口腔颌面外科研究生培养模式探索

口腔颌面外科学研究生的培养强调先是医学生、后是口腔医学生的教育模式。本文对如何提高口腔颌面外科研究生的综合素质做了初步的探索和总结。     

平阳霉素与地塞米松配伍治疗口腔颌面部血管瘤的临床观察

目的：总结分析平阳霉素和地塞米松配伍瘤内注射治疗口腔颌面部海绵状血管瘤的临床疗效。方法：选取口腔颌面部海绵状血管瘤260例，采用平阳霉素和地塞米松配伍注射治疗。用地塞米松5mg／1ml，配平阳霉素8mg，加2％利多卡因4mg，按体表瘤体面积每1cmx1cm注射1ml混合液计算计量，进行瘤体内注射。每隔10天注射1次，3—5次为一疗程，未愈者可重复联合治疗。结果：治疗后经半年至两年的随访，治愈203例（78．1％），基本治愈41例（15．8％），好转16例（6．1％），有效率100％。结论：平阳霉素与地塞米松配伍注射治疗口腔颌面部海绵状血管瘤，具有疗程短，不良反应小等优点，是一种安全、可靠、简便的治疗方法．     

颌面骨整形重建外科专业数据库的建立

目的：探讨颌面骨整形重建外科专业数据库建立的方法。方法：采用Microsoft Visual FoxPro (VFP)6．0软件编写数据库程序，数据库系统依据专科特点由各大类骨畸形模块组成，包括一般信息模块，先天性颌面骨畸形模块，创伤后颌面骨畸形模块，肿瘤切除手术后颌面骨畸形模块。结果：数据库专科数据采集全面，数据库表内字段设计符合专科特点，表之间链接可靠，数据库查询方便，具有数据挖掘功能，兼容更高级数据库软件，可成为子数据库，可接入互联网。系统维护可行。结论：该方法建立的数据库符合颌面骨整形重建外科专业数据库的要求，可以进行临床医疗、科研教学实际应用。     

多系统疾病对老年患者颌面部间隙感染的影响

目的探讨多系统疾病对老年患者颌面部间隙感染的影响.方法分析对比老年患者颌面部间隙感染22例,合并多系统疾病组14例,非合并多系统疾病组14例,分析对比两组的临床特点.结果合并多系统疾病组病因构成与非合并组相似,P＝0.649;合并多系统疾病组与非合并组的感染部位差别无明显性,P＝0.552;合并多系统疾病组有创治疗的比例与非合并组相似,P=1.000;合并多系统疾病组住院期间服用治疗其他疾病的药物的比例多于非合并组,P=0.006.结论应密切关注颌面部间隙感染老年患者是否合并其他系统疾病,进行有针对性地治疗.     

《口腔颌面部局部麻醉》网络课件的设计制作与应用

对《口腔颌面部局部麻醉》网络课件的设计制作思想、课件特色进行了详细介绍,并结合本课件的设计与应用对网络课程的制作问题进行了探讨。     

Combined and sequential treatment of oral and maxillofacial malignancies: an evolving concept and clinical protocol

Objective To introduce the concept and rational regimens and present the latest development of combined treatment of oral and maxillofacial malignancies. Data sources The related published literature was searched through the CNKI database and MEDLINE using the terms of oral cancer, oral and maxillofacial malignancies, combined and sequential therapy, multidisciplinary approach. Study selection The available related literature was read and evaluated. Studies that met the inclusion criteria were selected. Results The results show that oral and maxillofacial malignancies diagnosed at an early stages （stages Ⅰ and Ⅱ） can be well treated with surgery alone and/or radiotherapy with optimal outcome, but advanced or recurrent diseases should be treated with rational combined and sequential treatment modalities. The use of concomitant chemoradiotherapy, taxane-containing, three-drug induction regimens and Cetuximab in combination with chemotherapy or radiotherapy demonstrated favorable results in previously untreated patients with head and neck squamous cell carcinoma. Conclusions The concept of combined and sequential treatment of advanced oral and maxillofacial malignancies should be widely accepted, and the rational regimen for individual and each type of entity should be determined based on the anatomical site and the patient＇s performance status.     

口腔颌面部肿瘤患者外周血淋巴细胞粘附分子（CD44）测定的初步研究

目的:研究粘附分子CD44与某些恶性肿瘤的发生和转移的关系。方法:作者应用流式细胞免疫学方法(FCMI),对45例口腔颌面部肿瘤患者的外周血淋巴细胞粘附分子CD44进行了定量研究,结果:CD44在口腔颌面部肿瘤患者外周血淋巴细胞的表达明显增高,良性肿瘤患者术后CD44与健康组无差异(P>0.05);恶性肿瘤患者术前、术后CD44的含量均高于健康组,14例颈部转移患者的CD44与无转移者比较有显著性差异(P<0.001)。结论:外周血淋巴细胞粘附分子CD44可作为早期诊断口腔颌面部恶性肿瘤、监测肿瘤复发和转移的一个生物学标志物。     

Efficacy of speech aid prostheses for acquired defects of the soft palate and velopharyngeal inadequacy--clinical assessments and cephalometric analysis: a Memorial Sloan-Kettering Study

BACKGROUND: Restoration of speech after surgical resection for oropharyngeal cancer traditionally includes maxillofacial prosthetic intervention. Relatively few publications with objective speech outcomes exist. The purpose of this study was to evaluate speech outcome relative to the size of the surgical defect, the type of speech prosthesis, and the height and position of the speech bulb in relation to the posterior pharyngeal wall in the nasopharynx. METHODS: Fifty-five patients treated at the Memorial Sloan-Kettering Cancer Center Dental Service who underwent ablative cancer therapy were evaluated. All patients were 4 months or longer after surgery and were using a speech aid or obturator prosthesis at the time of the study. Speech samples for percent intelligibility and perceptual evaluation were collected and analyzed, in addition to aeromechanical measurements of palatopharyngeal function. Lateral cephalograms were taken while wearing the prosthesis using a radiopaque marker placed on the posterior aspect of the prosthesis for evaluating the height and position of the prosthesis obturator-speech bulb component. RESULTS: After adjustment for the differences between listeners, findings revealed that as the percentage of resection of palate or tongue increased, the intelligibility of speech decreased. Aeromechanical assessment of speech was the only outcome measure sensitive to the type of speech prosthesis. The position of the speech bulb component, as well as the angle measured, was correlated with the percent intelligibility. The amount of the prosthesis physically contacting the posterior pharyngeal wall was not significantly associated with any of the functional outcome measures. CONCLUSIONS: Speech aid and obturator prostheses contribute to a higher percentage of intelligible speech. A difference in intelligibility exists in relationship to the position of the prosthesis and the anterior tubercle of the atlas vertebrae (C1), both statistically and clinically. The position for optimal speech could not be specifically located mathematically (ie, 3 mm or 3 degrees inferior to the anterior tubercle of the atlas vertebrae) from the analysis. Subjective ratings of the efficacy of the obturator-speech bulbs by the clinicians did not correspond to the percent intelligibility. A strong statistical and clinical correlation exists supporting the efficacy of speech bulb-obturator intervention after velopharyngeal insufficiency for improved intelligibility of both words and sentences.     

Emergency department management of maxillofacial trauma

This paper highlights critical aspects of examination, diagnosis and early management of the maxillofacial trauma patient.     

Submental intubation in complex craniomaxillofacial trauma

The submental route for endotracheal intubation is an alternative to nasal intubation or tracheostomy in the surgical management of patients with complex craniomaxillofacial injuries. The critical indication for submental intubation is the requirement for intraoperative maxillomandibular fixation (MMF) in the presence of injuries that preclude nasal intubation and in a situation where a tracheostomy is not otherwise required. MMF to re-establish dental occlusion is essential for a normal functional result in dentate patients with fractures involving alveolar segments of the jaws. However, MMF precludes orotracheal intubation. Nasotracheal intubation is often used but is contraindicated in the presence of skull base fractures and will interfere with the access to certain fracture types. A tracheostomy has a high potential complication rate and in many patients, an alternative to the oral airway is not required beyond the perioperative period. A submental intubation has been used in 11 selected cases amongst 190 consecutively treated patients with craniomaxillofacial trauma over a 3-year period. These cases have been retrospectively reviewed and there have been no significant complications. The indications and technique used are described. Submental intubation is a simple and useful technique with low morbidity in selected cases of craniomaxillofacial trauma and the author's clinical experience with this technique is described.