Pyramidal and posterior osseous release for maxillary superior/posterior mobilization using an ultrasonic bone-cutting device after Le Fort I osteotomy

AimThe purpose of this study was to evaluate the efficiency of pyramidal and posterior osseous release (PPOR) for maxillary impaction using an ultrasonic bone-cutting device after Le Fort I (LFI) osteotomy.Materials and methodsIn total, 31 Japanese adults with jaw deformities, diagnosed as having maxillary excess with mandibular prognathism or deficiency, underwent LFI osteotomy and bilateral sagittal split osteotomy. The patients were divided into two groups: a trimming group (15 patients, four men and 11 women; mean age 24.8 years) and a PPOR group (16 patients, seven men and nine women; mean age 22.8 years). In the trimming group, osseous interference around the descending palatine artery (DPA) was removed using forceps, rounding bur, and reciprocating rasp. The PPOR technique was used to remove osseous fragments created by V-shaped osteotomy around the DPA following vertical osteotomy behind the DPA using an ultrasonic bone-cutting device (Variosurg 3; NSK, Tochigi, Japan). The operative times for maxillary osteotomy, total operative times (including bilateral sagittal split osteotomy), and total blood loss were assessed.ResultsThe mean planned amounts of maxillary impaction were 4.37 ± 1.27 mm in the trimming group and 4.38 ± 1.36 mm in the PPOR group (p = 0.98). The mean maxillary operative time for the PPOR group was significantly shorter, by 25.5% (p < 0.001). Total operative time for the PPOR group was also significantly shorter, by 24.3% (p < 0.001). Mean blood loss was significantly lower in the PPOR group than in the trimming group (p = 0.003).ConclusionThe PPOR technique for maxillary impaction after LFI osteotomy shortened the operative time and enabled secure reduction of the maxilla in patients who required the treatment of maxillary impaction with preservation of the DPA bundle.     

Application of an augmented reality tool for maxillary positioning in orthognathic surgery – A feasibility study

BACKGROUND: An augmented reality tool for computer assisted surgery named X-Scope allows visual tracking of real anatomical structures in superposition with volume rendered CT or MRI scans and thus can be used for navigated translocation of bony segments. METHODS: In a feasibility study X-Scope was used in orthognathic surgery to control the translocation of the maxilla after Le Fort I osteotomy within a bimaxillary procedure. The situation achieved was compared with the pre-operative situation by means of cephalometric analysis on lateral and frontal cephalograms. RESULTS: The technique was successfully utilized in 5 patients. Maxillary positioning using X-Scope was accomplished accurately within a range of 1mm. The tool was used in all cases in addition to the usual intra-operative splints. A stand-alone application without conventional control does not yet seem reasonable. CONCLUSION: Augmented reality tools like X-Scope may be helpful for controlling maxillary translocation in orthognathic surgery. The application to other interventions in cranio-maxillofacial surgery such as Le Fort III osteotomy, fronto-orbital advancement, and cranial vault reshaping or repair may also be considered.     

The role of the le fort I maxillotomy in the management of incompletely resected pituitary macroadenomas.

Objective: The options available for the treatment of a nonsecreting pituitary macroadenoma that has been incompletely resected include reoperation, fractionated radiation therapy, and radiosurgery. Reoperation in this setting may be hindered by the same obstacles that prevented a complete resection during the initial surgical procedure, and should prompt consideration of an alternate approach or exposure. Methods: Between January 1998 and December 2003, 10 consecutive patients were referred to the Department of Neurosurgery at the University of Texas Southwestern Medical Center for the evaluation of a nonsecreting pituitary macroadenoma that measured 3 cm or greater in diameter despite having undergone an attempt at a complete resection elsewhere. Each of these patients was reoperated using a Le Fort I maxillotomy to enhance the exposure provided by a traditional transsphenoidal approach. Results: A total or near total (> 95%) resection was achieved in each case. One patient required reoperation for the repositioning of a fat graft to treat a cerebrospinal fluid fistula and one patient experienced a worsening of anterior pituitary function postoperatively. Five patients noted improved vision and no patient experienced further visual loss. Three patients have required subsequent treatment of small foci of recurrent or progressing tumor with stereotactic radiation therapy. No patient has received fractionated radiation therapy. Conclusion: The added exposure provided by a Le Fort I maxillotomy facilitates the resection of pituitary macroadenomas that have been incompletely resected by a traditional transnasal, trans-sphenoidal approach.     

上颌骨Le Fort I型截骨进路切除巨大鼻咽纤维血管瘤

目的:探讨上颌骨LeFortI型截骨进路切除累及翼腭凹、颞下凹巨大鼻咽纤维血管肿瘤的可行性。方法:采用矫正上颌骨先天或后天畸形的LeFortI型截骨术式进路,切除位于鼻咽部、筛窦等深在部位的纤维血管瘤。结果:该进路术野显露充分,取得了理想的治疗效果。结论:上颌骨LeFortI型截骨进路是切除鼻咽、颅底部纤维血管瘤的理想进路。     

优化牙支持式上颌骨前部牵引成骨术与上颌骨Le FortⅠ型前徙术治疗唇腭裂患者的效果及对其腭咽部结构的影响分析

目的探讨优化牙支持式上颌骨前部牵引成骨术与上颌骨Le FortⅠ型前徙术治疗唇腭裂患者的效果,以及对其腭咽部结构的影响。方法将大连市口腔医院2017年1月一2020年1月收治的63例唇腭裂伴上颌骨发育不足患者纳人研究,依据随机数字表法分为观察组31例和对照组32例。对照组实施上颌骨Le FortⅠ型前徙术治疗,观察组实施优化牙支持式上颌骨前部牵引成骨术治疗。比较并分析两组治疗前后腭咽部形态参数、上颌骨前移距离、吹气试验和语言清晰度测听结果。采用Pearson相关性分析明确上颌骨前移距离与腭咽部形态各项参数之间的关系。结果治疗后观察组静止位的腭咽腔深度低干对照组,差异有统计学意义(P<0.05);两组治疗前后腭咽部形态其余各项参数及上颌骨前移距离,差异均无统计学意义(P>0.05)。治疗后观察组不捏鼻、捏鼻吹气试验时间均短干对照组,语言清晰度高干对照组,差异均有统计学意义(P〈O.O5)。Pearson相关性分析显示,上颌骨前移距离与各项腭咽部形态参数均无相关性(P>0.05)。结论优化牙支持式上颌骨前部牵引成骨术与上颌骨Le FortⅠ型前徙术治疗唇腭裂均有效,但是,优化牙支持式上颌骨前部牵引成骨术相较于上颌骨Le FortⅠ型前徙术,对患者腭咽部结构影响较小,值得推荐采用。     

三维测量技术在骨性Ⅲ类错颌双颌术后复发研究中的应用

目的探讨三维测量方法应用于骨性Ⅲ类错颌畸形患者正颌术后颌骨稳定性研究的可行性,分析术后颌骨的复发情况及其影响因素。方法以2019年7至12月于南京大学医学院附属口腔医院口腔颌面外科行双颌手术的骨性Ⅲ类错颌畸形患者为研究对象,患者均行上颌Le Fort Ⅰ型截骨术+双侧下颌矢状劈开术。收集患者术前1周(T0)、术后3 d(T1)、术后6~12个月(T2)螺旋CT数据,使用3D Slicer建模并导入Geomagic Qualify拟合配准、测量上、下颌骨各标志点三维移动距离。对T1、T2期各标志点坐标值行配对t检验或Wilcoxon符号秩和检验,并对有明显复发的标志点之间行Pearson相关性分析,P < 0.05为差异有统计学意义。结果共纳入15例患者,其中男5例,女10例,年龄18~25岁,平均21.3岁。T1与T2期各标志点水平向坐标值比较,仅在右下颌角点差异有统计学意义,T1期为(-50.47±4.44) mm,T2期为(-50.06±4.66) mm(t=2.948,P=0.011)。T1与T2期各标志点前后向坐标值比较,上颌骨上牙槽座点、左、右梨状孔点、左、右骨折线中点差异有统计学意义(P<0.05),复发率分别为37.7 %(1.36/3.61)、35.7%(1.15/3.22)、25.4%(0.84/3.31)、26.9%(0.84/3.12)、14.0%(0.41/2.92);下颌骨下牙槽座点、颏前点、颏顶点、颏下点、左、右下颌角点差异有统计学意义(P<0.01),复发率分别为36.9%(1.75/4.74)、53.9%(2.45/4.55)、55.5%(2.72/4.90)、61.7%(2.90/4.70)、85.3%(2.20/2.58)、93.4%(2.40/2.57);复发距离与移动距离均显著相关(r值为0.572~0.736,P < 0.05)。T1、T2期垂直向各标志点坐标值比较,上颌骨垂直向差异无统计学意义(P>0.05);下颌骨下牙槽座点、颏前点、颏顶点、颏下点差异有统计学意义(P<0.01),T2期较T1期发生明显的逆时针旋转。结论三维测量方法可准确反映骨性Ⅲ类错颌畸形患者双颌术后颌骨的三维变化,术后上、下颌骨在水平向均无明显复发,在前后向均存在复发,与手术距离显著相关,在垂直向仅下颌骨存在旋转移位。     

四倍体菘蓝毛状根的抗内毒素作用

目的：从菘蓝的同源四倍体植物诱导出毛状根,并探讨用毛状根代替自然根作为药用的可能性。方法;利用发根农杆菌Ａ４菌株感染四倍体菘蓝,采用细菌内毒素检查法考察诱导所得毛状根的抗内毒素作用。结果：Ａ４菌株能诱导四倍体菘蓝产生毛状根,毛状根具有较强的抗内毒素作用。结论：发根农杆菌诱导四倍体植物产生的毛状根有可能成为传统中药材的一种代用品。     

板蓝根化学成分研究

 目的从板蓝根中提取分离活性成分。方法板蓝根用95%乙醇渗漉，不同极性溶剂提取，再用硅胶柱色谱分离单体，测定化合物的理化常数和波谱数据，鉴定其化学结构。结果分离得到5个化合物，分别鉴定为：β-谷甾醇(β-sitosterol Ⅰ)，棕榈酸(plamitic acid Ⅱ)，琥珀酸(succinic acid Ⅲ)，胡萝卜苷(daucosterol Ⅳ)和远志醇(polygalitol Ⅴ)。结论化合物Ⅲ，Ⅴ为首次从该植物中分离得到。     

高效液相色谱-蒸发光散射检测法测定中药板蓝根中精氨酸的含量

目的 :建立中药板蓝根中精氨酸的含量测定方法。方法 :以LunaC1 8(4 6mm× 15 0mm ,5 μm)色谱柱为固定相 ,柱温2 5℃ ;以水 三氟醋酸 (99 8∶0 2 )为流动相 ,流速 0 2ml·min- 1 ;蒸发光散射检测器检测 ,漂移管温度 10 5℃ ,气体流速 3 0 0L·min- 1 。结果 :精氨酸在 0 5 0 4 μg～ 2 5 2 μg范围内线性关系良好 ,r=0 9992。平均加样回收率为 99 3% ,RSD =0 9% (n =5 )。结论 :该方法简便、准确 ,重复性好。