双侧下颌升支矢状劈开截骨(BSSRO)后退术对下颌角区的影响

目的:研究BSSRO后退术后下颌角区形态的变化。方法:通过38例骨性下颌前突患者BSSRO后退手术前后头颅定位正侧位片及口腔X线计算机体层摄影(CBCT)片对硬组织结构定点测量。结果:2种测量均显示术后下颌角角度较术前减小,下颌升支坡度亦减小;下颌骨的宽度将增加。结论:BSSRO术后下颌角变小,下颌骨宽度增加;将使患者的面貌变宽,咬合功能有所改善。     

170例重型颅脑损伤的临床分析

目的 总结重型颅脑损伤患者的救治方法及经验.方法 对我科收治的170例GCS评分3～8分的重型颅脑损伤患者的临床资料进行回顾性分析.结果 170例患者中标准外伤大骨瓣开颅术治疗135例,不需开颅手术17例,呼吸循环衰竭无法耐受手术治疗18例;按格拉斯哥预后评分法（GOS）评定：存活120例,随访6个月,恢复良好40例,中残20例,重残10例;死亡50例,其中术后死亡17例.结论 重型颅脑损伤患者病情危重、并发症多、病死率高,标准外伤大骨瓣开颅术可有效降低颅内压,解除脑疝,综合治疗可提高存活率.     

Bilateral benign paroxysmal positional vertigo: an unusual complication of orthognathic surgery

Benign paroxysmal positional vertigo (BPPV) is a common cause of vertigo of labyrinthine origin and usually idiopathic. However, 15–20% of all cases occur after trauma to the head, and it has rarely been reported after maxillofacial surgery, so to the best of our knowledge this is the first report of its bilateral occurrence after orthognathic surgery. It resolves slowly, but symptoms are incapacitating. It can be diagnosed from the history and physical examination, including the Dix–Hallpike test. Maxillofacial surgeons should be aware of it in patients who complain of dizziness after orthognathic surgery, and should know how to manage it properly.     

Complete Denture Occlusion: An Evidence‐Based Approach

Purpose : This study involved an extensive search for randomized controlled clinical trials comparing bilateral balanced and canine‐guided dentures, and questioned whether a bilateral balanced occlusion is imperative for successful denture treatment. Materials and Methods : Studies were identified by searching electronic databases (PubMed/MEDLINE, ISI Web of Science, LILACS, and BBD). The keywords “denture” and “occlusion” were used. The minimum inclusion requirements were (1) randomized controlled trials with patients of any age wearing both maxillary and mandibular conventional complete dentures (CDs), (2) comparison between bilateral balanced and canine‐guided dentures, and (3) assessment of masticatory function and/or patients’ satisfaction. Results : The search resulted in the identification of 5166 articles. Subsequently, 5156 articles were excluded on the basis of title and abstract. By the end of the search phase, seven randomized controlled trials were considered eligible. Conclusions : Current scientific evidence suggests that bilateral balanced occlusion is not imperative for successful treatment with conventional CDs in average patients. More studies are necessary to identify if specific clinical conditions may benefit from a balanced occlusion.     

Localized Neurofibromas in the Bilateral Orbits

Localized neurofibromas are rare in the orbit and, unlike the more common plexiform neurofibromas, are not typically associated with von Recklinghausen neurofibromatosis. We present a rare case of localized neurofibromas in the bilateral orbits.     

Interleukin 1 Receptor Antagonist and Tumor Necrosis Factor-α Gene Polymorphism in Patients with End-Stage Renal Failure

Urea and creatinine are not generally considered to be important uremic toxins despite evidence from dialysis experiments to the contrary, and despite striking elevations of these nitrogenous waste products in uremia. In order to study this problem in acute uremia, we used a new dietary method for prolonging the survival of bilaterally nephrectomized rats. Urea or creatinine were injected on three successive days starting one day after the inception of uremia. Urea or creatinine injections shortened the survival time of acutely uremic rats, and increased the involution of thymus and spleen. The extra urea, but not creatinine, increased the serum osmolality. These data indicate that urea and creatinine are toxic in the acutely uremic rat. Hypertonicity of the serum may contribute to the toxicity of urea. Additional mechanisms of toxicity and additional toxins are not excluded.     

Contralateral electrodiagnosis in patients with abnormal median distal sensory latency

Background

We hypothesized that electrodiagnostic evidence of carpal tunnel syndrome (CTS) on the contralateral, less-severe side correlates with disease severity.

Methods

We retrospectively reviewed 285 adults that had bilateral electrodiagnostic testing and a median distal sensory latency (DSL) greater than 3.6 ms on at least one side. Variables associated with abnormal contralateral median DSL were analyzed in bivariable and multivariable analysis.

Results

Patients with a nonrecordable median DSL on the worst side were significantly more likely to have electrodiagnostic evidence of contralateral CTS compared to patients with a prolonged DSL on the worst side (90 versus 65 %, respectively; p < 0.001). Bilateral symptoms were reported by 75 % of patients. The best logistic regression model for electrodiagnostic evidence of contralateral CTS included nonrecordable median DSL of the worst side and polyneuropathy (p < 0.001 and p = 0.14, respectively).

Conclusions

The finding that disease severity relates to the probability of contralateral abnormalities is consistent with the concept that CTS is typically bilateral. Patients with CTS on one side should be advised of the likelihood that it can be present or may develop on the other side.     

Awake craniotomy and electrophysiological mapping for eloquent area tumours

Objective

An awake craniotomy facilitates radical excision of eloquent area gliomas and ensures neural integrity during the excision. The study describes our experience with 67 consecutive awake craniotomies for the excision of such tumours.

Methods

Sixty-seven patients with gliomas in or adjacent to eloquent areas were included in this study. The patient was awake during the procedure and intraoperative cortical and white matter stimulation was performed to safely maximize the extent of surgical resection.

Results

Of the 883 patients who underwent craniotomies for supratentorial intraaxial tumours during the study period, 84 were chosen for an awake craniotomy. Sixty-seven with a histological diagnosis of glioma were included in this study. There were 55 men and 12 women with a median age of 34.6 years. Forty-two (62.6%) patients had positive localization on cortical stimulation. In 6 (8.9%) patients white matter stimulation was positive, five of whom had responses at the end of a radical excision. In 3 patients who developed a neurological deficit during tumour removal, white matter stimulation was negative and cessation of the surgery did not result in neurological improvement. Sixteen patients (24.6%) had intraoperative neurological deficits at the time of wound closure, 9 (13.4%) of whom had persistent mild neurological deficits at discharge, while the remaining 7 improved to normal. At a mean follow-up of 40.8 months, only 4 (5.9%) of these 9 patients had persistent neurological deficits.

Conclusion

Awake craniotomy for excision of eloquent area gliomas enable accurate mapping of motor and language areas as well as continuous neurological monitoring during tumour removal. Furthermore, positive responses on white matter stimulation indicate close proximity of eloquent cortex and projection fibres. This should alert the surgeon to the possibility of postoperative deficits to change the surgical strategy. Thus the surgeon can resect tumour safely, with the knowledge that he has not damaged neurological function up to that point in time thus maximizing the tumour resection and minimizing neurological deficits.