[A]1.A. B. C. D. E.2.,A. B. C.D. E.3.A. B. C.D. E.4.A. B. C.Le Fort ID., E.Le Fort III5.A. B. C.Le Fort ID. E.Le Fort IILe Fort III .6.A., B.,C. D. E.7,A. B. C.,D.,,E.,8,,,A. B. CD. E9,A.6 B.12 C.24 D.48E.,72,,10.(),A.4-6 B.6-12 C.12-24 D.24-48 E.48-7211,A.B. C. D.E.12,A. B. C.,,D., E.13,A. B. C.D.
E.14. ,A.1 B.4 C.7 D.0 E.OOO151A B. C.D. E.16.,,A, B. C.D. E.17.,A. B. C. D. E.18,,,,,., A. B. C.D. E.19.,,A. B. C. D. E.20,,A.,B.C.,D.E21.,,, A. B. C. D. E.22. ,A. B. C.D. E.23.A B.C. D.E.,24. A. B. C. D. E.25.A. B. C. D. E.26.A.1-2 B.2-3 C.3--4D.4-5 E.5-627.A. B. C.D. E.28.A. B. C.D.
E.29.A. B. C.D. E.30.,,A. B. C.D. E.31.,A. B.C. D.E.32.A. B.C. D.E.33.A. B. C. D. E.34. ,,,,,,A. B. C.D. E.35. ,,,,A. B. C.D. E.36.,A. B. C.D., E.37.A.,, B.,,C.,, D.,,E.,,38.A B.C. D.,E.39.,A. B. C.D. E.40 ,A. B. C.D.,E.,,41. A. B. C.,D. E.42 A B. CD. E.43.,A.,B.,C.,,D.,,,E.,44. A.,,B.,C.,D.,,6,E.,6,,,45. A. B. C. D. E.46. A.
B. C.D. E .47.,,A.,B.C.,D.,E.,,,48 ,A.B.C.,D.,E.,,49. A.B.C.D.E.50. ,A. B. C.D. E.51. ,, A. B. C. D. E.52. ,A.,;B.,;C.,;D.,E.,53.,A.B.,,C.,D.,E.54.,,A.6 B.8 C.12 D.24 E.4855. A. B. C. D. E.56.A. B. C. D.E.57.,A. B. C.D. E.,58.A. B. C. D. E.59.A. B. c. D. E.60.,A B. C.D. E.61.A. B. C.D., E.62.,A. B. c. D. E.63.A. B. C.D. E.64.,A.B.C.D.,, E.65.,A. B. c.D. E.66.A. B. C. D. E.67.A. B. C. D. E.68,,A. B.C. D.E.69.A.B.C.,D.E.70.A. B.C. D.E.71.XA() B.() c.()D.65. E.72. ,A. B.C. D.E.73. A. B. C. D. E.74. A. B. C.D. E.75.A.Le Fort I B.Le Fort IIC.Le FortIII D.E.76.,A. B. C. D. E.77.A. B. C.D. E78.A. B. C.D. E.79.A. B. C.D. E.80.A. B. C.D. E.81.A. B. C. D. E.82.A. B.C.塑胶外固定法 D.E.83.A. B. C.D. E.84.A.,B.,C.D.,E.,85.,A.,B.,C.,D.,,E.86.Champy,A. B. C.D. E.87.Champy,A. B. C.D. E.88. ,, ,A.1 B.2 C.3 D.4 E.5 89.,A.B.2-3 mm,c.D.3-4E. ,90.,A.,B.,,C.,,,D.,,E.,91.,,:A.B.,,C.,D.,E.,92.,,,:; 5,;;;2,.,x,.A.B.,,,c.,4D.4,E.,3-593. ,A.,B.,c.,D.,,E.,94. ,A.B.,C.D.E.95.A. B. c. D. E.96.,A. B. C. D. E.97.A. B. c. D. E.98.A. B. C. D.E.,99.,A. B. C. D. E.100.A. B. C. D. E.101.,A. B.C. D.E.102.,A.,B.C.,D.,E.,103.,A.,B.,C.,D.,E.104.KnightNorth,A. I B. IIC. III D. ⅣVE. VI1O5.,,A. B. C. D. E.106.,,A. B. c.D. E.107.A. 24-48 B.48-72 C. 3-5 D.5-7 E.7-l4 .108.,18,6,,,, ,1,,A. B.c. D.E.,109.22,,,,,,,,A. B. c.D. E.110.A. B. C.D. E.111.A. B. C.D. E.112.A., B.c. D.E.,113.A. B.C. D.E.114.A. B.X c.D. CT E.CT115.,A. B.C. D.E116.,,,,,,10,A.,B.,C.,,D.,,E.,117.,,,A.,,B.,C.,,D.,,E.,,118.,,A.1-2 B.3-4 C.5-6 D. 7-8 E. 2119,,A. B. C D. E.120.A. B. c.D. E.121.,1,,,,,,XCl,,,A.,B.,lC.,2D.,,E.,2,122.A. B. C.D. E.123.,,A. B. C.D. E.124.,A. B. C.D. E.125.A., B., C.D. E.,126.,2cm, ,.A.1 B.2 C.1D.3 E.6127.,,,1,,,.2X,A.,,B.,,C.,D.,10E.,6128.A.5 B.7 C.10D.2 E.1129.,A.5%B.0.1%C.15%D.18%E.15%130-132,,35,1,,.:, ,,,22,,,.130.A.B. C. D. E.131.A. B.C. D.E.132.A. B. C. Le Fort IIID. E133-135,,8,:,, ,,;,1,.133.X,A.B. C. D. E.134.A. B. C.D. E.135.,A. B. C.D. E.136-1392,.:,, ,22,,,1/3,,.136.A. B. C.D. E.TAT137.A. B. C.D. E.138.A B. C. D E.139-142,.139.A. B. C.D. E.140.,A. B. C.D. E.141.,A. B. C.D. E.142.A. B. c.D. E.[B}143-145A.4 B. 8 C.3 D.lO E. 2-3143.,144.,145.,146-148A. B. C.D. E.146.,147.148.149-151A. B. C. D. E.149.150.,151.152-155A. B. C.D. E.,152.153.154.155.156-159A. B. C.D. E.156.157.158.,159.160-169A. 1. B. 2 C.3 D.4 E. 5,6160.(Abbreviated Injury Scale, AIS),161.AIS,Le Fort Ⅰ162.AIS, Le Fort II163.AIS, Le Fort Ⅲ164.AIS,165.AIS,166.AlS,167.AIS,168.AIS,169.AIS,,5cm[x]170.,,,A. B. C.D. E.17l.A. B. C.D. E.172A. B. C.D. E. .173A. B.C. D.E.174.A. B. C.D. E.175.,A., B. C.D. E.176.A. B. C.D. E.177.A. B. C.D. E.178.,A. B. 6- C.D. E.179.A. B. C.D. E.180.,A. B. C. D. E.181.,,A., B.,C., D.E.182.A B.,,C. D.,E.183.A.B.,,c.,D.,E.184.,,A., B. c.D. E., .185.A.,,B.,,c.,,,D.,,E.,,,186.,A. B. c. D. E.187.,A.B.,,CD.E.188.,A:B.,C.,2-3D.,E.,189.,A.B.c.D.E.,190.,A. B. c.D.,, E.191.A. B. C.D. E.192A. B C.D. E.193.A.,,B.,,,C.,D.,E.194.,A.,B.,C.,D.,,,,E.,,195.,A. B. C.D. E.196.A., B.C. D.E.197.,A. B. c.D. E.198.,A. B. C.D. E.199.,A.,B.,,, C.,,D.,,4,3E.,200.,A. B. C.D. E.,201.A. B. C.D. E.202.,A.B.C.D.,E.203.A. B..C. D.E.204.A. B.C. D.E.205. ]A.,B.,C.D.E.206.,A. B.C.1-2,, D.E.,207.,A.B.,C.D.E.,208.A. B.C. D.E.,4209.,A. B.,C. D.E.210.A.B.,c.D.E.,211.,A. B. c. D. E212.X,A. B. c.D. E.213.A.,,.Bc.,,D.E214.XA. B. C.D. E.215.A.B.C.,D.,E.,216.A. B. C.D. E.217.,,,,,A. B c. D. E.218.,A. B. c.D. E.219.A.,B.,C.D.,, E.,220.,A.,B.,,C.,,,,D.,,,,E.,1500 U221.A.B.,C.,D.,,,E.222.,A.,,B.C.D.,,E.,,,223.,A.,B.,,,c.D.,E.224.,A.,B.,C.,,,,D.,,E.,225.,A.3% B. 5% C.0.1%D.18% E. 15%{226,___________,.227,,,______; ,_______;,__________228._____________.229.__________,,,,.230.___________231_________________________,_____.,_____,______.232_____,___________.233.,____________,_______________,______234____________,,,.235._________.236.________,________________237.________,________________.238.,________,____239.,________________,______240.____,___________, ________,________241.,__________242.-________,__________ __________ _________,_________243.,______ _______ _______,.244.245.________,_________,_____246.,________,____________________247.________,.248.,________249.________________,_________.250.________,_______________251.________ ___________ ____________;________.252.________________253.____________,.254.,-______________________.255.,_____________256._______ __________ _________________,_______ _________ _________.257.________,________,_______________258.,_______ _________ _________ _______________259.________________260.________.________________ .261.________,________;________,________.262.___________.263.,________,________; ________,________264.LE Fort I________;LE Fort II________LE FortⅢ________265.________,________.266.,________267.,,______ ,;________,.268.__________269.________,________________270.________________271.,, ________;,________; ________272.______________273.________.274._______________.275.________,_________.________, ________276._______,________, ________,________2J7.________________278.________,,________ .279.________________280.__________.281.________________.282.________,________________.283.-____,________________;________ ________________284.,,________ ______________285.,-________ ___________,________286.________,__________________287.,_________288.:________,__________ -_________ __________289.,_______, ,,.290.________291.'________292.,,,,________.293._________________.________ ________.294.,, ________,________295.________________.296., ________,________,________________297.________298.,_______,_________,________________299.,________300.:________________301.________{302.303..304..305..306..307..308.,,309..310..311..312.,313..314..315..316.317..318.,.319..320..321..322..323..324..325..326.Ⅱ,,.327,,1,, 0.3 Cm,,;1.5Cm,,,,;,3 Cm,..328..329..330..331..332..333.,334.,335.,336.,337.LE Fort.338..339..340,.341..342.,1.:,,,,,.,,,,,.343.,,,x, ,344.LE Fort I.345.LE FortⅡ.346.LE FortⅢ.347..348..349..350.351.E352. 353..354..355..356..357..358..359..360.,.361..362..363..364.,1,.365.,.366.,.367.KnightNorth.368. --22,,1. 5 Cm,lCm. ,,,369..370..371..372.(AIC).373..374..375..376..377.,,378.379. X 380.381. 382..383..384.,.385..386.,,.387..388.,389.,.390..391..392..393..394..395..396..397. {}1. D. 2.A 3.B 4.E 5.A 6.B 7.B 8.C 9.E 10.D l1.A 12. C 13.C14.C 15.A 16.E 17.D 18.D 19.E 20..c 21.C 22.C 23.E 24.A 25.E26.C 27.D 28.A 29.D 30.B 31.B 32.A 33.E 34.D 35.B 36.E 37.A38:A 39.A 40.C 41.E 42.D 43.D 44.D 45.A 46.C 47.C 48.D 49.B50.C 51.C 52.D 53.D 54.A 55.A 56. A 57. E 58 . A 59 . D 60. B 61. 0 62. D 63. D 64. D 65 . A 66. C 67. D 68. A 69. E 70.D 71.B 72.A 73.E 74.A 75.C 76.E 77.D 78.C 79.D 80.C 81.B 82.A 83.A 84.C 85.C 86.E 87.C 88.B 89.B 90.C 91.C 92.B 93.A 94.D 95.D 96.C 97.B 98.D 99.D 100.B 101.B 102.B 103.C 104.B 105.B 106.C 107.E108.D 109.C 110.D l11.D 112.A 113.C 114.E 115.A 116.E 117.D 118.C 119.A 120.B 121.B 122.C 123.B 124.A 125.B 126.B 127.D 128.C 129.B 130.B 131.C 132.D 133.C 134.C 135.E 136.C 137.D 138.C 139.C 140.B 141.E 142.E 143.A 144.E 145.C 146.C 147.B 148.0 149.A 150.C 151.B 152.D 153.A 154.C? 155.B 156.B 157.C 158.D 159.A 160.A 161.E 162.C 163.D 164.A 165.B 166.B 167.C 168.A 169.B 170.BCD 171.ABCD 172.ABCDE 173.ACE 174.BCDE 175.ABCE 176.ABO 177.ACD 178. ABCOE 179. CD 180. ABCOE 181. CDE 182. ABC 183. BCDE 184. CDE 185. ABDE186.DE 187.ABD 188.D 189.ABCDE 190.AB 191.E 192.A 193.ABCE 194.E195.BE I96.ACDE 197.ABCDE 198.BCDE 199.BCD 200.ACD 201.ABCDE 202.BCE 203. AB 204. AD 205. ABC 206. DE 207. DE 208.ABCD 209. ABCDE 210. CDE 211.ABCD 212.BE 213.ABCD 214.DE 215.BE 216.ABCDE 217.ACE218. BCD 219. ABCE 220. A 221. ABCD 222. ABCDE 223. BCDE 224. ADE 225. BE226.
228. 229.230.231.
234. 235.2-3236.
247.248.249.
251., , , ,,, 252. 253.254.
259. 260. ,261.
264., , ,,, ,,265.,266.267. 268.269.
272. 273.274. 275.
塑胶夹板固定
279. 280.281. 282.
289.290. 6-8291. 5-6292.293.(,,,,) (,,)
294. 295.296.
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Copyright 2011, 版权所有 长沙医学院网络中心.2012年口腔助理医师考试口腔颌面外科学试题及答案(8)
　　二、填空题（每空1分，共21分）　　1.阻生牙是指由于______，______或______的障碍而只能部分萌出或完全不能萌出，而且以后也不可能萌出的牙。　　【答案】邻牙；骨；软组织　　2.有左、右之分的牙钳是用于______的拔牙钳。　　【答案】上颌第一、第二磨牙　　3.中央性颌骨骨髓炎先在______内发展，再破坏______和______.而边缘性颌骨骨髓炎则先破坏______，再向______发展。新生儿颌骨骨髓炎的发病部位多见于______.放射性颌骨骨髓炎则见于______患者，其特点是病程发展______.　　【答案】骨髓腔；骨皮质；骨膜；骨皮质；骨髓腔；上颌骨；曾接受放射治疗；缓慢　　4.下颌骨骨折的好发部位是______、______、______和______.　　【答案】正中联合部；颏孔区；下颌角区；髁状突颈部　　5.颞下颌关节紊乱病是具有共同发病因素和临床主要症状的一组疾病的总称。其三大主要症状指______ 、______、 ______.　　【答案】下颌运动异常；疼痛；弹响和杂音　　6.______和______是贝尔面瘫或周围型面瘫的重要临床表现，也是与中枢性面瘫鉴别的主要依据。　　【答案】额纹消失；不能蹙眉　　三、简答题：（共计16分）　　1.试述拔牙后出血的原因及处理。（5分）　　答案：出血原因绝大多数为局部因素，偶有全身因素引起的手术后出血。异常出血的局部原因有炎症、牙龈撕裂、切口未缝合或缝合不当等。拔牙后患者过分漱口、吸吮拔牙创、过热饮食、过度活动等，亦可引起异常出血。创口感染也可引起的出血，称继发性出血。全身原因常见为高血压，其次为出血素质（检查血象及出、凝血时间正常，但多次拔牙均有异常出血）或血液病。　　处理：对全身因素引起的出血，应以预防为主，对复杂拔牙及怀疑有血液病的患者，术前应做血常规检查。术中应减少创伤，处理好拔牙创，嘱患者术后应注意的事项。处理拔牙创出血，首先注意患者的全身情况，询问出血情况，估计出血量，注意脉搏、血压的变化；并应根据情况，输入液体，甚至输血。了解全身情况以后，再进行局部检查，分析出血原因。处理首先应安慰患者，使其克服恐惧心理；然后根据出血原因和情况，给予相应处理。轻微渗血可用纱布卷压迫止血，一般效果较好。如果压迫后出血仍不减慢或停止，应打开切口进行检查。出血较多可填塞明胶海绵，以后可自行吸收；渗血较快或涌血者，需用碘仿纱条填塞，5～7日后去除；切口出血、因粘膜撕裂出血，应缝合止血；拔牙创边缘渗血，可敷止血粉，但不宜在拔牙窝内填放止血粉，因容易污染伤口，且影响拔牙创愈合；血液病引起的出血应对症处理，可给予促止血药物（如凝血质、止血敏）或维生素K、维生素C等，出血严重者应转专科处理。　　2.口腔颌面部感染的特点是什么？（7）　　答案：1）口腔颌面部特殊的解剖结构与环境有利于细菌的滋生繁殖，当机体抵抗力下降时，易于发生感染。　　2）由于牙的存在并以发生牙体及牙周围支持组织的炎症，易形成特有的牙源性感染。　　3）口腔颌面部潜在的筋膜间隙内含有疏松结缔组织，感染可循此途径扩散和蔓延。　　4）颌面部血液和淋巴循环丰富，颌面部静脉瓣膜少或缺如，当静脉受压时容易导致血液逆流，而导致严重并发症；顺相应淋巴引流途径扩散而发生区域性淋巴结炎。反之，血循与淋巴循环丰富有利于炎症的局限和消退。　　5）口腔颌面部为暴露部位，易受损伤而继发感染。　　3.某青年女性患者，因跌倒，颏部着地1小时求诊，检查发现┽12松动，向牙槽窝外移位约0.3cm，Ⅲ°松动，妨碍咬合；颏部可见一个长约1.5cm的裂口，边缘不整齐，创面周围可见泥沙，周围可见瘀斑，肿胀明显；颌面部骨骼未扪及压痛和台阶感，张口度约3cm，张口运动正常。试进行诊断并制定治疗方案。（4分）　　答案：（1）诊断为：┽12部分脱位，颏部挫裂伤。　　（2）治疗方案：①在局麻下将┽12复位回牙槽窝，采用牙考试大，收集整理弓夹板或金属丝结扎法在21┽～┽34进行患牙的固定；固定时间2～3周；术后定期复诊，如出现牙髓坏死，应进行根管治疗。②进行颏部挫裂伤清创缝合术，清创时应彻底清除创口内的泥沙等异物，严密缝合，5～7天后拆线。　　（3）口服抗菌药物3～5天以预防感染。　　（4）伤后24小时内肌注破伤风抗毒素1500U.　　四、问答题（共计26分）　　1.请简述牙拔除术的适应证？（10分）牙拔除术的适应证是相对的，在决定拔除一颗牙齿前，应当仔细地考虑这颗牙齿的功能和生理意义，因为拔除一个并非必须拔除的牙齿意味着不必要的局部组织毁坏和牙齿功能丧失。常见的拔牙适应证如下：　　（1）牙体病。由龋病造成的牙体广泛缺损、残根、残冠，不能再经牙髓治疗修复牙冠缺损者，是牙拔除的主要原因。如牙周病及根周情况良好可考虑保留牙根，作根管治疗。（2）根尖病。包括不能用根管治疗、根尖切除或牙再植术等保留的根尖病。（3）晚期牙周病。（4）外伤。外伤导致根折或冠根斜折而不能用桩冠修复者，应予拔除；前牙外伤而牙根折断部位在牙颈部以下过多或冠根斜折及骨折线上无法保留的牙。（5）错位牙和移位牙。影响功能或引起创伤及疾病的移位错位牙。（6）阻生牙。反复引起冠周炎或引起邻牙龋坏的阻生牙。（7）多生牙。影响美观，位置不正或引起创伤及疾病的多生牙。（8）治疗需要。因正畸需要或义齿修复需要拔除的牙；位于肿瘤放射区为预防发生并发症而需要拔除的牙。（9）乳牙。影响恒牙正常替换的滞留乳牙。（10）病灶牙。当患牙为局部疾患，如间隙感染、骨髓炎、颌骨囊肿等的致病原因时；或疑为某些全身疾患，如风湿病、肾炎、眼病等的致病原因时，可予以拔除。　　2.一患者右下颌第三磨牙近中阻生，冠周炎反复肿痛，一周前出现右面部肿胀，范围达颞区、咬肌区、颊部及颌下区，伴严重张口受限，可能有哪些间隙感染？请论述诊断依据及处理原则。（8分）　　答案诊断为右下颌智齿冠周炎伴发多间隙感染，可能发生感染的间隙有咬肌间隙、颞间隙、颞下间隙、翼下颌间隙、颊间隙及颌下间隙。诊断依据见下表（应稍展开论述）：可能感染的间隙 诊断依据 咬肌间隙 牙源性感染（智齿冠周炎） 咬肌区肿胀、张口受限 颞间隙 颞区肿胀、张口受限 翼下颌间隙 张口受限 颞下间隙 翼下颌、咬肌、颞间隙感染多伴有颞下间隙感染 颊间隙 颊部肿胀 颌下间隙 颌下区肿胀　　处理原则：　　（1）全身有效、足量抗生素，必要考试，大收集整理时作脓培养和药敏试验。　　（2）全身支持：患者张口受限，多间隙感染消耗及中毒症状较重，故应注意支持疗法。　　（3）局部穿刺，若有脓液则行切开引流。切开引流应行上下贯通引流，即距下颌下缘1.5～2cm作平行切口，颞部作与颞肌平行之纵切口或沿颞肌附着作弧形切口，分离脓腔、上下贯通后置引流条。　　（4）感染控制后拔除阻生智齿。　　3.真性关节强直和假性关节强直的鉴别诊断？（8分）　　答案：①病史：前者为化脓性炎症病史，损伤史等；后者为口腔溃疡、上下颌骨骨折史、烧伤以及放射治疗史等。②颌间瘢痕：前者无；后者有。③面下部发育：前者严重畸形（成年后患病不显）；后者畸形较轻（成年后患病无影响）。④牙合关系：前者严重错乱（成年后患病不明显）；后者轻度错乱（成年后患病无影响）。⑤X线征：前者为关节间隙消失，关节部融合呈骨球状（纤维性强直的关节间隙存在但模糊）；后者关节部正常，上颌与下颌之间间隙可以变窄，密度增高。
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