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Objective: To evaluate the effects of surgical navigation technique in the reconstruction of traumatic orbital wall defect.Methods: 20 patients underwent the operation with the aid of navigation for repairing traumatic orbital wall defect as the test group. 20 patients were treated without navigation as the control group. Treatment outcome was evaluated by correction of exophthalmos, orbital volumes and patient's self-satisfaction. Results: The mean difference of eyeball protrusion between the reconstructed and the unaffected orbit cavity in the navigation group and control group was (0. 81 ± 0. 35) mm and (1. 65 ± 0. 37) mm (P ＜ 0. 05), that of the orbital volume (0. 68 ± 0. 29) ml and (0. 98 ± 0. 22) ml (P ＜ 0. 05), respectively. The patient's satisfaction value of the navigation group was higher than in the control group (P ＜ 0. 05) . The operation duration in the navigation group was less than in the control group (P ＜0. 05) . Conclusion: Surgical navigation can improve the accuracy and the effects of operation for orbital defect reconstruction.
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Objective: To establish and verify the validity of a finite element(FE) model of fragment injury in swine mandibular composite tissue. Methods: Swine facial composite tissue digital information was obtained by 3D CT,the 3D model and the cylinder fragment with the diameter and height of 5. 5 mm were reconstructed and designed in mimics15. 0. The right mandibular angle region was impacted by the fragment with velocities in finite element analysis software. A two stage light gas gun was used to launch the same shape 30CrMnSi alloy fragment with the speed of 831,1 120 and 1 536 m/s respectively to impact swine mandibular angle area. The actual damage area and acceleration at jaw were measured and compared with the digital simulation results. Results: Compared with the data of digital simulation the fragment with the speed of 831,1 120 and 1 536 m/s resulted in the larger mandibular damage area of entry in the in vivo experiment by 13. 4％,23. 6％ and 22. 3％; that of exit by 18. 7％,23. 0％ and 26. 5％; the smallar accelaration peak by 16. 7％,15. 3％ and 14. 6％,respectively. Conclusion: A digital model of the swine mandible composite tissue fragment injury model is established. The simulation results of the FE model are consistent similar to those of the in vivo test data.
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Objective:To seek the possibility of using internally installed curved mandibular distractor to repair the partial mandibular curved defect.Methods:A curved mandibular defect was sectioned in each of 3 adult dogs.The distractor designed by our own group based on the steel ball conducted force was implanted.After 7 days of latency,the distraction was performed at the rate of 0.5 mm × 2 times per day,followed by 3 months consolidation period.The osteogenesis was evaluated by general observation,X-ray examination and HE staining.Results:No complication was observed after operation and during distraction.The new bone healed well into a curved shape.The X-ray examination revealed that the transport disc moved along with the predesigned rail curve.HE staining clearly showed neo bone formulation zone between the mature trabecular and connective tissue.Conclusion:The internal distractor based on the steel ball conducted force can realize the curved distraction osteogenesis of posteriormandibular.
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BACKGROUND: A three-dimensional spiral computer tomography can display stereoscopic pictures with multi angles on films or computer screens. However, it is hard to display complex three-dimensional anatomical morphology on two-dimensional films or computer screens. Thus, three-dimensional models are needed in craniomaxillofacial surgery simulation or conceptual design.OBJECTIVE: To establish a three-dimensional skull model using spiral computer tomography data and to explore its application in craniofacial surgery.METHODS: Skull of the patient was scanned with Picker 6000 spiral computer tomography with 2.0 slice thickness and 1.0 pitch,and the obtained data were treated in Voxel Q image workstation for three-dimensional reconstruction with volume rendering technique. After having been downloaded to personal computer at 0.1 mm interval, the transaxial two-dimensional image data were converted into two-dimensional digitized contour data by using image processing software developed by the experimental team. The wire frame and solid images of craniofacial triangular facets could be reconstructed when the digitized data were inputted into image processing software of Surfacer 9.0.RESULTS AND CONCLUSION: The three-dimensional wire frame and solid image of skull was reconstructed and computer aided design for plastic operation was accomplished on it. Then the simulacrum of underlay was obtained by rapid prototyping technology. A three-dimensional skull model could be established using spiral computer tomography data. It might play an important role in the diagnosis and treatment of tumors, injuries and abnormality in craniofacial surgery.
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BACKGROUND: There are many methods for repairing the hemifacial atrophy, the most common is preparing plaster facial mold of the patient, with wax piled on the surface to restore the patient's facial shape, and wax pattern serves as a reference of surgical pad. However, the therapeutic effect for the correction and treatment is not satisfactory due to varied abnormality and difficult plans.OBJECTIVE: To discuss the feasibility of manufacturing underlay for the treatment of hemifacial atrophy using computer-assisted design and rapid prototyping technology. METHODS: Skull of the hemifacial atrophy patient was scanned with Picker 6000 SCT, and the data obtained were processed in Voxel Q image workstation for 3-D reconstruction with volume rendering technique. After the interval lamination, the images were downloaded at 0.4-mm interval in a BMP format using CuteFTP 4.0 software. Then the transaxial 2-D image data were converted into digitized 2-D contour data by using image processing software developed by experimental team through a series of processes, including filtering, screening, noise reduction, and distortion correction. The edges and contour of the images was extracted to obtain a vector diagram of facial cranial cortical bone contour line. The digitized data were inputted into image processing software of Surfacer 9.0 for vector superposing, thus the 3-D wire frame and solid images of skull could be reconstructed. According to mirror-image symmetry relation, the point-cloud data of facial bone on the normal side was duplicated to the atrophied side. Thus a 3-D model of the underlay was produced between the atrophied bone and the mirror image of normal side. In order to compensate the atrophy of soft tissues, the model was designed 1.5 mm thicker. After the three-dimensional Surfacer data on the CAD were re-stratified, the contour editing of the underlay and the supporting set of prototype were completed in RpDataRepare, forming RP files and creating underlay template through rapidly output of the processing file for rapid prototyping required, as a reference of surgical procedures.RESULTS AND CONCLUSION: The 3-D solid model of the patient skull bone surface contour was obtained and simulacrum of the underlay was prepared with computer assistance and rapid prototyping. According to the simulacrum, the operation was carried out and got a satisfactory result. The manufacture of underlay for the treatment of hemifacial atrophy could be accomplished by computer assisted design and rapid prototyping in a highly precise and rapid manner. It is a promising technique in the field of individualized underlay making in craniofacial surgery.
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OBJECTIVE@#To summarize our experience of successful and failed management in 8 huge lobulated nasopharyngeal angiofibromas with intracranial extensions, and introduce some key points of perioperative treatments.@*METHOD@#Eight male case with an average age of 18 years, were all lobes extending into middle and/or anterior cranial fossa, in which 5 cases revealed blood supply from the internal carotid arteries and 3 cases were reoperated because of recurrence. Preoperatively, the tumor were evaluated by CT, CTA, MRI and/or MRA, and super selective embolization of the feeding arteries were crucial procedures. The combined craniofacial approaches were used to excise these tumors.@*RESULT@#Five cases were removed completely, and 3 cases were removed partly in which 2 were due to serious bleeding caused by lack of DSA technique at that time and 1 were due to neglecting the tumor lobe in the sphenoid sinus of the other side.@*CONCLUSION@#Reasonable perioperative management are very important for control of intra-operative blood loss, complete remodeling of the tumor and avoiding complication.
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Adolescente , Humanos , Masculino , Angiofibroma , Patologia , Cirurgia Geral , Neoplasias Encefálicas , Cirurgia Geral , Artéria Carótida Interna , Neoplasias Nasofaríngeas , Patologia , Cirurgia Geral , Invasividade Neoplásica , Resultado do TratamentoRESUMO
BACKGROUND: Skin defect is commonly repaired by autologous skin graft, but in which, it is required healthy skin provider and it probably results in scarring deformity to various extents. The successful construction and clinical application of tissue-engineered skin (TE skin) mark the major breakthrough in treatment of skin defect.OBJECTIVE: To analyze the relationship between operation method and healing rate, through repair of skin defect with TE skin, to provide experimental evidence on clinical application of TE skin.DESIGN: Randomized controlled observation was designed.SETTING: Department of Oral and Maxillofacial Surgery, Teaching-Research Room of Histology and Pathology and Experimental Center of Tissue Engineering, School of Stomatology, Fourth Military Medical University of Chinese PLAMATERIALS: The experiment was performed in Experimental Center of Tissue Engineering, School of Stomatology, Fourth Military Medical University, in which 6 healthy York pigs were employed, of clean grade,aged varied from 2.5 to 3 months. 3 groups were randomized, named TE whole-layer group, TE dermal and auto-epidermal group and auto-graft group, 2 pigs in each group. 8 wounds were prepared in each pig, round in shape and 50 mm in diameter, 16 wounds in each group, totally 48wounds.METHODS: ①Preparation of TE whole layer and TE true skin. ② In TE whole-layer group: The whole layer of skin was cut off from fat layeralong the drawn line. When bleeding stopped thoroughly and the wound was covered with wet physiological saline gauze, TE whole-layer skin was collected and windowing was done on the skin for drainage. Physiological saline was used to rinsed away the culture solution on the surface of TE skin, and then, the cuticular layer was upward-covered the wound, avoiding gas vacuole between cuticular layer and wound. Single-layer oleic gauze, physiological saline gauze, aseptic dry gauze and elastic sponge cushion were covered successively, about 3-5 mm in thickness each layer. After routine dressing, elastic bandage was wrapped with compression terminally. ③ TE dermal and auto-epidermal group: The whole- layer skin was cut off with same method. Thin split-thickness skin (TIS) 0.1-0.2 mm was collected with drum dermanuring machine and soaked in physiological saline. The same method was used to collect the managed TE true skin and cover it on the wound, covering immediately on autoTTS. The rest management was same as TE whole-layer group. ④ Autograft group: The whole-layer skin was cut off and the fat tissue was removed, afterwards, it was re-grafted on the auto-wound, covered with various layers of dressing and bandaged with compression. ⑤ The survival case was determined if it was discovered no infection, necrosis and scaling of grafted skin, less than 3 mm in diameter when the wound was opened for changing fresh dressing each time, otherwise, the failed case was recorded. The survival rate in each group was analyzed statistically in 4 weeks after operation.MAIN OUTCOME MEASURES: Survival situation of grafted skin in 4weeks after operation in each group.RESULTS: In 4 weeks after operation, the survival rate of grafted skin was 75% in TE whole-layer group was 87% in TE dermal and auto-epidermal group and was 94% in auto-graft group. The results were similar basically in comparison among 3 groups (x2=-2.34, P ＞ 0.05).CONCLUSION: The effect of TE skin graft on repair of skin defect is near to that of auto-epidermal graft, testifying that the repair of skin defect with TE skin is feasible.
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Objective: To estabish an animal model with blast injury in maxillofacial region and to study the biomechanical property of the model.Methods: Spherical explosive at different distances was used to make wound in maxillofacial region in dogs. The pressure on tissue at different level, the variation of horizontal acceleration and strain of the mandibular and temporal bone were dynamically measured.Results: About 3.5 cm?3.0 cm soft tissue defect and madibular splintered fracture occurred in maxillofacial region when the spherical explosive exploded on the surface of the dog's face and the animal survived. The pressure on mandible was respectively 3.6%?2.9% of the surface of dog's face when the spherical explosive exploded 0 and 1.00 cm away from the dog's face while the ratio of horizontal acceleration of cranium to mandibular was 1/8?1/6. Splintered fracture occurred in mandible when the mandibular strain was 11 375 ??.Conclusion: The model can be applied as an animal model with blast injuries in maxillofacial region.
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Objective:To design a new elastic implant-distraction apparatus. Methods:The implant-distraction apparatus consists of tow units, a TiNi shape memory alloy spring and an implant, made of pure titanium TA2.Spring was put into the hollow implant.After horizontal osteotomy, the implant-distraction device was placed into the partial edentulous area of mandible of 6 dogs to distract the alveolar bone.Results: The apparatus was manufactured.It could implement continual autodistraction and kept stable in the in vivo experiment. 10 weeks after application of the apparatus the transport bone segment was vertically augmented by 4.7 mm on average.Conclusion: The implant-distraction device is functional in distraction osteogenesis.
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Objective: To study the injury characteristics of blast injury in maxillofacial region wounded by spherical explosive. Methods: Spherical explosive was used to wound maxillofacial region in rabbits , after gross observation of the trauma , bone tissue specimens were collected from 0.5 or 1.0 cm to the boundary of wound 6 hours, 3 and 7 days after wounding respectively, the samples were prepared and stained with HE and modified Mallory's trichrome staining and observed under light microscope . Microcirculation in wounded bone was studied by ink injection and observed in ground bone sections. Results: No changes were found 6 hours after injury. Inflammatory infiltration were found 3 days after injury.Osteonecrosis was observed 7 days after injury, the structure of bone beyond 0.1 cm of the wound was found to be normal and restoration of bone was observed. Conclusion : Pathological changes of mandible injured by spherical explosive are similar to those of usual fracture except that the wound of blast injury is seriously polluted.
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Objective To sum up our experience in the preoperative management for anticoagulated valve replacement patients undergoing selective biliary tract surgery Methods Thirty eight patients were divided into normal liver function group of 23 cases (group A) suspending anticoagulant 3 days before the surgery and group B of 15 cases with abnormal liver function suspending anticoagulant plus VitK 1 injection 12 hours before the surgery Prothrombin time was measured, and result was compared with 115 normal controls Results There were no significant difference in prothrombin time between the two groups Conclusion A biliary tract surgery could be safe if anticoagulated patients receive adequate preoperative management
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Objective: To investigate the distraction osteogenesis technique in correction of severe retro-maxillary deformity following the repair of cleft palate. Methods:10 patients were included in the study. Orthodontic treatment was used as a regular procedure before operation. Distraction osteogenesis technique was used to correct the deformity and malocclusion. 4 of patients applied with the external distractor and others with internal distractor. Latency period was 7 days. Distraction rhythm is 0.8~1 mm/d,2~4 times/d. Consolidation period was 8~12 weeks. Orthognathic surgery was done after distraction finished when necessary. Results:The treatment process was smooth and no severe complication occurred. The maximum of distraction distance is 22 mm, and the minimum of distraction distance was 15 mm. No malunion or ununion occurred in all 10 patients. All the patients were satisfied with the results. Conclusion:Distraction osteogenesis is more suitable for correction of severe retro-maxillary deformity following the repair of cleft palate. Bone transplantation is unnecessary during the operation process with easier handling and lower risk.
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Objective:To evaluate the effect of orbital floor mesh plate in the treatment of orbital floor fracture. Methods:27 patients with orbital margin fractures were treated by surgical operation with orbital floor mesh plates or medial wall plates. All patients were observed for 3 months after operation.Results:It was observed that all patients with enophthalmos were cured and the patients with nerve injury recovered satisfactorily.Conclusion:Orbital floor mesh plate is effective in the treatment of orbital floor fracture.
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Objective: To study the relationship between bone morphogenetic proteins(BMPs),BMP receptor type IA (BMPR IA) and the oncogenesis of squamous cell carcinoma in oral epithelia. Methods: Expression of BMP 2/4,BMPR IA was immunohistochemistry analyzed in the specimens obtained from buccal mucosa, including 18 cases of normal mucosa(NB), 24 cases of chronic inflammation(NCI) and 58 cases of oral squamous cell carcinoma(SCC). Result: Weak staining of BMP 2/4 and BMPR IA was observed in normal and chronic inflammation samples,while stroug staining was found in 52 out of 58 cases of oral SCC. No significant difference was found among the heighly,intermediately and poorly differentiated SCC groups.Conclusion: BMP 2/4,BMP IA might be involved in oncogenesis and development of squamous cell carcinoma of oral epithelium.
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?Objective: To design a new implant distraction apparatus.Methods:The implant distraction apparatus was designed on the bases of Ilizarov theory,made of pure titanium TA 2 and prepared as a set including distractor and accessories.Inferior edge of a dog's mandible was prepared for implantation. After horizontal osteotomy, two implant distraction devices were applied.Results:The transport bone segment was vertically augmented 3 5 mm successfully,and the ditraction apparatus was stable.Conclusion: The implant distraction device is functional in distraction osteogenesis.
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Objective: To investigate the method of using tubular demineralized tubular bone matrix scaffold composited with marrow stromal osteoblasts to fabricate tissue-engineered bone in vivo. Methods: Marrow stromal cells were harvested from illiac bone of 5 New Zealand rabbits respectively. After being cultured and multiplied in vitro, marrow stromal cells were induced to differentiate to osteoblasts with dexamethasone. The induced cells were harvested and mixed with 1.5% alginate sodium solution to generate a cell suspension. The suspension was dropped into tubular demineralized bone (1～1.5 cm in length, 0.2～0.5 cm in diameter) and then gelled with 2.5% CaCl 2. The demineralized tubular bone matrix/osteoblasts composites were placed in the dorsum of the rabbit subcutaneously as autogenous cells transplantation. Samples were investigated 6 and 12 weeks after implantation with histological and roentgenographic examination. Results: Osteoid tissue and new bone were observed in 4 weeks. In 8 weeks, more new bone formation, cells lied in the lacunae and arranged in order were found.Conclusion: Demineralized tubular bone matrix can be used as scaffold for the marrow stromal osteoblasts and alginate which was employed as three dimension carrier for cell growing and producing extral cell matrix.
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Objective: To observe the effect of distraction osteogenesis and synostosis following the placement of implant-distraction apparatus. Methods: The bilateral premolars were extracted in six adult hybrid dogs. After twelve weeks, a box-shaped osteotomy on the random side of the alveolar bone was carried out and two implant-distraction apparatus were placed. After one week, the alveolar ridge was vertically augmented at 1.05 mm/d by distraction for four days. Following 6-week-fixation histological and radiographical evaluations were carried out. Results: All dental implant-distraction apparatus obtained good healing except one failed for inflammation and was removed. The alveolar ridge was vertically augmented 4. 00 mm on average. The radiolucency in the distraction site disappeared in 6 weeks. Histologically, the lengthened bone consisted of mature lamellar and canellous bone, and good synostosis was obtained. The transport bone segment was vertical- ly augmented 4.2 mm, the maximum augmentation was 5 mm. Conclusions: The dental implant-distraction apparatus may be used for vertical augmentation of the alveolar ridge.
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Objective:To investigate the causes, characteristics and treatment of maxillofacial trauma in children. Methods: A retrospective analysis of 470 consecutive maxillofacial records of the patients not older than 14 years was conducted. Data regarding age, gender, cause, anatomic site and treatment were reviewed. Results:Most of the patients were mals(335 cases, 71.3% ), with a male and female ratio of approximately 2. 5;1 of the injuries, 28. 5% were due to accidental falls, 17.0% traffic accidents and 10.0% sharp implementt cutting. Injuries of soft tissue often occurred on gingiva, cheek, lip and chin. Mandibuir fratures were the most common (55.1% ) of all bone fractures. Conservative therapy, such as closed reduction surgery, maxillomandibular fixation, was usually performed. Conclusion: ①Boys are more tendent to be victims of maxillofacial trauma than girls. ②Falls are the first cause of child victims. ③Gingiva, chin, lip, check and mandible are the most commonly injuried sites.
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0^05). Conclusion MMP\|2 and MMP\|9 may serve as indicators of invasion and malignant phenotype.Neither of them can represent the phenotype of metastasis,but both can represent that of matrix degradation.Moreover,MMP\|9 may play more important role in glioma invasion than does MMP\|2.