Descending necrotizing mediastinitis: a clinical analysis based on 10 years of published data in China / 口腔疾病防治

Objective@#To investigate the clinical characteristics, diagnosis, treatment, and prognosis of descending necrotizing mediastinitis (DNM) to provide a reference for the early diagnosis and timely treatment of DNM.@*Methods@#Data on DNM in China was electronically retrieved from the core databases and comprehensively reviewed from June 2012 to June 2023. The infection, pathogenic microorganisms, main symptoms, comorbidities and treatment methods of DNM were analyzed.@*Results@#The data of a total of 781 DNM patients, with an average age of (52.97 ± 5.64) years, were retrieved, including 554 males and 227 females. Odontogenic source, tonsillitis, pharyngeal abscess, sialoadenitis, upper respiratory tract infection, foreign body injury, or iatrogenic traumatic procedures are common causes. Among these, odontogenic infection is the most common source. Streptococcus sp. (n = 217) and Staphylococcus sp. (n = 82) were most isolated, followed by Klebsiella pneumoniae and Pseudomonas aeruginosa (equally n = 59). A total of 69.4% (542/781) of DNM patients recruited in this study were discovered to have various comorbidities, and more than one-third of these patients (n = 185) had diabetes. Of the broad antibiotics, carbapenem was most frequently used as treatment, and vancomycin was the most frequently coadministered. The mediastinal drainage approach varies widely, and the optimal regimen is still unknown. Seventy-two patients were treated with video-assisted thoracoscopic/mediastinoscopic surgical drainage, 22 patients were treated with percutaneous catheter drainage, 30 underwent the transcervical approach, and 40 underwent thoracotomy. A total of 617 patients who were selected underwent the appropriate combined operation for surgical drainage according to the specific location of the infected focus. The overall mortality rate of all 781 DNM patients included was 11.2%.@*Conclusion@#The most effective diagnosis and treatment of DNM is a high degree of clinical vigilance followed by prompt and adequate drainage with intensive care, including hemodynamic monitoring, nutritional support, computer tomographic scanning repeated as necessary, and combined use of systemic antibiotics.

Expert consensus on the evaluation and management of dysphagia after oral and maxillofacial tumor surgery / 实用口腔医学杂志

Surgical operation is the main treatment of oral and maxillofacial tumors.Dysphagia is a common postoperative complication.Swal-lowing disorder can not only lead to mis-aspiration,malnutrition,aspiration pneumonia and other serious consequences,but also may cause psychological problems and social communication barriers,affecting the quality of life of the patients.At present,there is no systematic evalua-tion and rehabilitation management plan for the problem of swallowing disorder after oral and maxillofacial tumor surgery in China.Combining the characteristics of postoperative swallowing disorder in patients with oral and maxillofacial tumors,summarizing the clinical experience of ex-perts in the field of tumor and rehabilitation,reviewing and summarizing relevant literature at home and abroad,and through joint discussion and modification,a group of national experts reached this consensus including the core contents of the screening of swallowing disorders,the phased assessment of prognosis and complications,and the implementation plan of comprehensive management such as nutrition management,respiratory management,swallowing function recovery,psychology and nursing during rehabilitation treatment,in order to improve the evalua-tion and rehabilitation of swallowing disorder after oral and maxillofacial tumor surgery in clinic.

Application of mixed reality technology in the diagnosis and treatment of oral and maxillofacial tumors / 口腔疾病防治

@#Oral and maxillofacial tumors are common oral and maxillofacial surgery-related diseases. Digital surgical technology, represented by virtual surgical design and surgical navigation, is the main auxiliary means of the surgical diagnosis and treatment of oral and maxillofacial tumors. However, the existing digital technology still has some problems and room for improvement in terms of 3D visualization imaging and intraoperative hand-eye coordination. At present, the application of 3D visualization technology represented by mixed-reality technology has been rapidly developing in the medical field. It assists in realizing the real-time stereoscopic presentation of medical images by superimposing 3D virtual images onto the real surgical environment. Mixed-reality technology has been gradually applied to the diagnosis and treatment of oral and maxillofacial tumors. Preoperatively, mixed-reality technology can be used to construct a 3D model of the tumor and its surrounding vital structures based on imaging data, at which point the medical team can personalize the preoperative assessment and design the surgical plan in the mixed-reality environment. Intraoperatively, the combination of mixed-reality technology and surgical navigation technology can be used to display the 3D virtual model in real time in the actual environment of the operation area, overcoming the hand-eye coordination problem associated with using navigation technology alone and further improving the accuracy and safety of oral and maxillofacial tumor surgery. The combination of mixed-reality technology and internet medical technology can provide a high-quality teaching platform to promote the development of regional oral and maxillofacial surgery practices. The limitations of mixed-reality technology include image occlusion, lack of accuracy when used alone, and long alignment times. In this review, the application of mixed-reality technology to the diagnosis and treatment of oral and maxillofacial tumors will be summarized and assessed by combining information from domestic and international literature reports with the practical clinical experience of the author group.

A virtual simulation system-based teaching method for the experimental course of oral local nerve block anesthesia / 中华医学教育探索杂志

Objective:To investigate the effect of the virtual simulation system-based teaching method for the experimental course of oral local nerve block anesthesia in improving the effect of traditional teaching methods.Methods:One hundred and eighteen undergraduate dental students were randomly divided into two groups, the experimental group was taught using a virtual simulation-based system, and the control group was taught using traditional teaching. The results of the teaching were comprehensively evaluated through course feedback questionnaires, analysis of theoretical test scores, evaluations of the trainees administering and receiving anesthesia on the current anesthesia, and faculty evaluations of the success of the anesthesia, and t-tests and chi-square tests were performed using SPSS 23.0.Results:There was no significant difference in baseline level between the two groups. The students in the experimental group thought that the learning was more vivid ( t=4.24, P=0.005) and had more self-confidence in local anesthesia ( t=4.99, P<0.001). The students in the experimental group felt less needle tip jitter during injection ( t=2.22, P=0.048) and better contact with the medial surface of the mandible ( t=2.22, P=0.020). The students who received anesthesia reported less pain during injection ( t=1.99, P=0.029) and better anesthesia of the inferior alveolar nerve ( t=3.36, P=0.039) in the experimental group. Teacher assessment revealed that the experimental group had a significantly lower failure rate of inferior alveolar nerve block than the control group ( χ2=4.40, P=0.036). Conclusions:The virtual simulation system can optimize the experimental teaching of oral local nerve block anesthesia and can achieve a satisfactory teaching effect.

Microbiological profile and antibiotic sensitivity of maxillofacial infections in an emergency hospital

Aim: To investigate the bacteriological profile of oral and maxillofacial infections and the pattern of sensitivity to a specific group of antibiotics in a reference emergency hospital in Brazil. Methods: This is a prospective cohort institutional study that studied patients affected by oral and/ or maxillofacial infections in a Brazilian emergency hospital, over a 12-month period, of different etiologies, through data collection, culture and antibiogram tests, and monitoring of the process of resolution of the infectious condition. The variables were analyzed using the chi-square and Mann-Whitney tests, using a significance level of 5%. Results: The sample consisted of 61 patients, 62.3% male. The mean age of participants was 34.3 years. Odontogenic infection was the most frequent etiology and the submandibular space was the most affected. The bacterial species Streptococcus viridans was isolated in 21.6% of cases. Levofloxacin, vancomycin and penicillin were the antibiotics with the highest frequency of bacterial sensitivity, while clindamycin and erythromycin showed the highest percentages of resistance. Conclusions: The results suggest that, among the most used antibiotics for the treatment of these infections, penicillin remains an excellent option of choice for empirical therapy

Emprego de dupla abordagem em fratura complexa de face: relato de caso / Use of dual approach in complex fracture of the face: case report / Uso de abordaje dual en fractura compleja de cara: reporte de caso

Objetivo: Relatar o tratamento de fratura de osso frontal e OPN. Relato de caso: Paciente G.S.M, 25 anos, foi encaminhado ao serviço de Cirurgia e Traumatologia Bucomaxilofacial (CTBMF) do Hospital Geral Clériston Andrade (HGCA). Em análise facial, notaram-se lesões em tecidos moles, hiposfagma em ambos os globos oculares, equimose periorbital bilateral e edema da região hemifacial esquerda, além de crepitação em região de OPN. Após a solicitação de Tomografia Computadorizada (TC) de face observou-se fratura complexa em região de terço superior esquerdo e região de glabela, acometendo osso frontal e margem supra orbital esquerda, além de fratura de OPN sem deslocamento considerável. Foi realizada uma abordagem cruenta por meio de um acesso coronal, e por meio deste foi realizada a redução e fixação dos arcos com placas e parafusos de titânio do sistema 2.0. Para o tratamento da fratura de OPN optou-se por uma abordagem incruenta devido ao mínimo deslocamento. Conclusão: O tratamento cruento com redução aberta e fixação interna rígida, mostrou-se uma abordagem eficaz para o alinhamento das fraturas do osso frontal, da mesma forma, a abordagem incruenta da fratura de OPN, embora conservadora, também apresentou bons resultados, demonstrando o sucesso da técnica empregada nesse caso... (AU)

Objective: To report the treatment of frontal bone fracture and OPN. Case report: Patient G.S.M, 25 years old, was referred to the Oral and Maxillofacial Surgery and Traumatology Service (CTBMF) of Hospital Geral Clériston Andrade (HGCA). In facial analysis, soft tissue lesions, hyposphagma in both eyeballs, bilateral periorbital ecchymosis and edema of the left hemifacial region were noted, in addition to crackling in the OPN region. After requesting a Computed Tomography (CT) scan of the face, a complex fracture was observed in the upper left third and glabella region, affecting the frontal bone and left supraorbital margin, in 5addition to an OPN fracture without considerable displacement. An open approach was performed through a coronal access, and through this the arches were reduced and fixed with titanium plates and screws of the 2.0 system. For the treatment of the OPN fracture, a closed approach was chosen due to the minimal displacement. Conclusion: Open reduction treatment with open reduction and rigid internal fixation proved to be an effective approach for the alignment of frontal bone fractures. success of the technique employed in this case... (AU)

Objetivo: Reportar el tratamiento de la fractura de hueso frontal y OPN. Caso clínico: Paciente G.S.M, de 25 años de edad, remitido al Servicio de Cirugía y Traumatología Oral y Maxilofacial (CTBMF) del Hospital Geral Clériston Andrade (HGCA). En el análisis facial se observaron lesiones de partes blandas, hiposfagma en ambos globos oculares, equimosis periorbitaria bilateral y edema de región hemifacial izquierda, además de crepitantes en región OPN. Tras solicitar una tomografía computarizada (TC) de rostro, se objetivó una fractura compleja en tercio superior izquierdo y región de glabela, afectando hueso frontal y margen supraorbitario izquierdo, además de una fractura OPN sin desplazamiento importante. Se realizó un abordaje abierto a través de un acceso coronal, mediante el cual se redujeron las arcadas y se fijaron con placas de titanio y tornillos del sistema 2.0. Para el tratamiento de la fractura OPN se optó por un abordaje cerrado debido al mínimo desplazamiento. Conclusión: El tratamiento de reducción abierta con reducción abierta y fijación interna rígida demostró ser un abordaje eficaz para la alineación de las fracturas del hueso frontal, éxito de la técnica empleada en este caso... (AU)

Perfil epidemiológico do uso de sistemas de fixação pela Cirurgia e Traumatologia Buco-Maxilo-Faciais em um Hospital Universitário / Epidemiological profile of the use of fixation systems by Oral and Maxillofacial Surgery and Traumatology in a University Hospital / Perfil epidemiológico del uso de sistemas de fijación por Cirugía Oral y Maxilofacial y Traumatología en un Hospital Universitario

Introdução: O tecido ósseo é um tipo de tecido conjuntivo especializado, caracterizado pelo seu metabolismo dinâmico. Ao sofrer um trauma, podendo ser cirúrgico (como osteotomias) ou não cirúrgico, resultando em uma fratura, o osso passa por dois processos de cicatrização, primária e secundária. A primária é caracterizada pelo mínimo movimento entre os fragmentos, e ocorre na presença de estabilização, sendo muitas vezes a fixação interna (FI) responsável por isso. A secundária ocorre na presença de um gap entre os fragmentos ósseos, na ausência de estabilização. Ambas resultam em consolidação óssea, mas apenas a primeira garante recuperação precoce de função (como fala e mastigação) e da estética facial do paciente. Objetivos: O objetivo deste trabalho foi realizar um levantamento epidemiológico a respeito do uso dos sistemas de fixação interna utilizados pela Cirurgia e Traumatologia Buco-maxilo-faciais no Hospital Universitário da UFPI. Metodologia e Resultados: Pesquisa submetida e liberada pelo Comitê de Ética em Pesquisa do HU-UFPI com o número CAAE: 52493221.9.0000.8050. Foram coletados dados de 271 procedimentos registrados no sistema do hospital. Havendo 228 pacientes no total, 69 que realizaram cirurgia em outro estabelecimento de saúde, mas apresentando falha de FI com indicação de remoção; divididos em sub-áreas, 146 procedimentos foram de trauma de face, 40 de correção de deformidades dentofaciais, 28 de ressecção de tumores e 14 de cirurgia reconstrutiva. Os sítios anatômicos onde houve maior número de instalação e remoção de FI foram: mandíbula, complexo órbito-zigomático-maxilar e maxila. Cirurgia reconstrutiva foi a subárea que teve três abordagens com substituição de FI, sendo em todas o sítio anatômico a mandíbula. As principais falhas de FI encontradas foram infecção e exposição. Conclusão: Tem se mostrado uma tarefa difícil determinar as razões pelas quais um sistema de fixação deve ser removido, mesmo quando este apresenta falha. Não há consenso entre os cirurgiões sobre um protocolo de remoção de FI após o período de consolidação óssea ter passado, mas é sugerido por alguns remover as placas e parafusos após um período de 3 meses, a fim de evitar sensibilidade, palpabilidade e outras complicações, no entanto é necessário considerar a morbidade de um segundo procedimento... (AU)

Introduction: Bone tissue is a type of specialized connective tissue characterized by its dynamic metabolism. When suffering trauma, which can be surgical (such as osteotomies) or non-surgical, resulting in a fracture, the bone undergoes two healing processes, primary and secondary. The primary healing is characterized by minimal movement between fragments and occurs in the presence of stabilization, often with internal fixation (IF) responsible for this. The secondary one occurs in the presence of a gap between the bone fragments, in the absence of stabilization. Both result in bone consolidation, but only the first guarantees the early recovery of function (such as speech and chewing) and the patient's facial aesthetics. Objectives: The objective of this study was to realize an epidemiological survey regarding the use of internal fixation systems used by Oral and Maxillofacial Surgery at the University Hospital of UFPI. Methodology and Results: This research was submitted and released by the Research Ethics Committee of the HU-UFPI with the number CAAE: 52493221.9.0000.8050. Data were collected from 271 procedures registered in the hospital system. There were 228 patients in total, 69 who underwent surgery at another health facility, but with IF failure with an indication for removal; divided into sub-areas, 146 procedures were for facial trauma, 40 for correction of dentofacial deformities, 28 for tumour resection and 14 for reconstructive surgery. The anatomical sites where there was more installation and removal of FI were: mandible, orbital-zygomatic-maxillary complex and maxilla. Reconstructive surgery was the sub-area that had three approaches with IF replacement, in all of which the anatomic site was the mandible. The main IF failures found were infection and exposure. Conclusion: It has proved to be a difficult task to determine the reasons why plates and screws of a fixation system should be removed, even when it fails. There is no consensus among surgeons on a protocol for removing IF after the period of bone healing has passed, but it is suggested by some to remove the plates and screws after 3 months to avoid tenderness, palpability, and other complications, however it is necessary to consider the morbidity of a second procedure... (AU)

Introducción: El tejido óseo es un tipo de tejido conectivo especializado que se caracteriza por su metabolismo dinámico. Cuando se sufre un traumatismo, que puede ser quirúrgico (como las osteotomías) o no quirúrgico, que resulta en una fractura, el hueso sufre dos procesos de curación, primario y secundario. La curación primaria se caracteriza por un movimiento mínimo entre fragmentos y se produce en presencia de estabilización, a menudo con la fijación interna (FI) responsable de ello. El secundario ocurre en presencia de un espacio entre los fragmentos óseos, en ausencia de estabilización. Ambos dan como resultado la consolidación ósea, pero sólo el primero garantiza la recuperación temprana de la función (como el habla y la masticación) y la estética facial del paciente. Objetivos: El objetivo de este estudio fue realizar una encuesta epidemiológica sobre el uso de sistemas de fijación interna utilizados en Cirugía Oral y Maxilofacial en el Hospital Universitario de la UFPI. Metodología y Resultados: Esta investigación fue presentada y difundida por el Comité de Ética en Investigación del HU-UFPI con el número CAAE: 52493221.9.0000.8050. Se recogieron datos de 271 procedimientos registrados en el sistema hospitalario. Fueron 228 pacientes en total, 69 que fueron intervenidos quirúrgicamente en otro centro de salud, pero con fracaso del IF con indicación de retiro; divididos en subáreas, 146 procedimientos fueron de traumatismo facial, 40 de corrección de deformidades dentofaciales, 28 de resección de tumores y 14 de cirugía reconstructiva. Los sitios anatómicos donde hubo mayor instalación y remoción de FI fueron: mandíbula, complejo orbitario-cigomático-maxilar y maxilar. La cirugía reconstructiva fue la subárea que tuvo tres abordajes con reemplazo de IF, en todos los cuales el sitio anatómico fue la mandíbula. Las principales fallas de FI encontradas fueron la infección y la exposición. Conclusión: Ha demostrado ser una tarea difícil determinar las razones por las cuales se deben retirar las placas y tornillos de un sistema de fijación, incluso cuando falla. No existe consenso entre los cirujanos sobre un protocolo para retirar el IF una vez transcurrido el período de curación ósea, pero algunos sugieren retirar las placas y los tornillos después de 3 meses para evitar sensibilidad, palpabilidad y otras complicaciones, sin embargo es necesario. considerar la morbilidad de un segundo procedimiento... (AU)

Liga Acadêmica de Cirurgia e Traumatologia Buco-maxilo-facial: um relato de experiência / Academic League of Oral and Maxillo-facial Surgery and Traumatology: an experience report / Liga Académica de Cirugía y Traumatología Oral y Maxilofacial: un relato de experiencia

A Cirurgia e Traumatologia Buco-Maxilo-Facial (CTBMF) é uma especialidade da Odontologia que tem como objetivo o diagnóstico e o tratamento das doenças, traumatismos, lesões e anomalias, congênitas e adquiridas, do aparelho mastigatório e anexos, e estruturas crânio-faciais associadas. Metodologia: Estudo descritivo, tipo relato de experiência, realizado a partir das vivências dos alunos envolvidos no projeto. O projeto promove discussões sobre agravos de saúde comuns na comunidade via palestras nos ambulatórios de cirurgia da FOP/UPE, atua através de postagens nas redes sociais sobre temas de grande importância em cirurgia bucal e de reuniões com aulas ministradas que provêm fundamentação teórica para capacitação dos alunos. Resultados: Desde sua fundação, a LABMF promove ações ambulatoriais para promover troca de conhecimentos sobre a CTBMF, desmistificar e instruir a população sobre exodontias e a importância do autoexame bucal. Atua com mutirões para atender a população em espera, e promove encontros científicos, proporcionando integração com outras faculdades. Conclusão: O projeto proporciona ao aluno a oportunidade de aprofundar seus conhecimentos em CTBMF e a desenvolver e aprimorar competências relacionadas à educação em saúde, liderança, comunicação, e outros. Ainda, provém retorno à população geral, repassando informações e conhecimentos pertinentes à sua saúde, tornando-os multiplicadores do saber... (AU)

Oral and Maxillofacial Surgery and Traumatology (CTBMF) is a specialty of Dentistry that aims to diagnose and treat diseases, traumas, injuries, and anomalies, congenital and acquired, of the masticatory system and appendages, and craniofacial structures associated. Methodology: Descriptive study, experience report type, carried out based on the experiences of the students involved in the project. The project promotes discussions about common health problems in the community via lectures at the FOP/UPE surgery outpatient clinics, works through posts on social media on topics of great importance in oral surgery, and meetings with classes taught that provide theoretical foundations for training professionals. students. Results: Since its foundation, LABMF has promoted outpatient actions to promote the exchange of knowledge about CTBMF, demystify and educate the population about extractions and the importance of oral self-examination. It works with joint efforts to assist the waiting population and promotes scientific meetings, providing integration with other faculties. Conclusion: The project provides students with the opportunity to deepen their knowledge in CTBMF and to develop and improve skills related to health education, leadership, communication, and others. Furthermore, it provides feedback to the general population, passing on information and knowledge relevant to their health, making them multipliers of knowledge... (AU)

La Cirugía y Traumatología Oral y Maxilofacial (CTBMF) es una especialidad de la Odontología que tiene como objetivo diagnosticar y tratar enfermedades, traumatismos, lesiones y anomalías, congénitas y adquiridas, del sistema masticatorio y apéndices, y estructuras craneofaciales asociadas. Metodología: Estudio descriptivo, tipo relato de experiencia, realizado a partir de las vivencias de los estudiantes involucrados en el proyecto. El proyecto promueve discusiones sobre problemas de salud comunes en la comunidad a través de charlas en los ambulatorios de cirugía de la FOP/ UPE, trabaja a través de publicaciones en redes sociales sobre temas de gran importancia en cirugía bucal y encuentros con clases impartidas que brindan fundamentos teóricos a la formación de profesionales. Resultados: Desde su fundación, LABMF ha impulsado acciones ambulatorias para promover el intercambio de conocimientos sobre el CTBMF, desmitificar y educar a la población sobre las extracciones y la importancia del autoexamen bucal. Trabaja en conjunto para atender a la población en espera y promueve encuentros científicos, brindando integración con otras facultades. Conclusión: El proyecto brinda a los estudiantes la oportunidad de profundizar sus conocimientos en CTBMF, y desarrollar y mejorar habilidades relacionadas con la educación para la salud, el liderazgo, la comunicación y otros. Además, retroalimenta a la población en general, transmitiéndole información y conocimientos relevantes para su salud, convirtiéndola en multiplicadora de conocimientos... (AU)

Reabilitação com prótese bucomaxilofacial: revisão de literatura / Rehabilitation with maxillofacial prosthetics

A odontologia reabilitadora tem como um dos seus ramos a especialidade de Prótese Bucomaxilofacial (PBMF), que visa restaurar ou substituir estruturas perdidas na região facial e no sistema estomatognático artificialmente, podendo ser ou não removidos pelo paciente. O presente trabalho objetiva revisar a leitura a respeito da reabilitação com PBMF e a sua aplicabilidade na clínica odontológica. Os indivíduos com alguma perda de estrutura na região de cabeça e pescoço, devido a traumas físicos e/ou químicos, defeitos congênitos, doenças autoimunes, neoplasias, infecções e parasitas, são pacientes para os quais há a indicação da reposição da parte ausente. As reconstruções podem ser perdas intraorais (área da maxila, mandíbula), extraorais (oculopalpebral, ocular, nasal, facial extensa e auricular) ou conjugadas. Esse é um trabalho multidisciplinar, com especialistas de áreas abrangentes e todos os especialistas trabalham de forma conjunta. Pode-se concluir que, embora seja uma das especialidades mais nobres da odontologia, ainda é muito desconhecida por parte dos estudantes e profissionais das áreas da saúde e são próteses absolutamente fundamentais para a reabilitação e qualidade de vida dos indivíduos que tem a necessidade do uso da prótese PBMF(AU)

Rehabilitating dentistry has as one of its branches the specialty of Oral and Maxillofacial Prosthesis (PBMF), which aims to restore or replace structures lost in the facial region and in the stomatognathic system artificially, which may or may not be removed by the patient. The present study aims to review the reading about rehabilitation with PBMF and its applicability in dental clinic. Individuals with some loss of structure in the head and neck region, due to physical and/or chemical trauma, birth defects, autoimmune diseases, neoplasms, infections and parasites, are patients in whom there is an indication for replacement of the absent part. Reconstructions can be intraoral (maximal area, mandible), extraoral (oculopalpebral, ocular, nasal, extensive facial and auricular) or conjugated losses. It is a multidisciplinary work, with specialists from the comprehensive areas and that all specialists work together. It can be concluded that although it is one of the noblest specialties of dentistry, it is still very unknown to students and health professionals, and they are absolutely fundamental prostheses for the rehabilitation and quality of life of individuals who need the use the PBMFprosthesis(AU)

Clinicopathological characteristics and prognosis of non-Hodgkin lymphoma in oral and maxillofacial regions: An analysis of 369 cases / 北京大学学报(医学版)

OBJECTIVE@#To investigate the clinicopathological characteristics and factors influencing the prognosis of non-Hodgkin lymphoma (NHL) in oral and maxillofacial regions.@*METHODS@#Clinicopathological data of 369 patients with oral and maxillofacial NHL initially diagnosed in Peking University Hospital of Stomatology from 2008 to 2020 were collected and analyzed retrospectively.@*RESULTS@#There were 180 males and 189 females. The median age of the patients was 56 years (3 months to 92 years), and the median duration was three months. Clinically, 283 cases manifested as mass, 38 cases as ulcerative necrotizing lesions, and 48 cases as diffuse soft tissue swelling. The lesions of 90 cases located in face and neck (75 cases neck, 20.3%), 99 cases were of major salivary glands (79 cases parotid glands, 20.9%), 103 cases of oral cavity, 50 cases of maxillofacial bones, 20 cases of Waldeyer's ring, and 7 cases of infratemporal fossa. In the study, 247 of the 369 patients had cervical lymphadenopathy, only 40 cases had B symptoms, and 23 cases had the bulky disease. Of the 369 NHLs, 299 (81%) were B-cell NHL, and 70(19%) were T-cell NHL. Diffuse large B-cell lymphoma, extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue, follicular lymphoma, and extranodal natural killer (NK)/T-cell lymphoma nasal type were the most common pathological subtypes. According to Ann Arbor staging, 87, 138, 106, and 38 cases were classified as staged Ⅰ, Ⅱ, Ⅲ, Ⅳ, respectively. The me-dian follow-up time was 48 months, 164 patients died during the follow-up period. The overall survival rates for one year, two years, and five years were 90.1%, 82.4%, and 59.9%, respectively, and the median survival was (86.00±7.98) months. Multivariate analysis showed that age (P < 0.001), Ann Arbor staging (P < 0.001), elevated lactate dehydrogenase (P=0.014), and pathological subtype (P=0.049) were the independent factors influencing the overall survival rate of NHL patients.@*CONCLUSION@#Oral and maxillofacial NHL has unique clinical characteristics and distribution patterns of pathological subtypes. Fewer patients had systemic symptoms. Neck and parotid glands were the most common sites invaded by NHL. Advanced age, Ann Arbor stage Ⅲ-Ⅳ, B symptoms, and T-cell NHL may predict a poor prognosis in oral and maxillofacial NHL patients.

Comparison of application of three dimensional microscope and optical microscope in oral and maxillofacial vascular anastomosis / 口腔疾病防治

Objective@#To investigate the application value of 3D microscope in vascular anastomosis in oral and maxillofacial surgery, to provide a reference for clinicians. @*Methods @#Eighty-seven cases of free flap reconstruction in oral and maxillofacial surgery were retrospectively included, including 30 cases in the 3D microscope group and 57 cases in the optical microscope group. The differences in intraoperative vascular anastomosis time, postoperative flap survival rate and doctor evaluation scores between the 3D microscope group and the optical microscope group were compared and statistically analyzed, and the feasibility of using three-dimensional microscope in surgery was evaluated. @*Results @#The arterial anastomosis time was (26.53±3.83) min/root in the 3D microscope group and (24.88 ± 2.97) min/root in the optical microscope group, and the difference was statistically significant (P<0.05). The venous anastomosis time was (30.68 ± 3.51) min/root in the three-dimensional microscope group and (28.70 ± 2.91) min/root in the optical microscope group, and the difference was statistically significant (P<0.05). There was no significant difference in the survival rate of flaps between the 3D microscope group (n = 28, 93.33%) and the optical microscope group (n = 53, 92.98%) (P>0.05). The doctor's evaluation scores of visual fatigue, training and learning, operative difficulty index, image sharing in the three-dimensional microscope group were higher than those in the optical microscope group, and the differences were statistically significant (P<0.05). @* Conclusion @# 3D microscope has good reliability and safety in surgery, a strong sense of three-dimensionality, and the convenience of teaching and training. It can be well applied to vascular anastomosis in oral and maxillofacial surgery.

Clinical analysis of patients with oral and maxillofacial infections in oral emergency / 北京大学学报(医学版)

OBJECTIVE@#To analyze the composition, incidence and clinical characteristics of oral and maxillofacial infections in oral emergency.@*METHODS@#A retrospective study on patients with oral and maxillofacial infections who visited the Department of Oral Emergency in Peking University School and Hospital of Stomatology from January 2017 to December 2019 was conducted. General characteristics, such as disease composition, gender, age distribution and position of involved teeth were analyzed.@*RESULTS@#A total of 8 277 patients with oral and maxillofacial infections were finally collected, including 4 378 male patients (52.9%) and 3 899 female patients (47.1%), with gender ratio of 1.12:1. The common diseases were periodontal abscess (3 826 cases, 46.2%), alveolar abscess (3 537 cases, 42.7%), maxillofacial space infection (740 cases, 9.0%), sialadenitis (108 cases, 1.3%), furuncle & carbuncle (56 cases, 0.7%) and osteomyelitis (10 cases, 0.1%). Male patients were more easily affected by periodontal abscess, space infection and furuncle & carbuncle than female patients with the gender ratios 1.24:1, 1.26:1, 2.50:1 individually, while the incidence of alveolar abscess, sialadenitis, furuncle & carbuncle had no significant gender difference. Different diseases were prone to occur at different ages. The peak ages of alveolar abscess were 5-9 and 27-67 years, while the peak age of periodontal abscess was 30-64 years. Space infection tended to occur between 21-67 years. There were 7 363 patients with oral abscess (3 826 patients with periodontal abscess and 3 537 patients with alveolar abscess), accounting for 88.9% of all the patients with oral and maxillofacial infections, involving 7 999 teeth, including 717 deciduous teeth and 7 282 permanent teeth. Periodontal abscess usually occurred in permanent teeth, especially the molar teeth. Alveolar abscess may occur in both primary teeth and permanent teeth. In primary teeth, the most vulnerable sites were primary molar teeth and maxillary central incisors while in permanent teeth the most vulnerable sites were first molar teeth.@*CONCLUSION@#Understanding the incidence of oral and maxillofacial infection was conducive to the correct diagnosis and effective treatment of clinical diseases, as well as targeted education for patients of different ages and genders to prevent the occurrence of diseases.

Ischemia-reperfusion injury of free tissue flaps, airway management, and prognosis in oral cancer patients / 口腔疾病防治

@#Free tissue flap transplantation is the preferred option for repairing and reconstructing postoperative defects in oral and maxillofacial-head malignant tumors. However, challenges remain for oral and maxillofacial-head and neck oncology surgeons in terms of ischemia-reperfusion (I/R) injury, airway management, quality of life and prognosis. I/R injury is an inevitable complication of free-flap transplantation surgery. In addition to shortening the vascular anastomosis time as much as possible during the surgical process, many studies have attempted to further prevent and treat free-flap I/R injury using physical intervention therapy, antioxidant and reactive oxygen species (ROS) scavenger therapy, hyperbaric oxygen therapy, etc. However, there is a lack of large-scale clinical randomized controlled trial evidence to further support these methods. Postoperative tracheal management of patients receiving free tissue flap transplantation is very important. In recent years, delayed extubation has been proposed as an alternative to traditional tracheostomy. This method can facilitate wound care for patients, reduce infections, speed up patient recovery, and reduce the incidence of vascular crises. In the future, such management is expected to improve the practicality and safety of delayed extubation by formulating more appropriate patient selection criteria and intensive care plans. Preoperative selection of suitable free tissue flaps according to the defect for repair and reconstruction is beneficial for improving the quality of life and survival rate of patients. At the same time, for patients who require postoperative radiotherapy, reducing the complications of postoperative radiotherapy and improving the quality of life of patients can be achieved through intraoperative nerve anastomosis, preradiation oral hygiene maintenance, early speech training, and other methods.

Application of mixed reality in standardized resident training on oral and maxillofacial-head and neck tumor surgery / 中华医学教育探索杂志

Objective:To evaluate the effect of mixed reality (MR) in the standardized resident training on oral and maxillofacial-head and neck tumor surgery.Methods:Twenty resident doctors, who received standardized training in the department of maxillofacial oncology of our hospital, were randomly divided into experimental group and control group. The MR teaching method was used in the experimental group, while the traditional teaching method was used in the control group. The teaching effect was evaluated by theoretical and operational tests and a questionnaire survey. Statistical analysis was performed with the SPSS 24.0 software. Statistical comparisons were performed by the Students' t-test or the Wilcoxon rank correlation test. Results:The theoretical test results showed that the scores of the experimental group were significantly higher than those of the control group (85.30±3.59 vs. 80.20±5.63, t = 2.41, P = 0.027). The operational test results showed that the scores of the experimental group were significantly higher than those of the control group (89.20±5.07 vs. 82.30±6.36, t = 2.68, P = 0.015). The questionnaire survey results showed that the MR teaching helped to easily acquire the knowledge of head and neck anatomy and operation skills. Besides, the doctors in the experimental group were more active and glad to communicate with others than those in the control group. In addition, the MR teaching method improved the learning interest of doctors. The doctors in the experimental group were more satisfied with the teaching effect than those in the control group, and they recommended that the MR teaching method be used in clinical training and teaching on oral and maxillofacial-head and neck tumor surgery. Conclusion:MR teaching can help doctors understand and master the knowledge of head and neck anatomy and operation skills and improve their learning interest, achieving a good teaching effect, so it has important application value in the standardized resident training on oral and maxillofacial-head and neck tumor surgery.

Application of digital 3D printed model combined with case-based learning in practice teaching of oral and maxillofacial surgery / 中华医学教育探索杂志

Objective:To investigate the application effect of the combined teaching model of digital 3D printed model and Tencent conference in case-based learning (CBL) teaching of oral and maxillofacial surgery.Methods:A total of 80 undergraduates in the classes of 2015 and 2016 were selected from School of Stomatology, Qingdao University. The students in the class of 2015 received traditional teaching, and those in the class of 2016 received the combined CBL teaching model of 3D printed model and Tencent conference. A questionnaire survey was used to evaluate the teaching effect, and theoretical examination was used to assess comprehensive abilities of the two groups. SPSS 24.0 was used to perform the chi-square test and the t-test. Results:There was no significant difference in the degree of satisfaction with teaching between the combined CBL teaching model of 3D printed model and Tencent conference and the traditional teaching model ( P>0.05), and both models were generally recognized and accepted by students. The experimental group had a significantly higher score than the control group (94.05±4.16 vs. 86.10±3.37, P<0.05). Conclusion:The combined teaching model of digital 3D printed model and Tencent conference integrates the advantages of the Internet and digital information and thus provides a certain reference for the teaching methods for other majors in stomatology.

Effects of thigh perforator flap on repair of oral and maxillofacial head and neck defects / 中华医学美学美容杂志

Objective:To investigate the clinical experience of different types of femoral perforator flaps in the reconstruction of oral and maxillofacial head and neck defects.Methods:From January 2018 to January 2021, 573 patients with oral and maxillofacial head and neck defects reconstructed by femoral perforator flap were collected in the Department of Maxillofacial Oncology, the Third Affiliated Hospital of Air Force Military Medical University (age range of 21-76 years, with a male to female ratio of 1.23∶1). According to the type of perforator flap, the patients were divided into ALT group, AMT group, TFL flap group and free muscle flap group. The incidence of postoperative complications, wound healing time and drainage volume in femoral area were compared among the 4 groups.Results:The ALT flap was used in 527 cases: 22 flaps had vascular crisis, 14 flaps had infection, 8 flaps had necrosis, 519 flaps survived; the mean healing time of the wound was (14.50±3.19) days, and the mean drainage volume was (49.9±21.3) ml. 28 cases were repaired with AMT flap: 2 flaps had vascular crisis and 1 had infection. All the flaps survived; the mean healing time of the wound was (14.18±2.75) days, and the mean drainage volume was (50.3±23.0) ml. 11 cases were repaired by TFL flap: 1 flap had vascular crisis and 1 had infection. All the flaps survived. The mean healing time of the wound was (14.09±2.66) days, and the mean drainage volume was (54.1±25.0) ml. 7 cases were repaired by free muscle flap survived without vascular crisis, infection and other postoperative complications; the mean healing time of the wound was 14.14±1.86, and the mean postoperative drainage volume was (49.9±21.1) ml. There was no significant difference in complication rate (flap necrosis, vascular crisis, infection, etc.) and repair effect among 573 patients with different flap types. The postoperative follow-up was conducted for 6-24 months, and the donor area was smooth and good in appearance, without obvious scar or functional influence. The repair effect of the affected area was satisfactory.Conclusions:Although there is a certain proportion of perforator vessel variation in the femoral perforator flap, the flap can be designed freely according to different types of variation. The thigh perforator flap has an essential application value in the repair of oral and maxillofacial head and neck defects.

Effect of titanium plate internal fixation combined with titanium nail intermaxillary traction on jaw fractures / 中华医学美学美容杂志

Objective:To observe the difference in the effect of simple titanium plate internal fixation and titanium plate internal fixation combined with titanium nail intermaxillary traction in the treatment of jaw fractures and their impact on the oral and maxillofacial function of patients.Methods:From August 2016 to May 2021, 94 patients with jaw fractures admitted to the Department of Stomatology, Linyi Central Hospital, Shandong (supplementing the gender, age range and average age of the patients), were divided into 47 cases in the control group, and the titanium plates were used alone, combined operation group 47 cases, titanium plate internal fixation combined with intermaxillary traction with titanium nails. The changes of oral and maxillofacial function and fracture healing were measured before operation and 3 months after operation, and the perioperative indicators and postoperative complications were recorded.Results:Three months after operation, the scores of maxillofacial function, mouth function and masticatory function in the combined operation group (0.52±0.09 points, 0.67±0.12 points, 0.58±0.08 points) were significantly lower than those in the control group (1.05±0.21 points, 1.14±0.22 points, 1.02±0.21 points) ( t=15.90, 12.86, 13.42, P<0.05). The effective rate of the combined operation group was 95.74% (45/47), which was significantly higher than that of the control group (80.85%, 38/47) (χ 2=5.05, P<0.05); there was no significant difference in operation time and hospitalization time between the groups ( P>0.05), the fracture healing time in the combined surgery group (65.02±7.06) d was significantly shorter than that in the control group (82.69±10.25) d ( t=9.73, P<0.05). The postoperative complication rate of combined treatment group was 6.38% (3/47), which was significantly lower than the control group 21.28% (10/47) (χ 2=4.37, P<0.05). Conclusions:In the treatment of jaw fractures, titanium plate internal fixation combined with titanium nail intermaxillary traction treatment can significantly improve the oral and maxillofacial function of patients, promote postoperative fracture healing, improve curative effect and reduce the incidence of complications compared with simple titanium plate internal fixation.

Treatment of dentofacial deformities secondary to condylar hyperplasia / 华西口腔医学杂志

Dentofacial deformities secondary to condylar hyperplasiais a kind of disease presenting facial asymmetry, malocclusion, temporomandibular joint dysfunction, and other symptoms caused by non-neoplastic hyperplasia of the condyle. The etiology is still unknown, and currently, pre- and post-operative orthodontics accompanied by orthognathic surgery, temporomandibular joint surgery and jawbone contouring surgery are the main treatment methods. A personalized treatment plan was developed, considering the active degree of condyle hyperplasia, the severity of the jaw deformity, and the patient's will, to correct deformity, obtain ideal occlusal relationship, and regain good temporomandibular joint function. Combined with the author's clinical experience, the etiology, clinical and imageological features, treatment aims, and surgical methods of condylar hyperplasia and secondary dentofacial deformities were discussed in this paper.

Design of full-chain teaching platform for oral and maxillofacial surgery / 医疗卫生装备

Objective To design a full-chain teaching platform for oral and maxillofacial surgery to solve the problems of the traditional teaching mode in medical students'clinical thinking ability,practical operation and evaluation.Methods A full-chain teaching platform for oral and maxillofacial surgery was developed with B/S architecture and front-end and back-end separation mode.The server end was programmed with Java language and the browser was realized with TypeScript language.The teaching platform developed was composed of three functional modules for basic training,practical operation and examination and evaluation.Results The platform developed enabled medical students to observe the whole process of oral and maxillofacial surgery in an immersive environment,and facilitated the practical operation and the evaluation for teaching effects.Conclusion The platform developed effectively standardizes the training of medical students in oral and maxillofacial surgery,improves their theoretical level,thinking ability and practical operation and enhances teaching effects for oral and maxillofacial surgery.[Chinese Medical Equipment Journal,2023,44(10):44-48]

Application of "whole-process and diversified" assessment in standardized training of oral and maxillofacial radiology / 中华医学教育探索杂志

In order to cultivate qualified oral clinicians, strengthen examination management, and strictly implement process assessment, Special Training Base of Oral and Maxillofacial Radiology in West China Hospital of Stomatology, Sichuan University, has implemented a whole-process and diversified assessment reform. In the part of process assessment, firstly the students were asked to fill in the workload form to give timely feedback on training and truly reflect attendance records; secondly, the performance of trainees in class was comprehensively evaluated in clinical training and theoretical teaching to improve their ability of comprehensive thinking of clinical problems. In the part of result assessment, the traditional theoretical assessment method was weakened, and the ability of comprehensive clinical research was strengthened. Trainees were guided to choose the topic flexibly and use standardized PPT format, and a comprehensive score was determined after assessment. Experts were invited to give their advice, so as to enhance the clinical confidence and scientific research confidence of trainees and help them expand their learning depth and breadth within the limited training time. The analysis of examination methods and assessment results shows that the "whole-process and diversified" assessment mode can truly reflect the training results of trainees and lay a solid foundation for further improvement and implementation of standardized training.