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目的 比较不同类型颧上颌复合体(zygomaticomaxillary complex,ZMC)骨折后眶下神经的损伤情况。方法 参照经典Zingg分类法,对2015年收治的70例单侧ZMC骨折进行分类,并测定其患侧与健侧眶下神经支配区皮肤的痛阈及两点辨别觉。利用不对称指数(asymmetry index,AI)对眶下神经损伤情况进行比较。应用SPSS19.0软件包对数据进行统计学分析。结果 70例ZMC骨折患者患侧眶下神经支配区均有不同程度感觉异常。对痛阈的测定结果显示,不同骨折类型间眶下神经损伤程度存在显著差异(P<0.05);两点辨别觉测定结果显示,B型与C型较A型骨折神经损伤程度更严重(P<0.05),B型与C型骨折间神经损伤无显著差异。结论 ZMC骨折容易引起眶下神经损伤, B型骨折患者神经损伤情况最重, A型骨折神经损伤最轻。 相似文献
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颧上颌复合体骨折的诊断与治疗 总被引:6,自引:0,他引:6
颧上颌复合体是面部最突出的部位之一,由于其解剖部位的特殊性,颧上颌复合体骨折在面中部骨折中占有相当大的比例。骨折后不仅引起局部凹陷畸形,甚至导致开口受限、复视等功能障碍。作者结合文献复习和临床经验,对颧上颌复合体骨折的原因、临床表现、治疗方法、手术入路和术后并发症等进行了讨论。认为眉侧切口联合口内切口入路,可以避免冠状切口的种种弊端。此法可在直视下开放复位,较好地暴露颧骨、上颌骨连接处及眶下区骨折,切断颧骨咬肌附丽,松解颧骨骨折块,再进行内固定,效果良好。手术后瘢痕小,面神经功能无损伤,外形及功能恢复良好,值得推广。 相似文献
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颧-眶复合体骨折的研究进展 总被引:1,自引:0,他引:1
颧-眶复合体解剖结构及毗邻关系复杂,骨质强弱不均,其损伤多样化,常伴有眼球运动复视和视力障碍,对其分类尚未规范化.三维CT重建是最好的诊断方法.颧-眶复合体骨折的治疗原则是重建面中部垂直及水平力柱和眼眶架结构,颧蝶缝是骨折固定的关键部位,术中应首先考虑颧弓的准确复位,眶底骨的重建是治疗的重点之一,可选用自体骨或非生物材料移植来完成. 相似文献
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目的 :探讨计算机导航结合个性化钛网进行颧上颌复合体(zygomaticomaxillary complex, ZMC)伴眶壁骨折修复重建手术的临床效果。方法:回顾性分析2018年6月—2020年12月我院收治的6例ZMC伴眶壁骨折患者的临床资料,所有患者均应用计算机导航及个性化钛网进行骨折修复重建手术。测量术前、术后健侧与患侧的眶容积,并采用配对t检验比较术前、术后健侧与患侧的眶容积差。术后常规复查,对瞳孔位置、复视情况、伤口愈合情况、面部外观及相关功能进行评价并随访,术后随访3~12个月。结果:术前健侧与患侧的眶容积差为(5.25±2.34) mL,术后健侧与患侧的眶容积差为(1.98±1.21) mL,两者差异有统计学意义(P<0.05);术后复视情况为5例治愈,1例好转;所有患者术前均有不同程度的瞳孔位置变化及眼球运动功能障碍,术后所有患者瞳孔位置变化及眼球运动功能障碍均得到明显改善;所有患者手术创口愈合良好,均未出现神经损伤、感染、植入体排斥等并发症,患者对术后外形、功能恢复满意。结论:计算机辅助手术导航结合个性化钛网进行ZMC伴眶壁骨折修复重建是一种精确、可行的方法,... 相似文献
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眶颧复合体骨折112例临床分析 总被引:3,自引:0,他引:3
目的 探讨眶颧复合体骨折的致伤原因、临床特点及治疗方式选择。方法 对 112例眶颧复合体骨折病例进行回顾性分析。结果 Ⅰ型骨折 2 4例 (2 1.4 % ) ,Ⅱ型骨折 5 1例 (4 5 .6 % ) ,Ⅲ型骨折 37例 (33% ) ,合并上下颌骨骨折 2 1例。 10 3例眶颧复合体骨折患者进行了手术治疗 ,其中 70例通过冠状切口入路 ,所有手术病例都进行钛板坚强内固定术。结论 眶颧复合体骨折应及时治疗 ,进行准确复位和坚强内固定。 相似文献
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个体化数字导板在颧眶复合体骨折中的应用 总被引:2,自引:0,他引:2
目的探讨个体化数字导板在单侧颧眶复合体骨折中的应用。方法 4例单侧颧眶复合体骨折患者,术前行头颅螺旋CT容积扫描,CT数据经重建软件处理,在虚拟三维头颅模型上模拟手术并设计复位导板,通过快速成型技术制做实体导板,术中引导骨折块复位。术后对手术效果进行评价。结果患者术后面部形态、功能满意。面宽及颧骨体高度双侧对称。结论个体化数字导板应用于颧眶复合体骨折的整复,可以明确骨折的复位位置,有利于骨折的精确复位,并且减少了手术的操作时间,达到更佳的手术效果。 相似文献
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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。 相似文献
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目的:探讨颧-眶复合体骨折的临床特点及头皮手术的临床效果分析.方法:对53例颧骨复合体骨折病例回顾性分析,手术通过头皮冠状切口入路、睑缘下和口内前庭沟切口,直视下解剖复位、固定;骨折断端进行钛板坚强内固定,眶底缺损用人工替代材料medpor进行重建,术前及术后通过临床观察和头颅三维螺旋CT检查评价治疗效果.结果:术后面中份及眼眶外形明显改善、咬合关系和张口度明显改善.陈旧性骨折的恢复相对较差.结论:多个切口入路能充分暴露骨折断端,有利于骨折段解剖复位,颧-眶复合体骨折应把握手术时机及时治疗、进行准确复位和应用替代材料重建眶结构. 相似文献
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D. SAKAVICIUS G. JUODZBALYS R. KUBILIUS G. P. SABALYS 《Journal of oral rehabilitation》2008,35(12):903-916
Summary The aim of this study was to investigate the severity of infraorbital nerve injury following zygomaticomaxillary complex fractures and to estimate the treatment methods facilitating its functional recovery. A total of 478 patients with unilateral zygomaticomaxillary complex fractures were treated. Infraorbital nerve sensory disturbances were diagnosed in 64·4% of the patients. Injury of the infraorbital nerve was expressed as asymmetry index, which was calculated as a ratio between the affected side and the intact side electric pain detection thresholds at the innervation zone skin before treatment and 14 days, 1, 3, 6 and 12 months postoperatively. A mean asymmetry index of 0·6 ± 0·03 and 1·9 ± 0·5 was registered for 57 (11·9%) patients with hyperalgesia and for 251 (52·5%) patients with hypoalgesia, respectively. As a result of retrospective analysis of infraorbital nerve sensory disturbances and its functional recovery, infraorbital nerve injury severity was classified as mild, moderate and severe. It was found that the dynamics and outcome of the functional infraorbital nerve recovery depend on the severity of the injury and the presence of infraorbital canal damage. Function was completely recovered within 3 months after treatment in cases with mild nerve injury. In moderate cases, complete recovery was seen within 6 months and in 34·6% of the severe cases, within a 12‐month period after treatment when infraorbital nerve decompression was performed according to the stated indication. Treatment based on infraorbital nerve injury classification offers a better prognosis for complete recovery of the infraorbital nerve function. 相似文献
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鼻眶、颧上颌骨骨折与视力损伤的临床研究 总被引:4,自引:1,他引:3
目的 探讨鼻眶,颧上颌骨骨折与视力丧失的关系。方法 对175例因鼻眶,颧上颌骨骨折病例进行回顾,并对其致病因素,骨折类型,视力损伤情况,临床处理及转归进行分析。结果 21例发生视力丧失或大部分丧失,其中鼻眶,颧上颌骨骨折导致单眼失明9例(4.57%),视力大部分丧失12例(7.43%),眼球摘除术2例,交通事故13例,其中5例失明。结论 鼻眶,颧上颌骨骨折可导致视力丧失,男性比女性更易导致视力丧失。临床处理应给予重视,正确评估眼外伤情况,挽救残存视力,促进视力恢复。 相似文献
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目的:分析颧骨复合体骨折临床特征,以提高其诊治水平。方法:回顾分析2001~2005年收治的20例颧骨复合体骨折病历资料。男16例,女4例,年龄20~50岁。结果:手术采用头皮冠状切口入路15例,头皮冠状切口加口内切口入路4例,1例另加睑下缘切口,术后1、2、6月追踪观察面部外形,开口度及咬合关系恢复情况良好。结论:三维CT重建是颧骨复合体骨折最佳检查方法,头皮冠状切口头皮是颧骨复合体骨折复位理想的手术方式。 相似文献
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Rohit Sharma Shailey Singh Seema Patrikar 《The British journal of oral & maxillofacial surgery》2018,56(1):29-33
We designed a retrospective study to evaluate the efficacy of retroseptal transconjunctival approaches in the management of fractures of the zygomaticomaxillary complex (ZMC). The patients were from a single institution, and had had three-point fixation of fractures of the ZMC between 2008 and 2016. A total of 77 patients (56 men and 21 women with a mean (range) age of 28 (18–54) years), were divided into two groups. Group I (n = 51) had had reduction and fixation of the infraorbital rim using a retroseptal transconjunctival approach. In group II (n = 26) the same approach had been used with lateral canthotomy and inferior canthlolysis for both the infraorbital rim and the zygomaticofrontal region. We analysed the association of both approaches with the outcomes of reduction, fixation, and complications. Suboptimal results were found in 13 patients in group I and one in group II (p = 0.017). There were also three patients with trichiasis and two with entropion in group I, and one each of both complications in group II. There was only one patient with a malopposed lateral canthus in group II. All 26 patients in group II had no perceptible scar along the extended line of incision. The risk of a suboptimal outcome was reduced by 20% (relative risk = 0.8) in group II. The retroseptal transconjunctival approach with lateral canthotomy and inferior cantholysis is safe, aesthetic, and effective in the management of fractures of the ZMC. 相似文献
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目的评价可吸收钉板在上颌骨与全面部骨折中的应用。方法选择2011年6月至2018年7月在武汉大学口腔医院口腔颌面创伤与颞下颌关节外科接受治疗的涉及上颌骨骨折的患者244例。全面部骨折的纳入标准是同时包含上颌骨骨折、颧骨颧弓眶骨骨折和下颌骨骨折。所有患者均主动要求使用可吸收钉板系统进行内固定。对其人口统计学信息、治疗情况和随访结果进行回顾性分析。结果 244例患者的上颌骨骨折部位全部使用可吸收钉板进行内固定,其中男145例,女99例;年龄6~73岁,平均35岁;上颌骨Le FortⅠ型骨折36例,Le FortⅡ型骨折111例,Le FortⅢ骨折型97例。涉及额骨骨折3例,鼻骨-眶-筛骨(NOE)复合体骨折42例,上颌骨矢状骨折37例,全面部骨折36例。全面部骨折患者中,颧骨颧弓眶骨、上颌骨、下颌骨同时使用可吸收钉板固定的有14例;仅颧骨颧弓眶骨、上颌骨同时使用可吸收钉板固定的有6例;仅颧骨颧弓眶骨使用可吸收钉板固定的有14例;另外2例患者的情况与上述三种分类均不符合。所有患者术前均有面部畸形,且出现咬合紊乱。复位和修复全面部骨折的方法按照\"由简单到复杂\"进行序列复位固定的原则。术后并发症情况:3例轻度错[牙合]畸形,1例颧骨部分缺损,1例眼球内陷,4例创伤瘢痕,2例眼睑下睑萎缩,2例颞肌萎缩。结论灵活应用可吸收钉板进行上颌骨及全面部骨折复位固定具有可行性。软组织问题引起的手术后并发症,包括撕裂和不对称,难以避免。 相似文献
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眶下进路在颧骨复合体骨折中的应用 总被引:1,自引:0,他引:1
目的:寻求颧骨复合体骨折手术治疗减小面部遗留瘢痕的方法。方法:对51例患者采用改良式眶下进路治疗颧骨复合体骨折,对以往眶下缘切口从睑缘改为骨性眶下缘位置即在患者下睑缘下1cm处,相当于眼轮匝肌下方眼袋的位置作同眼轮匝肌方向一致的弧形切口,切开皮肤皮下组织,钝性分离,推眼轮匝肌向上后直达眶下缘,切开骨膜,暴露眶下缘骨折处,其它小切口未做改变。术后均随访2~3个月,对其疗效进行评价。结果:切口隐蔽性好,而且可以充分暴露眶下缘、眶外侧壁、颧弓以及颧牙槽嵴骨折端,所有患者术后均Ⅰ期愈合,患者术后颧骨左右对称性、咬合功能及局部感觉均获得满意效果,除1例由于是疤痕体质面部小切口疤痕比较明显外,其余病例面部疤痕均不明显。结论:该方法创伤小,显露好,路径短,顺皮纹方向,只留下线样切口愈合,疤痕小不影响面部的整体美观。 相似文献
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Bradley Karkut Al Reader Melissa Drum John Nusstein Mike Beck 《Journal of the American Dental Association (1939)》2010,141(2):185-192
BackgroundThe efficacy of the extraoral infraorbital nerve block has not been studied sufficiently to ensure its appropriate clinical use. To compare the local anesthetic efficacy of the extraoral versus the intraoral infraorbital nerve block, the authors conducted a prospective, randomized crossover study.MethodsForty adult participants randomly received extraoral infraorbital nerve blocks of 1.8 milliliters of 2 percent lidocaine with 1:100,000 epinephrine at one appointment and intraoral infraorbital nerve blocks of 1.8 mL of 2 percent lidocaine with 1:100,000 epinephrine at another appointment in a crossover design. After administering the injections, the authors used an electric pulp tester to assess the maxillary central and lateral incisors, canine, premolars and first molar for pulpal anesthesia in four-minute cycles for 60 minutes. They considered anesthesia to be successful when the participant had no response to two consecutive 80 readings (the maximum output) with the electric pulp tester.ConclusionsThe authors found that the extraoral and intraoral infraorbital nerve blocks were ineffective in providing profound pulpal anesthesia of the maxillary central incisor (15 percent success rate) and lateral incisor (22 percent success rate). The pulpal anesthesia success rate was 92 percent for the canine for both types of nerve blocks, 80 to 90 percent for first and second premolars and 65 to 70 percent for the first molar, with no significant differences (P < .05) between the two nerve blocks. Pulpal anesthesia did not last for an hour in any of the teeth. Needle insertion pain and postoperative sequelae were more common after the extraoral infraorbital nerve block was administered.Clinical ImplicationsBoth nerve blocks would be ineffective in the central and lateral incisors. Both nerve blocks would be somewhat successful in the canine and premolars but not in the first molar. 相似文献
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目的:探讨计算机辅助治疗技术在颧上颌骨复合体骨折中的应用.方法:总结2008-10-2010-10期间于我科就诊的24例接受计算机辅助治疗颧上颌骨复合体骨折患者的临床资料,术前建立骨折三维模型并利用快速成型(rapid prototyping,RP)技术制作出个性化的实体模型,指导临床进行骨折段的复位与固定.结果:术后... 相似文献
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Saulacic N Lombardi T Stojcev-Stajcic L Iizuka T Stajcic Z 《Journal of oral pathology & medicine》2012,41(3):268-271
J Oral Pathol Med (2012) 41 : 268–271 Purpose: The aim of this study was to investigate the histomorphological changes of the infraorbital nerve of rats treated with ampicillin. Materials and Methods: The infraorbital nerve was approached through the infraorbital foramen, and 0.01 ml of ampicillin dissolved in distilled water was injected taking care not to damage the nerve. Saline solution was used in control animals. Nerves were dissected and after routine histology processing analysed by light microscopy. Results: Cross‐section of the nerve treated with ampicillin showed damaged axons with disintegration of heavily myelinated fibres, while thinly myelinated fibres remain unaffected. In the saline group, no damage was observed. The signs of regeneration of the damaged infraorbital nerves were detected on the fourth post‐operative week. Conclusion: Ampicillin can cause peripheral nerve damage when injected perineurally. 相似文献