钛板坚强内固定治疗下颌骨骨折的临床总结

目的:总结应用小型钛板治疗下颌骨骨折的临床经验。方法 :回顾性分析兰州大学第二医院口腔颌面外科,使用小型钛板坚强内固定技术治疗的157例下颌骨骨折患者的临床资料。经术后6个月、1年、2年随访,评价颌面部形态、咬合关系、骨折对位及愈合情况。结果:本组中151例咬合关系恢复良好,颌面部外形和咀嚼功能得以恢复,张口度正常,治愈率达96.18%。2例术后感染,4例发生钛板折断行二次手术取出,失败率3.82%。结论:小型钛板坚强内固定技术是治疗下颌骨骨折的良好方法,值得在临床上推广应用。     

下颌智齿断根移位于舌下间隙的处理

目的:探讨移位于舌下间隙的下颌智齿牙根的定位和取出方法。方法:回顾2009-07—2012-07间,6例下颌智齿拔出术中牙根移位于舌下间隙的病例,分析移位原因之后,采用双手合诊,结合影像学检查对牙根定位,行牙槽窝舌侧近远中松弛切口,翻瓣取出牙根。结果:手术成功取出移位牙根,6例牙根均移位于舌下间隙。患者术后无严重并发症。结论:牙槽窝近远中附加切口配合双手合诊,可准确定位并取出移位牙根。     

可吸收接骨板在下颌骨骨折内固定治疗中的临床评价

目的:同期观察分析生物可吸收接骨板(BAP)和钛板(TP)在下颌骨骨折内固定治疗中的临床应用效果。方法:2007年─2012年6年内,同期收治下颌骨骨折患者共286例。其中BAP治疗组127例,占总病例数44.4%,以六孔板10 mm螺钉为主,占该组73.35%,人均3.1块。TP组159例,占总病例数55.6%,人均2.3块。两组的部分病例术后辅以颌间弹力牵引。结果:术后创口近期均呈一期愈合,无明显不良反应;咬合关系恢复良好,张口无受限;X线表现从术后4～8周的动态观察表现为渐进性修复重建样影像。4周以后的中期观察在BAP和TP分组分别有4和6例出现类似排异状改变,经换药后治愈。结论:BAP和TP内固定后,排异反应、机械强度及固位作用是相同的,但BAP避免了TP组的二次手术和应力遮挡的弊端。对于机械强度较TP弱的缺点,BAP可通过双板以上的固定、紧密贴合的塑形能力、其本身具有的较强延伸弹性和机械强度等得到解决,并为此提高和延伸了其临床适应证。     

Endodontic treatment of a taurodontic premolar with five canals

Taurodontism is a morpho‐anatomical abnormality in the shape of a tooth. An enlarged pulp chamber, apical displacement of the pulpal floor and no constriction at the level of the cemento‐enamel junction are the characteristic features. Special care is required in all aspects of endodontic treatment of a taurodontal tooth, including identifying the orifice, canal exploration, cleaning, shaping and obturation of the root canal. This case report describes the successful endodontic treatment of a taurodontic mandibular second premolar with five root canals.     

Topography and Spatial Fascicular Arrangement of the Human Inferior Alveolar Nerve

Background: Topography and fascicular arrangement of the inferior alveolar nerve (IAN) can provide critical information for the estimation of damage to IAN based on patient symptoms, or conversely to evaluate the symptoms resulting from injury to the IAN. Purpose: The fascicular composition and organization of the IAN were determined to confirm the microarchitecture of the IAN bundles into each of the mandibular teeth, including the composition of the mental nerve. Materials and Methods: The IAN within the mandibular canal (MC) was examined in 30 hemifaces of embalmed Korean cadavers. Results: The most common patterns of nerve fascicle innervation to the mandibular teeth could be grossly classified into three: (1) the superior buccal portion of the IAN innervating the molars, (2) the superior portion innervating the premolars, and (3) the superior lingual or the superior lingual and inferior lingual portions in the posterior MC and the lingual portions in the anterior MC, innervating the incisors and canine. The buccal two‐thirds portion of the IAN was composed of the mental nerve. Conclusion: The IAN had distinctive fascicular organizations, which make it possible to forecast the degree, location, and extent of nerve damage according to presenting symptoms.     

The Dynamax System: A new orthopaedic appliance and case report

Abstract

The Dynamax appliance is a treatment modality for the correction of the Skeletal II malocclusion characterized by a mandibular retrusion. Progressive mandibular advancement, maxillary expansion, control of maxillary growth, incisor torque and control of vertical facial development are incorporated into a two-part appliance. The design facilitates laboratory construction, clinical handling and patient acceptability.

A prefabricated spring module forms the basis of the appliance, allowing both maxillary expansion and mandibular advancement. An easily adjustable progressive forward position of the lower jaw makes a construction bite unnecessary.

The spring module provides most of the structure of the appliance so that minimal acrylic is required and the appliance is fully contained within the freeway space. Contact between the upper and lower parts of the appliance occurs posteriorly in the lingual sulcus. Here the depth permits an extended vertical contact, to maintain a protrusive mandibular position throughout the range of mandibular opening, including during sleep. The lower portion of the appliance may be fixed or removable and multibracket treatment can be carried out in one or both arches at the same time as the orthopaedics.     

两种方法在拔除下颌阻生第三磨牙中的疗效比较

目的:观察和比较两种拔除下颌阻生第三磨牙的临床疗效。方法:门诊200例下颌阻生第三磨牙随机分为两组,各100颗。分别采用传统锤凿去骨法和涡轮机去骨法拔除,记录手术时间、术后疼痛、张口受限等情况并进行统计学分析。结果:两种手术方法在手术时间、术后疼痛、张口受限、肿胀程度等方面有统计学差异(P<0.05),传统锤凿去骨组出现干槽症与下唇麻木分别为5例和1例,涡轮机去骨组分别为1例和0例,组间比较差异无统计学意义(P>0.05)。结论:与传统锤凿去骨法相比,采用涡轮机去骨法拔除下颌阻生第三磨牙手术时间短,术后并发症较少,值得临床推广。     

Static reconstruction of malar region in facial paralysis: A new alternative technique for plasty of symmetric mouth appearance

Abstract

Static suspension using fascia lata graft is used as a reconstructive procedure against drooping of the mouth corner for treating longstanding facial paralysis. Although it achieves symmetry at rest, movement of the mouth corner at mouth opening is restricted to some extent because it is fixed with fascia lata to the immovable temporal fascia, the parotid fascia, or bones. This was overcome by suspending the mouth corner to the mandibular coronoid process with fascia lata, which enabled a shift of the mouth corner with mouth opening and closure. The nine patients discussed in this study were operated on since 1994 for longstanding facial paralysis and followed-up for over 1.5 years. As in conventional static suspension, the fascia lata was harvested and split into two bands. Next, one semi-oval fascial loop was inserted around the paralysed part of the mouth and tied with another fascial band at the mouth corner, which was looped to the mandibular coronoid process. The suspended fascia lata graft was relaxed with anteroinferior movement of the coronoid process at mouth opening, enabling the mouth corner to shift inferiorly. The mouth corner returned to its original position at mouth closure, and the nasolabial fold deepened during mastication. No limitation in mouth opening was observed. Suspension of the mouth corner to the mandibular coronoid process provided a dynamic element, thereby restoring a near-normal shift. The procedure is considered as an alternative for reconstructing the malar region of patients with facial paralysis and in whom dynamic reconstruction is not indicated.