口腔疾病防治 ›› 2018, Vol. 26 ›› Issue (2): 75–82.doi: 10.12016/j.issn.2096-1456.2018.02.002

• 专家论坛 • 上一篇    下一篇

微创外科技术在口腔颌面外科中的应用

黄志权(), 张大明   

  1. 中山大学孙逸仙纪念医院口腔颌面外科, 广东 广州(510120)
  • 收稿日期:2017-04-05 修回日期:2017-06-02 出版日期:2018-02-20 发布日期:2018-08-31
  • 作者简介:

    【通信作者简介】 黄志权,博士,主任医师,博士生导师。现任中山大学孙逸仙纪念医院口腔颌面外科副主任,广东省医学会颌面-头颈外科学分会常委、青年委员会副主任委员。2001年自中山大学口腔医学院毕业后就职中山大学孙逸仙纪念医院口腔颌面外科至今,其中2011~2012年在美国印第安那大学Simon癌症中心做访问学者。主持国家自然科学基金2项、广东省自然科学基金以及中央高校科研项目5项,发表学术论文50余篇,其中以第一作者和通讯作者被SCI收录21篇。从事颌面-头颈部肿瘤的诊治与研究工作。擅长腮腺肿瘤、舌癌、血管瘤与脉管疾病的诊治及颌面部良性病变的微创手术内窥镜治疗、颌面部微创激光手术治疗。

  • 基金资助:
    国家自然科学基金面上项目(81772892);广东省自然科学基金项目(2016A030313348);中央高校基本科研业务费

The application of minimally invasive surgery in oral and maxillofacial surgery

Zhiquan HUANG(), Daming ZHANG   

  1. Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China
  • Received:2017-04-05 Revised:2017-06-02 Online:2018-02-20 Published:2018-08-31

摘要:

口腔颌面部是构成人体容貌的重要组成部分,口腔颌面部病损的治疗手段、手术切口大小等都成为患者关心的问题。随着微创外科器械和影像学技术的不断进步,微创外科在包括口腔颌面外科在内的各个外科领域得到了快速发展。微创外科的宗旨是力求以最小的手术切口路径和最少的组织损伤完成对患者体内病灶的诊治。近年来,微创外科技术在口腔颌面外科的各个领域,如牙槽外科、口腔颌面部肿瘤、颌面创伤等都得到了较好的开展和应用,使传统的疾病诊治模式,尤其是手术入路和手术方式发生了重要改变。本文结合文献资料及笔者临床经验,阐述微创外科技术在口腔颌面外科的应用与发展。

关键词: 微创外科, 微创外科器械, 口腔颌面外科, 内窥镜, 手术治疗

Abstract:

Oral and maxillofacial area constitute an important part of the human appearances, the means of treatment, the size of surgical incision become the concern of patients. With the continuous improvement of minimally invasive surgical instruments and imaging technology, minimal invasive surgery has been rapidly developed in various surgical fields that including oral and maxillofacial surgery. The purpose of minimally invasive surgery is to seek the smallest surgical incision path and the minimal tissue damage to complete the diagnosis and treatment for the patients. In recent years, with broader development and application of minimal invasive surgical techniques in the field of oral and maxillofacial surgery, such as dento-alveolar surgery, maxillofacial tumor, maxillofacial trauma, the operative approach and surgical procedures of these diseases have been changed greatly. This article intends to synthesize the literatures and the author's clinical experiences, describing the application and development of minimally invasive surgery in oral and maxillofacial surgery.

Key words: Minimally invasive surgery, Minimally invasive surgical instruments, Oral and maxillofacial surgery, Endoscope, Surgical treatment

中图分类号: 

  • R782

图1

内窥镜辅助取出突入舌下间隙的下颌智齿断根 a: 口腔全景片中可见断根位于下颌下缘水平; b: CT检查可见断根位于下颌骨内侧; c: CT三维重建可见断根位于下颌舌侧; d:于内窥镜辅助下行断根的取出。"

图2

内窥镜辅助经口内切口施行下颌骨边缘性骨髓炎刮除术 a:口腔全景片中可见左侧下颌骨体部及升支的骨质增生; b: CT检查可见左侧下颌骨体部及升支的骨质增生; c: CT三维重建示左下颌骨体部及升支的骨质增生; d:内窥镜辅助下口内入路切口的设计; e: 内窥镜下边缘性骨髓炎刮治前; f: 内窥镜下边缘性骨髓炎刮治后。"

图3

内窥镜辅助下颌骨囊肿的刮治术 a: 口腔全景片示囊肿主要位于左下颌骨升支; b: 内窥镜辅助下口内入路切口的设计; c: 内窥镜下可见囊腔及埋伏牙; d: 内窥镜下埋伏牙拔除及囊肿刮治后囊腔与骨腔壁。"

图4

内窥镜辅助下副腮腺来源良性肿瘤切除术 a: 切口设计为耳屏边缘的耳前切口; b: 拉钩牵拉提起皮瓣(SF)后,于腮腺包膜(PGC)浅层向前行潜行分离;c: 内窥镜下肿瘤(T)显露充分,面神经颊支(N)亦清晰显露并被保护; d: 肿瘤完整分离并切除; e: 术后3个月复诊结果示术后瘢痕隐蔽,美观效果满意。"

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