颌外径路茎突过长手术的临床应用

茎突过长症以手术治疗为主,绝大多数采用口内径路切除扁桃体后将茎突截短[1],其缺点是手术需切除正常扁桃体,存在手术视野不清,分离不彻底,茎突截除不足及由此带来的一系列不良反应.我科采用颌外径路茎突过长截除术取得良好的手术效果.     

茎突过长症的诊断和手术治疗5例报告

目的总结茎突过长症的临床表现和手术方式。方法对5例茎突综合征病例进行螺旋CT或x线平片茎突检查,对其临床表现和手术方式进行分析。结果3例患者CT检查显示患侧茎突长分别40mm、42．8mm、84．0mm、85．6mm（1例患者为双侧患病）;2例患者x线平片显示患侧茎突长度为40．0mm和37．0mm,较正常人明显增长。其中4名患者行口外或口内手术入路茎突截短术,手术效果良好。结论CT容积漫游技术（volume rendering technique,VRT）较x线平片更能直观准确地显示茎突形态和长度。茎突截短术是茎突综合征有效的治疗方法。     

茎突过长综合症1例

在正常情况下,茎突长短影响不大,我科于2005年4月7日收治1例茎突过长而引起综合症状患者.     

改良舌腭弓L形切口治疗茎突过长综合征临床体会

目的探讨茎突过长综合征的诊断、改良舌腭弓L形切口手术治疗方法及术后疗效。方法回顾性分析16例采用改良舌腭弓L形切口手术治疗茎突过长患者的临床资料,分析其病史、临床症状、诊疗经过、影像学检查,随访观察手术效果并对患者术前术后疼痛情况进行VAS评分记录。结果 16例采用改良L形舌腭弓切口的患者术后患侧茎突长度平均为(2.17±0.52) cm,均无创口开裂、感染、出血等并发症;在术后至少6个月随访中,87.5%(14/16)患者症状完全消失,12.5%(2/16)患者症状明显缓解;术后VAS疼痛评分(0.38±0.62)分较术前(3.94±0.68)分有明显降低(P<0.05)。结论茎突过长综合征在临床诊断上易误诊,通过扁桃体窝扪诊以及影像学检查可有效提高确诊率,基于手术使用改良舌腭弓L形切口在保留扁桃体的同时可以有效截短,且患者术后疗效满意,在短期内随访未发现其他手术并发症,此法对于临床治疗茎突过长综合征有一定指导意义。     

茎突舌骨综合征一例报告

茎突舌骨综合征一例报告高庆红陈亚多茎突舌骨综合征，亦称Ｅａｇｌｅ综合征，临床少见。作者曾收治一例，现报道如下。患者王某某，男，５９岁，７年前感大张口时左侧颈部轻微刺痛，未作治疗。２月前，感疼痛明显，并出现吞咽时疼痛，到我院就诊。入院查体：全身情况好，...     

茎突综合征12例临床分析

目的 总结茎突综合征的临床表现、提高该病的诊断率。方法 对12例（14侧）茎突综合征病例的临床表现和治疗进行分析。结果 9例（11侧）确诊茎突过长，在全景X线片上测量，最短者27mm，最长达38mm。茎突向内侧弯曲2例，1例茎突舌骨肌韧带骨化，X线片显示茎突增粗。本组病例均行颈侧手术径路茎突切短术，茎突切除最长18mm，最短6mm，手术效果好。结论 茎突综合征不单是由于茎突过长所致，还与其方位与形态异常有关。全景片可作为其常规检查方法。茎突切除或截短术是最有效的治疗方法。     

茎突综合征：附5例报告

茎突综合征（附５例报告）天津医学院第二附属医院口腔颌面外科张兆祥天津医学院第二附属医院耳鼻喉科袁洁清茎突综合征（茎突——舌骨综合征）又称Ｅａｇｌｅ氏综合征。１９３７年Ｅａｇｌｅ氏首先报告了这一病征，因茎突过长引致咽痛、咽部异物感、吞咽痛、舌根侧缘痛、...     

茎突舌骨综合征23例诊治分析

目的：探讨茎突舌骨综合征的诊断和治疗特点。方法：对经手术治疗的23例茎突舌骨综合征的临床资料进行回顾性研究．探讨其临床症状、年龄、性别、茎突长度、临床检查等在该病中的特点,比较口咽径路和颈外径路手术治疗的价值。结果：(1)口咽部疼痛和异物感是该病的主要症状,占83％（19／23),其次为头痛、舌痛和耳部不适,占43％(10／23)。(2)女性发病多于男性。50～59岁和30～39岁为好发年龄,分别占43％(10／23)和30％(7／23)。(3)切除之茎突中91％(21／23)长度大于3cm,9％(2／23)的茎突短于3cm,但形态异常。(4)57％(13／23)的过长茎突可从口咽部触及。(5)通过颈外径路手术治疗能够安全、彻底地切除各种类型的病变茎突。结论：茎突舌骨综合征是头颈部疼痛的原因之一．完整的病史、仔细的茎突触诊以及影像学检查有助于该病的诊断。经颈外径路行茎突截除术是治疗该病的有效方法。     

35例茎突综合征临床分析

茎突综合征（ｓｔｙｌｏｉｄｓｙｎｄｒｏｍｅ）又称Ｅａｇｌｅ综合征,茎突过长综合征,茎突—舌骨综合征,临床上并不多见。作者对中山医科大学孙逸仙纪念医院口腔颌面外科的３５例茎突综合征作临床分析,报告如下。材料和方法１－一般资料：本组病例中男性９例,女性２６例;其中左侧１４例,右侧１９例,双侧２例;年龄最小２５岁,最大６４岁。平均４２．３岁,病程５个月～５年,均无家族史。临床表现为咽痛、咽不适感、耳颞部痛,下颌后凹或颈部痛、偏头痛等,但各有侧重,其中以咽部症状为主的占２０例,以头颈痛为主的占１５例。有…     

茎突综合征和翼钩综合征手术疗效与病理学观察

茎突综合征 (Ｓｔｙｌｏｉｄｐｒｏｃｅｓｓｓｙｎｄｒｏｍｅ ,ＳＳ)和翼钩综合征 (Ｐｔｅｒｙｇｏ ｕｎｉｆｏｒｍｅｓｙｎｄｒｏｍｅ ,ＰＳ)病因未完全明了 ,其临床表现极为相似 ,治疗措施相仿[1] 。为进一步探讨ＳＳ和ＰＳ病因及其手术治疗疗效。作者自 1997年 1月～ 2 0 0 1年 6月对 5 9例ＳＳ和ＰＳ患者分别作茎突切除术和翼钩切除术 ,观察手术疗效及其组织病理学改变。1　材料与方法1.1　研究对象ＳＳ患者 36例 (男 14例 ,女 2 2例 )中 ,左侧 16例 ,右侧 18例 ,双侧 2例。ＰＳ患者 2 3例 (男 8例 ,女 15例 ) ,其中左侧 9例 ,右侧 11例…     

颌面专用CT茎突检查技术的确立

目的：观察茎突的形态、长度及其比邻关系。探讨颌面专用CT（QR—DVT 9000 NEWTOM）茎突检查技术在常规X线检查中的优势。方法：对茎突疾病患者进行颌面专用CT扫描，对感兴趣区重建成像。结果：颌面专用CT是不需要特殊的体位，对被检查部位的扫描一次完成，对感兴趣区重建轴位影像进行矢状面、3D等影像处理分析，可以显示出茎突的真实影像。结论：颌面专用CT成像技术优于常规X线、平面及曲面断层检查，清楚地显示茎突的形态、长度及其比邻关系等信息。对茎突疾病具有重要的诊断价值，更能有效地指导临床手术。     

Retromandibular transparotid approach compared with transmasseteric anterior parotid approach for the management of fractures of the mandibular condylar process: a prospective randomised study

Fractures of the mandibular condyle lead to displacement of the condyle and loss of the height of the ramus. A retromandibular approach is the most commonly used for open reduction and internal fixation (ORIF) of such fractures. We aimed to compare the complications associated with a retromandibular transparotid approach with a retromandibular transmasseteric anterior parotid (TMAP) approach for their management. Thirty patients were randomly selected into two groups (15 in each): Group A comprised the retromandibular transparotid approach and Group B the retromandibular TMAP. The variables evaluated were: operating time, facial nerve injury, occurrence of Frey syndrome, and sialocoele at one week, four weeks, three months, and six months. The mean (SD) age in group A and B was 33.93 (17.97) years and 33.53 (16.15) years, respectively, and there were 28 men and two women. Mean (SD) exposure time in the transparotid approach was 26.93 (5.19) minutes and 25.4 (8.35) minutes in the TMAP approach. The incidence of facial nerve injury was 2/15 patients in the transparotid group and 3/15 in the TMAP group, all of which resolved within six months. The incidence of sialocoele was 2/15 in the transparotid group. The results did not show any significant difference in complications between the two approaches, but the retromandibular transparotid approach provided straight-line access in fractures of the condylar neck, with fewer incidences of nerve injury. The anterior parotid approach, on the other hand, provided easier access for fractures that were medially dislocated or of the condylar base but had an increased incidence of facial nerve injuries.     

A study of unfavorable splits in the sagittal ramus osteotomy with a short lingual cut

In the bilateral sagittal split osteotomy, a short lingual cut is made on the medial side of the ramus; however, in some cases, a true fracture occurs on the buccal side of the ramus. The purpose of this study was to evaluate the relationship between the splitting pattern of the mandible and the form of the mandible, the surgical technique used, and the postoperative occurrence of relapse after ‘unfavorable’ splits. The investigation examined 143 patients in whom a short lingual cut was attempted. The rate of unfavorable split was 14.7% (42/286). A strong correlation was observed between the reach of the lateral bone cut to the inferior border of the mandible and an unfavorable split. According to multivariate regression, the factors leading to an insufficient lateral bone cut were the degree of inward curvature of the ramus (P = 0.001) and the position of the lateral bone cut (P = 0.002). There was no significant difference in relapse between cases of unfavorable and normal splits. An unfavorable split does not affect the prognosis of the occlusion, but it is important to confirm the inward curvature of the ramus and set the position of the lateral bone cut adequately to avoid unfavorable splits.     

口内切口内镜辅助下行髁突骨折复位内固定

目的探讨内镜辅助下经口内行髁突骨折复位固定的可行性。方法经口内切口到下颌骨髁突外侧,辅以颊部小切口,利用内镜等特殊器械完成手术操作。结果复位固定3例患者,术后无面神经损伤,张口正常,咬合关系正常,咀嚼力正常。结论口内入路内镜辅助下行髁状突骨折复位与固定的方法具有安全、创伤小、疤痕小等微创外科手术特点。     

下颌骨髁状突骨折手术进路和固定方式的回顾性研究

目的:评价成人髁突骨折手术方法、内固定技术与临床分类的关系。方法:2 8例共3 4侧成人髁突骨折病例按不同标准进行分类,对采用不同手术进路、内固定技术进行分析,根据其分型进行对照研究。结果:以开口度、开口型、咬合关系、X线检查、咀嚼力、关节及周围肌肉弹响和疼痛等6个方面作为评价标准,手术优良率为92 .8%。结论:成人髁突骨折手术前必须精确分型、正确诊断,根据分类采取不同的手术进路和内固定技术是取得成功的关键。     

Maxillary-fronto-temporal approach for removal of recurrent malignant infratemporal fossa tumors: Anatomical and clinical study

PurposeFor recurrent malignant tumors occurring in the infratemporal fossa, it is difficult to select a proper surgical approach. We explore the efficiency of a new approach for removal of recurrent malignant tumors involving the infratemporal fossa based on the measurement on three-dimension CT, observation of six cadaveric specimens, and our surgical experience.Materials and methodsThe distances between the surgical landmarks in the infratemporal fossa were measured using CT data to determine the safe distance. And anatomy observation was examined on 6 formalin-fixed cadaveric specimens. Data from seven patients with recurrent malignant infratemporal fossa tumors were retrospectively analyzed.ResultsThe mean distance of the medial pterygoid plate from the zygoma was 52.12 mm. The maxillary artery can be found between the deep surface of the condyle and the sphenomandibular ligament, with mean distance of 8.25 ± 3.22 mm to the inferior border of the capsule of the temporomandibular joint. All tumors got gross resection using the maxillary-fronto-temporal approach with minor complication.ConclusionsThe advantages of the new approach include adequate protection of facial nerve with extended operation field; the exposed temporal muscle could be used to fill the dead space. This technique is especially useful to remove recurrent malignant infratemporal tumors safely.     

老年人短周期全科序列义齿修复治疗的临床应用

目的：研究老年人短周期义齿修复技术的临床运用原则并初步评价其临床疗效。方法：2008年6月至2009年8月从我院口腔门诊就诊患者中选择需要义齿修复的老年人,随机分为短周期序列修复组：年龄65-92岁,平均：74.14±6.93岁,男性7例,女性10例;正常修复组：年龄65-85岁,平均：72±5.15岁,男性：8例,女性：6例。应用微创拔牙、无翻瓣种植、即刻种植即刻修复、附着体义齿修复、即刻临时义齿等技术,完成咬合重建,随访三个月到十个月。结果：短周期修复序列组患者咬合重建时间为：47±30天,正常修复序列组患者修复时间95±25天,两者比较有明显差异（P〈0.05）。短周期序列修复序列组的29枚种植体骨结合良好,目前种植体存留率为100%,行使功能良好。短周期序列修复序列组患者对义齿修复效果均满意。结论：老年人短周期义齿修复的临床效果是可以预期的。可以缩短患者缺牙时间,减少手术创伤和拔牙后的牙槽骨吸收,并在最短的时间内重建患者口内咬合功能,明显改善老年人的生活质量。     

微种植支抗螺钉植入部位及植入方法研究

目的:对比观察3个不同部位种植体植入手术对微型种植支抗螺钉(简称微螺钉)植入后的影响。方法:在105例患者中随机选择45例错畸形患者,采用不完全翻瓣微螺钉植入方法,在牙槽骨的3个不同部位共植入微螺钉90枚。结果:植入在3个不同部位的微螺钉其成功率各有不同,微螺钉植入后周围组织的炎症程度存在差异;植入在膜龈联合处及角化程度高的腭侧粘膜区域其成功率最高(约90%),植入在游离龈处的成功率最低(约70%)。结论:种植支抗能有效提供矫正治疗中所需要的绝对支抗;在角化龈或膜龈联合处,采用不完全翻瓣微螺钉植入法,有利于其提高植入成功率、降低炎症程度及防止潜在风险的发生。     

Facial scars resulting from a transbuccal approach during osteosynthesis of a sagittal split osteotomy: A retrospective study

The purpose of the current study was to assess the quality of facial linear scars. The Stony Brook Scar Evaluation Scale (SBSES) was developed and validated as a tool to assess postoperative scars.Postoperative facial scars were rated using high-quality macrophotographs and SBSES by three independent raters at baseline and three months thereafter. Percentage agreement (PA) and intraclass correlation coefficient (ICC) were used to measure interrater and intrarater reliability. Scar outcomes ranging from 0 (worst) to 5 (best) were evaluated against age and gender.One-hundred-sixty-six patients with a mean age of 30.6 years (range of 17–59) were included in this study. Forty-four were male (26.5%), and 122 were female (73.5%). Mean total SBSES scores were 4.63 (range of 4.56–4.76) at baseline and 4.60 (range of 4.54–4.72) at three months. As patient's age increased, mean total SBSES scores also decreased significantly (r = −0.216, p = 0.005). Gender did not significantly affect raters’ perception of scar cosmesis (p = 0.847). Interrater reliability showed an ICC of 0.675 (95% CI, 0.609–0.731) and a PA of 65.4% at baseline, and an ICC of 0.655 (95% CI, 0.585–0.715) and a PA of 64.2% at three months. Intrarater reliability found ICCs ranging from 0.988 to 0.990 and a PA of 96.8% with 3 separate raters.Within the limitations of the study it seems that the transbuccal approach during osteosynthesis of a sagittal split osteotomy seems still to be acceptable when the patient gives his or her informed consent and advanced instruments like an angled screwdriver are not available.