Aim or purpose: To retrospectively review the clinical effect of comprehensive treatment of alveolar cleft (CTAC) using the mandible as the bone source. Materials and methods: Patients with alveolar clefts who met the inclusion criteria were subjected to a CTAC protocol that included the following: (1) preoperative orthodontic treatment for creating good soft-tissue conditions; (2) ‘area-like grafting’ with subperiosteal osteogenic chin bone instead of cartilaginous osteogenic iliac bone; (3) simulation of normal bone anatomy via a sandwich-like bone graft consisting of ‘cortical bone + cancellous bone + cortical bone’; and (4) strong internal fixation to ensure initial bone block stability. At 6 months postoperatively, the titanium plate was removed and cone-beam computed tomography was performed to evaluate the surgical results. Results: A total of 54 patients underwent treatment with the CTAC protocol. The average age at the initial operation was 10.3 ± 2.1 years, and the average hospital stay was 2.8 ± 0.6 days. At 6 months postoperatively, 49 patients (90.7%) showed good clinical results. The transplanted bone block formed a ‘cortical bone + cancellous bone + cortical bone’ structure similar to that of the normal jawbone. A mature bone bridge formed, and the impacted permanent teeth continued to erupt and enter the bone graft area. Conclusions: CTAC is a comprehensive restorative solution for alveolar cleft repair that integrates multiple concepts, including orthodontics, embryology, anatomy, and improvements to surgical methods. The method is easy to perform, causes little surgical trauma, and shows a stable success rate, and is thus worth promoting.

To retrospectively review the clinical effect of comprehensive treatment of alveolar cleft (CTAC) using the mandible as the bone source. Patients with alveolar clefts who met the inclusion criteria were subjected to a CTAC protocol that included the following: (1) preoperative orthodontic treatment for creating good soft-tissue conditions; (2) 'area-like grafting' with subperiosteal osteogenic chin bone instead of cartilaginous osteogenic iliac bone; (3) simulation of normal bone anatomy via a sandwich-like bone graft consisting of 'cortical bone + cancellous bone + cortical bone'; and (4) strong internal fixation to ensure initial bone block stability. At 6 months postoperatively, the titanium plate was removed and cone-beam computed tomography was performed to evaluate the surgical results. A total of 54 patients underwent treatment with the CTAC protocol. The average age at the initial operation was 10.3 +/- 2.1 years, and the average hospital stay was 2.8 +/- 0.6 days. At 6 months postoperatively, 49 patients (90.7%) showed good clinical results. The transplanted bone block formed a 'cortical bone + cancellous bone + cortical bone' structure similar to that of the normal jawbone. A mature bone bridge formed, and the impacted permanent teeth continued to erupt and enter the bone graft area. CTAC is a comprehensive restorative solution for alveolar cleft repair that integrates multiple concepts, including orthodontics, embryology, anatomy, and improvements to surgical methods. The method is easy to perform, causes little surgical trauma, and shows a stable success rate, and is thus worth promoting.

目的 利用逆行跨单突触狂犬病毒(RV)系统,研究投射到脊髓背角(SDH)的蓝斑(LC)内去甲肾上腺素能神经元的突触前神经元在全脑的分布情况.方法 第一步将二联辅助病毒注入到TH-Cre小鼠的LC中,两周后将重组RV注入到SDH中.小鼠存活一周后将其灌注取材,然后在激光共聚焦显微镜下观察LC-SDH通路的上游核团在全脑的分布情况.结果 利用逆行跨单突触RV系统,可以在脑内的次级运动皮层(M2)、杏仁中央核(CeA)、中脑导水管周围灰质外侧区(lPAG)、中脑导水管腹外侧区(vlPAG)、中缝背核(DR)和巨细胞网状核(Gi)等核团内观察到RV阳性神经元,说明这些核团与LC-SDH通路构成了三级通路.结论 脑内M2、CeA、lPAG、vlPAG、DR和Gi等核团与LC-SDH通路形成了三级通路.

回顾性总结空军军医大学唐都医院胸外科 2008 年 1 月～2022 年 1 月收治的 79 例纵隔感染患者的临床资料.79 例患者的主要致病原因为口腔颌面部感染下行扩散(39 例,49.4％)、食管/气管穿孔破裂(34 例,43.0％)和纵隔手术后感染(6 例,7.6％).68 例患者行外科手术治疗,术式以颈部脓肿切开引流术、开胸纵隔脓肿切开引流术及胸腔闭式引流术为主.8 例患者存在食管瘘行内镜下经瘘口置管"内引流".3 例患者因生命体征不稳定未行手术治疗.细菌培养 67 例患者中 36 例为阳性,感染细菌以链球菌、铜绿假单胞菌为主,合并 2 种或 2 种以上致病菌的混合感染 16 例.所有患者均应用抗生素治疗,以头孢类、硝基咪唑类、碳青霉烯类抗生素为主,其中两种及以上抗生素联合应用患者 42 例.患者平均住院时间为(24.2±14.0)d,重症监护室治疗37例.经治疗后痊愈 75 例,死亡 4 例.纵隔感染症状重、发展快,临床诊疗应结合病史及临床表现积极寻找病因,积极给予抗感染治疗和外科干预是有效、安全的治疗方式.

The adipose-derived stem cell exosomes are subcellular structures of adipose stem cells. They are nano-sized membrane vesicles that can transport various cell components and act on target cells by paracrine, and they play an important role in the exchanges of substance and information between cells. Scar healing is the commonest way of healing after skin tissue injury. Pathological scar can not only cause movement dysfunction, but also lead to deformity, which affects the appearance of patients and brings life and mental pressure to the patients. In recent years, many researches have shown that the adipose-derived stem cell exosomes contain a variety of bioactive molecules, which play an important role in reducing scar formation and scar-free wound healing, by affecting the proliferation and migration of fibroblasts and the composition of extracellular matrix. This article reviewed the recent literature on the roles and mechanisms of adipose-derived stem cell exosomes in scar formation, and prospected the future application and development of adipose-derived stem cell exosomes in scar treatment.

目的:探究纳米脂肪(Nanofat)用微针注射对增生性瘢痕的治疗效果.方法:制备纳米脂肪,将其分别装载于微针仪器E-Zinjector与1 mL注射器中,自动细胞计数仪检测纳米脂肪中脂肪干细胞的细胞活性.选取8只新西兰大白兔,对每只兔耳构建的4个瘢痕区域随机分别采用以下治疗:E-Zinjector注射生理盐水(0.9％NaCl+E-Zinjector)、1 mL注射器注射生理盐水(0.9％NaCl+Injector)、1 mL注射器注射Nanofat(Nanofat+Injector)和E-Zinjector注射Nanofat(Nanofat+E-Zinjector).治疗2周后取材,行HE、Masson染色,qRT-PCR检测α-SMA和COL-ⅠmRNA表达.结果:E-Zinjector负载的方式对脂肪干细胞活性没有影响.HE、Masson染色示,Nanofat+Injector和Nanofat+E-Zinjector组瘢痕的胶原密度适中、排列整齐,而0.9％NaCl+E-Zinjector组与0.9％NaCl+Injector组可见大量致密、杂乱的胶原组织.qRT-PCR检测显示Nanofat+Injector和Nanofat+E-Zin-jector组瘢痕组织中的a-SMA、Collagen-I基因表达显著低于0.9％NaCl+E-Zinjector与0.9％NaCl+Injector组,而Nanofat+E-Zinjector组较Nanofat+Injector组基因表达量更低.结论:纳米脂肪微针注射可有效抑制增生性瘢痕.

目的 评价"思维导图结合清单"教学法在颌面部间隙感染的临床实习带教中的应用效果.方法 选择2020年7月至2021年10月在第四军医大学口腔医院颌面外科病房实习的口腔专业本科生40名.采用随机数字表法将其分配至实验组和对照组,各20名.其中实验组采用"思维导图结合清单"教学法进行临床实习带教,对照组采用"传统帮带"模式进行临床实习带教.通过调查问卷和出科考试比较两组的实习效果.结果 本研究实际发放调查问卷40份,共收回40份,有效回收率为100％.实验组"临床实习明显巩固了我的相关理论知识""临床实习明显提高了我的医患沟通能力""经过临床实习,我现在完全掌握了颌面部间隙感染的诊疗流程"的自我评价分数均高于对照组,差异有统计学意义(P＜0.05).实验组"我认为'思维导图结合清单'教学法在颌面部间隙感染的临床实习中十分重要"的自我评价得分为(4.6±0.6)分.实验组出科考试成绩高于对照组,差异有统计学意义(P＜0.05).结论 "思维导图结合清单"教学法可明显提高颌面部间隙感染的临床实习带教效果,值得在教学中进一步推广.

目的:在钛表面构建高强度,具有微、纳米级梯度仿生形貌涂层,并评估其生物安全性.方法:采用酸蚀及磁控溅射技术构建微、纳米级梯度仿生形貌涂层;扫描电镜检验涂层构建效果;纳米划痕试验检测涂层强度;SD大鼠皮肤刺激试验,毒性、溶血试验及血清生化参数评估该涂层生物安全性.结果:扫描电镜显示该涂层具有微米级、纳米级梯度仿生形貌;纳米划痕结果显示该涂层强度达100 N;生物安全性检测结果显示该涂层不引起皮肤刺激与迟发型超敏反应,无全身毒性,新型涂层组大鼠和光滑组大鼠体重分别为(423.3±11.2)g和(429±10.07)g(P＞0.05),实验组与对照组溶血率分别为3.51％±1.04％和2.90％±0.65％(P＞0.05).结论:该研究制备的钛表面仿生形貌涂层,可兼顾临床应用中对涂层强度与生物安全性的双重要求.

After more than a century of development, autologous fat transplantation (AFT), a repair method for soft tissue defects and deformities, has the advantages of being simple, rapid, effective and safe, and it is increasingly favoured by plastic surgeons. This article reviews the developmental history of AFT, analyses its clinical application status in the oral and maxillofacial regions, and provides a preliminary summary and discussion of the research progress related to AFT. The hope is that that this technique could be widely applied for oral and maxillofacial diseases as well as facial rejuvenation indications. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

填塞碘仿纱包是腭裂修复术后创口处理的常用方法,但是临床发现,在规范化腭裂修复术与术后护理基础上,对绝大多数腭裂患儿,创口填塞碘仿纱包对术后康复无明确收益,反而会使术后疼痛增加、睡眠质量下降,建议进一步规范并减少碘仿纱包在腭裂修复中的应用.

Oral and maxillofacial space infections (OMSI) are common diseases of the facial region involving fascial spaces. Recently, OMSI shows trends of multi drug-resistance, severe symptoms, and increased mortality. OMSI treatment principles need to be updated to improve the cure rate. Based on the clinical experiences of Chinese experts and with the incorporation of international counterparts' expertise, the principles of preoperative checklist, interpretation of examination results, empirical medication principles, surgical treatment principles, postoperative drainage principles, prevention strategies of wisdom teeth pericoronitis-related OMSI, blood glucose management, physiotherapy principles, Ludwig's angina treatment and perioperative care were systematically summarized and an expert consensus on the diagnosis and treatment of OMSI was reached. The consensus aims to provide criteria for the diagnosis and treatment of OMSI in China so as to improve the level of OMSI treatment.

总结颌面部间隙感染围手术期观察要点与护理方法.对颌面部间隙感染患者围手术期护理进行归纳总结,术前通过接诊风险评估,降低护理风险,并正确判断护理问题;术后通过严密监测生命体征、全方位评估呼吸道状态、深入进行心理评估、合理指导调整饮食结构,科学进行健康宣教等.患者术前正确评估有效的避免了护理风险,顺利实施手术,术后均顺利康复出院.颌面部间隙感染术前全面有效的评估,可以降低窒息等高风险事件发生,术后呼吸道管理、伤口的定时冲洗、针对性的饮食护理、口腔卫生保健的健康教育,可促进患者的康复.

口腔颌面部间隙感染是一种起病急、发展快,且常会危及生命的口腔颌面外科的临床急症.张口受限、颌面部广泛肿胀、呼吸困难或窘迫、感染性休克、心力衰竭等是此类患者较常见的临床表现;高血压、糖尿病、冠心病及慢性阻塞性肺气肿等也是常见的并存疾病,因此,颌面部间隙感染围术期麻醉管理极具挑战性.本文通过从术前麻醉访视、麻醉诱导及气道建立、术中及术后麻醉管理等方面进行了全面探讨,期望能对颌面部间隙感染患者的围术期麻醉管理提供最佳方案.

换药治疗是口腔颌面部间隙感染治疗的重要环节,明确换药目的、选择合理的冲洗液及冲洗方式是有效换药治疗的关键.本文回顾了近两年我科收治的间隙感染患者的换药情况,提出了感染各时期不同的换药目的,建议充足的生理盐水/高渗生理盐水低压冲洗,根据感染分期动态调整换药及敷料更换频率,同时强调伤口湿性环境的维持应贯穿整个换药治疗过程,推荐“半封闭冲洗引流”方案.

CT检查作为口腔颌面部骨与软组织结构的主要影像学检查手段,及时准确研读CT影像对感染治疗具有重要意义.本文回顾了我院近两年收治的感染患者影像学资料,通过对CT窗位及窗宽选择、关键层面选取、CT影像研读及气道诊断等方面进行分析,总结了CT在颌面部间隙感染检查中的特点,推荐扫描时设置窗宽350 Hu,窗位40 Hu为常规参数,重点关注5大关键层面,依据软组织肿胀、脓液形成及气体积聚的影像特点判断病情,建议在气道受压时及早切开引流减压,术后留置气管插管至气道危象解除,当气道狭窄大于1/2时,立即行气管插管或气管切开.

在颌面部间隙感染诊疗过程过程中,彩色多普勒超声(彩超)检查起到了重要作用.该检查可以辅助诊断,明确感染进程及类型;鉴别诊断,了解是否为伴感染类疾病;实时精准引导治疗;评估切开引流的时机,评价术后疗效.将彩超检查用于颌面部间隙感染治疗,能更准确的评估病情,降低手术难度,提高该类疾病的治愈率.建议列入颌面部间隙感染诊治规范中,并加以推广.

糖尿病患者伴发的颌面部间隙感染临床较为常见,其诊治较常规间隙感染更为复杂.通过对近3年此类患者进行回顾性分析,总结该类患者诊治原则和流程,提供相应治疗规范.入院1周内对血糖进行良好控制,可以缩短住院时间,而其他感染指标的恢复则更依赖手术治疗.推荐予以基础胰岛素联合餐时胰岛素的治疗方案,并根据"7点血糖监测法"结果进行调整.

颌面部间隙感染的抗生素治疗由于致病菌的培养和鉴定滞后,往往需采取经验性用药.本文通过统计分析93例间隙感染病例中致病菌的分布、致病菌的药物敏感性、治疗过程中抗生素使用、病情转归情况等资料,为更加合理地应用抗菌素提出了建议.非重症间隙感染初期建议使用"头孢呋辛+ 奥硝唑",重症/危重间隙感染患者应早期应用"亚胺培南/亚胺培南+ 奥硝唑"覆盖所有可能的致病菌,然后结合阶段性治疗结果行降阶梯治疗.

实验室检查对颌面部间隙感染的病情判断至关重要.由于病原菌的培养、分离和鉴定耗时较长,不能做到早期快速诊断,难以及时采取针对性的治疗措施.因此,借用炎症反应标记物来早期判断感染的程度是临床中的常见手段.通过筛选间隙感染治疗中关键的实验室检查指标,可用于快速判断病情,间隙感染的程度主要应结合“C反应蛋白/超敏C反应蛋白+降钙素原”来诊断,患者全身状况应重点参考“血钾浓度+血气分析+糖化血红蛋白”等指标来诊断.本文旨在指导外科医师在较短时间内做出准确的判断,指导临床决策,给予患者最佳的治疗方案.