时分析其元素组成,对种植体-骨组织整体标本纵向界面进行元素线性扫描分析.采用未经表面处理的相同类型纯钛种植体作为对照.结果:Bio-Ti种植体周围新生类骨组织在3周时已有较多沉积,且与种植体结合较牢固,对少部分骨组织脱落处进行电镜观察及元素分析,种植体表面结构发生改建并且ca、P含量明显上升,微孔内及周围可以看到颗粒状类骨质沉积物.线扫描及面扫描结果显示,从骨组织过渡到种植体的微观区域的ca、P元素并未发生突变,提示两者之间磷酸钙成分的互相渗透与结合.结论:新型Bio-Ti表面陶瓷化纯钛种植体可以诱导体内类骨质早期沉积,与骨组织发生紧密结合,并显著缩短骨结合时间.     

Familial multiple odontogenic keratocysts

Multiple odontogenic keratocysts (OKCs) are principle features of nevoid basal cell carcinoma syndrome (NBCCS; Gorlin-Goltz syndrome). NBCCS is a genetic disorder transmitted by an autosomal dominant gene with variable expressivity, which is important to recognize when a patient has multiple OKCs. The cysts of the jaws are among the most common findings. Another feature is a certain appearance of the face, such as: large calvaria, high-arched eyebrows, broad nasal root, and mild hypertelorism. Before-therapy diagnosis is, therefore, as important as after-therapy diagnosis. Genetic counseling and examination may also be indicated. The purpose of this paper was to present a family case report of nevoid basal cell carcinoma syndrome with multiple odontogenic keratocysts. The features identified by these combined clinical, imaging, and histologic findings are described, along with a brief mention of the family history and a review of the literature.     

干燥方法对定量光导荧光系统分析早期脱矿病损的影响

目的研究不同的干燥方法对定量光导荧光系统(guantitative light-induced fluorescence,QLF)分析病损脱矿程度的影响,探讨最适合QLF临床检查使用的干燥方法.方法选择新鲜拔除的人无龋前磨牙8个,颊面用指甲油封闭留窗口大约3mm×3mm,置于脱矿液中,37℃摇床中7d形成脱矿病损.标本分别采用三种不同的干燥方法放置于空气中使之自然干燥、压缩空气干燥30s和棉卷干燥30s,然后进行QLF检查并采用盲法分析病损脱矿的严重程度.设置△Q(荧光损失量)值变化5%为病损入口,得出的数据导入SPSS 11.5软件进行统计分析.结果釉质脱矿病损随着干燥程度的增加,在QLF荧光图像中均表现为脱矿严重程度的增加.病损放置自然干燥564.386(±87.542)s后,QLF能够检测到最大荧光损失,压缩空气干燥30s和棉卷干燥30s后,能检测最大荧光损失的时间分别为39.250(±7.778)s和139.375(±13.212)s.压缩空气吹干30s后,QLF图像中病损表现出明显的荧光损失,与其他两种干燥方法有统计学差异(P＝0.000).结论压缩空气干燥30s后,病损表现的荧光损失可以用来反映该病损的最大荧光损失值.临床使用压缩空气对早期病损吹干30s是达到可靠干燥效果的最快速而实用的方法.     

Metastases to lingual lymph nodes from squamous cell carcinoma of the tongue

The diagnosis of squamous cell carcinoma (SCC) of the tongue metastasising to the lingual lymph nodes is rare. Until now lingual lymph nodes have not been mentioned in any system of lymph node classification. We report a case of SCC of the tongue with metastases to the lymph nodes in the superficial floor of the mouth, and to levels I and II lymph nodes. We provide evidence of the existence of lingual lymph nodes, and validate the practice of removing the lymph node-bearing-tissue of the floor of the mouth during neck dissection in cancers of the oral cavity.     

CT辅助咽后壁瓣手术设计

目的 建立CT辅助设计咽后壁瓣的方法,以提高治疗效果。方法 应用CT测量26例腭咽闭合不全者在静止和发“i”时腭咽腔的宽度和长度,观察分析咽后壁瓣成形术所需的宽度、长度和咽后壁瓣蒂的位置和与软腭的附着位置。结果 静止时腭咽腔的宽度15.10-37.25mm,平均27.01mm,长度12.54-30.39mm,平均22.10mm;发“i”时腭咽腔的宽度为9.11-34.06mm,平均17.69mm;咽后壁瓣蒂的位置都在第一颈椎平面或以上;与软腭的附着位置大部分在软腭的中后1/3处。结论 CT作为一种定量评价腭咽闭合功能的方法,能够辅助设计咽后壁瓣手术方法。     

Identification of a C-shaped canal system in mandibular second molars-part II: the effect of bone image superimposition and intraradicular contrast medium on radiograph interpretation

The purpose of this study was to investigate the effect of image superimposition from surrounding alveolar bone and intraradicular contrast medium on radiographic interpretation of a C-shaped canal system in mandibular second molars. Thirty mandibular second molars with fused roots were collected and stored in 10% formalin solution. After being scanned by microcomputed tomography and reconstructed, the buccal-lingual radiographs of each tooth were taken with or without intraradicular contrast medium and mandibular bony plates. The number of mesial and distal canals in the coronal-to-middle canal portion and the canal number in the apical 4-mm area were recorded. The buccal-lingual and three-dimensional view of reconstructed canal images were used to evaluate the accuracy of radiograph reading. The results were subjected to the Friedman and chi-square test. The results showed that without intraradicular contrast medium, the bone superimposition could decrease the accuracy of canal recognition significantly (p < 0.001), especially in the apical area. When contrast medium was in canals, the canal reading seemed not to be affected by the bone superimposition (p > 0.05). Based on these findings, the intraradicular contrast medium could increase the accuracy of canal recognition of a C-shaped canal system in mandibular second molars despite the bone image superimposition, especially in the detection of continuous C-shaped canals and the canals in the apical area.     

Heterotrophic ossification on a skin graft in a postburn scar of the chin

Some patients who have heterotrophic ossification (HO) in a postburn scar are occasionally seen in the clinic. The occurrence of HO following hip and abdominal surgery is common in males, whereas females are frequently affected following burns. The HO of skin grafts in burn scars of the superior body parts is uncommon, especially on the face. We report a recent case of a male patient in whom HO arose on skin grafts on his chin. The patient presented with a history of a painless chin mass for 48 years. Computed tomography scan suggested that the mass was located within subcutaneous tissue away from the lower jaw. The density of the mass was almost the same as the cortical bone of the lower jaw. The mass was completely resected under general anesthesia. It was a rectangular mass of 3× 0.5× 0.3 cm. Histological examination gave the diagnosis of HO, which was also confirmed by immunohistochemical stainings for vimentin. Recurrence was not found in this case by clinical and radiologic follow-up at 1 year after surgery.