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。     

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。     

颞部骨块形态形成模型极限环的唯一性

本文研究了颞部骨块形态形成的Gierer-Meinhardt模型,并得到该模型在大范围内极限环的唯一性．     

关节灌洗术联合透明质酸钠注射治疗颞下颌关节骨关节炎的疗效观察

目的:评价关节腔灌洗联合透明质酸钠注射治疗颞下颌关节骨关节炎(TMJOA)的疗效及安全性。方法:选取我院2014年5月-2015年5月收治颞下颌关节骨关节炎患者68例作为研究对象,根据入院时间先后顺序按照随机数字表法随机分为实验组和对照组各34例。所有患者在颞颌关节区域局麻下建立关节上腔的双通道灌洗系统,实验组用生理盐水反复冲洗关节腔后注射透明质酸钠,对照组只进行关节腔灌洗术,术后随访对比两组治疗前、治疗后4周、6个月时患者非辅助最大开口度、侧向运动幅度、咀嚼时疼痛感;同时采用酶联免疫吸附法(ELISA)测定两组治疗前、治疗后4周血清中白细胞介素6(IL-6)和肿瘤坏死因子α(TNF-α)水平并进行比较。结果:实验组患者治疗后4周、治疗后6个月时颞下颌关节最大张口度和侧向活动距离明显增大,而咀嚼时疼痛感明显减轻,且优于同期对照组,差异具有统计学意义(P0.05);实验组患者治疗后4周时血清IL-6、TNF-α水平较术前及同时期对照组均明显降低,差异具有统计学意义(P0.05)。结论:关节灌洗术联合透明质酸钠注射是治疗颞下颌关节骨关节炎的简单、安全有效治疗方法,治疗效果明显优于单纯关节腔灌洗,值得临床推广应用。     

自体颏部骨移植并种植体修复前牙槽骨缺损的应用研究

目的:评价自体颏部骨移植方法在前牙槽骨缺损植骨及种植的效果。方法:对16例前牙骨缺损的患者进行自体颏部骨移植,分别于植骨12～16周后植入种植体,共植入18枚种植体,术后16～20周完成修复治疗。结果:16例自体骨移植患者中,1例出现术后感染,经局部冲洗换药后后愈合良好,其余患者移植骨均已成活,修复后种植体至今均无脱落,局部外形良好。结论:自体颏部骨移植能有效恢复局部牙槽外形,为前牙美学修复提供良好的基础。     

牵张成骨联合正颌正畸技术治疗颞下颌关节强直的效果分析

目的：探讨联合采用牵张成骨以及正颌正畸技术治疗颞下颌关节强直的效果。方法：选取我院收治的50 例颞下颌关节强直 继发小下颌畸形患者,根据不同的手术方式将其分为观察组以及对照组,对照组仅采取正颌正畸治疗,观察组一期通过关节成形 术解除关节强直,完成正畸治疗后,二期采用牵张成骨以及颏成形术矫治小下颌畸形伴随OSAHS,术后进行8-35 月的随访,评价 治疗效果。结果：观察组的牵张距离、颏前移距离以及术后张口度均明显大于对照组,且最大张口度均大于20 mm,平均最大张口 度由术前的3.2 mm增加至术后的36.7 mm,P<0.05,观察组术后能够恢复正常咬合关系和咀嚼功能,两组患者术后的平均睡眠紊 乱指数（AH1）、LAST、后气道间隙（PAS）以及SNB 角度比较有统计学差异,P<0.05,观察组术后患者的OSAHS 症状均得到显著 的改善,未出现OSAHS复发情况。结论：牵张成骨联合正颌正畸技术治疗颞下颌关节强直可以获得满意的效果,可以很好的矫治 牙额面畸形,且能够有效改善伴发的OSAHS 症状。     

单节段固定关节突峡部融合治疗年轻人轻度峡部裂腰椎滑脱的临床观察

目的:介绍和分析单节段固定关节突峡部融合治疗年轻人轻度峡部裂腰椎滑脱的临床应用。方法:对2010.01-2016.01来我院就诊,诊断为峡部裂伴轻度腰椎滑脱的共计46例青年患者(30岁),采用单节段固定结合关节突峡部融合的方法进行治疗。分析包括患者术前与术后3月、6月及12月VAS(Visual Analogue Scale)疼痛评分,Lehmann腰椎功能评分等功能恢复指标的比较及融合率、并发症等临床观察指标的总结。结果:所有患者均至少接受12个月的术后随访,患者在术后(3,6,12月)的VAS评分及Macnab评分较术前均有显著改善和提高(P0.05)。影像资料显示:未出现不融合现象。1例患者出现皮肤浅层感染,处理后好转,余无明显并发症出现。结论:对于年轻人的轻度峡部裂伴腰椎滑脱患者,使用单节段固定结合关节突峡部融合的方法具有较好的疗效,且对后期影响较小。     

近代人群头骨颞线的分型和变异

颞线作为头骨表面咀嚼肌颞肌的附着痕迹,其形态变异对探讨人类体质特征及咀嚼功能具有一定意义。为了解颞线在现代人群中的变异情况,本文选取亚洲、非洲和欧洲278例近现代成年人头骨为研究材料,通过对颞线的颞弧形态、宽度、发育程度、粗糙度及末端位置的观察和分析,明确颞线的分类及其定义标准,获取颞线各种表现形式的侧别、性别和地区间变异的数据,为体质人类学的研究提供参考资料。研究结果显示：1）颞线无显著侧别间差异;2）颞弧形态和发育程度无显著性别和地区间差异;3）顶部颞线宽度及粗糙度有显著性别间差异：男性顶部颞线整体较宽,粗糙型个体大多为男性;4）额部和顶部颞线宽度及粗糙度有显著地区间差异：超宽条带状颞线只出现在云南和华北地区标本,欧洲地区标本脊状颞线和粗糙型比例较高,非洲地区脊状颞线比例较高但粗糙型较低;5）颞线末端止于枕骨的类型极少;6）颞线宽度在额部和顶部及其与颞弧形态显著相关,颞线发育程度在额部与顶部显著相关。     

微型钛板联合颌间牵引钉内固定术治疗颌骨骨折疗效观察

目的:探讨微型钛板联合颌间牵引钉内固定术治疗颌骨骨折的临床效果及其在临床的安全性。方法:随机选取颌骨骨折患者共60例,将上述患者随机平均分成对照组与观察组。分别给予与单纯微型钛板坚固内固定治疗和微型钛板联合颌间牵引钉内固定术治疗方法。分析比较这两组患者4周内的临床治疗效果及安全性。结果:术后4周两组间临床治疗效果比较显示:采取微型钛板联合颌间牵引钉内固定术治疗的观察组治疗效果明显好于给予单纯微型钛板坚固内固定治疗的对照组。观察组总有效率为87%,对照组总有效率为53.3%,差异有统计学意义(P0.05).两组手术过程均顺利实施,患者术后均无严重并发症发生,术后恢复情况较好,经比较两组术后不良反应的差异无统计学意义(P0.05)。结论:微型钛板联合颌间牵引钉内固定术是治疗颌骨多发骨折有效安全方法。     

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。     

Anterior zygomatic electrodes: a special electrode for the study of temporal lobe epilepsy

The position of a surface electrode over the anterior zygomatic arch is described. Epileptiform activity recorded at this position is compared with that recorded by sphenoidal electrodes in 21 cases of temporal lobe epilepsy. In 100% of the cases abnormalities were detected with both electrodes, although in 11% of the cases the findings could not be definitely described as epileptiform in the anterior zygomatic electrodes.     

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.     

Anatomy of the frontal branch of the facial nerve: the significance of the temporal fat pad

The anatomy of the temporal region, with reference to the frontal branch of the facial nerve, was examined in 12 fresh cadaver dissections. In all dissections, the frontal branch traveled in a constant plane along the undersurface of the temporoparietal fascia and was quite superficial as it crossed the zygomatic arch. The deep temporal fascia and superficial temporal fat pad are anatomically important structures which adjoin the periosteum of the zygomatic arch and lie deep to the frontal nerve. Based on these relationships, a safe method of dissection within the temporal region is formulated.     

Surgical anatomy and blood supply of the fascial layers of the temporal region

In 15 fresh cadavers (30 sides), we studied the two layers of fascia in the temporal region, with particular regard to their blood supply and to their usefulness--together or separately--as microvascular free-tissue autografts. The superficial temporal fascia (temporoparietal fascia, epicranial aponeurosis) lies immediately deep to the hair follicles. It is part of the subcutaneous musculoaponeurotic system and is continuous in all directions with other structures belonging to that layer--including the galea above and the SMAS layer of the face below. The deep temporal fascia (temporalis fascia, investing fascia of temporalis) is separated from the superficial fascia by an avascular plane of loose areolar tissue. It completely invests the superficial aspect of the temporalis muscle down to (but not beyond) the zygomatic arch. It is firmly attached to periosteum all around the margin of the muscles. Below it is attached to the upper border of the zygomatic arch. We found the deep temporal fascia to be supplied solely by the middle temporal artery, a constant branch of the superficial temporal. The middle temporal artery arises 1 to 3 cm below the upper border of the zygomatic arch, runs always superficial to the arch, and enters the deep temporal fascia immediately above that layer's attachment to the zygomatic arch. If the middle temporal vessels are protected, the two layers of temporal fascia can be raised together as a fully vascularized tissue island. This island can be fashioned as a bilobed or a double-layered flap, depending on the manner of dissection. The potential surgical usefulness of these findings is discussed.     

The skeletal anatomy of mandibulofacial dysostosis (Treacher Collins syndrome)

Three-dimensional osseous surface re-formation imaging from CT scans was used to examine the facial skeletons of 14 living patients with mandibulofacial dysostosis. Partial to complete aplasia of the zygomatic process of the temporal bone, mild hypoplasia to aplasia of the frontal process of the zygoma, antimongoloid slant of the transverse orbital axis, and hypoplasia of the medial pterygoid plates and muscles are common to all patients examined. Deformities of the zygoma, zygomatic process of the frontal bone, mandible, and lateral pterygoid plates and muscles vary from minimal to severe, including aplasia. The body of the zygoma is the least affected part of the bone. Right-left asymmetry characterizes these deformities in all patients. The most consistent skeletal aplasia (cleft) in mandibulofacial dysostosis involves the zygomatic process of the temporal bone rather than the zygoma itself.     

The functional significance of the squamosal suture in Australopithecus boisei.

A juvenile Australopithecus boisei specimen from the Omo basin, southern Ethiopia, is found to exhibit and extraordinarily large overlap of the temporal squama on the parietal, a phenomenon shared with at least two adult specimens of A. boisei. An attempt is made to interpret the overlap as a structural (bony/ligamentous) adaptation necessitated by the unique combination of certain components of the masticatory system of A. boisei. These are: (1) the massiveness and strength of the temporalis muscle, (2) its relatively anterior location, and (3) the lateral position of the masseter muscle due to the flaring of the zygomatic arches. The effect of the temporalis muscle is to create excessive pressure on the portion of the squamosal suture along the parietal, while the lateral placement of the masseter and the resultant increase of pressure on the temporal squama via the zygomatic arch tend to "loosen" the contact between the temporal and parietal bones.     

Forms and Social Signal Value of Smiles Associated with Pleasant and Unpleasant Sensory Experience

Episodes of facial displays involving the zygomatic action (AU12: lip corner pulling or smiling) were selected from a large sample of children (n = 95) exposed to pleasant and unpleasant odours in the presence of an unfamiliar person in order to investigate potential differences in morphological, temporal patterning and social signal value of smiling. In a first experiment, using the facial action coding system (FACS: Ekman & Friesen 1978), a considerable morphological flexibility of smiles was observed in relation to the subjects' hedonic experience. The facial configurations of smiling were formed by a number of actions in the upper (AU 4: brow lowering), middle (AU 9: nose wrinkling) and lower face (AU 14: dimpling, AU 15: lip comer depressing, AU 17: chin raising, AU 23: lip tightening) and the mouth was more often ‘closed’ in response to unpleasant odours. When exposed to pleasant odours, zygomatic action co-occurred more frequently with an opening of the mouth (AUs 25, 26, 27) or with a raising of the cheeks (AU 6). An analysis of the temporal patterning of zygomatic actions showed that they occurred more rapidly, dropped off the face less abruptly with a stepped decrease, were less smooth, and were often associated with shorter gazes directed toward the examiner in response only to unpleasant odours. These findings suggested that a number of subjects might exert some control on their smiling while confronted with a presumed social constraint, namely the smelling of unpleasant odours in the presence of an unfamiliar person. In a second experiment, the communicative value of smiling was investigated in a real-time projection of 10 variants of smiling to a panel of receivers (n = 52). The Duchenne smile (AU 6 + 12 + 25) and smile with lips opening (12 + 25) provided more accurate information about the hedonic valence of the inhaled odour than did the other types of smiling. In contrast, the perceived valence of the facial displays simultaneously combining zygomatic action with muscular actions of the lower face (AUs 15, 17, 23) appeared more difficult to discriminate by untrained receivers. It was hypothesized that the senders displayed some forms of smiling possibly to mask their responsiveness to unpleasant odours in signalling ambiguous or incorrect information about their internal state to a recipient.     

Depth of the facial nerve in face lift dissections

Facial nerve depth was measured in 12 cadaver face halves after bilateral face lift dissections. The main nerve trunk emerged anterior to the midearlobe and was 20.1 +/- 3.1 mm deep. Nerve exit from the parotid edge also was deep, averaging 9.1 +/- 2.8 mm for temporal, 9.2 +/- 2.2 mm for zygomatic, 9.6 +/- 2.0 mm for buccal, and 10.6 +/- 2.7 mm for mandibular branches. Distal to the parotid gland, danger areas where nerve branches became superficial were distal temporal, lower buccal, and upper mandibular branches over the masseter muscle and marginal mandibular as it crossed the facial artery. Some protection in these danger areas was provided by fascia, especially superficial temporal and masseteric, while platysma provided some protection for the mandibular branch. Fascial and muscle protection was less in thin cadavers. Face lift dissection can be rapid in areas where facial nerve branches are deep or absent, such as postauricular, inferior to the zygomatic prominence, and near the earlobe.