目的 比较重度OSAHS多平面同期手术与多平面分期手术的疗效.方法 回顾性分析南阳市口腔医院睡眠中心2010年1月-2012年1月间的45例重度OSAHS多平面阻塞患者的临床及术后随访资料,其中多平面同期手术方案者17例(同期方案组),多平面分期手术者28例(分期方案组).结果 同期方案组治愈率29.4％,显效率94.1％,有效率100％.分期方案组手术治愈率10.7％,显效率64.3％,有效率78.6％.分期方案组疗效较差,病人依从性差及治疗周期长是很重要的原因.28例分期方案组患者中,完成治疗方案者(1 ～3次手术)10例,未完成治疗方案者18例,其中仅一次手术者9例.结论 重度OSAHS患者多平面手术可提高疗效,同期手术可缩短治疗周期,提高病人依从性,分期手术可避免过度手术,降低围手术期风险.

Objective To investigate the clinical effect of severe OSAHS multidisciplinary collaborative therapy. Method 82 cases with severe OSAHS patients were randomly divided into group A, B, 41 cases in each group. Group A was treated with multidisciplinary collaborative therapy, group B was treated with oral appliance therapy. The two groups were followed up for 1 year. The clinical efficacy and complication incidence rate of the two groups were compared. The sleep quality related parameters and living quality indexes of the two groups before and after treatment, during the follow up period were compared. Results The clinical effect of group A after treatment, at 6,12 months after follow up were significantly higher than those of group B (P＜0.05 or 0.01). The complication incidence rate of group A during the treatment was significantly higher than that of group B (P＜0.01), after 6, 12 months' follow up, the difference between the two groups had no statistic significance (P＞0.05). There was statistic significance in the sleep quality related parameters in group A after treatment and during the follow up period (P ＜0.01). In group B,there was statistic significance in the AHI,TS90％,LSaO2, drowsiness index compared with those before treatment (P＜0.01); each indexes in group A changed more significantly than those in group B (P＜0.05 or 0.01). living quality indexes of group A after treatment and during the follow up period were significantly higher than those before treatment (P＜0.01),and were significantly higher than those of the control group (P＜0.01). Conclusion Multidisciplinary collaborative therapy in the treatment of severe OSAHS has significant effect, it can effectively improve the sleep quality and living quality, and it is worthy of clinical application.

重建钛板修复下颌骨缺损是目前临床上应用较为广泛的一种修复下颌骨缺损手段.本研究对2002年1月-2012年12月期间共计32例手术失败患者的手术失败的原因进行分析和总结,以期为以后的临床提供参考依据.

目的:观察存在上气道结构性狭窄的重度阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apneahypopnea syndrome,OSAHS)鼻、口咽、喉咽多平面阻塞同期手术的治疗效果,探讨提高OSAHS疗效、减少复发的经验.方法:2008年4月-2013年12月,对21例严重OSAHS患者通过临床检查和Alice 5多导睡眠监测仪监测(PSG),术前睡眠呼吸暂停低通气指数(AHI)58.8～74.0,平均67.8,SaO2最低0.25～0.67,平均0.46,最长睡眠呼吸暂停时间52～77 s,平均63.3 s.全麻下同期完成鼻腔扩容手术、腭垂腭咽成形术(uvulopalatopharyngoplasty,UPPP)、腭扁桃体切除手术;颏部“开窗”、“凸”形或“梯形”截骨,前徙颏部及颏舌肌和舌骨上肌群的颏前徙术;舌骨下肌群切断、舌骨悬吊术.气管插管维持24～48 h.结果:经过8～68个月随访,21例手术创口均一期愈合,睡眠呼吸障碍症状消除或明显减轻,8例打鼾消失,13例仰卧位时仍有轻、中度鼾声,均无睡眠憋醒现象,同期颏成形患者对外形改善满意.PSG监测术后AHI10.2～24.2,平均20.3,SaO2 0.82～0.99,平均0.91,最长呼吸暂停时间11～35 s,平均17.9 s.结论:存在上气道结构性狭窄的重度OSAHS采取同期多平面手术治疗,可明显提高治疗效果且缩短疗程,经治病例均获得较满意疗效.

目的:探讨口腔颌面部多发性骨折及并发症的诊治要点。方法:回顾性分析47例颌面部多骨复合骨折的病例救治体会。结果:术后颌关系良好,面部无明显畸形,无张口受限者35例,效果差者12例。结论:颌面部损伤的急救处理应有整体观念,应特别注意全身情况,尤其是有无颅脑损伤、软组织伤、失血性休克等危机生命的并发症,待病情平稳后,则争取及早治疗颌面部骨折。

Background and Objectives: To analyse the clinical characteristics of infective osteonecrosis of jaws combined with diabetes mellitus and improve the diagnosis and treatment of disease.

目的总结自体游离骨移植修复下颌骨缺损临床疗效.方法自1997年4月以来,应用自体游离肋骨、髂骨修复下颌骨缺损21例;选用髂骨18例;肋骨3例;按缺损区设计切取一定长度和形状自体游离肋骨或髂骨,植入下颌骨缺损区微型钛板固定.结果修复下颌骨缺损21例.经3个月～5.5年随访,18例一期愈合;2例伤口感染,1例部分骨坏死.结论自体游离肋骨和髂骨移植同期修复下颌体缺损,其相容性好无排异反应,手术简便无需吻合血管,曲度和形状符合下颌骨体及升支外形要求,效果稳定.目前仍是恢复下颌骨连续性和面部外形的基本方法.

OBJECTIVE:To study the effects of jaw advancement in treating micromandibular deformity associated with obstructive sleep apnea syndrome (OSAS) by ramus osteotomy and genioplasty.METHODS:From April 1998 to February 2002, 12 patients with micromandibular deformity associated with OSAS (aged 14-36 years, 7 females and 5 males) were treated. Invert "L" shape ramus osteotomy and inverted replantation of posterior segment of ramus were performed to reconstruct the TMJ with the jaw advancement and genioplasty at the same time in 7 cases; mandibular angle osteotomy, bone grafts and genioplasty in 3 cases; and the jaw advancement by ramus sagittal osteotomy and genioplasty in 2 cases of the first branchial arch syndrome.RESULTS:The follow-up period was 6 months to 4 years. All the patients gained good appearance and had the distance of opening movement over 3.0 cm. Micromandible and facial asymmetries were corrected satisfactorily. The ratio of SaO2 was ascended from 82%-92% (preoperation) to 97%-99% (postoperation). OSAS was relieved.CONCLUSION:The jaw advancement by ramus osteotomy and genioplasty for treating micromandibular deformity associated with OSAS can correct the maxillofacial deformities and enlarge the upper airway space to relieve OSAS. This method has achieved satisfactory result.

旋转推进法是临床上修复单侧唇裂最常用的术式.但在临床实践中观察到对单侧Ⅲ0唇腭裂患者,应用旋转推进法修复唇裂,术中患侧唇峰下降有限,术后随访患侧唇峰较对侧高,唇弓形态差.为此,我们采用旋转推进法结合对偶三角瓣法整复单侧Ⅲ0唇裂34例,效果较好,现报告如下.

目的观察陈旧性髁状突骨折手术切开复位固定的疗效.方法对21例保守治疗失败、6例延误治疗的陈旧性髁状突骨折,采取耳前切口切开复位小钛板坚强内固定治疗.结果经过治疗的27例陈旧性髁状突骨折,创口均甲级愈合,张口度恢复,咬合关系改善,钛板无松动、移位和排异反应,无颞下颌关节强直发生.结论小钛板坚强内固定是治疗陈旧性髁状突骨折的可靠方法,对髁状突明显移位或脱位的骨折宜及早实行手术切开复位固定.

颞下颌关节(TMJ)强直的外科治疗方法较多,应用下颌升支垂直截骨、下颌升支后缘倒置再植术式的TMJ重建术治疗TMJ强直,因下颌升支高度的保持,有利于发挥下颌骨有效的杠杆作用和力偶作用,可较好地恢复关节功能[1～6].作者收集1989年5月至2001年5月对实行TMJ重建手术治疗的48例(62侧关节)TMJ强直患者的资料,对其远期疗效进行分析,报道如下.

目的观察下颌升支截骨下颌骨前徙术治疗小下颌畸形伴阻塞性睡眠呼吸暂停综合症(OSAS)的疗效.方法颞下颌关节强直伴小下颌畸形9例,第一鳃弓综合征下颌骨发育不良小下颌畸形2例, 均伴有严重的OSAS症状,11例分别行下颌升支截骨、下颌骨体前徙术,同期施行颏成形术,其中5 例施行了舌骨下肌群离断、舌骨悬吊术,手术截骨骨段以小钛板坚强内固定.结果经过3个月～3年的随访观察,11例中张口度均恢复至3.0 cm以上,面部外形明显改善,睡眠打鼾、憋醒、大汗症状消失或明显改善,睡眠时血氧饱和度由手术前的86～92%增加至手术后的98～99%.结论下颌升支截骨下颌前徙术治疗小下颌畸形伴OSAS,对扩大口咽通气道,解除睡眠时呼吸阻塞症状,改善睡眠时呼吸功能可获得较满意的效果,并可同时改善面部容貌.

目的介绍颌面骨多发性复杂性骨折的整复经验,探讨治疗方法与疗效.方法对31例复杂性颌面骨骨折病例采取小钛板坚强内固定,辅助颌间牵引的方法进行骨折的整复和功能重建.结果全部病例创口甲级愈合,面部外形基本恢复正常,张口度均在3.0cm以上,咬(牙合)关系恢复.结论解剖复位骨折段,及时进行坚强内固定手术是骨折病人康复的关键.

目的:总结舌癌切除后应用前臂皮瓣游离移植修复舌组织缺损的经验. 方法:对24例舌癌根治切除后,应用吻合桡动脉、头静脉的游离前臂皮瓣移植修复舌组织缺损、完成舌再造手术.结果:24例中成功23例,皮瓣坏死失败1例,成功率95.8%.经随访,再造舌组织形态、功能满意. 结论:前臂皮瓣游离移植舌再造修复术对舌组织缺损的修复和功能重建效果较好,患者的生存质量得到提高.

上颌骨切除术后遗留的面颊部粘膜侧软组织缺损,常应用游离断层皮片移植修复,既增加了供皮区的创伤,延长了手术时间,术后又常因植皮挛缩导致张口受限.1997 年以来我们采取带蒂颊脂垫移植替代植皮手术,即刻修复上颌骨切除手术导致的面颊部粘膜侧软组织缺损22例,获得满意疗效,总结报告如下:

本文对7例髁状突陈旧性骨折错位愈合所致的开(牙合)畸形和牙颌面畸形的临床资料、手术治疗方法、结果进行了介绍,对手术注意事项、适应症选择等问题进行了讨论.

面神经解剖是腮腺手术关键的操作技术,常用的解剖手术有三种,每种手术方法对面神经均有一定的刺激,可导致不同程度面神经功能障碍.为了探讨手术方式对面神经的影响程度,作者自1996年1月至1999年1月,采用面神经干及周围支解剖方法,分别对2组共46例病人进行手术及临床观察,初步评价两种手术方式的效果.

口腔粘膜结核临床上发病率较低,国内文献报道极少,本文对经治的7例进行临床病理分析总结,认为本病主要是结核杆菌直接感染口腔粘膜所致,结核病灶以增生型病变为主,中老年开放性肺结核患者为易感人群.