Oral and maxillofacial surgery

口腔颌面外科
  • 文章类型: Letter
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  • 文章类型: Case Reports
    传统的牙科手术正在通过寻求尽可能多地保留原始组织的方法来重新审视。种植牙科也看到了各种技术的出现,这些技术对天然组织的改变最小。无翼技术涉及通过新鲜拔出的窝或通过股壁穿孔放置植入物,不升高粘膜骨膜瓣。本文介绍了三例以病人为中心的病例报告,传统的基于牙科种植的全口康复,这是用无翼技术成功进行的,在不同的临床情况下。每个病例在恢复患者牙列的形式和功能方面都表现出良好的结果。
    Conventional operative dental procedures are being revisited with an approach that seeks to preserve the original tissue as much as possible. Implant dentistry has also seen the advent of various techniques which make minimal alteration to natural tissue. The flapless technique involves implant placement either through a freshly extracted socket or through a tansmucosal punch hole, without elevating mucoperiosteal flap. This paper presents a report on three cases of patient centric, conventional dental implant-based full-mouth rehabilitation, which was successfully carried out using the flapless technique, under varied clinical situations. Each case showed a favourable outcome in terms of restoration of the form and function of the patient\'s dentition.
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  • 文章类型: Journal Article
    目的:这项研究的目的是确定有监督的机器学习算法是否可以准确地预测口腔颌面外科住院患者中排泄的计算机化医师订单输入。
    方法:来自电子病历的数据包括患者人口统计学,合并症,程序,生命体征,实验室值,并对用药单进行回顾性收集。预测变量包括患者人口统计学,合并症,程序,生命体征,和实验室值。感兴趣的结果是药物订单是否被作废。使用MicrosoftExcel和Pythonv3.12清理和处理数据。梯度提升决策树,随机森林,K-最近的邻居,和朴素贝叶斯训练,已验证,并测试了排泄药物订单预测的准确性。
    结果:这项研究使用了来自1,204名患者入院5年的37,493份药物订单。3,892份(10.4%)的用药订单被作废。梯度提升决策树,随机森林,K-最近的邻居,朴素贝叶斯的接收器工作曲线下面积为0.802,95%CI[0.787,0.825],0.746,95%CI[0.722,0.765],0.685,95%CI[0.667,0.699],和0.505,95%CI[0.489,0.539],分别。精确召回曲线下面积为0.684,95%CI[0.679,0.702],0.647,95%CI[0.638,0.664],0.429,95%CI[0.417,0.434],和0.551,95%CI[0.551,0.552],分别。
    结论:梯度增强决策树是监督机器学习算法中表现最好的模型,在预测口腔颌面外科住院患者的空计算机医师医嘱输入的测试队列中具有令人满意的结果。
    OBJECTIVE: The aim of this study is to determine if supervised machine learning algorithms can accurately predict voided computerized physician order entry in oral and maxillofacial surgery inpatients.
    METHODS: Data from Electronic Medical Record included patient demographics, comorbidities, procedures, vital signs, laboratory values, and medication orders were retrospectively collected. Predictor variables included patient demographics, comorbidities, procedures, vital signs, and laboratory values. Outcome of interest is if a medication order was voided or not. Data was cleaned and processed using Microsoft Excel and Python v3.12. Gradient Boosted Decision Trees, Random Forest, K-Nearest Neighbor, and Naïve Bayes were trained, validated, and tested for accuracy of the prediction of voided medication orders.
    RESULTS: 37,493 medication orders from 1,204 patient admissions over 5 years were used for this study. 3,892 (10.4%) medication orders were voided. Gradient Boosted Decision Trees, Random Forest, K-Nearest Neighbor, and Naïve Bayes had an Area Under the Receiver Operating Curve of 0.802 with 95% CI [0.787, 0.825], 0.746 with 95% CI [0.722, 0.765], 0.685 with 95% CI [0.667, 0.699], and 0.505 with 95% CI [0.489, 0.539], respectively. Area Under the Precision Recall Curve was 0.684 with 95% CI [0.679, 0.702], 0.647 with 95% CI [0.638, 0.664], 0.429 with 95% CI [0.417, 0.434], and 0.551 with 95% CI [0.551, 0.552], respectively.
    CONCLUSIONS: Gradient Boosted Decision Trees was the best performing model of the supervised machine learning algorithms with satisfactory outcomes in the test cohort for predicting voided Computerized Physician Order Entry in Oral and Maxillofacial Surgery inpatients.
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  • 文章类型: Journal Article
    背景:评估印度人口口腔癌患者生活质量(QoL)的研究很少。口腔鳞状细胞癌(OSCC)患者的定期随访和QoL评估可以帮助制定全面的支持策略,以改善其QoL结果。目的和目的本研究旨在评估口腔癌患者的QoL并将QoL与人口统计学和治疗参数相关联。材料和方法该研究包括先前向口腔颌面外科报告的口腔癌患者。在治疗前后使用EORTCQLQ-C30和QLQ-HN43问卷进行QoL评估。临床人口统计细节,治疗数据,后续数据,和记录的平均QoL是从牙科信息档案软件中的患者记录中获取的。在治疗前和间隔一个月进行QoL评估,三个月,六个月,12个月,24个月,治疗后36个月。使用IBMSPSSStatisticsforWindows进行统计分析,版本23(2015年发布;IBMCorp.,Armonk,纽约,美国)。使用重复测量方差分析(ANOVA)来比较平均QoL评分和各个间隔的随访频率。卡方检验评估了性别之间平均QoL的差异,在不同的地点,以及初级闭合和移植物放置之间。显著性设定为小于0.05的p值。结果本科共报告90例OSCC患者。对90例(100%)患者进行了术前QoL评估。在这些病人中,41例(45%)已进行手术.41名患者中有25名(60%)对定期随访有反应,并对这些患者进行QoL评估。术后即刻阶段后,只有12例(48%)在3个月后报告.只有6人(24%)接受了12个月的随访,5人(20%)进行了为期两年的随访,1人(4%)接受了3年随访。OSCC治疗后随访次数持续减少(p=0.00)。治疗前,平均QoL指数为4.64。女性的术前QoL略高于男性,为4.76。得分为4.67(p=0.157)。OSCC治疗后立即,注意到QoL分数下降,平均得分为4.25(p=0.32)。切除后接受初次闭合的患者的术后QoL平均得分为4.9,而接受移植物放置的患者的平均得分为4.6(p=0.157)。结论本研究强调了口腔癌对患者生活质量的持久影响,并强调需要进行持续研究以探索有助于持续改善QoL的具体干预措施。它强调个性化,这类患者的整体护理方法。
    Background Studies evaluating the quality of life (QoL) among oral cancer patients in the Indian population are scarce. Regular follow-ups and QoL assessment in oral squamous cell carcinoma (OSCC) patients can aid in comprehensive support strategies to improve their QoL outcomes. Aim and objectives This study aimed to assess the QoL of oral cancer patients and correlate the QoL with demographic and treatment parameters.  Materials and methods The study included oral cancer patients who had previously reported to the Department of Oral and Maxillofacial Surgery. QoL assessment was done using the EORTC QLQ-C30 and QLQ-HN43 questionnaires before and after treatment. The clinico-demographic details, treatment data, follow-up data, and recorded mean QoL were procured from the patient records in Dental Information Archival Software. Assessment of QoL was done before treatment and at intervals of one month, three months, six months, 12 months, 24 months, and 36 months postoperatively after treatment. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 23 (released 2015; IBM Corp., Armonk, New York, United States). A repeated measures analysis of variance (ANOVA) was utilized for comparing the average QoL scores and frequency of follow-ups across various intervals. Chi-square tests assessed differences in mean QoL among genders, across different sites, and between primary closure and graft placement. The significance was set at a p-value of less than 0.05. Results A total of 90 OSCC patients had reported to the department. A preoperative assessment of QoL was done for 90 (100%) patients. Out of these patients, surgery has been performed on 41 (45%). Twenty-five out of 41 (60%) patients had responded to regular follow-up, and QoL was assessed for these patients. After the immediate postoperative phase, only 12 (48%) had reported after three months. Only six (24%) had a 12-month follow-up, five (20%) had a two-year follow-up, and one (4%) had a three-year follow-up. There was a constant decrease in the number of follow-ups after the treatment of OSCC (p=0.00). Prior to treatment, the mean QoL index was 4.64. Females had a slightly higher preoperative QoL of 4.76 compared to males, with a score of 4.67 (p=0.157). Immediately after the treatment of OSCC, a decline in QoL scores was noted, with a mean score of 4.25 (p=0.32). Patients who underwent primary closure after excision had a mean post-op QoL score of 4.9, while patients who underwent graft placement had a mean score of 4.6 (p=0.157). Conclusion This study highlights the enduring impact of oral cancer on a patient\'s quality of life and emphasizes the need for ongoing research to explore specific interventions that can contribute to sustained improvement in QoL. It emphasizes personalized, holistic care approaches for such patients.
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  • 文章类型: Journal Article
    背景/目标:自成立以来,尸体模型一直是全球牙科和医学教育的支柱。在澳大利亚,牙科学校的教育工作者是最早在口腔外科的正式教学中使用尸体猪头的人之一。此后,这种做法在大多数现代牙科课程中都不受欢迎。这项初步研究的目的是从学生的角度确定尸体猪模型在口腔外科培训中的实用性(格里菲斯大学,黄金海岸,澳大利亚)。方法:30名所有三年级牙科学生的参与者参加了两个小时的会议,其中包括30分钟的讲座,然后是90分钟的实践研讨会。讲座概述了学生在实践过程中的步骤和监督,并由颌面外科顾问提供。在研讨会结束时,参与者被要求匿名填写一份打印的问卷,其中有8个与他们的经历相关的问题.结果:在研讨会之前,三分之二(61%)的参与者认为他们在第三年的牙科学校课程中被教导过适当提高粘膜骨膜皮瓣的外科手术,尽管只有43%的学生协助专业住院医师举起粘膜骨膜皮瓣,而14%的学生报告自己进行了手术。几乎所有学生(96%)都同意猪模型对他们的牙科教育很有用,如果有机会,他们将再次使用该模型进行练习。问卷的完成率为93.33%。结论:这项初步研究表明,猪头呈现出一种有用的,学习基本口腔外科手术的低成本辅助手段。
    Background/Objectives: Cadaveric models have traditionally been a mainstay of dental and medical education worldwide since their inception. In Australia, educators at dental schools were among the first to use cadaveric porcine heads in formal teaching in oral surgery. This practice has since fallen out of favour in most modern dental curricula. The aim of this pilot study was to determine the utility of cadaveric porcine models for oral surgery training from a student perspective (Griffith University, Gold Coast, Australia). Methods: Thirty participants who were all third-year dental students attended a two-hour session comprising a 30 min lecture followed by a 90 min practical workshop. The lecture outlined the steps and supervision of students during the practical and was provided by a consultant maxillofacial surgeon. At the conclusion of the workshop, participants were asked to anonymously complete a printed questionnaire with eight questions related to their experience. Results: Prior to the workshop, two-thirds (61%) of participants felt that they had been taught the surgical procedure for raising mucoperiosteal flaps adequately in their dental school curriculum during their third year, although only 43% of students had assisted specialty residents in raising a mucoperiosteal flap and 14% reported having performed the procedure themselves. Almost all students (96%) agreed that the porcine model was useful for their dental education and that they would practice the exercise using the model again if provided with the opportunity. The questionnaire had a 93.33% completion rate. Conclusions: This pilot study indicates that porcine heads present a useful, low-cost adjunct in the learning of basic oral surgical procedures.
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  • 文章类型: Journal Article
    下颌前区的外科手术需要对复杂的解剖结构有深刻的了解,以确保患者的安全。舌孔(LF)及其骨内管是关键结构,为精神区域提供血管和神经支持。LF的患病率被广泛认可,人口之间的差异。
    该研究涉及650名成年参与者。使用高分辨率锥形束计算机断层扫描(CBCT)收集数据,并进行了统计分析,建立评分者之间的协议。
    人口有不同的年龄分布,男性占53.23%,女性占46.77%。正中舌管见于上、下(65.38%)。大多数参与者有舌侧管(60.92%)。最普遍的舌孔为4(30.62%)。研究发现性别与LF直径之间没有显着关联,分布在不同的行进方向,或LF位置。然而,雄性的直径稍大。
    这些发现为基于解剖位置的LF变化提供了有价值的见解,不同年龄组的测量结果无统计学显著差异.这些知识有助于口腔颌面外科领域的发展,确保更好的患者结果。
    UNASSIGNED: Surgical procedures in the anterior mandibular region require a profound understanding of the complex anatomical structures to ensure patient safety. The lingual foramen (LF) and its intra-osseous canal are pivotal structures, supplying vascular and neural support to the mental region. The prevalence of LF is widely recognized, with variations among populations.
    UNASSIGNED: The study involved 650 adult participants. Data were collected using high-resolution cone-beam computed tomography (CBCT), and statistical analysis was conducted, establishing inter-rater agreement.
    UNASSIGNED: The population had a varied age distribution, with males comprising 53.23% and females comprising 46.77%. The median lingual canal was found in the Supra and Infra spinosum (65.38%). Most participants had lateral lingual canals (60.92%). The most prevalent lingual foramina was 4 (30.62%). The study found no significant associations between gender and LF diameter, distribution in different travel directions, or LF locations. However, males had a slightly larger diameter.
    UNASSIGNED: The findings provide valuable insights into LF variations based on anatomical locations, and there were no statistically significant differences in measurements across different age groups. This knowledge contributes to the evolving field of oral and maxillofacial surgery, ensuring better patient outcomes.
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  • 文章类型: Journal Article
    当前研究的目的是评估和深入了解参加Qassim大学临床课程的牙科学生对口腔颌面外科(OMFS)专业的看法。在卡西姆大学的牙科诊所进行了一项基于调查的横断面研究,经过大学牙科研究中心的批准。该研究针对的人群包括Qassim大学注册的80名牙科实习生和本科生(BDS)。从每个学年(第三年到实习生),随机选择了20名学生,确保男性和女性部门的代表。在分析了牙科学生实习生和班级年的数据后,结果发现,关于问题3:"你认为口腔颌面外科医师在实践中最常执行的手术是什么?",没有统计学上显著的关联(P=0.859a).在实习生和牙科学生中,绝大多数人认为提取第三磨牙是最常见的手术。所报告的比例最低(70.4%)为实习生班,而在四年级学生中报告的百分比最高(91.7%)。牙科学生对OMFS的看法在本科培训期间发生了变化。通过对这些看法有更深入的理解,专门从事OMFS的学术教师可以提高他们教育学生的能力,反过来,加强整体专业。
    The objective of the current research was to assess and gain insight into the perceptions held by dental students enrolled in the clinical program at Qassim University regarding the specialty of oral and maxillofacial surgery (OMFS). A survey-based cross-sectional study was carried out at the dental clinics of Qassim University, following approval from the Dental Research Center of the university. The study targeted a population consisting of 80 dental interns and undergraduate students (BDS) enrolled at Qassim University. From each academic year (third year to interns), a random selection of 20 students was made, ensuring representation from both male and female sections. Upon analyzing the data regarding the intern and class year of dental students, it was found that there were no statistically significant associations with regard to question 3: \"What do you perceive as the most commonly performed procedure by oral and maxillofacial surgeons in practice?\" (P = 0.759a). Among intern and dental students, a significant majority identified extraction of the third molars as the most frequent procedure carried out. The lowest percentage (70.4%) was reported among the intern classes, whereas the highest percentage (91.7%) was reported among the fourth-year students. The perceptions of dental students toward OMFS undergo changes during their undergraduate training. By gaining a deeper understanding of these perceptions, the academic faculty specialized in OMFS can enhance their ability to educate students and, in turn, strengthen the overall specialty.
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  • 文章类型: Journal Article
    喉部填塞在口腔颌面手术中是必不可少的,以防止血液和组织碎片吸入。减少术后并发症。传统的口服途径方法往往不足,特别是在口腔粘膜下纤维化(OSMF)等严重的三聚体病例中,TMJ强直,和创伤后的条件,由于有限的张口。这项研究介绍了一种使用鼻咽气道(NPA)进行咽喉包装的新技术。该方法包括通过NPA插入止血敷料,确保最小的侵入性和有效的气道管理。用喉镜或纤维镜确认正确的定位,并且敷料被固定以防止移位。这项技术很简单,可重复,与传统方法相比,伤害更小。在我们的中心,通过NPA对35例全身麻醉下手术的患者进行咽喉填塞,结果满意度高,无并发症报告。
    Throat packing is essential in oral and maxillofacial surgeries to prevent blood and tissue debris aspiration, reducing postoperative complications. Traditional oral route methods are often inadequate, especially in severe trismus cases like Oral Submucous Fibrosis (OSMF), TMJ Ankylosis, and post-traumatic conditions due to limited mouth opening. This study introduces a novel technique using a nasopharyngeal airway (NPA) for throat packing. The method involves inserting a hemostatic dressing through an NPA, ensuring minimal invasiveness and effective airway management. Proper positioning is confirmed with a laryngoscope or fiberoptic scope, and the dressing is secured to prevent dislodgement. This technique is easy, reproducible, and less injurious compared to traditional methods. At our center, throat packing via NPA was performed on 35 patients undergoing surgery under general anesthesia, resulting in high satisfaction and no reported complications.
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  • 文章类型: Journal Article
    背景:在重建手术中,游离皮瓣手术的有效教学有待改进。需要容易获得和广泛获得的培训,而没有高财务成本或道德问题,同时仍然提供现实的体验。我们的目的是为微血管皮瓣开发适当的训练模型。
    方法:我们确定了猪半头的可用性最合适,成本,和现实主义。这些主要是由食品工业产生的,所以不需要牺牲动物,从动物福利的角度来看,它更符合道德。我们评估了作为皮瓣供体部位的适用性,并分析了51个标本的血管解剖结构。
    结果:解剖评估显示可靠且恒定的血管解剖结构,允许设计一个皮瓣模型,可以有效地说明微血管皮瓣手术的整个过程。该过程分为6个关键步骤。在标记距口腔外侧角5.3cm的血管蒂后,可以收获皮瓣。皮肤岛设计和随后的组织解剖,直到筋膜皮瓣凸起,类似于径向瓣。皮瓣收获完成后,它可以自由转移进行缺损重建。微血管吻合可以在宫颈区域的受体血管上进行,难度可以单独调整。
    结论:所开发的训练模型在外科现实性方面是一个合理的折中方案,可用性,说教价值,和成本/时间效率。我们相信这是一个强大而有效的工具,具有改善外科教育和培训的巨大潜力。
    BACKGROUND: In reconstructive surgery, improvements are needed in the effective teaching of free flap surgery. There is a need for easily accessible and widely available training without high financial costs or ethical concerns while still providing a realistic experience. Our aim was to develop an appropriate training model for microvascular flaps.
    METHODS: We identified pig head halves as most appropriate regarding availability, cost, and realism. These accrue largely by the food industry, so no animals need to be sacrificed, making it more ethical from an animal welfare perspective. We evaluated the suitability as flap donor site and analyzed the vascular anatomy of 51 specimens.
    RESULTS: Anatomical evaluation revealed a reliable and constant vascular anatomy, allowing the design of a flap model that can effectively illustrate the entire process of microvascular flap surgery. The process was divided into 6 key steps. The flap can be harvested after marking the vascular pedicle 5.3 cm from the lateral corner of the mouth. Skin island design and subsequent tissue dissection follow until a fasciocutaneous flap is raised, similar to a radial flap. Upon completion of flap harvesting, it can be freely transferred for defect reconstruction. Microvascular anastomosis can be performed on recipient vessels in the cervical region, and the difficulty can be individually adjusted.
    CONCLUSIONS: The developed training model is a reasonable compromise in terms of surgical realism, availability, didactic value, and cost/time effectiveness. We believe it is a powerful and effective tool with high potential for improving surgical education and training.
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  • 文章类型: Case Reports
    背景:单囊性成釉细胞瘤是一种罕见的成釉细胞瘤,其特点是缓慢的增长和相对局部的侵略性,主要起源是下颌骨的后部,它也指那些显示临床的囊性病变,射线照相,或颌骨囊肿的大体特征。
    方法:一名27岁女性患者主诉下颌骨广泛肿块,右唇和下巴严重肿胀和麻木。口腔检查显示右下颌骨磨牙区肿胀,颊板扩张。影像学和组织病理学特征与单囊性成釉细胞瘤的诊断一致。因此,手术切除了病灶,在术后5年随访期间,未发现临床或放射学复发。
    结论:虽然先前关于颌骨后部单囊性成釉细胞瘤的报道显示预后良好的病变表现为单眼实体,该病例报告了扩张性单囊性成釉细胞瘤的多房性外观和攻击行为。此外,虽然一些研究将单囊成釉细胞瘤的单眼外观与阻生牙齿联系起来,我们的病例提示先前存在的病变可能与患牙相关的多房单囊性成釉细胞瘤有创伤性联系.
    结论:该病例表现为罕见的多房单囊性成釉细胞瘤,尤其是受累的牙齿。它还表明了固体成釉细胞瘤向单囊性成釉细胞的潜在转化。
    BACKGROUND: Unicystic ameloblastomas are a rare variant of ameloblastomas, which are characterized by slow growth and being relatively locally aggressive, with the main site of origin being the posterior portion of the mandible, it also refers to those cystic lesions that show clinical, radiographic, or gross features of a jaw cyst.
    METHODS: A 27-year-old female patient presented with a chief complaint of extensive mass of mandible along with severe swelling and numbness of right lips and chin. The oral examination revealed a swelling in the molar region of the right mandible with buccal plate expansion. The radiographic and histopathologic features were consistent with the diagnosis of unicystic ameloblastoma. Consequently, the lesion was surgically removed, and no clinical or radiological recurrence was detected during 5 years post-operative follow-up.
    CONCLUSIONS: While previous reports of unicystic ameloblastoma in the posterior portion of the jaw showed favorable prognosis lesions appeared as a unilocular entity, this case reports multilocular appearance and aggressive behavior of expansive unicystic ameloblastoma. Furthermore, while some studies linked the unilocular appearance of unicystic ameloblastoma to impacted tooth, our case suggests a possible traumatic link of preexisting lesion into multilocular unicystic ameloblastoma related to impacted tooth.
    CONCLUSIONS: This case presents a rare multilocular unicystic ameloblastoma appearance, notably with impacted tooth involvement. It also indicates the potential transformation of solid ameloblastoma into unicystic ameloblastom.
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