下颌角、颧弓截骨整形手术患者同期自我意象重塑的心理干预探讨

目的 探讨下颌角、颧弓截骨整形手术患者同期行自我意象重塑心理干预治疗的临床效果.方法 将行下颌角、颧弓截骨整形的患者分为两组.A组（159例）在围手术期进行自我意向重塑的干预治疗;B组（159例）为对照组,不进行自我意向干预.结果 本组共318例患者.A组对术后效果很满意者72例（45.3%）,满意无意见者47例（29.6%）,个别部分有异议者33例（20.7%）,不满意者7例（4.4%）;B组对术后效果很满意者41例（25.8%）,满意无意见者32例（20.1%）,个别部分有异议者63例（39.6%）,不满意者23例（14.5%）.结论 对进行下颌角、颧弓截骨整形术的患者,同期行自我意象重塑的心理干预治疗,患者满意度高,可在临床推广.     

Flapless placement of zygomatic implants using dynamic navigation: an innovative technical note

Zygomatic implants are routinely used for the rehabilitation of the midface and edentulous maxilla; the procedure is carried out under general anaesthesia and requires the direct lifting of the Schneiderian membrane. A prefabricated surgical guide is usually used to direct the position of the zygomatic implants during surgery. This proof-of-concept study explored an innovative flapless approach for placement of zygomatic implants guided by dynamic navigation. Under local anaesthesia eight zygomatic implants were placed using a flapless technique. The preplanned position of zygomatic implants was transferred to the operating theatre using dynamic navigation, which guided the sinus lift procedure and the planned osteotomy. Operative complications were recorded, the accuracy of the implant position was measured and postoperative morbidities including pain and swelling were evaluated. Surgical complications were minimal, the Schneiderian membrane was intact in all the cases except one, which required the application of resorbable collagen membrane. Satisfactory accuracy was achieved regarding the precision of implant position and angulation. One of the patients developed maxillary sinusitis three months following surgery. Postoperative pain and swelling were minimal. The dynamic navigation guided flapless placement of zygomatic implants under local anaesthesia is a feasible technique with minimal surgical complications and postoperative morbidities.     

40例颧眶骨折患者的围手术期护理

总结40例颧眶骨折患者围手术期的护理要点,术前加强生命体征、颅脑损伤症状的观察及安全护理,术后重视口腔、眼及伤口护理,对于存在复视及张口受限的患者,进行眼肌功能训练和张口训练是围手术期护理的关键.40倒患者术后3个月均恢复良好.     

Maxillary all-on-four therapy using angled implants: a 16-month clinical study of 1110 implants in 276 jaws

The maxilla is a challenging area for dental implant restoration. Encroachment of anatomic structures such as the sinus and nasal floor make vertical placement difficult. Implants placed at an angle may be used to avoid these anatomic structures or eliminate the need for a bone grafting procedure. The question occasionally arises about the possible detrimental effects of placing implants at an angle. This article reviews relevant literature, presents two case reports on maxillary angled implants and presents 3 years of data on 276 All-on-Four restorations.     

双侧上颌骨缺损颧种植体修复的有限元分析

目的:研究颧种植体结合血管化腓骨瓣修复双侧上颌骨缺损的生物力学分布情况,为临床上颌骨缺损功能性修复提供理论参考.方法:基于患者的CT扫描数据、图像及图形处理技术,模拟上颌骨双侧骨缺损状态.依照临床上颌骨缺损后修复设计方法,应用腓骨瓣、颧种植体结合常规种植体植入,利用三维有限元法分析该设计的生物力学情况.结果:颧种植体结合血管化腓骨瓣修复双侧上颌骨缺损模型的应力分布中,应力最大值分别出现在颧种植体穿过腓骨和颧骨的部位.种植体结构中弯曲变化的位移不明显,并且种植体整体位移在颧骨附近逐渐减小为零.结论:实验表明(牙合)力引起的应力主要由颧骨和腓骨所承担,颧种植体结合血管化腓骨瓣修复双侧上颌骨缺损能够合理分散并传导(牙合)力,其周围支持组织具有良好的应力分布.该方法恢复了双侧颧突支柱的功能,是一种双侧上颌骨缺损功能性重建的有效方法.     

颧骨骨折不同手术入路的临床对照研究

目的 比较不同手术入路在颧骨骨折治疗中的临床效果.方法 选取2005年1月至2011年4月于本院进行手术治疗的58例颧骨骨折患者为研究对象,将其随机分为A组与B组各29例,A组采用头皮冠状切口进行治疗,B组采用局部小切口入路进行治疗,后将两组患者的治疗效果、并发症发生率、满意率及术前、术后1个月、3个月的QOL评分进行比较.结果 两组患者治疗效果差异无统计学意义(P＞0.05),而B组并发症发生率低于A组,满意率高于A组,术后1个月、3个月的QOL评分均优于A组,差异有统计学意义(P＜0.05).结论 局部小切口入路在颧骨骨折中的临床疗效较佳,并且对于改善患者的生存质量也优势明显.     

Hyperbaric Oxygen Therapy in the Management of Zygomatic Bone Osteomyelitis

IntroductionZygomatic bone osteomyelitis is a rare condition having an incidence of 1.42%. Zygomatic osteomyelitis can be due to haematogenous infection with tubercle bacillus, facial bone fractures or very rarely due to an unknown aetiology like in our case. If surgically managed alone, it would lead to complete loss of zygomatic bone, causing high morbidity to the patient in terms of function and aesthetics like loss of globe support causing dystopia, loss of facial projection causing facial asymmetry. Restoration of facial symmetry and globe support would require extensive procedures such as non-vascular bone grafting or patient-specific implant placement or microvascular bone flap transfer.Materials and MethodsHyperbaric oxygen therapy (HBOT) was used to try and preserve the zygoma by promoting revascularisation. The patient received 100% oxygen at 2.5 absolute atmospheric pressure for 90 min, one session per day for 5 days in a week using a mask system in a multiplace chamber. The patient was reviewed clinically and radiologically after each 5 dives of HBOT sessions. After a total of 30 dives of HBOT, CT examination was repeated. There was partial reconstitution of cortical bone without any additional residual bone lesion. Minimal residual sequestra were noted. At this stage, the patient underwent conservative sequestrectomy in contrast to extensive surgery if HBOT was not contemplated. ConclusionHBOT has the potential to be a very useful adjunct in the treatment of osteomyelitis in head and neck surgery; however, there is a need for carefully designed trials, avoiding methodological bias due to the great variability of patients, infectious agents, antibiotic resistance, host factors, to broaden the evidence of this therapeutic modality.     

微创下实施内固定治疗颧骨骨折的疗效及安全性

目的 探讨经口内微创入路实施内固定治疗颧骨骨折的临床疗效及安全性。方法 选取2005年6月—2013年6月收治的71例颧骨骨折患者,随机分为实验组和对照组。实验组采用经口内径路切开复位及微型钛板内固定术,对照组采用经冠状切口切开、明视下骨折复位及微型钛板内固定术。比较2组患者术前及术后3个月的伤侧鼻侧、颞侧运动度、开口度和眼球内陷程度,比较2组患者术后6个月的临床疗效及术后并发症发生率。采用SPSS18.0软件包对数据进行统计学分析。结果 2组患者术后3个月的伤侧鼻侧、颞侧运动度均显著低于术前（P<0.01）;实验组术后3个月的伤侧鼻侧、颞侧运动度均显著低于对照组（P<0.01）。2组患者术后3个月的开口度显著大于术前,眼球内陷程度显著小于术前（P均<0.01）;实验组术后3个月的开口度显著大于对照组,眼球内陷程度显著小于对照组（P均<0.01）。实验组术后半年的临床疗效显著高于对照组（P<0.05）。实验组的术后并发症发生率显著低于对照组（P<0.05）。结论 经口内微创实施内固定治疗颧骨骨折创伤较小,同时手术疗效佳,术后并发症发生率低,值得临床推广应用。     

改良眶颧-海绵窦入路显露基底动脉上段的应用解剖

目的探讨改良眶颧-海绵窦入路增加基底动脉上段显露的方法。方法在10例标本上模拟了经眶颧-海绵窦入路,同时增加磨除前后床突,观察对基底动脉上段显露的改善情况。结果磨除前床突后形成的间隙为床突间隙,存在于颈内动脉与动眼神经间的膜为颈内动脉动眼神经膜。(沿此膜即可进入海绵窦,磨除后床突后,暴露鞍背、上斜坡,即可显露基底动脉上段)单纯眶颧入路显露基底动脉的长度(5.66±1.07mm),视角(前后方向48.6±5.1°,上下方向51.9±5.5°);附加磨除前后床突后显露基底动脉的长度(7.68±1.12mm),视角(前后方向56.5±5.7°,上下方向61.9±6.0°)。结论经眶颧-海绵窦入路中磨除前床突和后床突,可显著增加对基底动脉上段的显露。     

皮下双筋膜切口治疗颧弓M型骨折

目的探讨皮下双筋膜切口治疗颧弓M型骨折的治疗效果。 方法对48例颧弓M型骨折患者于中间骨折线表面顺皮纹作切口,顺表浅肌肉腱膜系统（SMAS）表面分离,确认M两端骨折线位置后,在SMAS表面作2个小切口,先分离、暴露M两端骨折线后再于2个切口间的SMAS下骨面贯通,形成隧道,再暴露M中间骨折线。直视下对颧弓M型骨折进行复位、固定。 结果所有患者手术时间均缩短,均解剖复位,术后无神经损伤。 结论皮下双筋膜切口是治疗颧弓M型骨折较好方法,增大了手术视野,方便了医生操作。