下颌骨整形手术后突发窒息的可能原因分析及防治

目的：总结行气管内全麻经口内入路下颌骨整形术的患者术后出现突发性呼吸困难、窒息的主要原因。方法：回顾性分析2007年7月～2012年6月在全麻下经口内入路下颌骨整形术患者的临床资料。结果：本组714例术后患者中,28例患者术后出现呼吸困难症状,22例予保守治疗,6例予以二次手术探查止血,均痊愈出院。结论：防止下颌骨整形术术后窒息,除了要注意术中手术操作外,更重要的是加强术后病情观察及对窒息的应急处理。     

A comparison of airway interventions and gastrostomy tube placement in infants with Robin sequence

The purpose of this study was to evaluate feeding impairment following non-operative or operative management of airway obstruction in a large series of infants with Robin sequence (RS) by rate of G-tube placement. A retrospective study was conducted at Boston Children’s Hospital including 225 patients (47.1% female) with RS treated between 1976 and 2018. Subjects were grouped by intervention required for successful management of airway obstruction: non-operative only (n = 120), tongue–lip adhesion (TLA, n = 75), mandibular distraction osteogenesis (MDO, n = 21), or tracheostomy (n = 9). The operative group had a higher rate of G-tube placement (58.1%) than the non-operative group (28.3%, P < 0.0001). Subjects in the TLA and tracheostomy groups had higher odds of G-tube placement than subjects in the MDO group: odds ratio (OR) 5.5 (95% confidence interval (CI) 1.8–17.3, P = 0.004) and OR 27.0 (95% CI 3.2–293.4, P = 0.007), respectively. Syndromic patients and those with gastrointestinal anomalies also had higher odds of G-tube placement: OR 3.5 (95% CI 1.7–7.2, P = 0.001) and OR 5.9 (95% CI 1.6–21.0, P = 0.007), respectively. Infants with RS who require an airway operation and those with a syndromic diagnosis or gastrointestinal anomalies are more likely to require placement of a G-tube. Of the operative groups, MDO was associated with the lowest G-tube rate, compared to TLA and tracheostomy.     

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??Canted occlusal plane is the main feature of mandibular deviation. The causes of occlusal plane canting are very complicated and inconclusive. A large number of studies have shown that it is related to bite force??bite contact area??chewing movement and even head or neck position. CBCT is the best diagnostic method for assessing occlusal plane canting at present. Canted occlusal plane and mandibular deviation are mainly ipsilateral??and a small number reveals contralateral. It can also have adverse effects on temporomandibular joint and mastication??and it has been difficult to be corrected with non-surgical methods. Based on the existing literature??we summarized the canted occlusal plane features??adverse effects and the commonly used non-surgical treatment methods.     

Splinted and unsplinted overdenture attachment systems: A systematic review and meta‐analysis

Splinted and unsplinted overdenture attachment systems have unique advantages and disadvantages. The aim of the present systematic review was to determine the influence of splinted and unsplinted overdenture attachment systems on the marginal bone loss, prosthetic complications and implant survival rate. PubMed/MEDLINE , Scopus and Cochrane databases were searched for articles published up to October 2017, using the following search terms: “overdenture AND attachment OR overdenture AND bar OR overdenture splinted.” The PICO question “Do splinted overdenture attachment systems promote better clinical results in comparison to unsplinted systems?” was evaluated. Eligible studies included randomized controlled clinical trials, prospective studies with at least 10 participants and a minimum follow‐up of 6 months, and studies published in English that compared splinted and unsplinted attachment systems within the same study. The 95% confidence interval (CI ) was considered for all outcomes analysed. After completion of the different steps in the article selection process, nine articles were included in the qualitative and quantitative analyses. A total of 984 implants were placed in 380 patients (mean age: 62.8 years). The meta‐analysis demonstrated no statistically significant differences between splinted and unsplinted attachment systems with regard to marginal bone loss (P  = .39; MD : ?0.11; 95% CI : ?0.37 to 0.14), complications (P  = .31; RR : 1.26; CI : 0.80‐1.99) and implant survival rate (P  = .14; RR : 0.37% CI : 0.10‐1.36). In addition, splinted and unsplinted overdenture attachment systems achieved similar results with regard to marginal bone loss, prosthetic complications and implant survival rate.     

Relationship between frontal craniofacial morphology and horizontal balance of lip‐closing forces during lip pursing

The objectives of this study were to quantitatively evaluate the relationship between frontal craniofacial morphology and the horizontal balance of the lip‐closing forces (LCF) generated during maximum voluntary pursing‐like movements in patients with mandibular deviation. Thirty‐one subjects (median age 25·4 ± 8·9 years) without a history of orthodontic treatment were randomly selected from among the orthodontic patients who visited our hospital. Lip‐closing forces was recorded in eight directions during maximum voluntary pursing‐like lip‐closing movements. The subjects were divided into the deviation (two males and 11 females) and non‐deviation groups (four males and 14 females). There was no significant difference in the total LCF between the deviation and non‐deviation groups. In the deviation group, the mean LCF value on the deviation side of the upper lip was significantly lower than that detected on the non‐deviation side of the upper lip, while the mean LCF value for the deviation side of the lower lip was significantly higher than that for the non‐deviation side of the lower lip. In contrast, no significant difference in upper or lower lip LCF was detected between the deviation and non‐deviation sides in the non‐deviation group. The difference in the LCF generated in the lower lip between the deviation and non‐deviation sides was significantly positively correlated with mandibular menton deviation and significantly negatively correlated with the difference in maxillary height between the deviation and non‐deviation sides. These results suggest that the horizontal balance of the upper and lower lip LCF produced during pursing‐like lip‐closing movements in patients with mandibular deviation is related to frontal craniofacial morphology.     

复方氯己定含漱液预防干槽症临床观察

目的:评价复方氯己定含漱液预防下颌阻生智齿拔除术后干槽症的临床效果。方法:临床搜集需拔除下颌阻生智齿的342例患者,共342颗牙,随机分为复方氯己定含漱液组(A组)、口服抗生素组(B组)和消炎抗菌可溶止血纱布组(C组),比较3组术后干槽症的发病率。结果:A组干槽症发病率显著低于C组(P<0.05);A组与B组、B组与C组间比较,干槽症发病率均无显著性差异(均P>0.05)。结论:下颌阻生智齿拔除后,口腔应用复方氯己定含漱液可有效预防术后干槽症的发生。     

Severe trismus due to bilateral elongated mandibular coronoid process in an infantile-onset Pompe disease patient: A case report

Pompe disease is a rare neuromuscular disorder characterized by orofacial muscle weakness with consequent dysphagia and poor weight gain. We report the first case of severe trismus due to abnormal elongation of the coronoid process of the mandible in a child with infantile-onset Pompe disease. Bilaterally elongated mandibular coronoid processes cause abnormal impingement between the coronoid process and the zygomatic process, which in this patient, resulted in a maximal interincisal opening of only 6 mm. Although rare, clinicians should be aware of the development of coronoid process elongation in neuromuscular disorders with hypotonia, specifically those involving hypotonic orofacial muscles.