oral surgery

口腔外科
  • DOI:
    文章类型: Case Reports
    本文的目的是报告一名5岁儿童患有多种牙齿异常的临床病例和4年随访,强调早期诊断和使用联合儿科手术和正畸方法的重要性。一个五岁的男孩,在他母亲的陪同下,寻求龋齿和牙齿疼痛的牙科护理。临床和影像学检查显示龋齿活跃,下颌右第二前磨牙区域的一个多余的乳牙,原发性下颌右第二磨牙严重强直。治疗计划包括拔除多余的牙齿以及切开和拔除坚固的磨牙。当病人6岁时,永久性下颌右第一磨牙显示出喷发过程改变的迹象,并开始正畸治疗。将带有螺旋弹簧的单侧带环空间保持器放置在第一磨牙上,该螺旋弹簧旨在移动第一磨牙。一张新的全景射线照片,患者7岁时获得,提示上颌右犬的顶端区域存在牙瘤。手术切除和病变的组织病理学检查证实这是一个正在发展的牙瘤。手术后,由于咬合异常,包括上颌横向缺损,深覆盖,和中线偏差,患者接受了Haas型矫治器的快速上颌扩张治疗.当病人8岁时,正畸治疗继续使用可移动的Hawley扩张器和正畸下颌舌弓。目前,在9岁的时候,在手术暴露受影响的永久性上颌右犬并结合正畸附件以进行牵引后,该儿童仍在接受固定正畸治疗。采用多学科方法管理牙齿异常可促进良好的预后,并确保对年轻患者进行全面治疗。
    The objective of this article is to report the clinical case and 4-year follow-up of a 5-year-old child with multiple dental anomalies, emphasizing the importance of early diagnosis and use of combined pediatric surgery and orthodontic approaches. A 5-year-old boy, accompanied by his mother, sought dental care for dental caries and tooth pain. Clinical and radiographic examinations revealed active caries, a supernumerary primary tooth in the region of the mandibular right second premolar, and severe ankylosis of the primary mandibular right second molar. The treatment plan involved extraction of the supernumerary tooth as well as sectioning and extraction of the ankylosed molar. When the patient was 6 years old, the permanent mandibular right first molar showed signs of an altered eruptive process, and orthodontic treatment was initiated. A unilateral band-and-loop space maintainer with coil springs designed to move the permanent first molar was placed on the primary first molar. A new panoramic radiograph, obtained when the patient was aged 7 years, suggested the presence of an odontoma in the apical region of the primary maxillary right canine. Surgical removal and histopathologic examination of the lesion confirmed that it was a developing odontoma. After surgery, due to occlusal anomalies that included transverse maxillary deficiency, deep overbite, and midline deviation, the patient underwent rapid maxillary expansion therapy with a Haas-type appliance. When the patient was 8 years old, orthodontic treatment continued with a removable palatal Hawley expander and a orthodontic mandibular lingual arch. Currently, at the age of 9 years, the child is still undergoing fixed orthodontic treatment after surgical exposure of the impacted permanent maxillary right canine and bonding of an orthodontic attachment to enable traction. A multidisciplinary approach to the management of dental anomalies promotes a favorable prognosis and ensures comprehensive treatment of young patients.
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  • 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: Case Reports
    背景/目的:对因牙周炎而需要拔牙的患者进行种植治疗是一项重大挑战。在规划牙种植体的放置时,考虑种植体周围炎至关重要。植入物治疗的可预测性取决于硬组织和软组织质量的适用性。本文的目的是提供一个病例报告,证明需要拔除所有牙齿的牙周炎患者的安全治疗方案,以增加角化粘膜区为目标的软组织管理,并提供可靠的假肢解决方案。次要目的是回顾有关牙种植体周围角化粘膜的重要性及其与种植体周围炎发生的相关性的相关文献。病例介绍:一名65岁女性患有全身牙周炎,IV级C级和非常差的口腔卫生来治疗和康复下颌。CBCT显示,牙齿34-44区域的牙周病变和唇舌脊尺寸为8.0至10.2mm。第一次手术包括拔牙和牙周损伤摘除,同时将四个植入物放置在牙齿32、34、42、44的位置。第二阶段手术涉及使用两个游离的牙龈移植物增加角化粘膜。结论:本病例报告描述了牙周炎患者的治疗过程,包括立即植入感染区域,使用免费的牙龈移植物和最终放置保留的覆盖义齿进行最终修复的软组织增强。经过两年的观察,尽管卫生条件可疑,未发现牙龈炎症症状。此外,文献中关于牙龈角化不足与种植体周围炎的发生之间的相关性的信息有限。
    Background/Objectives: Implant treatment in patients who require teeth extraction due to periodontitis presents a significant challenge. The consideration of peri-implantitis is crucial when planning the placement of dental implants. The predictability of implant treatment relies on the suitability of both hard and soft tissue quality. The aim of this article is to present a case report demonstrating a secure treatment protocol for implant procedures in patients with periodontitis requiring the extraction of all teeth, soft tissue management targeted at increasing the keratinized mucosa zone, and the provision of a reliable prosthetic solution. The secondary objective is to review the relevant literature regarding the significance of keratinized mucosa surrounding dental implants and its association with the occurrence of peri-implantitis. Case presentation: A 65-year-old female with generalized periodontitis, stage IV grade C and very poor oral hygiene came for treatment and rehabilitation of the lower jaw. CBCT revealed periodontal lesions and labio-lingual ridge dimensions in the region of teeth 34-44 from 8.0 to 10.2 mm. The first surgery included teeth extraction and periodontal lesions enucleation with simultaneous placement of four implants in the positions of teeth 32, 34, 42, 44. The second-stage surgery involved increasing the keratinized mucosa using two free gingival grafts. Conclusions: The present case report described the treatment process of the patient with periodontitis, including immediate implantation in the infected region, soft tissue augmentation using free gingival grafts and the ultimate placement of a bar-retained overdenture for final restoration. After two years of observation, despite questionable hygiene, no symptoms of gingival inflammation were detected. Furthermore, there is limited information in the literature regarding the correlation between inadequate keratinized gingiva and the occurrence of peri-implantitis.
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  • 文章类型: Journal Article
    暂无摘要。
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  • 文章类型: Journal Article
    拔牙后,牙槽过程的再吸收的生理现象被触发,特别是如果存在根核周围病变,有时可能与上颌骨后部的口窦沟通有关。为了研究一种微创方法,招募了19名在上颌骨后进行拔牙的患者。所有病例在拔牙和牙槽突后均出现直径为2-5mm的口窦连通,在某些情况下,有一个或多个骨壁的部分缺陷。在这些情况下,使用带有暴露的致密聚四氟乙烯膜的开放式屏障技术,使用单一外科手术来保留牙槽脊。提取插座的底部填充有胶原蛋白羊毛。使用基于源自猪松质骨的碳酸盐-磷灰石的生物材料重建残余骨过程。六个月后,所有患者均被召回,并接受与植入物-假体康复计划相关的影像学检查.收集与鼻窦健康状况以及再生骨的平均高度和厚度有关的数据。影像学评估证实了上颌窦底的完整性和新骨形成,检测垂直骨尺寸在3.1mm和7.4mm之间(平均5.13±1.15mm)和水平厚度在4.2mm和9.6mm之间(平均6.86±1.55mm)。这项研究的目的是强调管理口腔沟通的优势,同时,获得牙槽骨的保存和再生。开放屏障技术似乎对于在拔除后部位对直径达5mm的口腔通信进行微创管理是有效的。具有良好的硬软组织再生能力。
    After dental extraction, a physiological phenomenon of reabsorption of the dentoalveolar process is triggered, especially if periradicular lesions are present, which can sometimes be associated with oroantral communication in the upper posterior maxilla. To investigate a minimally invasive approach, 19 patients undergoing tooth extraction in the posterosuperior maxilla were recruited. All cases presented an oroantral communication with a diameter of 2-5 mm after tooth extraction and the alveolar process and, in some cases, with a partial defect of 1 or more bony walls. In these cases, a single surgical procedure was used to preserve the alveolar ridge using an open barrier technique with an exposed dense polytetrafluoroethylene membrane. The bottom of the extraction socket was filled with a collagen fleece. The residual bone process was reconstructed using a biomaterial based on carbonate-apatite derived from porcine cancellous bone. After 6 months, all patients were recalled and subjected to radiographic control associated with an implant-prosthetic rehabilitation plan. Data relating to the sinus health status and the average height and thickness of the regenerated bone were collected. Radiographic evaluation verified the integrity of the maxillary sinus floor with new bone formation, detecting a vertical bone dimension between 3.1 mm and 7.4 mm (average 5.13 ± 1.15 mm) and a horizontal thickness between 4.2 mm and 9.6 mm (average 6.86 ± 1.55 mm). The goal of this study was to highlight the advantage of managing an oroantral communication and, simultaneously, obtain the preservation and regeneration of the alveolar bone crest. The open barrier technique appears to be effective for the minimally invasive management of oroantral communication up to 5 mm in diameter in postextraction sites, with a good regeneration of hard and soft tissue.
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  • 文章类型: Journal Article
    孤立的冠状突骨折并不常见,医源性孤立性骨折极为罕见。此病例描述了孤立的冠状突的移位骨折,该骨折被认为是由于牙医施加的过大的力而被忽略并未治疗约一个月。患者是一名50多岁的女性,她接受了磨牙拔除。她的牙医混淆了她的三丝症状,疼痛,和面部水肿与复杂的拔牙程序。在锥形束计算机断层扫描(CBCT)扫描后,我们发现她右侧的下颌冠状突遭受了纵向骨折,断裂的碎片向上和向内旋转。在手术成功消除了破碎的冠状突之后,患者接受了有针对性的物理治疗,取得了优异的效果.在为期五个月的随访中,病人张开嘴的能力大大提高了,她的面部外观几乎恢复到原来的状态。
    Isolated coronoid process fractures are uncommon, and iatrogenic isolated fractures are extremely rare. This case describes a displaced fracture of an isolated coronoid process thought to be due to excessive force applied by a dentist that had been overlooked and left untreated for about a month. The patient was a woman in her late 50\'s and she had undergone a molar extraction. Her dentist had confused her symptoms of trismus, pain, and facial oedema with the complex tooth extraction procedure. Following a cone-beam computed tomography (CBCT) scan we showed that the mandibular coronoid process on her right side had suffered a longitudinal fracture, and the fractured fragment had rotated upwards and inwards. Following successful surgical elimination of the fragmented coronoid process, the patient received targeted physiotherapy sessions that yielded excellent results. At the five-month follow-up, the ability of the patient to open her mouth had improved enormously, and her facial appearance almost recovered to its original state.
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  • 文章类型: Case Reports
    简介和重要性:朗格汉斯细胞组织细胞增生症是一种罕见的疾病,其特征是朗格汉斯细胞在各种组织中的增殖。虽然它通常会影响骨骼,皮肤,和其他器官,口腔表现较不常见,但可能具有诊断挑战性.
    方法:我们介绍了一例在14岁青少年中出现口腔表现的LCH的临床病例。患者出现进行性颌骨疼痛约两个月。
    方法:口内检查显示下颌角前庭肿胀,前庭触诊疼痛。然而,病变的相邻牙齿没有移动,活力测试是积极的。放射学检查显示左下颌角存在不均匀的低密度溶骨性病变。组织病理学分析证实了LCH的诊断,牙龈组织中朗格汉斯细胞弥漫性浸润。患者被转诊到马赛医院,选择了治疗性弃权,每6个月进行一次临床和放射学随访,为期5年.在6周,观察到病变的显着减少和骨膜重建现象。一年后,病变已自发消退。临床讨论:疾病活动性评分允许定义疾病的严重程度和活动性并确定治疗。朗格汉斯细胞组织细胞增生症的临床表现是高度可变的。该疾病的严重形式发生在2岁之前,其特征是多系统受累和神经退行性受累。
    结论:活检后病灶自发消退。在这种情况下,及时诊断和多学科管理对于成功的治疗结果至关重要。该病例强调了在牙科实践中识别LCH的口腔表现对于早期诊断和适当管理的重要性。
    Introduction and importance: Langerhans cell histiocytosis is a rare disorder characterized by the proliferation of Langerhans cells in various tissues. While it commonly affects bones, skin, and other organs, oral manifestations are less frequent but can be diagnostically challenging.
    METHODS: we present a clinical case of LCH with an oral manifestation in a 14-year-old adolescent. The patient presented with progressive jaw pain for approximately two months.
    METHODS: Intraoral examination revealed vestibular swelling at the mandibular angle, with painful vestibular palpation. However, the adjacent teeth to the lesion were not mobile, and the vitality test was positive. Radiographic examination showed an inhomogeneous hypodense osteolytic lesion at the left mandibular angle. Histopathological analysis confirmed the diagnosis of LCH with diffuse infiltration of Langerhans cells in the gingival tissue. The patient was referred to Hospital in Marseille and therapeutic abstention is chosen, clinical and radiological follow-up is established every 6 months for 5 years. At 6 weeks, a significant decrease in the lesion and an osteoperiosteal reconstruction phenomenon are observed. After one year, the lesion has spontaneously resolved. Clinical discussion: The disease activity score allows defining the severity and activity of the disease and determine the treatment. The clinical presentation of Langerhans cell histiocytosis is highly variable. The severe form of the disease occurs before the age of 2 and is characterized by multi-system involvement and neurodegenerative involvement.
    CONCLUSIONS: The lesion resolved spontaneously after the biopsy was performed. Prompt diagnosis and multidisciplinary management are crucial for successful treatment outcomes in such cases. This case highlights the importance of recognizing oral manifestations of LCH in dental practice for early diagnosis and appropriate management.
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  • 文章类型: Case Reports
    此病例报告描述了一个9岁男孩的治疗方法,该男孩因2颗多余的牙齿而上颌中切牙受累。顺序方法包括手术切除多余牙齿以及两个阶段的手术暴露和受影响牙齿的正畸牵引导致门牙的正确重新定位。在不同治疗阶段的密切监测和多学科合作导致了成功的美学结果,具有最佳的牙周健康和功能闭塞。
    This case report describes the treatment of a 9-year-old boy with impacted maxillary central incisors due to 2 supernumerary teeth. A sequential approach comprising of surgical removal of the supernumerary teeth and 2 stages of surgical exposure and orthodontic traction of the impacted teeth resulted in correct repositioning of incisors. Close monitoring and multidisciplinary cooperation during various stages of treatment led to a successful esthetic outcome, with optimal periodontal health and functional occlusion.
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  • 文章类型: Case Reports
    一只8岁的雄性完整混合品种狗接受了3.7×3×3.6cm1级多小叶骨软骨肉瘤(MLO)的治疗,该肉瘤来自右冠状突的背侧,并进行了冠状切除术,子宫肌瘤切除术,和尾部上颌骨切除术.十个月后,这只狗出现了一个接近直角过程的肿胀,这被认为是局部复发。血液工作和初始分期测试(腹部超声)具有轻度异常,无临床关注/意义。第二天,狗住院,计划进行颅骨和胸部的计算机断层扫描(CT)扫描。一夜之间,肿胀迅速增加,狗变得横向躺着,发热,和低血压。实验室评估显示低血糖,乳酸升高,带中性粒细胞升高,具有中等毒性,最符合败血症.狗经过液体复苏后稳定下来,静脉注射(IV)抗生素,IV葡萄糖,和压缩机支持。一旦稳定下来,进行了对比CT扫描,这显示了腮腺唾液膨出感染的证据。据我们所知,这是第一例描述继发于感染的持续性腮腺唾液酸膨出的败血症的兽医病例。
    An 8-year-old male intact mixed breed dog was treated for a 3.7×3×3.6 cm grade 1 multilobular osteochondrosarcoma (MLO) arising from the dorsal aspect of the right coronoid process with a coronoidectomy, a zygomectomy, and a caudal maxillectomy. Ten months later, the dog presented for a swelling near the right angular process, which was presumed to be a locoregional recurrence. Blood work and initial staging tests (abdominal ultrasound) had mild abnormalities of no clinical concern/significance. The dog was hospitalized with a plan for computed tomographic (CT) scan of skull and chest the following day. Overnight, the swelling rapidly increased, and the dog became laterally recumbent, febrile, and hypotensive. Laboratory evaluation revealed hypoglycemia, elevated lactate, and elevated band neutrophils with moderate toxicity, most consistent with sepsis. The dog was stabilized with fluid resuscitation, intravenous (IV) antibiotics, IV dextrose, and pressor support. Once stabilized, a contrast CT scan was performed, which revealed evidence of an infected parotid gland sialocele. To our knowledge, this is the first veterinary case that describes sepsis secondary to an infected protracted parotid sialocele.
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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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