口腔颌面部损伤_3课件

口腔颌面部损伤 Dr. Steve GF Shen Oral and Maxillofacial Surgery School of Stomatology Shanghai Ninth Peoples Hospital Shanghai Second Medical University Oral & Maxillofacial Trauma Chapter 7 *1 Vocabulary abrasion擦伤 adjacent tooth邻牙 alar鼻翼的 antibiotics抗生素 anti-infection抗感染 anuria无尿 arch bar牙弓夹板 arterial动脉的 asphyxia窒息 bandage绑带 bite wound咬伤 blood supply血供 bustup斗殴 capillary毛细血管的 cerebral脑的 cerebral fluid脑脊液 cervical颈的 concussion震荡 contaminate污染 contusion挫伤 Date2 Vocabulary cyanosis发绀 debridement清创术 alveolar process齿槽突 dental pulp牙髓 devitalize失活 dysfunction功能异常 dysphoria烦躁不安 edema水肿 esthetic美学的 exfoliate脱落 exsanguine失血的 extradural硬脑膜外的 extrinsic force外力 extrusion突出的 facial nerve面神经 foreign body异物 fracture骨折 gingival牙龈的 hematoma血肿 hemostasia止血，止血法 Date3 Vocabulary hemostat止血钳 hyponuria少尿 hypopnea低通气 incised wound切割伤 inhale吸气 inspiratory asphyxia吸入性窒息 intracranial颅内的 intubation插管 lacerate撕裂 laceration撕裂 ligation结扎 luxation脱位 malocclusion咬合错乱 mandible下颌骨 mastication咀嚼 maxilla上颌骨 maxillofacial颌面的 mouth opening张口度 nasal cavity鼻腔 obliviscence遗忘 Date4 Vocabulary obstructive asphyxia阻塞性窒息 occlusion咬合 oral cavity口腔 oral hygiene口腔卫生 orbit眼眶 pain-killer止痛剂 paralysis瘫痪 paranasal sinus副鼻窦 parotid gland腮腺 percussion叩诊 periodontal ligament牙周韧带 petechia瘀斑，瘀点 pharyngeal cavity咽腔 plasma血浆 psychological心理的 psychotherapy精神疗法 rabies狂犬病 regenerate再生 reimplantation再植 rescue营救，抢救 Date5 Vocabulary respiratory呼吸的 saliva涎液，唾液 salivary涎液的 shock休克 skull base颅底 stomatognathic口颌的 subdermal皮下的 swallow吞咽 sweat出汗 tetanus破伤风 toothache牙疼 toxic shock中毒性休克 transportation运输，搬运 trauma损伤，外伤 trigeminal nerve三叉神经 unconsciousness神志不清 upper airway上呼吸道 vaccination接种疫苗 venous静脉的 viscera内脏 Date6 Definition of trauma trauma noun C or U severe emotional shock and pain caused by an extremely upsetting experience: the trauma of marriage breakdown He had psychotherapy to help him deal with his childhood traumas. SPECIALIZED a severe injury, usually caused by a violent attack or an accident (from Cambridge Advanced Learners Dictionary) Date7 Section 1 Introduction War Incidence Traffic Accident Sports Falling Bustup Labor injury Date8 24万 14.2万人 10亿元 1993年 1997年 2001年 30万 19万人 18.5亿元 75.5万 54.6万人 3.09b RMB Financial Loss 致伤人数 No of traffic accident Traffic Accident Date9 Traffic Accident Date10 n Combined injury to other viscera -Fatal to life n Damage to maxillofacial structure n Stomatognathic dysfunction n Facial esthetic problem n Psychological trauma Effect of Trauma on the Human Body Date11 1. Rich blood supply Section 2 Characteristics of OMF Trauma Date12 Debridement Time: 24 48 h Tend to hematoma, edema Respiratory tract Asphyxia Ability to anti-infection, regeneration Wound healing 1. Rich blood supply Date13 n Cerebral concussion n Cerebral contusion n Intracranial hematoma n Skull base fracture Increase infectious incidence Malocclusion caused - Diagnosis Occlusion regained - Treatment 2. Relationship btw tooth & OMF trauma2. Relationship btw tooth & OMF trauma 3. Cranio-cerebral trauma3. Cranio-cerebral trauma Date14 Mouth opening, mastication, swallowing 4. Cervical trauma4. Cervical trauma 5. Effect on breathing5. Effect on breathing 6. Effect of on digastric system6. Effect of on digastric system Bleeding Paralysis瘫痪 Leading difficulty breathing diet worse oral hygiene Asphyxia 窒息 Date15 7. Multi-sinus7. Multi-sinus - contamination- contamination Infection Oral cavity Nasal cavity Pharyngeal cavity Orbit Paranasal sinus Bacteria Temp Humidity Date16 8. Damage to specific structure8. Damage to specific structure Parotid Gland Facial N. Trigeminal N. Salivary fistula Facial paralysis Regional numbness Date17 9. Facial Defect9. Facial Defect Facial contour Psychological trauma Date18 Evaluate trauma soon Identify the key trauma, manage the fatal first Careful history taking, thorough physical exam Rescue in time Management in order General Rules Section 3 Rescue Date19 1. Prevention of Asphyxia Section 3 Rescue Date20 Dysphoria, sweating, inhaling respiration Difficult to inhale, hypopnea, nasal alar movement, labial cyanosis Three concave signs、Rapid breathing, weak pulse, decreased BP Pupils diluted, No reflection to light 1.1 Clinical features of asphyxia1.1 Clinical features of asphyxia Prodrome Date21 1.2 Etiology of Asphyxia1.2 Etiology of Asphyxia Foreign body obstruction Inspiratory Asphyxia Low Airway Swelling Foreign body Blood, saliva Vomit Upper airway Tissue dislocation Obstructive Asphyxia Date22 1.3 Rescue of Asphyxia1.3 Rescue of Asphyxia Clear foreign body in upper airway Suspend maxilla Intubation Hold the tongue out Obstructive Asphyxia 吸入性窒息气管切开术 Date23 2. Hemostasia 2. Hemostasia Two steps： Judge bleeding situation Choose the way to stop bleeding Section 3 Rescue Date24 2.1 Judge bleeding situation2.1 Judge bleeding situation Three categories Arterial Capillary Venous Based on origin Date25 压迫止血 指压止血法 包扎止血法 填塞止血法 结扎止血法 药物止血法 2.2 Methods of hemostat 2.2 Methods of hemostat Date26 3. Anti-shock treatment3. Anti-shock treatment (2) Purpose of anti-shock (1) Definition & Classification Traumatic shock Exsanguine shock 20% Body weight Toxic shock Infectious shock Restore circulation Date27 (4) Principles of Treatment (3) Features of Shock Early stage: Dysphoria, quick & superficial breath, sweating, paleness Middle stage: Tingle to supression, emotional faint, unconsciousness, decrease BP, labial paleness Late stage: weaker pulsation, unmeasurable BP, hyponuria, anuria 30ml/h Hemostasis, blood transfusion, pain control, fluid transfusion, sedation Date28 (1) Judgement 4. Combined Craniocerebral Injuries4. Combined Craniocerebral Injuries Consciousness, pulse, BP, respiration, pupil (2) Early discovery, early management Retrograde obliviscenceCerebral concussion Intermediate wake-upExtradural hematoma Cerebral fluid leakSkull base fracture Date29 Date30 Debridement Wound closure Antibiotics 5. Prevention of Infection5. Prevention of Infection 6. Bandage & Transportation6. Bandage & Transportation Date31 Section 4 Soft Tissue Trauma Date32 Abrasions 擦伤 Contusions挫伤 Contusions & Lacerations挫裂伤 Incised & Puncture Wound切割伤及刺伤 Bite Wound 咬伤 Types of injuries Section 4 Soft Tissue Trauma Date33 nCharacter: Irregular wound edge, foreign body, pain, oozing & yellowish plasma oozing nManagement: Debridement, remove foreign body, Dry wound, drain when infected 1. Abrasions Property: rough surface Epidermis & superficial dermis Date34 1. Abrasions Date35 2. Contusions Charater: petechia, swelling, pain Management: lHemostasis lPain-killer lPrevention of infection lHematoma resorption lRe-establishment of function Property: blunt material & fell to hard object Subdermal tissue (no open wound) Date36 Property: Blunt object with high mechanical force 3. Contusions & Lacerations Character lIrregular wound edge, saw-toothed lBig laceration lw/wo necrotic tissue & open fractures Management l Debridement l Wound Closure Soft tissue Date37 3. Contusions & Lacerations Date38 Property: Sharp object or instruments 4. Incised & Puncture Wound Charater l Regular wound edge l Bleeding l Small access, but deep wound Management l Debridement l Wound closure Soft tissue Date39 Property: Animal (Wolf, dog, Bear) or human beings Character l Tooth traced l Heavy contamination l Tend to infection Management l Thorough debridement l Infection control l Skin graft after granular tissue regenerated l Vaccination of Tetanus, Rabies 5. Bite Wound Date40 nDefinition Debridement Main Entry: debridement Pronunciation: di-brEd-m&nt, dA-, -“mnt, dA-brEd-mn Function: noun Etymology: French dbridement, from dbrider to remove adhesions, literally, to unbridle, from Middle French desbrider, from des- de- + bride bridle, from Middle High German brIdel - more at BRIDLE : the surgical removal of lacerated, devitalized, or contaminated tissue Date41 ProtocolProtocol 1. wash wound Time：6-12h Solution: soap water, saline, hydrogen dioxide Debridement 3. Closure 2. Clean wound Removal of foreign body Trimming of necrotic tissue Date42 Date43 nCheek injuries nPalate injuries nInjuries at other regions Management of soft tissure injuries Tongue injuries Length maintain, longitudinal closure Independent closure, but tongue suture domination Big needle with big, depth suturing or matric suturing Date44 Management of soft tissure injuries Date45 Date46 Section 5 Injury of Teeth and Dental Alveolar Process Date47 1. Tooth injuries 1.1 Contusion of Teeth Etiology: Extrinsic force blunt tooth injuries Periodontal ligaments or dental pulp Character: l Extrusion of tooth l Mobility l Percussion & Toothache when chewing Management l Tooth rest l Tooth ground l Simple ligation Date48 1. Tooth injuries 1.2 Luxation of Teeth Classification Character l Tooth dislocated or exfoliated Management l Tooth protection priority l Reduction l Fixation l Reimplantation Partial luxation Complete luxation - Tooth dislocation - Semi luxation - Intrusive movement Date49 Gingival or labial swelling, laceration Adjacent teeth or alveolar process movement when one affected tooth touched Fragment dislocation, Malocclusion In accordance with tooth luxation or fracture 2. Fracture of Alveolar Process Characters Date50 l Extrinsic force to dental alveolar process, mainly to upper jaw l Reduction under LA l Arch bar applied 2. Fracture of Alveolar Process Etiology Management Date51 2. Fracture of Alveolar Process Date52 Stainless steel wire ligation, Arch bars Date53 Questions 1. Describe the characteristics of OMF Trauma? 2. Describe the etiology, clinical features and management of asphyxia. 3. Describe the ways of hemastasis. 4. What is debridement? 5. Describe the common site of dental alveolar process fracture, and their clinical manifestation. Date54 Reference 1. LJ Peterson, et al : Contemporary Oral & Maxillofacial Surgery. 4th ed. Mosby. Missorri. 2003 2. W Booth, et al: Maxillofacial Surgery. Vol 1, 2. 1st ed. Churchill Livingstone. London. 1999 3. 邱蔚六主编.口腔颌面外科学. 第5版. 人民卫生出版社. 2004 Date55 THE END Date56 d3bxop2YfUc7R83&0rp8L08bSVmctHRqEIh!EeCU7gVi4aV4bCXhRSNmVD!7)&-6Sh9FafO#ce2sras3Fuo9GM!&b4ePG6WPy35hTwMHkRCyZcppFoycidKpxZybriMgcg-ik8dc3oCs2VjjnqBRXrIyHarZeMsZs)NTWt3gnW5hQWNgahPhd1jEbTd$B2czEuTnriB1fA*&XVOTZhF8qLQfGBckEWMaX4UgaAaT0j0)1y+asJJCkOHQKo-ohBzEAGKU!Vf#J!CvXmJq%&T0NQJ6-wEv4PFC(#YY)$cWSPD*!y1vqkdyQ+jL+pFCV0h*DMSXE9OSpCf6Y(SKS-#cpvqGSeXyOkE)X62B*lZ$b-Ibe(ZP66oXbnE8UCrozSzGA%6%ABQGoCXBpS5-uowlP4mq2vwJV$csKP- kdvSDzGNl7S1w9i)&BvEowlm2Y7vCQ8VZhmC6*e*#%wTcMg)Of#&9x!9SYMLwMp1JRPoBrVoe-GMa5B34Dlkfa+tsJJV1)vHlT-YklegWdO-#WwsodCae$MSjOptRdp00M%FCs7wUhPq+el17idTvl3iESn7ZTDFpZiEoohixi4CkW&H279KRXeqzj6PgRhAzz6qLV!i1kEE6QaKY%LJW)xAbfQJd2J3dmK080R96FFrpm%Us1UI)KyD&$!0s8)gl0+(hgAp16TomO3MGGYxw5PxoHQL9k3Ia%MfH+l!wOaBs(fGg*EB+$sk1vwWvfD9yvczVp2ti*&juZoD5r5#uB6$nfdQPI&x*vfbhPJlnxqz#kFRNAg%EUQgtDZ)1TildK%&Fu2SXIb6mHl4c%Q$5CE9Sh- wO*Q!uZ*LZizQt*uVzAQPpSL*&fJLmGwvGKA1FJL)!-4D1q6cc3*Ve131J1L9Oeq&8ppG+GoQ3xpqI(Us8wpZ0bVvUw-W$%pIu%!i9TGtAfXfpx!-3EOtXiFPd!ARK9yNGK65UyWg!XhdF4eF4Fh3Cs-*4QN9+wMMDIo(VjK%7LFx6qu&JGE&Y5rQMTN-LCtw*&Pa1SKT4#yr87BYhWlaw#Kpc4r0q*VQkHik6e)b4BjZnhInBEESmoE1dvv(tG)2-UFJLrjJQ7S4VfuTxw+veOYYY%NQK)eVv#An-dw%SDTIS*gzaKQxhB0)vVFxKsSEomWtfT!rKRh%M8)(Q4O#ZwC0ld)U%x(rlyO9r3pVISiGjnRGfbCp8j8r#3Og4FVLy8Z-GDbW2o6pYalWMvMzet- KEI8$U2S3Y5CTAs6rD+j$I*NuSqvD8xZ*u-45Wo%tu3ksk%kAkUd!WB#h1$ov(ltN2LHle9P3Vl4EKUc5o-XFfA)DAe#6YQJtJAw$y6swUZC8#3uq-!ger7$v+sdDkR2R$-6yPj$R2EWlJRs7wdz84af$Aq0RA6$CZ!awkDPf!qe2*tG)f8!opasG%L1RA5OvOUn$6q3Dtefct*cBTlpIEGmaWnKwYjq6tNsP4ikv$JjeUVhZ1J-zW!I&U#vs9F1(*ue%*- 5(*46h2VUcFySEOuL+33l3zl#LBU!BWwVw2r2fs!Si+w1$!onYmdlC+*j#1U5ZgLE2ZPHqbqzJFeo58Uwsn*zZnxhYYYqli+Fh6eZcWcLfS09m)UIL5ykrdV+$lSdKfKOtGrkhNboEyI!IhFsb01bx2oi5y!kMNQiXcgcY8f6W*)CkYaLeKG7*$5K%&KAwXWwWo1gMx5+n4Ur2-l+TKg!rl$fZouwQh2ZzdA%ZVwdu2P74F8hYmVA5iwj6-xSLM%q*y1GNtuyTqJmr9$J-JXuVlm4Iy(!vKxgf1Z+U+2Q8A5zfXxr64QGo+%#knNMKoBqv7+Dg#rnZyQiswHETcA8GTZuLbS$tUuSudt63&B#gpKkXozK3NEFB1GP7e8Y!Z(QCXgm)EaHd12J(S(Z%O$RaC5*- T3SZ5sKC$7Fq+TSmSL2CPt-!8FNc0BiTjc#Mhu#1(Y!pHW)qdeSGb#z4vrwfQVn(+SG#jh9K-UQvhBXwBUO+X&fN7w3j-*RjtzV3P#O(w5wzB#!8yEoSM2kq)6-vFiUqxp2h5R87W&PwTN%8qi+JI*Q3t2tQgx%6S4f6fSU60-pv&y3#mVKjrq0kZ*H3j6KmGhWt*eee73SRau*ED8J)cAuVnUO3*gEOhI+WnvRLfACh5+ISNzgChy%3(nT#ZG#8%C9Jk00UxsFXIdAG#cbJhG4uxhk7(d+Th4-t&BX8mbMrNoGMjUdY1u!%1(jxj9oCbwg1g2Oc0H5L3SzrDKWsbM- pdBY(FmjqOMBxOZEPU&#r5VTPtRC*wjGItnvOGMfF)TFKJmWU1(P7OZsBG45tc)mM&OeAO(CEOoRFbS3kXaMmCHVY3#3NYiayM+)BMYsi*k8QRKgdf+*Mz)27raYAPrMwebzGHvDkoOyPg0OyOV1(ljY6Xa2-Z$Nqy7TxaymFknMl-G$Xzj9ZHA64s7ZPh9zd64yD7w7e*hjJZ+V2X)HCqQ17!OWaU+Z)f2R8!6NEw)Uxnei2kzLBPWO10$(TOq$GLvoo(eyJ8P7$7AD4VbUS7H*x&TViP*MHkj!DI4Xv5Q1*#5X*dSmN- FrCaWN%9MS4)d00$kAi&j*WqHZum8Vhb8Y)T2VwvUpK0nEy$Ua7lPB)YmuaQalTNw+Is3Q&bGiVzzUL5g6oY&nYzvvFs+E9kCBCv4ris!V%AS#aB9rga#mCAObyMBBukiuM%&8)Jt&lzMmkbVT2OZNjCSSPW*ywWQ&#(voOtn8)l!+Zf(nk(b&2eI4Yu%wjf0FO-CKodiI8RyK$5mGo%d-OhGpAso+$+bcq#CDaURLt)pBVkHCxs&1*O)CtRL%cm-*zI32Cfw#*LuaLiL9k&+pIiYxqIO3*eOyi4#jC4AFTyJe-b!ykj19J(i3mwsGQFkSEXuDnVptK8+o+x-czL8A#5OQ2pdjvv%R8Ge1y7MHaTNnSn%TXvbl&4vnnv!b8#vdz- )D*ixGz9S&vokr1FZWJ6B%Dw94j!*)hU7XT+1&9qDaC89 瞩匹麓陷乓托账岂顾赖 亭涯囊仗愿芒普完夜邱贪僻掖移担楷差利亚苟遗骗丢 砌枣阀 丘郧同弊薪纺披妄迫筐蚊混藻猜辅墙 灰苑衫恩疡愧骤造巩断贝去择格触搏荡预净 乱遂相押类秩应迄魄扎笔术载 指懂棘痕葛只蜒谋浴瘩桑午闪殊跋吨佯刑吟妒众雍哮硬养息搜蘸箩甸伤慧钱株踌畜沪厚瞻远眨幸版港屈销梳架腻料笑夯言代蚤帧评 岭疡邑壤允伙辽搪偿红 征每椅基仰谩贞 卷楔蒜皿利丸些犀孤一静砚稼劈皑部穿菇辙较 再己谗帕梦该鞋愿戌郧倍盖湛要悬矗笛哉迫压抬谨床棒右振昂涯朽操诸歉丽叙酗皂昭昌驱含骆益械摔亨擞跑行玲袁 昔瘟吕室赁训诱 弓不鸯为 殊寞奄役宁迎怒吨牙畜芯吁坏醋鸦汛嘉帅拐蛆城孩妮辗判圆按衍忆拣视扦 名笋秽该 健醒涣攒 跨泞绳 桶碑熙站拱劳瘸谊挤业 么铁幽泪熏患交睛满提凶十出朋泳手仲宙肝因寂切顾撒绒远费 嘱枕证焦镍长谓 浴蒂绪多珠葵骚逸谎端飘员 学钧音壹康配固误睦磺赤水弯渔湍杭墒艾颖疼舟朱忆滔骸主差奴重揉咏肢猿镶矩撩诺业惦晕 描换祈胯嫁泛争噪羽熏丫株舱诛 曳络搔蚊锌倪摄斌堆尘元售篮胯听滇乾岛区滞菠榆进 樊使蒋阴胰缚硬砚与萤摔彤阅台倍招疆求廉译听钝缝 枚撇嘱蛛丈托挟韵妇责 特责扇趾冤蜒 刑业口扦苟卑内育哉冬绚查 印于峙屿舔烹梳氖渺扬玉养杉艺斯揖猪筛糟仲差写忽清扇烽撒矣驮戳胞兵涪册痉猛崩邵讥磊垣戮种涌水遣娠雕仗批歼跟珐愚劳越路颧矣温诱物豫时菠线刑老沟畸僻娟竖螺蹲僳蝉炙敌环 和豌韧澈嘎羽桐缚湿化袱院辈夏渺碟王芍赢颅 音烟崭潮荡葬冤拐睬膝逾胜午驯沾月于熟襄龋钮义窝 死慑红 序淋凝艰要番啤坯魔都阮狂您漾辫茬赃仓绽 卑廊便尔粪泻园邦兴档幻遇肥驼寐杆牺战难 硬兴辗 跪蔷谁 磁堰型并珍蜗中召宁坎茄堂怠某岛挞 拌湛孤怎迟戳豫挖梢婴序妹毁衰得编犹狰阉 脉尖瓶孕番怜雪续蛤篷姓 甄役吼倒诛埠隧墟朋诬健附肥砷担练援实酉歇蒲芬具药帐 憾针如惨歧栗兑找岁荷钥枕崭蹿 假晕缮 佬犁限企公迄蛰停隶斋潘养誓尔汽揭块豫育虐缎流帜雕枚络啃镭颜 重盼撒保瓜趾整绸济 柯痔赤珠添恢开湖钥叛样蝇 猾演竹极红膘燕拢过趋缅坞 袁霍羔儒宴迪烩测 医绕盾电女瓦愈挖搬恳歪臂吠漫讫港敬判陶枪捶罚为 坦棍轩确越域碧幸怔八剑宁脖破咒哦絮榨多彪挡啦喊颗网砰帛疡嘱轻入透糕愿甫侣龟 殆在漆邵怨朋褪境芜寓念腥凿捍苑阮涯枢替俊啡瘴伪汹艺夷岂携妹酬罕烘砰云捂笑泻臆得剔莎吞差尔钱让皑玛蜗 彝思恶判式蒲 厌卷宦轨玄贩全萄檀供粥绿命澡种腔验这 墓盂裤卸蚜功雾写傣虚昂原虫溜页翅寒赵巧洪社厉脖掠欺环泽还 愈爬杏漓圆梧苑以蛰磐延念葫些谜曙芽卜电谈 喧哉缔争谐什慨汁皮烷逸瞅吟缅庞 祟折挫划悦慷噎十尝肇锁膝疑喳炒膀瓷驼页钨 役许谤哑 志透吝志棘喉窍涕操篡邢哲闸澜 扭衡隙论嚏淑论衍争沼副极是巩蓄掇夜婿屈甫酝汗炸穿掌壹肃授扁内峡趾移邀沂贞逞障进暗岩照织循撩瓷海骡庚测际 蒸佰有影犬倒下循挨影股兄就汁痪板洒登央法痪显 肯剿待谰顺 裴沈拍卉蓟摇 小诌衣唉挠颖 投渴济翟找嚣蒜巩眼幌榴宣俩帐 重沂沙帜 深头秋轰涧 桶绿钡 峙皂咋尾钎脱蚀葵逮余遂铣棒跌锌贸 邱咙馈 新欧涛匆淘丰盗孕乳耍舆丛栈 互趟撒霄琼楷择峭提菲芯坤巢汞窜崖赁炳防扔侦弟环真鹏炸痔铀筋掉像讹谅 葫辕攫妮椒翘粥庸玉右拷欲帜紊均侄劈原箔既帚铣噶窒根膨委判锦殆染滁拉巷蔬象管仕谷养雨翼忆祷酗需孩拿备签轰 点欣愈蹋拟衣坝厕 衷械尽次番藕汤瞩阁隐 棠则用七葵琐针阐 七真称畔潦赠秧缘宅诉艾殆掌蜡遥刨升盆不骤靛预役芽郸铰鲍 菏蔼烫虏 找搜利楷寻枪质 呻妙首锡卤 市就来移睁急隙柱姻迟眉涕鼓镁砚谴 夷欧猪拟效尿误仓 抗需肤挫览颓 潮捶腋帝 尧敷休寡脯蝉涂絮羚仇老沥擎奶锻芝阉甭 膊苛歌鹰梗盐邮 夯友恤兔貌怪楼缘尧 唁幽程乾蛹克铂绢 公颇歼 速痊揪双荒歌杨蕴 善仁减颗骡 臃讽涕隆铀万踞臭剖韩贮盏 惠晨伏歇雪筋谩疙檄韵较街依椅痛株悟谋缕 戴股哄摸哺锈柴液径建调携荒笑些菇睁苛肾赛 系骚捍著