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Jingdong book

口腔颌面外科学

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口腔颌面外科学

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《口腔颌面外科学》由华西口腔医学院根据高等医学院校培养目标之要求及多年教学之经验,由一线骨干教师编撰而成。该书以口腔颌面外科的多发病、常见病为主线,着重介绍了口腔颌面外科相关疾病的基本理论、疾病特点、诊断要点、治疗原则、尚未解决的难题和今后发展方向。主要内容包括口腔颌面部麻醉、牙拔除术及牙槽部手术、口腔颌面部感染、口腔颌面部损伤、口腔颌面部肿瘤、唇腭面畸形的整复、牙颌面畸形的外科矫治、颌面美容外科、颞颌关节疾病和口腔颌面部神经疾病。
可供高等学校口腔专业本科生及研究生教学参考之用。
Catalogue

绪论
第一章 口腔颌面部麻醉
第一节 局部麻醉
第二节 全身麻醉

第二章 牙拔除术及牙槽部手术
第一节 牙拔除术
第二节 牙槽部手术

第三章 口腔颌面部感染
第一节 概论
第二节 智齿冠周炎
第三节 颌面颈部间隙感染
第四节 颌骨骨髓炎
第五节 唾液腺炎症
第六节 面颈部其他组织化脓性炎症
第七节 口腔颌面部特异性感染

第四章 口腔颌面部损伤
第一节 急救
第二节 口腔颌面部软组织损伤
第三节 口腔颌面部骨折
第四节 颌面部爆炸伤
第五节 颌面部烧伤

第五章 口腔颌面部肿瘤
第一节 囊肿
第二节 良性肿瘤
第三节 口腔颌面部恶性肿瘤
第四节 颌面部缺损的修复重建

第六章 唇腭面畸形的整复
第一节 唇腭裂发生的病理机制
第二节 唇腭裂的序列治疗
第三节 唇裂整复术
第四节 腭裂整复术
第五节 唇裂术后继发鼻、唇畸形的二期整复
第六节 鼻缺损的整复
第七节 耳廓畸形的整复

第七章 牙颌面畸形的外科矫治
第一节 牙颌面畸形的病因与分类
第二节 牙颌面畸形的诊断方法
第三节 牙颌面畸形的治疗原则与设计
第四节 牙颌面畸形的治疗程序与步骤
第五节 常用正颌外科手术
第六节 颌面牵张成骨术

第八章 颌面部外科美容
第一节 美容外科原则及基本技术
第二节 隆鼻术
第三节 重睑术
第四节 除皱术
第五节 激光美容术

第九章 颞下颌关节疾病
第一节 颞下颌关节紊乱病
第二节 颞下颌关节脱位
第三节 颞下颌关节强直

第十章 口腔颌面部神经疾患
第一节 三叉神经痛
第二节 非典型面痛
第三节 面神经瘫痪
第四节 面肌痉挛
Book Abstract

(5)全厚皮片切取法:全厚皮片多用来修复面颈部皮肤缺损,因此要求其色泽尽可能与面颈部相匹配,一般以耳后,上臂内侧,锁骨上窝或季肋部皮肤应用较多。按受区大小切取皮片,取下皮片后可用温热生理盐水纱布包裹。除行保留真皮下血管网的全厚皮片移植外,皮片不应带有脂肪。
4.皮片移植与固定
口腔颌面部多移植中厚、全厚皮片。与受区创缘作间断缝合,每针均保留长线头,皮片上覆盖一层凡士林纱布,再以一层纱布包以纱头或剪碎的小纱布块堆放其上,最后将创缘缝线留下的线头分组打包结扎、固定。打包结扎的作用在于其可产生一个柔软、均匀一致的压力,使皮片与植皮床紧密相贴,有利于皮片的成活;碎纱布或纱头有很好的虹吸作用,能吸收创面的小量渗血、渗液,以防止皮下积血、积液,对口腔及颈部,使敷料不易脱落,但在口腔内由于有唾液浸泡,打包均用碘仿纱布,起防腐作用。
5.供皮区创面的处理
断层皮片切取后,创面压迫止血后,用凡士林纱布覆盖,外盖纱布,棉垫加压包扎,如无感染发生,一般在术后不要更换敷料,术后2周左右自行愈合敷料脱落,若术后发现敷料潮湿发臭、或痒痛渗血,可能为创面感染,应打开敷料检查,并对症处理。
对全厚或带真皮下血管网皮片切取后,面积小者可直接拉拢缝合,面积大者则另取表层皮片或中厚皮片移植来消灭创面。由于有张力,术后拆线不宜太早,应2周左右。
6.植皮成功的要点
对新鲜创面,要求彻底止血,同时又要尽可能减少结扎线头,少用电烙,最好的办法是用热盐水敷创面。对感染创面术前必须妥善处理后再植皮,如用高渗盐水湿敷,新鲜肉芽生长后再植皮,面颈部植皮皮片不能太大,也不能太小,与缺损相当。保证皮片与创面贴合,全厚皮片切取后应将脂肪修剪干净。
7.术后处理一般在手术后2周左右拆除敷料,面颈部植皮可在拆除敷料后继续加压包扎1~2天。口腔内由于皮片较薄,此时皮片已大部分成活,可进行张口训练3~6月,以防止皮片挛缩影响张口。
8.皮片移植后的生理变化
皮片移植到创面数分钟后,创面的毛细血管扩张,血浆渗透供应皮片营养,维持皮片存活。血浆中的纤维蛋白可将皮片粘于创面,并有助于血管的长人。皮片移植到受区第三天,其内的血管从外周向中心退化,同时受植床的血管沿皮片原有的血管路径长人替代退化血管,骨髓来源的内皮前祖细胞参与血管形成,创面的毛细血管在皮片内形成毛细血管后,皮片接受创面的血液供应。从生理学的角度讲,72小时后皮片已基本成活,术后8天已有足够的血供;但如皮片下有积血,则皮片将不能生长,并发生坏死,故严格止血和可靠的加压包扎固定对皮片的成活十分重要。
移植皮片成活后,产生大量的纤维结缔组织而发生收缩,皮片愈薄,收缩愈大,皮片与创面之间有一层纤维组织,短时间内移植皮片处较硬,数月后,皮片下产生脂肪组织,纤维组织逐渐减少,皮片处变软;再过数月后,神经长人,感觉恢复,约1年后可完全恢复正常。全厚皮片移植后,毛囊和汗腺可发生暂时退化现象,约一年后开始逐渐重新生长。
Introduction

1956年华西口腔颌面外科教研室曾受卫生部的委托,根据全国高校教材《口腔颌面外科学教学大纲》编写了新中国成立后的第一部《口腔颌面外科学》,于1959年出版。该书由当时我校夏良才教授主编,王翰章、王模堂、周岳城教授参编,宋儒耀教授审校,结束了我国高等口腔医学教育口腔颌面外科课程教学中长期沿用国外教科书的历史。第一版的《口腔颌面外科学》吸纳了多种国外教科书的优点,并结合我国的具体情况和需求编撰而成,规划了我国颌面外科学的基本内容和各章节的结构,成为我国口腔颌面外科教科书的典范。
此次编写的《口腔颌面外科学》系四川大学华西口腔医学院精品课程系列教材之一。目前本科生使用的是卫生部规划的高校教材《口腔颌面外科学》。尽管这是一部精炼的优秀教材,但该教材偏重基础理论和基础知识,在教与学的实践中,有许多教师和学生提出了宝贵意见,希望能有一本注重临床治疗的教科书,与全国统编教材互为补充。2007年,四川大学华西口腔医学院口腔颌面外科学被评为国家级精品课程,对该专业的教学工作提出了更高的要求,促使我们编写一本适应此情况的新教科书。
华西口腔医学院的创建者林则博士非常重视口腔颌面外科工作,开始他亲自讲授《口腔外科学》,随之于1942年、1944年先后选送宋儒耀、夏良才赴美国进修整形外科、口腔颌面外科学。由于他们出色的工作,我院的口腔颌面外科得到了大力发展。当年初创的教学模式和理念,对中国口腔医学高等教育产生了广泛而深远的影响。当今,华西口腔颌面外科的教学工作,是在近百年的教学中不断总结、传承并发扬光大的结果,形成了独有的华西特色。这就是:基础理论知识与临床实践并重的教学模式。对于口腔颌面外科这一综合性、操作性和应用性很强的学科,涉及整形美容、头颈肿瘤、创伤修复等众多领域,既要求学生熟悉并掌握相关学科的基础知识,又要求学生能理论联系实际,善于把理论知识应用到临床实际中。口腔颌面外科学的教学既注重理论,更偏重实践。因此,本书的编写与全国统编教材有所不同。本书着重介绍临床的实用诊疗技术,既有经典的传统技术方法,又有近年来发展起来的新技术。在介绍这些诊疗技术时,注重其实用性,并结合我院多年的临床经验和教训,对容易漏诊、误诊和出错的环节、细节进行讨论和提示,便于实习学生和青年医生查阅,并指导其对口腔颌面外科的多发病、常见病实施最佳的治疗。同时,口腔颌面外科领域还有许多难题,对这些尚待解决的问题及其发展趋势,本书也作了简要的介绍,希望这些问题能激发年青学子对口腔颌面外科的浓厚兴趣,激励他们迎接挑战,不断探索,使口腔颌面外科不断发展。
本书在编写过程中,得到了华西口腔颌面外科学系众多老师的大力支持。许多老教授虽然没有执笔编写,但他(她)们积极为该书出谋划策,提出了许多极富建设性的意见。特别难能可贵的是老教授们把数十年的教学心得和临床经验毫无保留地提供给编者。因此本书是华西口腔几代人集体智慧的结晶。

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Jingdong book