Maxillofacial Surgery

颌面外科
  • 文章类型: Case Reports
    该病例报告介绍了一名59岁的女性患者,患有结肠乙状结肠部分腺癌的下颌牙龈转移,8年前接受了根治性结肠切除术,同时进行子宫切除术和左卵巢切除术(由于肿瘤受累)。因为转移扩散到肝脏,进行了部分左侧叶切除术,因为左肾上腺的转移性病变,切除后者,并对左肾进行部分切除.病人接受了几个疗程的化疗,靶向治疗,和免疫疗法。2024年,由于口腔中的肿瘤块正在生长并干扰正常的营养和言语,她住院,并对病变进行了根治性切除,同时切除了右侧下颌受累的下颌骨。形态学分析显示大细胞神经内分泌癌转移,免疫组织化学染色证实了病变的胃肠道起源。该病变被认为是乙状结肠原发性腺癌表型转化的结果。患者术后时间正常,伤口愈合顺利,并继续接受临床肿瘤学家的治疗,有针对性的,和免疫疗法。然而,病变出现后五个月和手术切除后三个月,在她的一般状况严重恶化之后,她在家里去世了。
    This case report presents a 59-year-old female patient with mandibular gingival metastasis from adenocarcinoma of the sigmoid part of the colon, who underwent radical colectomy with simultaneous hysterectomy involving and left oophorectomy (due to tumor involvement) eight years ago. Because of metastatic spread to the liver, a partial left lateral lobectomy was performed, and because of a metastatic lesion in the left adrenal gland, the latter was excised and a partial resection of the left kidney was performed. The patient was given a number of courses of chemotherapy, target therapy, and immunotherapy. In 2024, because of a tumor mass in the oral cavity that was growing and interfering with normal nutrition and speech, she was hospitalized and a radical resection of the lesion was performed along with the involved underlying bone of the lower jaw on the right. The morphological analysis revealed metastasis from large cell neuroendocrine carcinoma and the immunohistochemical stains verified the gastrointestinal origin of the lesion. The lesion was accepted as being a result of the phenotypical transformation of the primary adenocarcinoma of the sigmoid colon. The patient had a normal postoperative period and a smoothly healing wound and continued to be under the management of clinical oncologists supporting chemo-, targeted, and immunotherapy. However, five months after the appearance of the lesion and three months after its surgical removal, after a serious deterioration of her general condition, she passed away at home.
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  • 文章类型: Journal Article
    背景:下颌骨上升支的缺陷,包括髁突头颈部或整个颞下颌关节(TMJ),很难重建。重建主要基于使用同种异体关节假体,软骨移植,下颌支背侧的牵张成骨,或各种来源的骨微血管皮瓣。为了开发一种克服这些方法限制的方法,我们最近引入了一种顺序嵌合皮瓣,该皮瓣由股外侧髁皮瓣(LFC)和旋髂深动脉皮瓣(DCIA)组成,用于重建多达一半的下颌骨和髁突头颈部。方法:对4例诊断为以下的患者使用嵌合皮瓣:难治性骨髓炎,扩展复发性牙源性角化酶,Goldenhar综合征,腮腺腺癌.经过诊断检查,在所有患者中都收获了LFC和DCIA皮瓣,并在顺序嵌合设计中用于重建下颌体和髁突头颈部。结果:手术后至少24个月至70个月的随访显示,所有四名患者均成功重建。LFC提供了软骨关节表面,在所有患者中,通过稳定的咬合和不受限制的张口以及保留或恢复外侧和内侧偏移来实现令人满意的咀嚼功能。DCIA允许在解剖学上类似于非萎缩的下颌体的骨重建。无皮瓣相关并发症发生。结论:顺序嵌合LFC和DCIA皮瓣是重建下颌骨和髁突头颈部一半的合适方法。适用于无法使用同种异体关节置换或其他方法失败的情况。由于需要收获两个皮瓣,护理负担加重,需要一个仔细的指示。该技术适用于在显微外科领域已经获得丰富经验的颌面外科医生。
    Background: Defects of the ascending ramus of the mandible, including the condylar head and neck or the whole temporomandibular joint (TMJ), are difficult to reconstruct. Reconstruction is mainly based on the use of alloplastic joint prosthesis, costochondral grafting, distraction osteogenesis of the dorsal part of the mandibular ramus, or osseous microvascular flaps of various origin. With the objective of developing a method that overcomes the restrictions of these methods, we recently introduced a sequential chimeric flap consisting of a lateral femoral condyle flap (LFC) and deep circumflex iliac artery flap (DCIA) for reconstruction of up to half of the mandible and the condylar head and neck. Methods: The chimeric flap was used in four patients with the following diagnoses: therapy-refractory osteomyelitis, extended recurrent odontogenic keratozyst, Goldenhar syndrome, and adenocarcinoma of the parotid gland. After a diagnostic workup, LFC and DCIA flaps were harvested in all patients and used in a sequential chimeric design for the reconstruction of the mandibular body and condylar head and neck. Results: Follow-up from at least 24 months up to 70 month after surgery showed a successful reconstruction in all four patients. The LFC provided a cartilaginous joint surface, allowing for a satisfactory masticatory function with a stable occlusion and unrestricted mouth opening and preserved or regained lateral and medial excursions in all patients. The DCIA allowed for a bony reconstruction anatomically resembling a non-atrophied mandibular body. No flap-related complications were observed. Conclusions: The sequential chimeric LFC and DCIA flap is an appropriate method for reconstructing up to half of the mandible and the condylar head and neck. It is suitable in cases where alloplastic joint replacement cannot be used or where other methods have failed. Due to the necessity of harvesting two flaps, the burden of care is increased, and a careful indication is required. The technique is reserved for maxillofacial surgeons who have already gained significant experience in the field of microsurgery.
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  • 文章类型: Case Reports
    神经鞘瘤在颌面部区域并不少见;然而,那些口内定位的人,特别是,硬腭是最不经常描述的。在目前的病例报告中,我们展示了一个17岁的女孩,在右边有组织学证实的硬腭神经鞘瘤,起源于右腭大神经.在她的情况下,尽管从肿瘤压迫中溶解了腭骨,这种疾病是无症状的,仅引起微弱的局部不适感。在全身麻醉下通过手术切除病灶,并通过在后部喂食基部上的舌粘膜瓣进行整形重建来补偿所产生的pal粘膜缺损。恢复期顺利。
    Schwannomas are not uncommon in the maxillofacial region; however, those with intraoral localization and, in particular, the hard palate are among the least frequently described. In the current case report, we present a 17-year-old girl with a histologically verified schwannoma of the hard palate on the right, originating from the right greater palatine nerve. In her case, despite the lysis of the palatine bone from the tumor compression, the disease is asymptomatic, causing only a weak sensation of local discomfort. The lesion was removed surgically under general anesthesia and the resulting defect of the palatal mucosa was compensated by plastic reconstruction with a lingual mucosal flap on a posterior feeding base. The recovery period was uneventful.
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  • 文章类型: Case Reports
    Robotic surgery is known as the \"third technological revolution\" in the field of surgery, and is an important milestone in the development of modern surgery. However, our country\'s innovative surgical robot industry is still in its early stages, and it is only being utilized in certain surgical fields. To explore the effectiveness of the application of domestic surgical robot in oral and maxillofacial surgery, the author successfully completed a case of benign parotid tumor resection with the assistance of a domestic autonomous robot. The operation was successful, facial nerve function was preserved, and postoperative wound healing was good.
    机器人手术被誉为外科学领域的“第三次技术革命”,是现代外科学发展的重要里程碑。然而我国创新型手术机器人产业尚处于起步阶段,仅用于部分外科领域。为了探讨国产手术机器人在口腔颌面外科应用的有效性,笔者在国产自主手术机器人辅助下顺利完成腮腺良性肿瘤切除1例,手术顺利,面神经功能保存完好,术后创口愈合良好。.
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  • 文章类型: Journal Article
    该研究旨在评估和讨论由多孔羟基磷灰石制成的创新PSI的使用,相互连接的孔隙促进骨整合,称为MyBoneCustom®植入物(MBCI),用于颌面部骨重建。使用MBCI进行各种应用的13例患者接受颌面骨重建手术的多中心队列,从生殖器成形术到眶底重建,包括颧骨和下颌骨重建,用于节段性缺陷和骨增强。随访时间1~22个月,平均9个月。没有感染,流离失所,或报告术后骨折。必要时可以对MBCI进行围手术期修改。此外,外科医生报告说,手术期间节省了大量时间。对于术后CT扫描的患者,在术后6个月随访控制时可见骨整合征象,1年后观察到连续骨整合。讨论了与当前使用的技术相比的优缺点。MBCI提供了新的骨重建的可能性与长期的观点,同时排除了钛和PEEK的缺点。与MBCIs的高骨整合潜力相关的低术后并发症水平为这种新的羟基磷灰石PSI在颌面部骨重建中的更广泛使用铺平了道路。
    The study aimed to evaluate and discuss the use of an innovative PSI made of porous hydroxyapatite, with interconnected porosity promoting osteointegration, called MyBone Custom® implant (MBCI), for maxillofacial bone reconstruction. A multicentric cohort of 13 patients underwent maxillofacial bone reconstruction surgery using MBCIs for various applications, from genioplasty to orbital floor reconstruction, including zygomatic and mandibular bone reconstruction, both for segmental defects and bone augmentation. The mean follow-up period was 9 months (1-22 months). No infections, displacements, or postoperative fractures were reported. Perioperative modifications of the MBCIs were possible when necessary. Additionally, surgeons reported significant time saved during surgery. For patients with postoperative CT scans, osteointegration signs were visible at the 6-month postoperative follow-up control, and continuous osteointegration was observed after 1 year. The advantages and disadvantages compared with current techniques used are discussed. MBCIs offer new bone reconstruction possibilities with long-term perspectives, while precluding the drawbacks of titanium and PEEK. The low level of postoperative complications associated with the high osteointegration potential of MBCIs paves the way to more extensive use of this new hydroxyapatite PSI in maxillofacial bone reconstruction.
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  • 文章类型: Case Reports
    努南综合征(NS)是一种常见的先天性综合征,其特征是在儿童中常见的多种异常。在这篇文章中,我们描述了一个患有先天性心脏病的病人,重度二尖瓣反流,和Nonaan综合征表现为左上颌肿胀和疼痛,通过完整的手术切除左上颌牙瘤进行治疗。基于这个案子,我们得出的结论是,许多口腔异常可能与NS有关,因此需要跨学科的治疗计划和及时的治疗。将口腔表现作为诊断NS的评分标准的重要性不可低估。因为NS中口头发现的重要性在很大程度上被忽视了。
    Noonan syndrome (NS) is a common congenital syndrome characterized by multiple anomalies commonly observed in children. In this article, we describe a case of a patient with congenital heart disease, severe mitral regurgitation, and Nonaan syndrome presented with left maxillary swelling and pain, which was treated by complete surgical excision of the left maxillary odontoma. Based on this case, we conclude that numerous oral abnormalities may be related to NS and thus necessitate interdisciplinary treatment planning and prompt therapy. The importance of including oral manifestations as a scoring criterion in diagnosing NS cannot be overstated, as the significance of oral findings in NS has largely been overlooked.
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  • 文章类型: Case Reports
    甲状舌管发育的先天性异常是儿科人群中的常见病理。甲状腺造血的确切频率尚不清楚,因为这种情况很少在临床上表现出来,几乎总是偶然发现。甲状腺舌管囊肿的乳头状癌相对少见,如果及时发现和治疗,预后良好,主要发生在成人。我们在这里提出的病例极为罕见:患有甲状腺舌管囊肿和甲状腺舌管囊肿癌(TDCa)的甲状腺乳头状癌。到目前为止,世界医学文献中只描述了两名这样的成年患者(24岁和35岁的女性)。我们介绍的患者是一名14岁的女性,是第一个被描述为患有甲状舌管囊肿和甲状腺发育不全(THA)的乳头状癌的青少年。这种疾病没有任何临床表现,病人是由她的父母带来的,以改善她的美学外观。体格检查和放射学评估均未显示任何恶性肿瘤迹象。只有在进行了局部解剖检查后,我们的团队才做出了诊断。在这个病人的情况下,由于其早期诊断,该疾病的传播仅限于甲状舌管囊肿的边界,并且没有区域和远处转移。手术切除导致完全治愈,没有任何术后数据提示残留疾病。在她的病例中,甲状腺的功能没有受到影响,尽管她左叶发育不全,有多个证据,即所检查的甲状腺标志物的正常血液浓度:游离三碘甲状腺原氨酸(FT3),游离甲状腺素(FT4),甲状腺球蛋白(TG),促甲状腺激素(TSH),抗TG(甲状腺抗体测试(TAT)),抗甲状腺过氧化物酶(TPO)(微粒体抗体测试(MAT)),和正常的身体和心理发展。
    Congenital abnormalities in the development of the thyroglossal duct are a common pathology in the pediatric population. The exact frequency of hemiagenesis of the thyroid gland is not known because the condition is rarely manifested clinically and is almost always discovered incidentally. Papillary carcinoma of thyroglossal cysts is relatively uncommon, has a good prognosis if promptly detected and treated and occurs mainly in adults. The case we present here is an extremely rare occurrence: a patient with papillary thyroid carcinoma of the thyroglossal duct cyst and thyroglossal duct cyst carcinoma (TDCa). So far, only two such adult patients (women aged 24 and 35) have been described in the world medical literature. The patient we present is a 14-year-old female and is the first described adolescent with papillary carcinoma of the thyroglossal duct cyst and thyroid hemiagenesis (THA). The disease didn\'t have any clinical manifestations, and the patient was brought in by her parents to improve her aesthetic appearance. Neither the physical examination nor the radiological evaluation showed any signs of malignancy. The diagnosis was reached by our team only after the patoanatomical examination. In this patient\'s case, due to its early diagnosis, the spread of the disease was limited only to the borders of the thyroglossal duct cyst and the absence of regional and distant metastasis. Surgical removal led to a complete cure, without any postoperative data suggestive of residual disease. The functions of the thyroid gland in her case were not affected, despite her left-lobe agenesis, to which there are multiple proofs, namely the normal blood concentration of the examined thyroid markers: free triiodothyronine (FT3), free thyroxine (FT4), thyroglobulin (TG), thyroid stimulating hormone (TSH), anti-TG (thyroid antibody test (TAT)), anti-thyroid peroxidase (TPO) (microsomal antibody test (MAT)), and normal physical and psychological development.
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  • 文章类型: Case Reports
    半颜面增生(HFH)是一种罕见的先天性疾病,其特征是面部组织明显的单侧过度生长。HFH的一种亚型是先天性面部浸润性脂肪瘤病(CIL-F)。这种疾病的特征是面部软组织中成熟脂肪细胞的单侧弥漫性浸润,并与骨骼肥大有关。这项工作旨在报告一例aCIL-F患者,在青春期出现右侧面部不对称和进行性生长,由于伴随的单侧髁突增生的迹象导致下颌不对称。十七岁时,进行了髁突切除术以阻止不对称下颌骨生长的进展.五年后,患者发生CIL-F相关颞下颌关节强直,表现为进行性张口受限和颞部面部疼痛。在这个CIL-F患者中,使用同种异体全关节假体的TMJ重建成功地进行了最佳的最大张口,完全缓解颞部面部疼痛,术后1年牙齿咬合稳定。具有完整的同种异体全关节假体的TMJ重建被证明是可预测的,稳定,1例CIL-F相关的颞下颌关节强直患者因进行性下颌骨不对称性而曾接受过髁突切除术治疗,且可选择安全的治疗方案。
    Hemifacial hyperplasia (HFH) is a rare congenital disorder characterized by marked unilateral overgrowth of the facial tissues. A subtype of HFH is congenital infiltrating lipomatosis of the face (CIL-F). This disease is characterized by unilateral diffuse infiltration of mature adipose cells in the facial soft tissue and is associated with skeletal hypertrophy. This work aims to report a case of a CIL-F patient with right facial asymmetry and progressive growth at adolescent age, causing mandibular asymmetry due to signs of concomitant unilateral condylar hyperplasia. At the age of seventeen, a condylectomy was performed to stop the progression of asymmetric mandibular growth. Five years later, the patient developed CIL-F-associated temporomandibular joint ankylosis, manifesting as progressive restricted mouth opening along with temporal facial pain. In this CIL-F patient, a TMJ reconstruction with an alloplastic total joint prosthesis was successfully performed with optimal maximal mouth opening, complete alleviation of temporal facial pain, and stable dental occlusion one year postoperatively. A TMJ reconstruction with a complete alloplastic total joint prosthesis proved to be a predictable, stable, and safe treatment option in a patient with CIL-F-associated TMJ ankylosis who was previously treated with condylectomy due to progressive mandibular asymmetry.
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  • 文章类型: Case Reports
    If diagnosed early, prostate cancer (PCa) has a good prognosis and an excellent five-year survival rate. However, this favorable behavior can be drastically worsened by the presence of another synchronous or metachronous higher-grade malignancy. In the current case report, we present and analyze a 76-year-old patient who underwent radical prostatectomy because of prostate gland adenocarcinoma, diagnosed on needle biopsy. The low Gleason score and the early stage of the PCa are in significant contrast with the widespread metastatic disease that is observed during the follow-up. Additional clinical examination, imaging, and histological evaluation reveal a high-grade salivary duct carcinoma, a metachronous primary in the left parotid gland. The presence of these two malignancies raises a series of diagnostic difficulties faced by medical professionals, in part because of the tendency of prostate gland and salivary gland tumors to show some overlapping features regarding their biological behavior and immunohistochemical aspects.
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  • 文章类型: Case Reports
    背景:所有有颞下颌关节紊乱症状和肺癌病史的患者都应怀疑下颌骨骨转移。本报告的目的是介绍一例肺腺癌后下颌髁突转移的病例。
    方法:2020年12月,颌面外科评估了一名71岁的患者左下颌髁突是否存在大的溶骨性病变。面部没有变化或遮挡,下颌运动得以保留。手术切除后,组织学提示肺腺癌转移。
    结论:迄今为止,只有7例con突转移被描述为肺癌。这种病理学的临床和放射学特征几乎总是阴影,而不是特异性的。
    结论:这项研究还关注罕见疾病,如转移到下颌髁突。它还强调了多学科方法在诊断和治疗过程中的重要性。
    BACKGROUND: Mandibular bone metastases should be suspected in all patients with temporomandibular joint disorder symptoms and lung cancer history. The purpose of this report is to present a case of metastasis to the mandibular condyle following pulmonary adenocarcinoma.
    METHODS: In December 2020, a 71-year-old patient was evaluated by the Department of Maxillofacial Surgery for the presence of a large osteolytic lesion in the left mandibular condyle. There were no changes to the face or occlusion, and mandibular movements were preserved. After surgical removal, histology revealed pulmonary adenocarcinoma metastasis.
    CONCLUSIONS: To date, only 7 cases of condylar metastases are described by lung cancer. This pathology\'s clinical and radiological features are almost always shaded and not specific.
    CONCLUSIONS: This study also focuses on rare conditions, such as metastases to the mandibular condyle. It also stresses the importance of a multidisciplinary approach both in the diagnostic and therapeutic process.
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