现代创伤救治理念与口腔颌面部多发伤救治

多发伤的救治需要应用现代创伤救治理念,通过加强多学科间的合作,共同制定救治方案,达到理想的救治效果。本文在了解现代创伤救治理念,理解理念要点的基础上,分析口腔颌面部多发伤救治中伤情评估的策略和方法,探讨专科救治的时机和影响因素,提出伴发身体其他部位损伤的颌面伤患者综合救治中专科确定性手术的时机和适应证,以加深口腔医学专业医生对现代创伤救治理念的理解,提高其对口腔颌面部多发伤的救治能力和治疗效果。     

合并多发伤的口腔颌面骨折47例救治体会

目的: 观察合并多发伤的口腔颌面骨折的救治效果。方法：对47例合并多发伤的口腔颌面骨折患者,在保持呼吸道通畅,保持生命体征稳定的前提下,与相关专科合作,处理颅脑外伤、胸腹外伤、骨盆或长骨骨折等多发伤。处理口腔颌面骨折的重点是在骨折复位后以微型钛板作坚固内固定,辅以颌间固定,坚持术后功能锻炼。结果：47例患者均无严重并发症发生,口腔颌面外伤治愈率为95.74%。结论：合并多发伤的口腔颌面骨折应根据伤情和严重程度决定救治次序,针对不同类型颌面骨折,选择合适的微型钛板作坚固内固定。     

颅面复合伤早期救治体会（附52例报告）

颅脑、颌面解剖结构邻近,常见合并损伤情况。据丁鸿才、周树夏等人统计,颌面伤合并颅脑伤的占13.17％,面骨骨折合并颅脑伤的占29％。临床上以颅脑伤为主,同时伤及颌面的颅面伤多由颅脑外科收治,而以颌面伤为主兼有颅脑损伤,且初诊时无颅脑急诊手术指征的颅面伤患者多由颌面外科收治,因     

30例口腔颌面部复合伤合并严重全身损伤救治的体会

随着社会不断进步 ,工业建设、城市交通、建筑等方面的飞跃发展 ,创伤有逐年上升趋势 ,对人类的危害也越来越严重[1] 。口腔颌面部损伤常伴有全身其他组织器官的损伤 ,在治疗上既要恢复口腔颌面部的形态与功能 ,又要考虑合并全身损伤的治疗 ,给治疗增加了较大难度。我院 1988～ 1999年收治 30例严重复合性损伤病人 ,经过多学科协同治疗 ,取得了较满意的疗效 ,现总结如下。1　临床资料1.1　性别和年龄　男性 2 5例 (83.3% ) ,女性 5例 (16 .7% ) ,年龄最大 6 5岁 ,最小 3岁 ,平均年龄 33.7岁。1.2　致伤原因　交通事故最多 2 1例 ,其中陆上交…     

颌面部交通事故伤患者191例的救治

目的 总结口腔颌面部交通事故伤患者救治的要点。方法 回顾分析191例口腔颌面部交通事故伤患者救治的临床资料。结果 本组191例,经过积极抢救,取得良好效果,均获治愈。结论 颌面部交通事故伤患者抢救要多科协作配合,采取综合抢救措施,密切观察病情是提高救治率的重点。?     

颅颌面部发育不对称多发畸形1例

患儿，女，4岁，汉族。主因面部不对称，腭部裂隙4年于2005年5月11日以“先天性软腭裂”收住院。4年前息儿出生时即被发现其面部两侧不对称，无左耳廓及外耳道，悬雍垂裂开，不能吮乳，面部不对称随其生长发育愈发严重。既往体健。患儿足月顺产，其母妊娠期间无特殊感染及不适。家族中无类似患者，无其他遗传病患者。临床检查：全身情况，意识清楚，智力正常。心肺肝脾未见明显异常，脊柱四肢无畸形，活动自如，肛门、外生殖器未见异常。口腔颌面外科检查：头稍偏向左侧，面部两侧不对称，左侧睑裂稍小并向下倾斜，正视前方时眼球向外上转，眼睑可闭合，视力弱。     

颌面部创伤休克28例的救治体会

创伤休克是颌面损伤严重的并发症,是伤员死亡的主要原因之一。因此,防治创伤性休克是抢救伤员生命的重要课题。近20年来,我科成功地救治了颌面部创伤休克28例(不完全统计资料)。现就诊断和救治情况报告如下。临床资料28例中,男22例,女6例。年龄最小者5岁,最大者60岁。其中24例为非火器伤,4例为火器伤。包括颈外动脉和颈内动脉破裂伤各1例,颈内静脉破裂伤     

颌面部爆炸伤13 例的救治体会

颌面部爆炸伤,由于其伤情复杂,损伤面积较大,伤口内常有异物存留,污染严重,给临床救治带来一定困难。现将我科在１９９０年至１９９６年间收治的１３例颌面部爆炸伤救治体会总结如下,供同道参考。１临床资料本组１３例颌面部爆炸伤均为男性,年龄２２～４３岁,平均...     

颌面部损伤伴复合伤76例临床分析与治疗

目的探讨颌面部损伤伴常见复合伤的伤情特点、救治原则及处理要点。方法对76例颌面部损伤的患者进行回顾性临床分析。结果颌面部损伤高发年龄段为20~40岁,占60%,致伤原因以交通事故居首位,占64%。患者经过及时、综合、多科联合治疗,除1例颌面部损伤并发颅底骨折、硬脑膜下血肿及另1例并发颈椎脱位而死亡,其余患者均获得渐愈或治愈。结论在颌面部损伤患者的诊治过程中要做到及时抢救,全面检查,联合治疗。     

分诊制下326例口腔颅颌面创伤急诊住院患者临床分析

目的： 总结分诊制下口腔颅颌面创伤急诊救治经验。方法： 回顾分析2020年9月—2021年8月间上海交通大学医学院附属第九人民医院南部院区口腔颅颌面创伤患者急诊接诊救治情况。期间共接诊36 599例患者,急诊留观处理1 683例,住院治疗326例。收集住院患者入院前处理情况,包括基础生命支持（急诊止血、液体复苏、损伤控制手术）、伤情、高级生命支持、多学科联合救治及转归情况等。采用SPSS 13.0软件包对数据进行统计学分析。结果： 326例急诊入院患者中,男253例,女73例,男女比例3.47∶1;年龄20~73岁,平均（41.64±15.34）岁。最常见原因为道路交通伤（169例）,其中电瓶车事故伤138例,占81.63%;其次为生活意外伤（89例）,其中跌伤65例,占73.01%;工伤33例,其中坠落伤14例,占42.42%;其他损伤35例。83例进行初级生命支持（心电监护、液体复苏,清创止血）,其中输血30例,气管插管或切开7例,石膏或支具外固定9例。65例实施损害控制性手术。235例直接收住口腔颅颌面科,54例根据创伤情况收入相应专科,37例收入EICU继续高级生命支持。所有患者均成功救治,326例患者经急诊或延期手术得到确切治疗,4例出院后做二期修复。结论： 采取急救辅助下的专科诊治是有效解决分诊制下日益增多口腔颅颌面创伤救治需求的有效措施。由急诊科牵头,强调以生命救治、器官功能保护和重建、社会回归为中心,在各个专科之间开展协作,是口腔颅颌面多发伤救治成功的关键。     

伴全身多系统创伤颌面伤患者的综合救治

目的:研究伴发身体其他部位创伤的颌面伤患者综合救治中专科确定性手术时机和适应证。方法:回顾性统计4所大型综合医院口腔科病房近20年收治的4 869例口腔颌面部创伤患者的临床资料,分析伴发身体其他部位创伤状况和专科手术时机。结果:4 869例患者中,面骨骨折3 364例,软组织伤1 505例。伴发其他部位创伤1 524例(占31.3%),其中颅脑伤570例(37.4%),肢体伤545例(35.8%),胸部伤170例(11.2%),眼创伤151例(9.9%),脊柱伤54例(3.3%),腹部伤34例(2.2%)。74%的颅脑伴发伤患者伤后4周内、76.2%的眼伴发伤患者伤后7d内进行了面骨骨折手术治疗。而肢体、脊柱、胸腹部伴发伤患者,面骨骨折手术均有不同程度延误。结论:伴发多系统创伤的颌面伤患者的救治需要多学科间的合作,在患者呼吸系统、循环系统等全身状况稳定的情况下,大部分颌面多发伤患者可以同期或早期进行专科处理。     

Fixation of bimaxillary osteotomies with resorbable plates and screws: experience in 20 consecutive cases.

PURPOSE: This study evaluated the potential effectiveness of resorbable plate and screw fixation for skeletal stabilization of simultaneously performed maxillary and mandibular osteotomies. PATIENTS AND METHODS: Twenty consecutive patients underwent simultaneous maxillary and mandibular osteotomies that were fixed using copolymeric poly L-lactic acid/polyglycolic acid (PLLA/PGA) plates and screws. Prefabricated acrylic intermediate and final splints were used as guides and then removed at completion of the surgery. Guidance elastics were applied at 2 weeks postoperatively. RESULTS: The LeFort I osteotomies included segmentalizations with and without bone grafts (7/20), impactions (4/20), advancements (8/20), and unilateral downgrafting with a bone graft (2/20)- one of which was segmental. The mandibular sagittal split osteotomies involved advancements (11/20), setbacks (5/20), and asymmetric rotation (4/20). Three patients had simultaneous genioplasties, which were also stabilized with resorbable fixation. All maxillae were fixed with four 2.0-mm L-shaped plates and screws. The mandibular rami were maintained with three 2.5-mm bicortical screws per side. The mandibular symphyseal segments were held in position with two or three 2.5 mm bicortical screws. All surgeries were accomplished uneventfully, and no problems in the immediate postoperative stability of the occlusion were encountered. Follow-up ranged from 12 to 25 months. CONCLUSIONS: The initial clinical findings suggest that this form of bone fixation is a viable alternative to standard metallic fixation techniques for certain maxillomandibular deformities in which excessive bony movements are not performed. Differences exist in both intraoperative application and postoperative management of masticatory function. This is partially a US government work. There are no restrictions on its use.     

25例颧上颌复合体骨折诊治方法的探讨

目的:对颧上颌复合体(ZMC)骨折的致伤原因、三维CT检查及坚强内固定方法进行回顾性分析。方法:25例患者均经三维CT检查、图像重建并行坚强内固定手术治疗,术后随访3～12个月。结果:25例患者中,交通事故伤13例(52%),工业事故伤5例(20%)。局部塌陷畸形21例,咬合紊乱19例,张口受限15例,复视伴眼并发症17例,眶下神经支配区麻木11例,5例伴有上颌矢状骨折。25例患者三维CT重建图像均清晰显示主体解剖图像及周围关系,图像直接显示了颌骨骨折的部位及空间结构关系。所有患者选用微型钛板行坚强内固定手术治疗,22例获得满意效果。结论:对于ZMC骨折患者,通过选择局部切口、冠状切口及前庭沟切口,用微型钛板行坚强内固定术,可以获得满意的疗效。     

Use of patient-reported outcome measures in oral and maxillofacial trauma surgery: a review

In the UK, about one person/100/year sustains a facial injury, so trauma surgery accounts for a considerable part of the caseload in oral and maxillofacial surgery (OMFS). Patient-reported outcome measures (PROM) allow for patient-centred assessment of postoperative outcomes, but to our knowledge, most research in OMFS trauma does not currently include them. To investigate their use, we searched Medline to find relevant studies that reported outcomes from inception in January 1879 to August 2016. Those not in the English language and those that did not report operations were excluded. We retrieved 416 articles, of which 21 met the inclusion criteria (five randomised controlled trials and 16 cohort studies) yielding 16 outcome measures. Most of these had been devised by authors (eight studies), four studies reported use of the Geriatric Oral Health Assessment Index, and three the Nasal Obstruction Symptom Evaluation. Most were used in studies on mandibular surgery (n = 13), followed by those on nasal and facial surgery (n = 3 each). There is a great heterogeneity in the use of these assessments in OMF trauma. In view of their increasing importance compared with simpler objective measures that may not be relevant to the patients’ own perception, more research is needed to establish which of them can be used to measure the QoL of patients treated for OMF trauma.     

内镜辅助下腮腺切除术14例报道

目的：探讨内镜辅助下进行腮腺手术切除的临床效果。方法：对2004年10月-2006年9月就诊的15例腮腺肿物住院患者采用无注气内镜辅助下腮腺切除手术。通过耳垂后下方皮纹小切口，在颈深筋膜浅层，采用高频超声刀切割分离，远端借助监视器锐性分离，暴露腮腺浅叶。内镜下解剖面神经主干及分支，超声刀切除腮腺，伤口负压引流。结果：耳垂后下方切口长4．0—5．4cm，平均4．8cm。手术麻醉时间平均115min。腮腺浅叶切除3例，部分腮腺浅叶切除11例。术后病理诊断为多形性腺瘤8例，Warthin瘤4例，淋巴上皮病1例，淋巴结反应性增生1例。随诊6～31个月，平均14个月。面神经轻度麻痹5例，均在6个月内恢复正常。结论：内镜辅助下腮腺切除手术适用于腮腺浅叶良性肿瘤的切除，切口小且隐蔽，手术创伤小，有利于患者的恢复。     

Management of a complex dentoalveolar trauma with multiple avulsions: a case report

Abstract –  Treatment of permanent tooth avulsions in an adolescent poses significant difficulties for the dental clinician. This case report gives details about the treatment of a complex dentoalveolar trauma involving multiple avulsions of primary molars, permanent incisors, permanent molars, and premolar toothbuds. Immediate treatment of the injury and short-term esthetic replacement of the dentition is described. A brief review of current research relative to the treatment of permanent tooth avulsions is provided.     

导航手术在颅颌面外科的应用及误差控制

导航手术越来越多地应用于颅颌面种植修复、损伤、面部整复、正颌外科、放疗及射频热凝治疗。精确性是导航手术的关键,误差的控制贯穿于影像获取、配准、实时跟踪及导航手术操作的各个步骤中。本文就颅颌面外科的导航手术应用及误差控制作一综述。