Abdominal Dermis-Fat Graft Versus Conventional Temporalis Myofascial Flap Interposition in Temporomandibular Joint Ankylosis: A Prospective Clinical Comparative Study

IntroductionTemporomandibular joint (TMJ) ankylosis is an extremely disabling condition with almost complete inability to open the jaws causing difficulty in chewing, speech, poor oral hygiene and cosmetic disfigurement. Temporalis myofascial flap still remains the most common interpositional material used; however, patients usually complain of pain during movement, unesthetic bulging in the temporal region and trismus due to scar contracture. The main aim of the study was to evaluate the efficacy of abdominal dermis-fat graft and compare it with temporalis myofascial flap as to see which of the two grafts offers more advantages and provides better postoperative results following TMJ ankylosis surgery. Materials and MethodsA total of 30 diagnosed cases of TMJ ankylosis were randomly divided into two groups of 15 patients each. All the patients underwent TMJ ankylosis release under general anesthesia followed by abdominal dermis-fat interposition in Group A and temporalis muscle in Group B. The patients were assessed for pre-operative and postoperative mouth opening (immediate and 6 month postoperative), pain during physiotherapy, donor and surgical site complications and recurrence of ankylosis.ResultsThe mean maximum inter-incisal opening in dermis-fat group was significantly higher than temporalis group both at immediate and 6 month postoperative periods (p = 0.041, 0.001). Physiotherapy was less painful in dermis-fat group than in temporalis group, and the differences in VAS scores among the 2 groups showed high statistical significance (p < 0.001). Hypertrophic scar developed at the donor site in 2 patients in dermis-fat group; however, it was located below the beltline and hardly noticeable. A total of 9 patients (4 in Group A and 5 in Group B) developed temporary facial nerve weakness, and no case of re-ankylosis was noted in either group.ConclusionDermis-fat graft in temporomandibular joint ankylosis showed better results than conventional temporalis myofascial flap in terms of postoperative mouth opening, physiotherapy and jaw function with esthetically acceptable results.     

1～14岁正常儿童胫后神经体感诱发电位正常值及其特点

目的：探讨正常儿童胫后神经（PTN）体感诱发电位（SEP）的特点及正常值。方法：对121名正常儿童进行PTN—SEP检测,分析各波的特点及各波参数随年龄变化规律。结果：PTN—SEP随年龄增长,波幅增高,使波容易辨认,波幅在个体问变异较大。左右双侧对应波的潜伏期（PL）和峰间期（IPL）比较差异无显著意义（P〉0．05）,各组男女间PL和IPL无性别差异（P〉0．05）。外周神经电位的腰髓电位（LP）、马尾电位（cE）、胭窝电位（PF）等3个波的潜伏期随年龄增长PI。延长,而P40和N45等皮层电位的PL在8岁前变化则不明显（相邻组间P〉0．05）,8岁后延长明显。PF-T12的IPL也随年龄增长而延长（相邻组间P〈0．05）;而T12-P40IPL3岁组较1岁组延长,但差异不明显,以后随年龄增长而缩短,6岁组达成人值。结论：儿童PTN—SEP的正常值按年龄组划分是完全必要的。由于各波PL受身长的影响大,因此绝对PL不宜作为PTN—SEP的异常标准。PTNSEP是评价小儿躯体感觉通路、脊髓、脑干和大脑功能的客观指标,具有较大的临床实用价值。     

牙髓干细胞对面神经损伤修复研究进展

面神经损伤严重影响患者的身心健康,近些年,利用干细胞治疗神经损伤受到广泛关注。牙髓干细胞因其具有多种优势,在神经损伤的修复治疗中显示出巨大的优势,为面神经损伤的治疗提供了新的思路。本文将概述牙髓干细胞对面神经损伤修复的研究进展和应用前景。     

高血压交感神经相关发病机制

高血压是心脑血管疾病的独立危险因素之一,其发病机制较为复杂,包括水钠潴留、肾素-血管紧张素-醛固酮系统的激活、胰岛素抵抗和交感神经活性亢进等,并受遗传、环境等因素影响。其中,交感神经的异常激活可通过免疫系统、体液代谢等途径介导血压升高及相关靶器官损害,对高血压的发生发展至关重要。因此,探究高血压与交感神经之间的关系、阐述与交感神经有关的新疗法对高血压的防治具有重要意义。     

Is Bilateral Mental Incisive Nerve Block Better than Unilateral Mental Incisive Nerve Block during the Endodontic Management of Mandibular Incisors with Symptomatic Irreversible Pulpitis? A Prospective Single-blind Randomized Clinical Trial

IntroductionThe purpose of this clinical trial was to comparatively evaluate the anesthetic efficacy of unilateral and bilateral mental incisive nerve block (MINB) during the endodontic treatment of inflamed mandibular incisors.MethodsThe study was designed as a crossover single-blind study. A total of 76 patients requiring endodontic intervention in at least 2 mandibular incisors participated in this trial. The patients randomly received unilateral or bilateral MINB of 1.8 mL of 2% lidocaine with 1:80,000 epinephrine at 2 separate appointments. To blind the procedure, a saline injection was given on the contralateral side in the unilateral injections. The endodontic procedure was initiated in the incisors on the side of the first anesthetic injection. Patients with a negative response to electric testing received endodontic access opening under rubber dam. Patients were asked to report pain, if any, during the endodontic procedure by using a Heft-Parker visual analog scale. The anesthetic success was defined as no or mild pain on Heft-Parker visual analog scale (score, 0–54). The statistical analysis was performed with McNemar tests at P values <.05.ResultsThe success rates of unilateral MINB and bilateral MINB were 38% and 64%, respectively, for the central incisors and 44% and 69%, respectively, for the lateral incisors. The difference was statistically significant (P < .05).ConclusionsThe bilateral MINB was more successful during the endodontic management of mandibular incisors with inflamed pulps. However, both the techniques failed to give 100% success rates.     

What factors affect the attachment of the inferior alveolar nerve to the buccal plate following sagittal split osteotomy?

PurposeThis study aimed to assess the factors that can possibly affect the positioning of the inferior alveolar nerve (IAN) in the proximal or distal segment following sagittal split osteotomy (SSO).Materials and methodsThis was a prospective cohort study. The patients were assigned according to the position of the IAN: the IAN was attached to the buccal plate in group 1 (27 SSOs), while it was in the distal segment in group 2 (83 SSOs).ResultsThe mean of the buccolingual thickness of the proximal segment at the vertical cut of the osteotomy (BLTP) was 5.0 ± 0.62 mm in group 1 and 4.16 ± 0.72 mm in group 2. The mean of the distance between the IAN and the external cortical bone at the distal of the second molar before the osteotomy (IANB) was 0.5 ± 0.24 mm in group 1 and 1.24 ± 0.45 mm in group 2. There were significant differences for the mean BLTP and IANB between the two groups (P = 0.001).ConclusionIt seems that the thickness of the buccal plate of the proximal segment, the distance from the IAN to the external cortical bone, the osteotomy technique, and the presence or absence of impacted third molars may be associated with the positioning of the IAN following SSO.     

2种浓度利多卡因对下颌智牙拔除麻醉效果的影响

目的：探讨低浓度利多卡因行下牙槽、舌、颊神经一次阻滞麻醉的效果。方法：采用自身对照研究,前瞻性分析3 mL 1%利多卡因1∶100 000肾上腺素（低浓度组）或3 mL 2%利多卡因1∶100 000肾上腺素（高浓度组）行下牙槽、舌、颊神经阻滞麻醉拔除下颌智牙的差异。患者术后经过21 d的洗脱期,选择对应浓度的利多卡因拔除对侧阻生牙。分析2组间注射时疼痛水平（疼痛评估量表,NRS）、麻醉起效时间、麻醉深度及麻醉持续时间的差异。采用SPSS 17.0 软件包对数据进行统计学分析。结果：21例患者（平均年龄24岁）完成试验,其中62%为女性。低浓度组的疼痛水平（1.09,95% CI,0.77~1.41）显著低于高浓度组（1.66,95%CI,1.33-1.99）（P=0.010）。低浓度组下牙槽、颊、舌神经阻滞麻醉起效时间（52~63 s）显著快于高浓度组（259~335 s）（P=0.000）。下牙槽、舌、颊神经麻醉深度2组之间未见显著差异（P=0.751）。在疼痛NRS值为1~3的患者中,低浓度组,9例（100%）均在分牙时疼痛（下牙槽神经麻醉深度浅）;高浓度组3例（43%）分牙时疼痛,4例(57%)翻瓣时疼痛（颊神经麻醉深度浅）（P=0.019）。高浓度组麻醉持续时间比低浓度组平均长61 min（52~69 min）（P=0.000）。结论：用低浓度利多卡因组行下牙槽、舌、颊神经阻滞麻醉起效快,注射时疼痛水平低,术后下唇麻木不适感消失快。术中轻微疼痛,高浓度组常因颊神经麻醉深度较浅引起,低浓度组因下牙槽神经麻醉深度较浅引起。     

实时弹性定量成像技术在腕管综合征正中神经病变中应用及与MRI正中神经扁平率相关性研究

[目的]评估VTIQ的剪切波速度(shear wave velocity,SWV)在CTS患者中的应用,同时分析与MRI钩骨钩水平正中神经扁平率(median nerve flattening ratio MNFR) 相关性,以探讨SWV在诊断CTS中的临床应用价值。[方法]对临床诊断为CTS 40例患者(67只腕关节)及20例健康对照组(40只腕关节)进行VTIQ检测及二维超声检测。评估指标是SWV及CSA。比较两指标CTS组与对照组组间差异。绘制两指标诊断CTS的ROC曲线。回顾性分析临床诊断CTS患者MRI资料,测量MNFR。评估SWV及CSA与MNFR相关性。[结果]CTS组SWV、CSA与对照组比较差异有统计学意义(P＜0.05)。正中神经SWV诊断CTS最佳截值3.30m/s,计算SWV的灵敏度、特异度和准确率高于CSA。两指标联合诊断效能灵敏度,准确率高于单一指标。SWV、CSA与MNFR之间存在相关性。[结论] CSA及SWV两指标的改变反映了CTS患者正中神经形态学增粗,组织学变硬。VTIQ技术与MRI测量结果有较好一致性。遵照规范及指南条件下应用VTIQ技术在诊断CTS患者正中神经病变中有较好的可行价值。VTIQ技术及正中神经横截面积联合应用可以减少漏诊率,可为患者正确规范化治疗CTS提供更丰富的影像诊断依据。     

术前连续股神经阻滞在老年髋部骨折患者救治绿色通道中的应用

目的探讨术前连续股神经阻滞在老年髋部骨折患者救治绿色通道中的应用。方法选取2017年5月至2019年5月髋部骨折患者120例,根据患者镇痛意愿分为静脉镇痛组37例、术后股神经阻滞组41例、术前股神经阻滞组42例。静脉镇痛组接受常规治疗,术前1 h口服塞来昔布,术后传统自控静脉镇痛;术后股神经阻滞组接受绿色通追流程,术前1 h口服塞来昔布,术后连续股神经阻滞镇痛;术前股神经阻滞组接受绿色通道流程,术前和术后均连续股神经阻滞镇痛。比较各組手术等待时间、手术时间、术后首次下床时间及住院时间,拔管时间、清醒时间,比较各组术后6h、12h、24h、48 h、72 h视觉模拟评分法(VAS)评分及住院期间并发症发生情况。结果术前股神经阻滞组、术后股神经阻滞组手术等待时间、术后首次下床时间、住院时间均短于静脉镇痛组(P<0.05);术后不同时间点,术前股神经阻滞组VAS评分均低于静脉镇痛组和术后股神经阻滞组(P<0.05);术前股神经阻滞组、术后股神经阻滞组肺部感染发生率、切口感染发生率均低于静脉镇痛组(P<0.05)。结论绿色通道下行术前连续股神经阻滞镇痛,能有效缩短老年髋部骨折患者手术等待时间,降低术后疼痛程度,降低并发症发生率,,促进患者早期康复。