口腔颌面部牙源性感染的微生物学及药物治疗

<正>在口腔颌面部感染的现代研究中,仍然延续传统的以感染途径分类的方法:即牙源性感染和非牙源性感染。其中牙源性感染是颌面外科临床中最多见的感染类型。有资料显示:牙源性感染病例占口腔颌面外科病例总数的11.3%[1]。亦有学者报道,牙源性感染占颌面颈部脓肿及蜂窝织炎病例的77.7%[2]。陈文君等[3]报道,在112例口腔颌面部间隙感染中,牙源性感染99例,占88.3%。     

口腔颌面部多间隙合并颈部及胸腔纵隔感染的回顾性分析

目的探讨口腔颌面部多间隙感染合并颈部及胸腔纵隔感染的诊断、治疗及预后。方法回顾性分析5例口腔颌面部多间隙感染合并颈部及胸腔纵隔感染患者的临床资料,分析其感染来源、临床特点、并发症及处理。结果 5例患者均为牙源性感染,临床表现为颌下、口底、颈部广泛肿胀,脓液形成。影像学显示2例纵隔及胸腔内有脓液形成。经过及时广泛切开引流及多学科综合治疗,4例痊愈,1例死亡。结论对于临床上颌面多间隙感染合并颈部广泛肿胀的病例应予高度重视,影像学检查在早期诊断中有很高价值,应尽早行多部位的切开引流及多学科综合治疗。     

Rehabilitation after Surgical Treatment for Retinoblastoma: Ocular Prosthesis for a 6‐Month‐Old Child

Maxillofacial prosthetic (MFP) rehabilitation can be especially challenging in a young, precooperative, or behaviorally compromised child presenting with an enucleated eye. Retinoblastoma is the most common intraocular malignancy in childhood and is one of the most common pediatric cancers. Treatment consists of enucleation (or removal of the entire globe) followed by placement of orbital implants. Unrestored anopthalmic sockets exhibit growth retardation and can lead to facial disfigurement. This report describes the challenges faced during rehabilitation of a 6‐month‐old girl with an anophthalmic socket due to enucleation for retinoblastoma. The objective of the MFP team was to provide a custom‐built, acrylic ocular prosthesis in as comfortable and atraumatic manner as possible. The case was a success and underscores the value of a multidisciplinary dental approach for the treatment of children with very special needs.     

口腔颌面部间隙感染病原菌研究现状

<正>感染是一种古老的疾病,17世纪初对人类疾病病死率的统计中,牙源性感染较高的病死率就引起了人们的重视。20世纪初期,口腔颌面部的感染疾病病死率在10%～40%,当时的常见病原菌为革兰阳性球菌,如金黄色葡萄球菌。随着20世纪20年代抗生素的发明与应用,口腔颌面部感染所致的严重并发症及病死率大幅下降。     

Radicular cyst in a patient with untreated Wiskott–Aldrich syndrome: A case report

Wiskott–Aldrich syndrome (WAS) is a condition with variable expression, which causes persistent thrombocytopenia and, in its complete form, also causes small platelets and humoral immunodeficiency. A 14-year-old boy, diagnosed with WAS but never treated, presented with symptoms of heart and renal failure. His right buccal region was swollen and his right first molar showed a cyst-like image on dental X-ray films. The boy's symptoms were attributed to an infected cyst, greatly aggravated by WAS-related immunodeficiency. The boy was sedated and the affected tooth and cyst were enucleated. Invasive treatment was safely achieved by paying close attention to whole-body management.     

Substantial CT radiation dose reduction does not affect the preference for CT over direct digital radiography to diagnose isolated zygomatic fractures – A study in human cadavers

IntroductionZygomatic fractures can be diagnosed with either computed tomography (CT) or direct digital radiography (DR). The aim of the present study was to assess the effect of CT dose reduction on the preference for facial CT versus DR for accurate diagnosis of isolated zygomatic fractures.Materials and methodsEight zygomatic fractures were inflicted on four human cadavers with a free fall impactor technique. The cadavers were scanned using eight CT protocols, which were identical except for a systematic decrease in radiation dose per protocol, and one DR protocol. Single axial CT images were displayed alongside a DR image of the same fracture creating a total of 64 dual images for comparison. A total of 54 observers, including radiologists, radiographers and oral and maxillofacial surgeons, made a forced choice for either CT or DR.ResultsForty out of 54 observers (74%) preferred CT over DR (all with P < 0.05). Preference for CT was maintained even when radiation dose reduced from 147.4 μSv to 46.4 μSv (DR dose was 6.9 μSv). Only a single out of all raters preferred DR (P = 0.0003). The remaining 13 observers had no significant preference.ConclusionThis study demonstrates that preference for axial CT over DR is not affected by substantial (∼70%) CT dose reduction for the assessment of zygomatico-orbital fractures.     

Craniofacial osseointegration

In year 2007, 30 years have elapsed since the first patient was supplied with a craniofacial osseointegrated implant. The reason for implanting in this patient was a severe conductive hearing loss, which necessitated the use of a bone conduction hearing aid. By utilizing the possibility to transmit sound to the cochlea via direct bone conduction, a new era in audiology was established. Further applications of osseointegration in the craniofacial field is related to the rehabilitation of patients with defects from cancer therapy, malformations, traumatic amputations and burns. Specific fields of osseointegration in this respect are due to possible side effects from radiotherapy and chemotherapy that will affect osseointegration negatively. Other aspects are related to osseointegration in children. This review will focus on the knowledge gained during the first 30 years of craniofacial osseointegration.     

Biocompatible implant mimicking cartilage: A new horizon for reconstructive facial field

Cartilage is avascular with limited to no regenerative capacity, so its loss could be a challenge for reconstructive surgery. Current treatment options for damaged cartilage are also limited. In this aspect there is a tremendous need to develop an ideal cartilage-mimicking biomaterial that could repair maxillofacial defects. Considering this fact in this study we have prepared twelve silicone-based materials (using Silicone 40, 60, and 80) reinforced with hydroxyapatite, tri-calcium phosphate, and titanium dioxide which itself has proven their efficacy in several studies and able to complement the shortcomings of using silicones. Among the mechanical properties (Young’s modulus, tensile strength, percent elongation, and hardness), hardness of Silicone-40 showed similarities with goat ear (P > .05). Silicone peaks have been detected in FTIR. Both AFM morphology and SEM images of the samples confirmed more roughed surfaces. All the materials were nonhemolytic in hemocompatibility tests, but among the twelve materials S2, S3, S5, and S6 showed the least hemolysis. For all tested bacterial strains, adherence was lower on each material than that grown on the plain industrial silicone material which was used as a positive control. S2, S3, S5, and S6 samples were selected as the best based on mechanical characterizations, surface characterizations, in vitro hemocompatibility tests and bacterial adherence activity. So, outcomes of this present study would be promising when developing ideal cartilage-mimicking biocomposites and their emerging applications to treat maxillofacial defects due to cartilage damage.     

严重口腔颌面外伤患者的临床处理措施

目的对严重口腔颌面外伤患者的临床处理措施进行分析。方法选取我院2012年10月至2013年10月所接受治疗的38例严重口腔颌面外伤患者,对其临床资料进行回顾性分析,以对其临床处理措施进行总结。结果经过有效处理,38例患者的临床治愈36例,治愈率为94.74%,无效2例,无效率为5.26%。结论在严重口腔颌面外伤患者中临床治疗中,一定要及时采取有效处理措施,这样才能够对患者临床治愈率提高,改善患者生活质量。