目的:通过系统评价研究髁突高位切除术治疗单侧髁突肥大(UCH)导致偏颌畸形的治疗效果.方法:运用计算机网络检索Medline(Pubmed)、Embase、Corchane图书馆、Web of Science、中国生物医学文献数据库中关于髁突高位切除术治疗UCH的研究,检索时间限制在 1985～2022 年.使用纽卡斯尔-渥太华量表(NOS)和MINORS清单对纳入的文献进行质量评价.使用Corchane图书馆支持的Review Manager 5.1 软件进行Meta 分析.结果:经过有效文献分析后发现,髁突高位切除术是治疗UCH的一种有效治疗方式;髁突高位切除术与髁突比例切除术对避免患者进行二次正颌手术的效果差异无统计学意义(RR=2.37,95％CI:0.33-17.16,P＞0.05);髁突高位切除术后患者进行正畸治疗对咬合关系改善的效果优于不进行正畸治疗(RR=0.05,95％CI:0.00-0.74,P＜0.05).结论:髁突高位切除手术是治疗UCH的一种有效方式,患者在术后需要行正畸治疗以改善咬合关系.

目的:观察流体剪切力(fluid flow shear stress,FFSS)刺激下大鼠原代髁突软骨细胞发生凋亡的特点.方法:采用16 dyn/cm2的FFSS刺激原代髁突软骨细胞0.5、1、2及4 h,用钙显色试剂盒检测细胞内钙离子(Ca2+)的变化;钙蛋白酶(Calpain)活性检测试剂盒检测Calpain的活性变化;荧光染色观察细胞骨架的变化;蛋白质印迹法(Western blot)检测踝蛋白1(Talin 1)、整合素β1(Integrinβ1)、促凋亡调节蛋白Bim、B细胞淋巴瘤-2蛋白(B-cell lymphoma-2,Bcl-2)、活化形式的胱天蛋白酶-3(Cleaved-Caspase-3)等凋亡相关分子的表达水平变化.结果:FFSS刺激原代软骨细胞不同时长后,细胞内Ca2+浓度均显著上升,在1 h时达到峰值,并一直维持在较高的水平;Calpain的活性早期明显升高,于1 h达到峰值,但4 h时又降至0 h组水平;肌动蛋白(F-actin)及其相关的Talin和Integrinβ1蛋白表达水平随加力时间的延长而降低;凋亡相关的Bim和Bcl-2蛋白表达水平分别呈现升高和降低的趋势;凋亡执行分子Cleaved-Caspase-3表达水平也逐渐升高(以上均P<0.05).结论:FFSS刺激可升高细胞内Ca2+水平,激活Calpain,增加Talin蛋白的水解,最终导致软骨细胞凋亡.

目的:使用人工智能检测正面照判断面部对称程度并评估其临床应用的可行性.方法:收集512名不对称牙颌面畸形患者正面照及正位X线头影测量片,分别利用自行编写的人工智能程序和Dolphin11.8软件进行分析,利用SPSS 25.0软件对两种方法获得的数据进行t检验.结果:双侧面部关键点与正中参考线的距离之比两种方法获得的数据均无显著的统计学差异(P>0.05);而咬合平面及面下1/3偏斜角度人工智能获得的数值小于头影测量值(P<0.05).结论:目前人工智能程序可以较准确的判断人脸双侧对称性,但对偏斜角度的测量尚需进一步改进.

目的:分析264例眶壁骨折患者的临床和流行病学特征.方法:对264例眼眶骨折患者的病历进行回顾性分析.根据年龄,性别,病因,症状,检查结果,骨折部位,相关的损伤,治疗和并发症对患者进行分析.结果:患者平均随访时间为6(3～ 10)个月.男女比例为4:1.平均年龄为33(6 ～82)岁.眼眶骨折的主要原因是交通事故(36.4％),其次是殴打(32.6％).发生率最高的骨折类型是眶内侧壁骨折(33％).主要症状为受伤部位疼痛(100％),检查主要发现眶周水肿和瘀斑(100％).最常见的相关损伤是脑外伤(14％).保守治疗134例(50.1％),手术治疗130例(49.9％).后期最常见的并发症是皮肤感觉丧失(11％).结论:眼眶骨折的主要原因是交通事故,其次是殴打.发生率最高的骨折类型是眶内侧壁骨折.

目的:通过活体动物实验观察人胰岛素样生长因子-1(insulin-like growth factor,IGF-1)与Sonic hedgehogxinh(Shh)介导的信号通路促进了髁突过度生长的作用.方法:制备IGF-1高表达表型转基因小鼠模型.将转基因鼠随机分为为5组:Cyclopamine刺激组;NVP-AEW541刺激组;IGF-1刺激组;Cyclopamine+IGF-1刺激组;生理盐水刺激组:空白对照,每组3只.随机选取一侧关节腔自31 d起隔天连续进行上述药物注射,共14 d,注射结束后收获实验侧髁突,固定,比较两侧髁突大小,分析差异性.结果:Cyclopamine刺激组及生理盐水刺激组实验侧与对照侧髁突大小比较差异无统计学意义.NVP-AEW541刺激组、IGF-1刺激组以及Cy-clopamine+IGF-1刺激组实验侧髁突小于对照侧髁突(P<0.05).结论:IGF-1介导的信号通路促进了髁突肥大髁突的过度生长.

目的 探讨牵张成骨术治疗小下颌畸形伴重度阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的效果.方法 选择2015-01～2017-12期间在该院诊断为小下颌畸形伴重度OSAHS并行牵张成骨术治疗的10例成年患者作为研究对象,观察治疗前后患者的外形、呼吸暂停低通气指数(AHI)、最低血氧饱和度、上气道狭窄处直径、颏部位置等改变情况.结果 10例患者夜间憋气、白天嗜睡等主观症状均消失,面型改善明显,最低血氧饱和度均升至正常范围内.9例患者AHI均降低至5以下,气道最狭窄处直径显著扩大,颏部平均前移距离为(15.72 ±2.94)mm.结论 对于由小颌畸形引起的重度OSAHS,牵张成骨术是一种非常稳定且有效的治疗方法.

目的:探讨Sonic hedgehog (Shh)与人胰岛素样生长因子-1(IGF-1)介导的信号通路在促进髁突肥大病理进程中的作用及串话机制.方法:选取正常髁突及髁突肥大软骨标本,以及骨髓间充质细胞(BMSC),体外分离进行平板及三维培养,按不同的实验目的划分为不同的比较组,每个比较组按不同的实验目的各含不同的刺激组,分别添加IGF-1,NVP-AEW541,Cyclpamine,U0126/LY294002因子等单独或联合刺激,孵育后收获细胞进行计数或进行real-time PCR或Western Blot实验.结果:髁突肥大软骨细胞中加入Cyclopamine,COLX、PCNA、MMP-13基因和蛋白表达量明显降低,而cleaved-easpase-3明显升高(P＜0.05),细胞数目明显降低(P＜0.05).添加Cyclopamine刺激的髁突肥大软骨细胞,磷酸化状态P-AKT和P-ERK均显著降低(P＜0.05),Cleavedcaspase-3蛋白表达水平显著升高(P＜0.05).在BMSC加强IGF-1及Shh的刺激后COLX、COL2、PCNA、MMP13、BCL2基因的表达量均明显升高(P＜0.05).单独加强IGF-1或Shh刺激,均可引起另一信号通路的加强(P＜0.05).结论:Shh与IGF-1介导的信号通路存在串话机制促进肥大髁突软骨细胞及间充质细胞增殖、分化及凋亡的作用,并通过PI3-K AKT和MAPK-ERK通路发挥作用.

Purpose: Our aim was to explore how the remodeling capacity of children's mandibular condyles affected the morphologic changes of fractured condyles after conservative treatment. Patients and Methods: A retrospective study was designed and performed in children and adult patients with mandibular condylar fractures. Computed tomographic imaging was reviewed for all patients to analyze the morphologic changes and risk factors for traumatic temporomandibular joint ankylosis. Results: From 2012 to 2017, 81 patients younger than 18 years and 10 adult patients accepted treatment in our department. There were 23 young patients (aged < 18 years) with 41 fractured condyles and 10 adults with 14 fractured condyles who were managed with conservative treatment, and the morphologic changes were analyzed with the aid of Mimics 19.0 software (Materialise, Leuven, Belgium). The fractured condyles with intracapsular fractures completed the remodeling progress within 3 to 4 months, and condyles with neck or base fractures took more than 6 months. In contrast, we found no remodeling in adults. Of the 81 young patients, 3 had temporomandibular joint ankylosis. Each case was analyzed regarding the risk factors, morphologic changes, and remodeling features. Finally, the common points of these cases were summarized. Conclusions: The shape of fractured condyles can be remodeled after conservative treatment in young patients instead of bony fusion between the fractured fragments compared with adult patients. (C) 2018 American Association of Oral and Maxillofacial Surgeons

Objective: To compare the effects of surgical and conservative therapy in the treatment of orbital blow-out fracture. Methods: 90 cases of obital blow-out fracture were treated by surgical(n = 40) and conservative(n = 50) trerapy respectively, the patients were fllowed up for 12 months. The treatment outcome was retrospectively analysed. Results: Of the 40 patients managed surgically 39 were with complete follow up data, 19 had diplopia in peripheral gaze before surgery, 13 (33％) had at 3-month and 12 (31％) had at 6-month follow-up. 31 had enophthalmus before surgery and 3(8％) had at 3-month and 6-month follow-up. Of the 50 patients managed conservatively 26 were with complete follow-up data, 11 had diplopia in peripheral gaze initially, 9(35％) had at 3-month and 8(31％) had at 6-month follow-up. 15 had enophthalmus initially and 13(50％) had at 3-month and 6-month followup. Conclusion: Surgical therapy is more effective for the treatment of enophthalmus. The effects tend to be stable 3 months after treatment, the ratio of diplopia in peripheral gaze after treatment by the 2 treatments is similar(about 30％ of the total cases).

[Abstact] Objective:To evaluate the effects of the treatment of temporomandibular joint ankylosis (TJA) with secondary deformities by sequential treatment including distraction osteogenesis.Methods:40 patients aged 9 to 53 years old(average 24.5) with TJA were retrospectively analysed.11 patients were with unilateral and 29 with bilateral TJA.27 patients were companied with OSAHS.All patients underwent distraction osteogenesis as the initial surgery,followed by arthroplasty.The orthognathic treatment was performed along with or after the arthroplasty.The therapeutic effects were evaluated by the improvement of maximum mouth opening,face profile and snoring.Results:After the treatment procedure was ended,the mouth opening and face profile of all patients were improved remarkably,and the snoring disappeared.The patients were followed up for 4 to 72 months (average 20.5 months),the joint ankylosis recurrence was found in 4 patients.Conclusion:Treatment of TJA with secondary deformities by the sequential treatment including distraction osteogenesis,arthroplasty and orthognathic surgery can improve the face profile and airway accurately.

Objective To study the ballistic characteristics of different types of fragments,and provide useful references for the clinical treatment.Methods Twenty pieces of soap were respectively penetrated by steel fragments with 1 length-diameter ratio at the speed of 1 900m/s,1 100m/s,500m/s,and by steel fragments with 0.5,1,2 length-diameter ratio at the speed of 1 100m/s.Then the ballistic characteristics was analyzed and the differences between the ballistic characteristics were observed.Results When the length diameter ratio of the fragment was 1,the entrance diameter,depth and volume of ballistic cavity were increased in different degrees with the increased velocity,but the depth of the cavity was relatively smaller.When the speed was 1 100m/s,the entrance diameter of the cavity was decreased with increase length diameter ratio, and there was no significant difference between the volumes with increased depth.Conclusion The fragment`s speed and length-diameter ratios affect the ballistic diameter,depth and cavity volume in different degrees,which have great value for the diagnosis and treatment of trauma caused by high speed fragments.

Objective:To study the effects of hyaluronic acid(HA) and TGF-β1 on the growth of mandibular condylar cartilage and the hyperthophic differentiation of the condylar chondrocyts.Methods:60 condyle samples from newborn mice were in vitro cultured and treated with HA(0.5 mg/ml),TGF-beta 1 (5 ng/ml) and without additional agent(the control) respectively.The Morphological observation,Alizarin Red Staining,Alkaline phosphatase staining and condylar cartilage surface area measurement were conducted after 1,2,4,6 and 8 weeks of culture respectively.Results:High-density photoresist area was observed in the condylar cartilage of the control group after 4 weeks of culture.Alizarin Red Staining and Alkaline phosphatase staining showed condylar cartilage matrix production and calcification.The HA group showed no high-density photoresist area at all time points,however,the cartilage area was significantly increased (P ＜ 0.05);the TGF-beta 1 group showed high-density photoresist area after 2 weeks of culture.but the cartilage area were not significantly changed(P ＞ 0.05).Conclusion:HA can promote the growth of condylar cartilage in vitro,but have an inhibitory effect on chondrocyte differentiation.TGF-β1 plays a role in mandibular condylar chondrocyte hypertrophic differentiation in the early days of in vitro culture.

Objective:To study the mechanism of the temporomandibular joint(TMJ) trauma caused by the fragment impact with different velocity on pig mandibular.Methods:12 pig heads were penetrated at the right mandibular angle by 1 g cylindrical fragment with the speed of 900,1 200,1 500 m/s(n=4) respectively.The strain of the bilateral condyle necks and the acceleration of the bilateral mandibular angles and the forehead were measured,the stress characteristics of each part was analysed.Results:The ratio of acceleration of impact side the opposite side and the forehead was 8:1.9:1 in the low speed group,9.9:2:1 in the middle speed group and 10.2:2:1 in the high speed group.The ratio of strain of impact side and the opposite side was 2.87 in the low speed group,2.43 in the middle speed group and 1.70 in the high speed group.Conclusion:When the mandibular is impacted by fragment from the lateral,the lateral force which causes linear fracture of condylar neck is mainly on the impact side,the axial force which causes comminuted fracture of condylar neck,as well as on the opposite side.

AIM:To investigate the effect of Shh signaling pathway on the apoptosis of the chondrocytes in the cartilage with condylar hyperplasia(CH).METHODS:Chondrocytes were isolated from 6 CH and 3 normal cartilage specimens.Western blotting and Real-timePCR were used to detect the expression levels of cleaved-caspase-3 and BCL-2.Then the expression levels of Shh and Smo were assessed by immunohistochemistry and Western blotting.Finally,chondrocytes were treated with Shh,cyclopamine,LY294002 or U0126,the expression levels of cleaved-caspase-3 and BCL-2 were examined.RESULTS:As compared with normal chondrocytes,CH chondrocytes showed lower apoptotic activity and expressed higher level of BCL-2 mRNA and lower level of cleaved-caspase-3 (P<0.05).Shh and Smo had higher expression in CH chondrocytes.Shh stimulation significantly inhibited the apoptosis of chondrocytes.On the contrary,cyclopamine stimulation significantly increased the apoptosis of chondrocytes.LY294002 and U0126 treatments reduced BCL-2 mRNA expression in both groups (P<0.05).CONCLUSION:Shh promotes human TMJ cartilage overgrowth in the developing process of CH by inhibiting chondrocyte apoptosis via PI3K/AKT and MAPK/ERK pathway.

Objective To explore how to improve the undergraduate teaching practice about oral and maxillofacial surgery tumors,including courseware and teaching forms.Methods Making teaching multimedia courseware and improving teaching skills for undergraduate students,according to the current tumor knowledge of oral and maxillofacial tumor surgery and morden multimedia technology.Results We set up the "nine" chapters and 18 class hours new multimedia teaching courseware of the oral and maxillofacial-head and neck oncology;one faculty member completed all the "teaching modes",discussed the teaching characteristics in accordance with cognitive load theory,improved the modem multimedia courseware technical means.Conclusion Teaching reforms should be made with the progress of information media technology in oral and maxillofacial tumors.

Objective:To evaluate the influence of mandibular sagittal split back surgery on temporomandibular joint(TMJ).Methods:50 patients with temporomandibular joint disease(TMD) underwent mandibular sagittal split back surgery were included.The symptoms of the TMJ of jaw pain,clicking of jaw joint,abnormal jaw opening(limitation,asymmetrical movement) were examined before and after operation,data were quantitatively analysed.Results:After surgery all the scores of the symptoms were reduced(P<0.05).Conclusion:Mandibular sagittal split back surgery may effectively improve the symptoms of TMD.

Objective:To study the effects of hyaluronic acid(HA)on the calcification of mandibular condylar cartilage.Methods:Mandibular condylar cartilage and long bone cartilage were sampled from neonatal mice(3 d)and were randomly divided into medium control group and HA group.After 6 weeks of in vitro culture,the degree of calcification was evaluated by HE staining,Alizarin Red staining and ALP staining.The expression of VEGF and MMP-13 was detected by immunohistochemical staining.Results:In the medi-um control group calcification in cartilage was not found,VEGF and MMP-13 were expressed in the cartilage matrix and in some cells, the long bone cartilage surface area was increased(P <0.05).In the HA treatment groups of condyl and long bone cartilage no calcifi-cation was found,increase of the cartilage surface area was observed;VEGF and MMP-13 were negative in the cartilage matrix was de-creased,and the positive expression cells were reduced(P <0.05).Conclusion:HA can inhibit calcification of mandibular condylar cartilage,which may be associated with the inhibition of VEGF and MMP-13 expression.

The learning of head and neck anatomy has been regarded as a difficult issue in teaching Maxillofacial Surgery .The main cause includes complex and confusing concepts and student’s lacking of knowledge of clinical significance of anatomic structures .We attempted to set up Clinical context in teaching process so that students could consider or observe anatomic structures from a Doctor ’s role . Based on this role playing ,students appeared to learn more actively and more enthusiastic ,mainly be‐cause they understood more on the clinical significance of these structures and knew how to transform these knowledge into clinical application .We believed the introduction of Problem based learning in clinical context motivated creativity and enthusiasm of students ,and promoted their interest in anato‐my learning ,therefore is a meaningful approach in special education of Oral and Maxillofacial Surger‐y.

Objective:To evaluate the effects of maxillomandibular advancement and contrarotation in the treatment of severe com-plicated multilevel obstructive sleep apnea/hypopnea syndrome (OSAHS).Methods:1 2 patients (all males,aged 26 to 56 years) with severe complicated multilevel OSAHS were treated by orthognathic surgery methods of maxillomandibular advancement and cont-rarotation and followed up for 6 -1 2 months.Results:After surgery the symptoms of all patients,such as snoring,waking up be-cause of stoke and streaming with sweat,disappeared or were ameliorated remarkably.The AHI index declined from 51 -70 before operation to 0 -3 after operation.While sleeping,their blood oxygen saturation augmented from 30% -70.1 % presurgically to 93%-99% postsurgically,and their average blood oxygen saturation increased from 60% -72% presurgically to 95% -99% postsurgi-cally in all 1 2 patients.Conclusion:Orthognathic surgery method of maxillomandibular advancement and contrarotation is effective in the treatment of severe complicated multilevel OSAHS.

The loss of midface structures always leads to significant functional and cosmetic deficits, and the reconstruction work remains a challenge for surgeons. We report a rare case with severe midfacial defects involving the maxilla, nasal bone, and zygoma. This patient was treated with a comprehensive approach that included distraction osteogenesis, computer-aided surgery, a fibula bone graft, dental implantation, orthognathic surgery, and rhinoplasty. The treatment procedures required 4 years to complete, and a dramatically improved facial contour and stable occlusion were achieved. The results demonstrated the importance of a multidisciplinary approach and computer-aided design when treating severe maxillofacial deformities. Other important elements of the treatment process were the meticulous physical examination, the selection of an optimal treatment sequence, the skill of the surgeons, and more importantly, the patient-oriented mindset.