颧骨复合体骨折手术治疗的临床研究

目的：观察和对比头皮冠状切口及小切口联合入路在各种颧骨复合体骨折治疗中的效果。方法：分析2002年～2005年于我院口腔颌面外科救治的62例颧骨复合体骨折病人手术入路及临床效果。结果：根据不同类型的骨折,选择不同术式和切口,术中患者使用微型钛板行坚固内固定,术后均达到面形及功能的恢复。结论：对于大部分颧骨复合体骨折可以采用小切口的单独或联合入路进行治疗,对于颧骨体颧弓粉碎性骨折及陈旧性骨折应采用头皮冠状切口加必要的辅助切口。     

颞部Gillies切口在颧骨复合体骨折手术中的应用

目的:颞部Gillies切口在颧骨复合体骨折手术中的应用效果。方法:运用颞部Gillies切口治疗25例病人颧骨复合体骨折,观察手术进路,显露术区,在直视下行颧骨骨折复位内固定术。结果:25例患者应用此术式均可显露骨折区域,满足颧骨复合体骨折的手术显露需要,而且与常规颧骨复合体骨折(头皮冠状切口)手术相比,减小了出血及损伤神经的可能。结论:颞部Gillies切口在颧骨复合体骨折手术中优于其它手术路径,值得临床推广。     

颧颞部骨折术后并发颞部凹陷的临床回顾性研究

目的：分析不同颧颞部骨折性质与颞部凹陷的相关性,评价颧颞部骨折术后并发颞部凹陷的防治效果。方法：对105例颧颞部骨折病例进行回顾性分析,52例患者行颞部凹陷修复术,采用头皮冠状切口,应用钛网修复颞部凹陷,术后通过长期随访评价治疗效果。结果：陈旧性骨折颞部凹陷的发生率显著高于新鲜骨折,但治疗后颞部外形均有明显改善。结论：钛网植入能有效地修复颧颞部骨折术后并发的颞部凹陷,但应把握手术时机及治疗方法。     

颧颞部骨折术后并发颞部凹陷的临床回顾性研究

目的:分析不同颧颞部骨折性质与颞部凹陷的相关性,评价颧颞部骨折术后并发颞部凹陷的防治效果。方法:对105例颧颞部骨折病例进行回顾性分析,52例患者行颞部凹陷修复术,采用头皮冠状切口,应用钛网修复颞部凹陷,术后通过长期随访评价治疗效果。结果:陈旧性骨折颞部凹陷的发生率显著高于新鲜骨折,但治疗后颞部外形均有明显改善。结论:钛网植入能有效地修复颧颞部骨折术后并发的颞部凹陷,但应把握手术时机及治疗方法。     

补锌对兔实验性颧骨骨折愈合影响的生物力学研究

通过对１８只实验性颧骨骨折新西兰兔在骨折愈合过程中采用补锌和未补锌两种方法,来比较研究补锌对骨折部位的生物力学影响,进而阐明锌对骨折愈合的作用。     

南京直立人与印尼、周口店直立人的面颅形态比较

本文对南京直立人1号头骨与印尼Sangiran17头骨和周口店11号头骨作面颅形态上的比较。结果表明,南京1号头骨的面颅与周口店11号头骨的有许多共同的形态:较小的面颅尺寸、眶下区呈扁平状、较扁平的上部颜面、眶上圆枕较纤细、中眶型的眼眶、发育有颧切迹、上颌骨颧突基部位置较高等。南京1号头骨的面颅在另外一些方面显示出与Sangiran17头骨的形态上相近:阔上面型的面型、眶上圆枕内侧部比外侧部稍靠前、眶上圆枕下缘略呈平直状、鼻梁发育有中矢锐嵴、鼻梁横向呈峰状拱起、颧骨下缘外展、颧结节相对位置稍偏外侧、颧骨较高等。南京直立人面颅兼具周口店直立人11号头骨的和印尼直立人Sangiran17头骨的形态。从南京直立人的面颅形态可以推测我国南方的与北方的直立人群之间在体质形态上已经出现一定程度的地理变异。南京1号头骨面颅上的某些形态特征,如颧骨下缘外展等,可能反映了特征的梯度变异现象。这些特征的梯度变异的成因目前还很难确定。     

冠状- 睑下缘- 口内联合切口手术治疗眶- 上颌- 颧骨复合骨折

目的:探讨经冠状-睑下缘-口内联合切口行眶-上颌-颧骨复合骨折坚强内固定术的临床应用价值。方法:回顾性分析69例患者经冠状-睑下缘-口内联合切口行眶-上颌-颧骨复合骨折解剖复位,钛板坚强内固定。结果:69例均一期愈合,68例治疗效果优良,1例治疗效果欠佳;2例轻度睑外翻,两周后恢复正常,无额纹变浅、面神经损伤等其他并发症。结论:冠状-睑下缘-口内联合切口具有切口隐蔽、面部疤痕不明显、显露充分、并发症少等优点,是治疗眶-上颌-颧骨复合骨折的良好手术进路。     

冠状-睑下缘-口内联合切口手术治疗眶-上颌-颧骨复合骨折

目的：探讨经冠状-睑下缘-口内联合切口行眶-上颌-颧骨复合骨折坚强内固定术的临床应用价值。方法：回顾性分析69例患者经冠状-睑下缘-口内联合切口行眶-上颌-颧骨复合骨折解剖复位,钛板坚强内固定。结果：69例均一期愈合,68例治疗效果优良,1例治疗效果欠佳;2例轻度睑外翻,两周后恢复正常,无额纹变浅、面神经损伤等其他并发症。结论：冠状-睑下缘-口内联合切口具有切口隐蔽、面部疤痕不明显、显露充分、并发症少等优点,是治疗眶-上颌-颧骨复合骨折的良好手术进路。     

中国和欧洲早期智人的比较研究

中国与欧洲的早期智人头骨在颧骨额蝶突前外侧面的朝向、颧颌角、上颌骨颧突、鼻区、上面部高度、额鼻额颌缝形状、眉间区、矢状脊、印加骨和铲形门齿诸特征的形态或出现率等方面有明显差异。那时此两大地区存在相对独立的人类进化线,其间还有一定程度的基因交流。当时此两地区的人类居群分属于不同的人种。这一假说还可从古文化和古环境的资料得到支持。     

高原鼢鼠(Myospalax baileyi) 不同地理种群的形态变异

本文采用主成分分析和聚类分析两种方法,分析了高原鼢鼠(Myospalax baileyi)12 个地理种群17 项形态特征的变异。主成分分析结果显示,分析构建的雄性前3 个主成分累积贡献率为78.483% ,而雌性前4 个主成分累积贡献率为79.587% 。对种群间形态差异分析贡献最大的指标为颅全长、基长、后头宽等反映头骨大小性状,以及顶嵴、额嵴最小间距体现的颧弓扩张程度指标。主成分分析结果与聚类分析结果一致,12 个地理种群分化构成两个大的地域性群体:一个由甘肃种群构成的甘肃群体;另一个由四川种群和青海种群构成的混合群体。两个地域性群体实际上反映出两个不同的分化方向:一个方向表现为头骨较小,顶嵴、额嵴相对分开即颧弓扩张程度小,如甘肃群体;另一个则表现为头骨较大,顶嵴、额嵴相对靠拢即颧弓扩张程度大,如混合群体。这种地域群体的形态变异可以解释为,地下洞道系统中环境因子选择作用对高原鼢鼠形态变化产生了重要影响。     

Zygomatic implant-retained fixed complete denture for an elderly patient

Dental rehabilitation of a completely edentulous geriatric patient has always been a challenge to the clinician, especially in treating those with higher expectations and demands. Treatment duration and the amount of residual alveolar bone available are often important considerations when planning for dental implant-based fixed treatment for these patients. With the introduction of zygomatic implants, a graftless alternative solution has emerged for deficient maxillary bone with provision for immediate loading. This article describes the treatment of a completely edentulous elderly patient using zygomatic implants in conjunction with conventional implants. The implants were immediately loaded using a definitive acrylic resin fixed denture reinforced with a cast metal framework, to provide function and aesthetics.     

The importance of the zygomatic arch in complex midfacial fracture repair and correction of posttraumatic orbitozygomatic deformities

Collapse of the zygomatic arch following trauma results in inadequate anteroposterior projection of the zygomatic body and an increase in facial width. Accurate assessment of the position of the zygomatic arch in relation to the cranial base posteriorly and the midface anteriorly is the key to the acute repair of complex midfacial fractures and the secondary reconstruction of posttraumatic deformities of the orbitozygomaticomaxillary complex. Loss of projection of the zygomatic arch may occur with injuries confined to the orbitozygomaticomaxillary region or in association with complex midfacial fractures. A safe anatomic approach to the zygomatic arch allows exact anatomic restoration of the zygomatic arch using miniplates and screws and results in the reconstruction of an outer facial frame with a correct anteroposterior projection and facial width. The zygomatic arch injury is diagnosed using axial CT scanning. Three-hundred and seventeen arches have been exposed through a coronal incision following acute trauma and 47 arches have been exposed in patients requiring late correction of a posttraumatic orbitozygomaticomaxillary deformity. Permanent palsy to the frontal branch of the facial nerve has occurred in one patient following the exact definition of the anatomy of this region.     

Endoscopically assisted malarplasty: one incision and two dissection planes

Asian society is uniquely concerned about the distinctive facial features associated with malar prominence. Various methods of reduction malarplasty have been developed and are currently being applied. In this study, a new approach to malarplasty was experimentally assessed between December of 1999 and August of 2001. After having received careful observations of their facial features and full counseling sessions, 32 patients were selected. These patients had three distinctive characteristics: (1) severe zygomatic arch prominence and normal zygomatic body prominence, (2) desire for only a reduction of the lateral prominence, and (3) desire for a less invasive surgery. Through a short incision in the temporal area, the authors performed the dissection as two different planes. Endoscopic dissection between the superficial layer of deep temporal fascia and the temporoparietal fascia to the zygomatic body and blunt dissection under the deep layer of the deep temporal fascia to the zygomatic arch were performed. Complete osteotomy of the zygomatic arch and an incomplete osteotomy of the zygomatic body were then performed with a reciprocating saw. Finally, the zygomatic arch for the zygoma infraction was pressed manually. The major advantages of this procedure are its simplicity and the short operation and recovery time, with little bleeding and edema.     

The role of the zygomatic arch in the statics of the skull and its adaptive shape

The zygomatic arch of mammals is usually considered a phylogenetic relic of the fenestrations of the skull roof which may be observed in morphological sequences of primitive vertebrate skulls. If this concept is correct, the element is comparable (though not homologous) to the jugal arches of diapsid reptiles. Two major questions then remain unanswered: why different elements are maintained in reptiles and mammals during evolution, and why the arches are maintained as relics of ancestral forms. It is tempting to respond to the latter question with a very simple answer, namely that the elements function in order to sustain mechanical stresses. In this paper, we raise the questions which quality of stresses occurs in a primate skull within the zygomatic arches and what relationship these stresses hold to the morphology of these bony elements. An answer has been sought by means of finite element stress analysis. We found that the zygomatic arch in primate skulls represents a structure which carries, under all biologically relevant conditions, either compressive or tensile stresses. In a very simple model of the human skull under bite forces, a strip of stresses occurs lateral to the orbits, which seems roughly comparable to the zygomatic arch. Once such a structure exists and is used as an insertion of adductor muscles, it will be exposed to bending stress in side view and in frontal view. Morphological details of the zygomatic arch (curvature, profile, suture) are well suited to sustain the evoked stresses by a minimum of material.     

Multivariate allometry of the robust australopithecine zygomatic foramen: Bootstrap approach to confidence limits

The oddly rounded and disproportionate temporal fossa (or zygomatic foramen) in hyper-robust australopithecine fossils has elicited comment. Is this feature a scaled, positively-allometric version of hominoid anatomy in general or a unique adaptation? Multivariate allometry employing log principal component analysis is directed at the question, but confidence limits of the sampling error associated with these estimates are either dependent upon questionable multivariate theory or else unattainable by theory. The bootstrap method is therefore employed to estimate these aspects of dispersion. The size and shape of the hyper-robust australopithecine zygomatic foramen cannot be explained by simple extrapolation of primate interspecific allometries; although the positively and negatively allometric aspects of scaling are similar, the actual coefficients of scaling are significantly larger in the crucial variable in the australopithecines.     

Intraoral approach for reduction malarplasty: a simple method

Young Korean women with prominent zygoma may experience stress in daily life because the Oriental physiognomy often associates prominent zygoma with bad luck. Moreover, prominent zygoma in a wide Oriental face has the effect of making a person appear older and stubborn. Zygomatic reduction is often necessary to relieve stress from self-consciousness about facial appearance and to obtain younger and softer features. As such, most zygomatic procedures are cosmetic; therefore, an entirely intraoral approach with no skin incision is desirable. The current operative method of zygomatic reduction consists of two steps. The zygomatic body and arch are exposed through a mucoperiosteal incision from the maxillary canine to the first molar area. The first step is to grind and file the zygomatic body. The second step is made on the zygomatic arch. Using an oscillating saw, a partial-thickness osteotomy is made just posterior to the orbital rim, and a full-thickness osteotomy is made just anterior to the articular tubercle of the zygomatic arch. Light pressure on the posterior part of the arch produces a greenstick fracture of the anterior osteotomy site and a complete fracture of the posterior osteotomy site, resulting in inward repositioning of the zygomatic arch. This method of zygomatic reduction is simple, easy, effective, and leaves no conspicuous scars on the face.     

颧根与侧颅底重要结构的解剖学测量

目的：通过测量颧根与侧颅底各重要结构间的距离关系,为临床侧颅底外科手术治疗提供定位参考。方法：取成人颅骨标本50例（去颅盖标本8例,整颅42例）100侧,用游标卡尺、圆规和直尺测量颧根与侧颅底重要结构的距离。结果：实验测得左右侧颧根与外耳门前缘中点、乳突尖、茎突、翼突外侧板根部、舌下神经管外口、茎乳孔、颈静脉孔外缘、颈动脉管外口后缘、棘孔、卵圆孔、破裂孔的距离分别为22.30±2.84mm和22.02±3.27mm、40.37±3.21mm和40.56±3.54mm、32.53±2.78mm和32.92±2.68mm、35.13±3.14mm和35.19±2.74mm、49.29±2.88mm和48.98±2.87mm、32.92±2.44mm和33.05±2.61mm、35.15±2.86mm和34.68±3.13mm、33.17±2.78mm和33.17±2.72mm、28.83±2.62mm和28.68±2.63mm、31.15±2.76mm和31.49±2.73mm、43.67±3.32mm和44.15±3.02mm,左右侧数据无差异（P〉0.05）。结论：颧根可以作为侧颅底外科手术的定位标志,为直视条件下经颞下等入路的侧颅底外科手术提供解剖学依据。