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  • 近年来,口腔颅颌面-头颈外科得到主管部门中山大学及所在单位孙逸仙纪念医院的大力扶持和经济投入。2010年12月挂靠我院口腔颌面外科的中山大学颅颌面外科中心主任调整为由我院口腔颌面外科学科带头人陈伟良教授担任。通过整合中山大学的医疗资源以支持口腔颌面外科发展。近三年来,口腔颌面外科医疗业务升幅、临床SCI论文数量和医疗服务质量等的综合考评居全院各科室首位。年收治病人数达1600多人次,为华南地区同专科之最。已经成为中山大学口腔颌面外科本科生、硕士生、博士生、博士后以及广东省三级甲等医院口腔颌面外科专门人才的重要培养基地。该科已竞争为院重点专科,为适应口腔颌面外科临床的发展,相关医疗用地和床位数不断增加,前年开始,增城院区和南院区各划20和10张病床,加院本部原有的50张床,现口腔颌面外科床位数达80张。随着64排CT、MR、彩超、超声刀、内窥镜、手术显微镜、MEVATROV PRIMUS 67-7467型医用电子直线加速器、数字减影血管造影X线机(DSA)及单光子发射型电子计算机断层扫描仪(SPECT)等一大批高端设备陆续引进,极大的强化口腔颌面外科的临床支撑条件。目前,扶持专科设备近3年资金投入达六百多万元。该专科已经成为华南地区口腔颌面外科综合实力最强的单位之一。 该科正在对对原来临床强项,如口腔颌面肿瘤综合治疗,口腔颌面血管瘤和脉管疾病和颌面创伤等进行多中心前瞻性临床研究,以提高肿瘤病者生存率和生存质量为主要目标;开展早期口腔癌内窥镜前哨淋巴结活检术;加快新型简单,成活率高的组织瓣的开发与临床应用;加大投入和开展。硬组织缺损的CAD/CAM、微创手术、机器人手术和导航手术等先进设备和技术。 近年来口腔颅颌面-头颈外科掌握先进医疗技术、解决疑难重症的能力、主持开展新技术新业务情况如下: 一.颅面肿瘤的根治手术 在华南地区开展首先颅面肿瘤的根治手术,提高了波及颅底的口腔颌面外科肿瘤病人的生存率并取得医疗成果[2,3]。 游离腓骨瓣重建下颌骨 供骨区术后 四.血管瘤和脉管畸形的综合治疗 1. 血管瘤的综合治疗 口腔颌面部增生期血管瘤用普奈洛尔治疗[50]、退化期血管瘤手术治疗[14]和口腔粘膜冷冻治疗[19]疗效显著。增生期血管瘤普奈洛尔治疗,疗效显著、方法简单、安全且费用低廉。对于发生在口腔粘膜和唇红缘内的婴糼儿血管瘤,开创性的应用吸入麻醉的方法下进行液氮冷冻治疗。其作用机理为,冷冻后的组织细胞内外立即产生冰晶,细胞外的冰晶使得细胞外的水分减少,从而提高了细胞外的离子浓度和渗透压,继而导致液体流动及细胞膜的破坏。在消融阶段,其细胞内的冰晶破坏内质网和线粒体,大的冰晶及缓慢的消融可产生的较好的冷冻治疗效果[19]。 血管瘤患儿 血管瘤冷冻术 冷冻术后 颌面部大面积血管瘤 用药物治疗以后 眶区血管瘤 药物治疗后 2. 静脉畸形的综合治疗 对面颈部巨大静脉畸形区室化并用OK-432 和平阳霉素/博来霉素行硬化治疗,取得理想疗效。平阳霉素由平阳链球菌产生通过抑制脱氧核糖核酸的合成而影响细胞代谢功能,降低细胞内谷胱甘肽水平而导致细胞死亡。OK-432是溶血性链球菌A3 型低毒变异株产生的外毒素A,具有超抗原性, 可非特异性刺激T 细胞和单核细胞,局部注射OK-432 后, 细胞因子激发高度扩张的静脉腔内衬的成熟内皮细胞,产生免疫反应性炎症反应,形成肉芽组织和纤维化, 达到硬化病损的目的。对区室化OK- 432 和平阳霉素硬化治疗面颈部巨大静脉畸形病例临床总结,效果理想[8,30]。纤维蛋白凝胶联合OK- 432和平阳霉素硬化治疗的机理是,纤维蛋白凝胶作为一种载体用于对抗癌药和止痛药提供缓释;因而纤维蛋白凝胶联合平阳霉素和OK-432治疗静脉畸形可延长硬化剂的作用时间;平阳霉素和OK-432又发挥协同作用,可较长时间对静脉畸形病变的内皮细胞的作用。纤维蛋白凝胶联合OK- 432 和平阳霉素硬化治疗较区室化OK- 432 和平阳霉素硬化治疗其先进性主要体现为:①前者毋需后者行区室化之操作,整个治疗过程仅需行注射即可,且同样可达到满意的效果;②前者不会存在因区室化缝线对术后患者造成的思想压力;③前者术后所形成的疤痕较后者少,并可改善患者的美观影响较小。 左面部静脉畸形 硬化治疗术 手术治疗后 3 .动静脉畸形的综合治疗 近年来应用DSA 及超选择性栓塞术、颌骨骨腔内骨蜡充填和刮治术、纤维蛋白凝胶联合OK- 432 和平阳霉素硬化治疗、放射治疗和手术切除等综合手段治疗口腔颌面部动静脉畸形,取得突破性进展[1,27]。论文[1]目前被国际期刊杂志发表的论文引用30多次。 1)超选择性栓塞:所谓“超选择性”是指将导管插入颈部的“三级分支动脉”,如舌动脉、颌外动脉、颌内动脉等,将栓塞物更直接、更准确地到达病变区。采用超选择性栓塞治疗头颈部动静脉畸形,更有效、更快速的对头颈部动静脉畸形所致的突发性大出血进行止血,不仅可以有效地抢救患者生命,同时为后续的骨蜡填塞治疗创造条件[1,27]。 2)颌骨骨腔内骨蜡充填和刮治术:超选择性栓塞1-2周后,可在全麻下行颌骨骨腔内骨蜡充填和刮治术。骨蜡充填后2月,显露颌骨并打开瘤腔,此时出血不多,骨腔内组织被骨蜡挤压在骨壁呈纤维囊样,很容易将之刮除。术中可保留下牙槽神经,还可能保留牙胚和已萌出的牙齿。残留骨腔用异体冻干骨严密充填,缝合软组织。骨蜡填塞颌骨动静脉畸形的骨腔,能够有效压迫颌骨骨腔异常扩张的动静脉畸形血管,继之产生血管的纤维化,从而达到封闭颌骨骨腔异常扩张的血管的目的。对比既往的治疗方法,完整的保留了颌骨的完整性,同时显著的减少了手术的创伤、时间和手术难度,保存外形与功能,值得推广应用。 3)纤维蛋白凝胶联合OK- 432 和平阳霉素硬化治疗:对于发生在软组织内的动静脉畸形,在超选择性栓塞后,再行硬化治疗,效果更好。对于头颈部软组织内的动静脉畸形,利用平阳霉素对内皮细胞的增值抑制作用和OK- 432的局部免疫反应性炎症刺激作用相结合,将二者联合应用抑制头颈部软组织内的动静脉畸形的血管内皮细胞,使其发生无菌性炎症,封闭管腔,达到治疗目的[1,27]。 对动静脉畸形综合治疗的先进性在于: ①对于发生于颌骨的动静脉畸形急诊出血,采用DSA下超选择性栓塞术,安全、有效,为患者赢得了进一步治疗时间,为后续治疗提供有利条件,也体现多学科合作的综合治疗趋势。②栓塞术后1-2周,行颌骨骨腔内骨蜡充填和刮治术,术后1月刮除骨蜡,残留骨腔用异体冻干骨严密充填。这样在保证了治疗彻底性的基础上,避免了传统破坏性手术导致的颌骨、牙齿生长发育障碍和面容畸形,最大限度地保留颌骨的完整性,保留了尽可能多的牙胚,更符合生物力学的原理,而且对患者颌面部外形美观、咀嚼功能影响较小,避免了切除颌骨给患者带来的巨大心理压力,提高了患者的生存质量。③本治疗方法简单、安全、有效,易于临床推广。DSA下超选择性栓塞术+颌骨骨腔内骨蜡充填和刮治术相比于传统手术切除颌骨+游离髂骨瓣或腓骨瓣修复颌骨缺损,前者手术简单、出血少,无供区并发症,无需显微外科技术支持,易于推广。④对于发生在软组织的动静脉畸形,栓塞术后,行纤维蛋白凝胶联合OK- 432 和平阳霉素硬化治疗。硬化剂在纤维蛋白凝胶充当的缓释系统下持续作用,避免患者多次就诊,节约了患者就诊时间与社会资源,具有很好的社会经济效益。 口腔颌面部动静脉畸形 三维CT血管重建显示血管畸形 综合治疗以后 4.巨大淋巴管畸形的治疗 生物胶联合OK-432和博来霉素治疗面颈部淋巴管畸形[45],疗效显著、方法简单、安全且费用低廉。婴幼儿头颈部巨大淋巴管畸形致上呼吸道阻塞的紧急手术救治临床研究,抢救成功率百分之百[26]。 颈部巨大淋巴管畸形 正位像 硬化治疗术 硬化治疗术后侧面 硬化治疗后正面 口咽部淋巴管畸形 CT显示颈部巨大肿物 手术治疗后 呼吸困难紧急气管切开 相关临床研究成果在国家级继续医学教育项目和国际学术会议进行推广 美国马里兰州大学Ord 教授在病区查房 陈伟良教授在国际会议上作学术报告 发表英文论文50篇,其中SCI收录46篇﹡为通信作者(如需要可来函,免费提供) 50. Chai Q, Chen WL﹡, Huang ZQ,et al. Preliminary experiences in treating infantile hemangioma with propranolol. Ann Plast Surg, 2011 May SCI, Proof 49. Chen WL, Zhou M, Ye JT, et al. Maxillary Functional Reconstruction Using a Reverse Facial Artery–Submental Artery Mandibular Osteomuscular Flap with Dental Implants. J Oral Maxillofac Surg, 2011 Mar, SCI, Proof. 48. Tang QL, Fan S, Li HG, Chen WL﹡, et al. Expression of Cyr61 in primary salivary adenoid cystic carcinoma and its relation to Ki-67 and prognosis. Oral Oncol. 2011 Mar 23. [Epub ahead of print] SCI 47. Zhen Y, Wang JG, Tao D, Wang HJ, Chen WL﹡. Efficacy survey of swallowing function and quality of life in response to therapeutic intervention following rehabilitation treatment in dysphagic tongue cancer patients. Eur J Oncol Nurs. 2011 Mar 26. [Epub ahead of print] SCI 46. Wang YY, Chen WL﹡, Huang ZQ, et al. Expression of the membrane-cytoskeletal linker Ezrin in salivary gland adenoid cystic carcinoma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011 May 5. [Epub ahead of print] 45. Chen WL, Huang ZQ, Chai Q, et al. Percutaneous sclerotherapy of massive macrocystic lymphatic malformations of the face and neck using fibrin glue with OK-432 and bleomycin. Int J Oral Maxillofac Surg. 2011 Feb 28. [Epub ahead of print] SCI 44. Chen WL, Huang ZQ, Yang ZH, et al. Deep Plane Cervicofacial Flap for Reconstruction of Large Oncosurgical Defects of the Cutaneous Face and Neck. Chin J Dental Research, 2009,12(1),27-30. 43. Chen WL, Ye JT, Yang ZH, et al. Mandible reconstructed with mandibular osteomuscular and facial-cervico-pectoral flap. Asian J Oral Maxillofac Surg. 2011;(23):69-72 42. Chen WL, Wang YY, Zhang DM, et al. Use of the contralateral retroangular island flap for reconstructing midfacial defects after skin cancer ablation. Head Neck. 2011 Jan 18. [Epub ahead of print] SCI 41.Wang JG, Chen WL﹡, Ye HS, et al. Reverse facial artery-submental artery deepithelialised submental island flap to reconstruct maxillary defects following cancer ablation.J Craniomaxillofac Surg. 2010 Dec 30. [Epub ahead of print] SCI 40. Huang ZQ, Chen WL﹡, Li HG, et al. Extracellular matrix metalloproteinase inducer expression in salivary gland tumors: a correlation with microvessel density. J Craniofac Surg. 2010;21(6):1855-60. SCI 39. Chen WL, Zhang DM, Yang ZH, et al. Extended supraclavicular fasciocutaneous island flap based on the transverse cervical artery for head and neck reconstruction after cancer ablation. J Oral Maxillofac Surg. 2010;68(10):2422-30. SCI 38. Chen WL, Chang SH, Ye ZT, et al. A pedicled mandibular osteomuscular flap for reconstructing composite mandibular defects. Oral Surg. 2010;3(1):16-21. 37. Chen WL, Zhang B, Wang JG, et al. Reconstruction of large defects of the neck using an extended vertical lower trapezius island myocutaneous flap following salvage surgery for neck recurrence of oral carcinoma. J Plast Reconstr Aesthet Surg. 2011;64(3):319-22. SCI 36. Zhang B, Wang JG, Chen WL﹡, et al. Reverse facial-submental artery island flap for reconstruction of oropharyngeal defects following middle and advanced-stage carcinoma ablation. Br J Oral Maxillofac Surg. 2011;49(3):194-7. SCI 35. You YH, Chen WL﹡, Wang YP, et al. The feasibility of facial-submental artery island myocutaneous flaps for reconstructing defects of the oral floor following cancer ablation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;109(6):e12-6. SCI 34. Chen WL, Huang ZQ, Li JS, et al. Percutaneous sclerotherapy of juvenile nasopharyngeal angiofibroma using fibrin glue combined with OK-432 and bleomycin. Int J Pediatr Otorhinolaryngol. 2010;74(4):422-425. SCI 33. Chen WL, Yang ZH, Huang ZQ, et al. Facial Contour Reconstruction After Benign Tumor Ablation Using Reverse Facial-Submental Artery Deepithelialized Submental Island Flaps. J Craniofac Surg. 2010;21(1):83-86. SCI 32. You YH, Chen WL﹡, Wang YP, et al. Reverse facial-submental artery island flap for the reconstruction of maxillary defects after cancer ablation. J Craniofac Surg. 2009;20(6):2217-20. SCI 31. Fan S, Chen WL﹡, Pan CB, et al. Anesthetic efficacy of inferior alveolar nerve block plus buccal infiltration or periodontal ligament injections with articaine in patients with irreversible pulpitis in the mandibular first molar. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;108(5):e89-93. SCI 30. Chen WL, Huang ZQ, Zhang DM, et al. Percutaneous sclerotherapy of massive venous malformations of the face and neck using fibrin glue combined with OK-432 and pingyangmycin. Head Neck. 2010,32(4):467-472. SCI 29. Li HG, Li JS﹡, Chen WL﹡, Wang L,et al. Prognostic significance of erythropoietin and erythropoietin receptor in tongue squamous cell carcinoma. Br J Oral Maxillofac Surg. Br J Oral Maxillofac Surg. 2009;47(6):470-5. SCI 28. Chen WL, Yang ZH, Li JS, et al. Submental flap for reconstructing tongue defect with V-Y advancement flap for repairing submental defect. Otolaryngol Head Neck Surg. 2009;141(2):202-206. SCI 27. Chen WL, Ye JT, Xu LF, et al. A multidisciplinary approach to treating maxillofacial arteriovenous malformations in children. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;108(1):41-47. SCI 26. Chen WL, Zhang B, Wang JG, et al. Surgical excision of cervicofacial giant macrocystic lymphatic malformations in infants and children. Int J Pediatr Otorhinolaryngol. 2009;73(6):833-7. SCI 25. Yan L, Chen WL﹡, Zeng SG, et al. Inhibition of VEGF expression in tongue squamous cancer cells via RNA interference silencing of iNOS gene. Int J Oral Maxillofac Surg. 2009,38(4):369-373. SCI 24. Li JS, Chen WL﹡, Huang ZQ, et al. Pediatric Mandibular Reconstruction After Benign Tumor Ablation Using a Vascularized Fibular Flap. J Craniofac Surg. 2009,20(2):431-434. SCI 23. Chen WL, Chen ZW, Yang ZH, et al. The trapezius osteomyocutaneous island flap for reconstructing hemimandibular and oral defects following the ablation of advanced oral malignant tumors. J Craniomaxillofac Surg. 2009,37(2):91-95. SCI 22. Chen WL, Liu S, Li HG, et al. Transplantation of a reverse facial artery pedicled submandibular gland in a dog. Int J Oral Maxillofac Surg. 2008;37(11):1054-8. SCI 21.Chen WL, Ye JT, Yang ZH, et al. Reverse facial artery-submental artery mandibular osteomuscular flap for the reconstruction of maxillary defects following the removal of benign tumors. Head Neck. 2009;31(6):725-731. SCI 20. Fan S, Chen WL﹡, Yang ZH, et al. Comparison of the efficiencies of permanent maxillary tooth removal performed with single buccal infiltration versus routine buccal and palatal injection. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009,107(3): 359-363. SCI 19. Chen WL, Zhang B, Li JS, et al. Liquid nitrogen cryotherapy of lip mucosa hemangiomas under inhalation general anesthesia with sevoflurane in early infancy. Ann Plast Surg.2009;62(2):154-7. SCI 18. Chen WL, Fang SL. Removal of second branchial cleft cysts using a retroauricular approach. Head Neck. 2009;31(5):695-698. SCI 17. Chen WL, Ouyang KX, Li HG, et al. Expression of Inducible Nitric Oxide Synthase and Vascular Endothelial Growth Factor in Ameloblastoma. J Craniofac Surg. 2009;20(1):171-175. SCI 16. Chen WL, Fang S, Wang K, et al. Reconstruction with Extended Vertical Lower Trapezius Island Myocutaneous Flap for Total Glossectomy. Chin J Dental Research, 2008,11(1),42-46. 15. Chen WL, Yang ZH, Wang YJ, et al. Removal of the submandibular gland using a combined retroauricular and transoral approach. J Oral Maxillofac Surg. 2009;67(3):522-7. SCI 14. Chen W, Li J, Yang Z, et al. SMAS fold flap and ADM repair of the parotid bed following removal of parotid haemangiomas via pre- and retroauricular incisions to improve cosmetic outcome and prevent Frey's syndrome. J Plast Reconstr Aesthet Surg. 2008;61(8):893-898. SCI 13. Chen WL, Yang L, Zeng SG, et al. Effect of using RNA interference to alter iNOS gene expression on the proliferation of tongue squamous cell carcinoma cell line Tca8113. Br J Oral Maxillofac Surg. 2008,46(6):435-438. 12. Chen WL, Feng HJ, Li HG. Expression and significance of hypoxemia-inducible factor-1alpha in osteosarcoma of the jaws. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;106(2):254-257. SCI 11. Chen WL, Yang ZH, Li JS, et al. Reconstruction of the tongue using an extended vertical lower trapezius island myocutaneous flap after removal of advanced tongue cancer. Br J Oral Maxillofac Surg. 2008,46(5):379-382. SCI 10. Chen WL, Li JS, Yang ZH, et al. Two submental island flaps for reconstructing oral and maxillofacial defects following cancer ablation. J Oral Maxillofac Surg. 2008;66(6):1145-56. SCI 9. Chen WL, Li JS, Yang ZH, et al. Extended vertical lower trapezius island myocutaneous flap for repairing extensive oropharyngeal defects. J Oral Maxillofac Surg. 2009;67(6):1349-53. SCI 8. Chen WL, Yang ZH, Bai ZB, et al. A pilot study on combination compartmentalization and sclerotherapy for the treatment of massive venous malformations of the face and neck. J Plast Reconstr Aesthet Surg. 2008;61(12):1486-92. SCI 7. Chen WL, Chen ZW, Yang ZH, et al. Pedicled Mandibular Osteomuscular Flap for Zygomatic Reconstruction through a Modified Weber-Ferguson Incision. J Craniofac Surg. 2008; 19(1):235-240. SCI 6. Chen WL, Feng HJ, Li JS, et al. Expression and pathological relevance of inducible nitric oxide synthase in osteosarcoma of the jaws. Int J Oral Maxillofac Surg. 2007;36(6):541-4. SCI 5. Chen WL, Li J, Yang Z, et al. Extended vertical lower trapezius island myocutaneous flap in reconstruction of oral and maxillofacial defects after salvage surgery for recurrent oral carcinoma. J Oral Maxillofac Surg. 2007, 65(2):205-11. SCI 4. Chen W, Zeng S, Li J, et al. Reconstruction of full cheek defects with combined temporalis myofacial flaps and facial-cervico-pectroral flaps. Oral Surg Oral Med, Oral Pathol Oral Radiol Endod. 2007, 103(1): e10-e15. SCI 3. Chen WL, Deng YF, Peng GG, et al. Extended vertical lower trapezius lsland myocutaneous flap for reconstruction of cranio-maxillofacial defects. Int J Oral Maxillofac Surg. 2007, 36(2):165-70. SCI 2. Chen WL, Li JS, Yang ZH, et al. Recurrent ameloblastoma of the anterior skull base: three cases treated by radical resections. J Craniomaxillofac Surg. 2006;34(7):412-4. SCI 1. Chen W, Wang J, Li J, et al. Comprehensive treatment of arteriovenous malformations in the oral and maxillofacial region. J Oral Maxillofac Surg, 2005,63(10):1484-1488 0278-2391. 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