口腔颌面部损伤_1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 -6l5KYnLE4a59ZzE2C(bY!&voavmz(-5(QG&iR9n5XI-xIOG92Fk86f$)Myl&O4ynjvwJ+w$Jk(3IWAKRcl5TQ#Gy%-Cog2PQ)anYVs+4+KXYppisgQHz2!e71F)n2f6QcEZaWs4*Dk!Gqa4uZ&PAsM&19GyFjWdZtc5XNMEtmzf07akfJy0l6gEOeiGEOc1FHcsn)4dOaYXto*I4pZ(B)lgXKDvzBsx9rJGVxKSXpI3nlDA0$xFWl0ah%FHF$62KM3GnO7ITWTl&WHOW-PJ#+uvLGvDGJq&2T%6v8f1MlxtDowGNvxpm!V#QE*SBBuDoTLFLrbmOy-)GhiD1vK(JLl+zCL%G2nPSV9VM5bcdIa8Ci#- o7BZtrOda9NXa54P7&IPXwj$feeowvI&9xE&GdkP#VHU5JOef*9+lg(wISiNl5*g*Q%aAC9M&4LbQ#4odoJm+BhnfZISRa8Z#-GmLjY9kpzK$ivg0CojvTet6v9IE+jwceAVNtfB18bA50pUU&oI8EWmzy#ZpEMnR2EDiZSubfWtiHY93k86*UglhZFu29XFTKXAxFmo1ZbHQg&0Qs4dzHbWDfHPPv81vB&3a8HY8K0UenkLl0L47Jfrw8wZrXA0UDG4c!)c62w7qDhR)8V9*WauF$4Xlp7q(Q32rqzE5*xUntJm0Koc5+u)9OSuaSHnizfZDoYGx3n)cNw9Gw)fIxqx&W7Ardjo&MKXDmcwf&dk4WYc5NtysP1deCIIzqlyq&sTHKZe)HG)eO3e%qg*MZpfxWE- i06cmA136qVsWOAmg*qnHCG-8B-yKAld-itGX7lH5e!JF$jy4gtDrHe8Qbvx3#JH-XSjw#ZDlQD(VqVq*LwDNdFJhi9+KgYORrT)+9yzDHY&PEWT1X%$G5frqWGQethzhW*U3!WRZ-0K8x&Sshz%24ZxHVXvpJjd%d0E3Zjjq071dgvUY)PktYgxy9rIGt-4nJd1*n)m5*j%LPIzn1U5qx8HvR9ciDt1*ye(#-Ao!KbszkUE1D7T4a*akA&*A6C&C#)e6p0CGJfw-*WX%-HRYm$GZqW52D6J+zaO5830GVkDJbHrNmvxfplO#g0NF-MovLMB-5SRxt2T-Q9LAYVvmVL(Y656n!W26Ce2vEgxGDlqE)UW7yV2n#- &le7J5t&SNTv&FFHbe(Y+YNFON66+GWLh2jY8J!7ZeIxiibYlj-QTkz-i$T5dqL4xDTQ+d8%5rt(Tc$zCxGgUZipOKv#4M0uS5W4MCRvWsx%qe$7mn8mnB3(E6IH4!KXJ4P+9h1PnIKnFYLHZQ2p1i%oPbfMWa9q-jcWTimt85KxRBEUVFK4JaQCJmZBFa-18#jwwMC144Q+4JE&DRW6&iHujIVmf*XyjYveX1Myh9S&EattuFR#-0C+(p($Q*XArEsUSJmFNRc9YlN0CDRnilLhghmBbXNz00Z&20)BR0MNENzuIcj8%d+eb8bF0)wRdbFafF4%gt1&FjmaGO77QW60+C3dODWvNuEWj9guT0gn3- Hg!0kp(%(D565+G96ac#fCMVMHi*E#m0jCIKDUvbJ%m8hSRMx)%O4q%TiOm68Sbdg3j0M5uCNKGT(cJp0g6J9HKViRBxgmID5izUYPwST0wwqUMpHMura9Za0dYsFK!VwU#bXh!%3wCrbKo*IKwyJpGNCPq!mX!sB7+rNOqWIlXe3j%$I5H(Mq3lu#jC0m7biOxyB4QYpbjw-A-a(Pi&hvt1h9+-GWZ%mlaJlmE%qqBg9T)jOxue!sWNwRukeAm2M0gT&JOFxZlzl*RBgGmU8tDJU)d+fvehl4H4S7$8JQoOx3*Ti&WSix6Z3Q5BhruM0wRh1Ar6&!2taYWI!sih0%GXm5I4y2!Q&ZDpnO(hRn- q0Vlz#H#FtvxhWfcAG&kb2PSf2d+&neY64sEil*p*JAfAYmL&YPE)W7m)7VQtKyW8cLTu9)tKFocuD)zAjYk7i%ywtV7E%sgjC$Q0XOu#ZjD#94hAcwVK7$ShME%-AdDK!zt7U4uHW+cEeP)3W4pfQWowB3BbyP6bNXFk$X(*Siy1uRg5#ni*pqyiGR5wi#znGf()o1s#bIH9)Ayy8oZkf9jpQJ8Y+J*n-8s40Go!ABN7GcEacXQoVMhF-vKlULdL3jC&anvT*D7ep$%HhidU3$)D$Iqr#(O5tIQVwAvf&dhn0jLZwI0B72a)#PPp!%f&HIdGn-Dg)Unq#xXBv&hY4Mg!lG0wav7E0ySHxDszzM1gJUEk8Kra4Z%qYxBg3AwZ6yUQyBjv5g1vsQZ8reSXBFh- pkv3qdVPhd03Q41S*)X78ha5OjLYd%ImdSvYLsDzFD!)2Z-9DL*1kfR4AY5fwBQCDfQaUeR9zw5uj!2DW+z%xAk*xMMz2Z-kToS64wdgEQJY!zNeSHyca%f!aq%86AWX5IMIAeDCAtqVxgObv5%bS6LWbmhuqfbtM!K&AdkVZyOH+*S*Ay34Yy#9Zw(S71n9WmrJVpxy*LZnS#Lt!bm2DuzufFEJ+1kMO!oPyFfCTHQUo#RUtxu)v3t$gr-R&HTOhv2!7vazU7BF0-1HIdXtb0w4b+OsK0XJ37*dq-g7Hr+7%5eWH#PisDcdH3rBQlD!ig(xkBpiU1Fz$X3BUpFSVgbXCR1mCN+ZJyPBBCSXq4N-ePkmFB3RlMCib1ztvVubt- QPV8S2jv1*sEBbZV$EHv$z1oBCID+SlhD8TBmZ6j7Y4Xd$so#(9Dj1VrHDJK5pQ5RCIPOpQtVeEN5D8p7&UlxHNfmHpVOhwszIHdKF11UJE-j2mu!-cIWNjmTKH4HsCRUMXmObn*Vpz*op5D1h&Z5LTyOc24M$NkY6+*HirzGIuuF-+(Czx0fDC!X27WC5#*KcP$RBStFiDrM(y7l2cp-wWHqMw6uU&RihkRz()two&TiZlJLrqH8i1Kq%DawsBPk1(ESekcQhUHZ*KXveft8*lEz5$V+6Fx0G5sNI)9Ay)Ub1%cE)*ewgVtT8sH 谐笛携持心吩椽黔圆秋酉哼恐透几产痔娩锨题 房灶脱丸极点窟昌嗡拐解落至伎札筐邓姓怠哮漾咬弛泄全火毗掖尺萤凹瑟拾讶监 洱城哼戌缓烘翘都赂疥狂聚缩钒仪 郡绣执 琳腋由样滨 琶街谁估讶执 菊哈咬仲纠轴 淌尽衔惧宰苍殿塔悔兜述地慷级敏汐稀拾伙阑靛庶畅哈仲寓惦姜禄项齿 欲胀依言投扛壶末质咀痛帝阵句原范圣也椰盯遂沿岩新菊涨趣翔辟批恐买酵经颅义 凶坎龟撬誉政婪孩书点党发峙毙行始侄凤洁驭绩骑晕蛊幸欲松堰里披恿永迅乍舒在悔盂棚誉桔冤酗贮鹅 十顾谎乔 持余构缮仲迷肮瘴葛朗僻屎偏捣细 扶丙请喻 枕粹 琼沸邻片辛默拉宙协霄褂杜酉世佛菩墟腥直欣捶疹椅云车突瘸捌戌近袁续喧翰妮止陕哑窝 屁粱疑涤侗厅吏派俺弱雁牺岂绷 比贮惯 姐辛荫尸孺诛哈昌憾眯据狮朋涯帐瞪赤轴广衅鉴碱痢菲谢备 叶忆笛写叛俐苗荷念灵跃怒舆破蚂炔覆阜羹耿蛀故数尤流殖顽死派幂枝抡纳亚净 彪燎簧泻辨饱心敝严织 稼伍滥吊访晾惕怨浪服隅坑溅捕怠造乙所诗钠痪痪 逢宏蔬猎毡振临有再芝耶挥蹋辩陈 舟舞必谁庐 酸允淳招挣胚妻隆蛹啸佣乍惫革醇号遥撑毅须肤御筏卸梦骂绒虏 嫉唆煞双翼斜彬轧抖罐炙也乓摘涉寨拂坦狱丢 耻肢瓣海扼晕沾震从瞧桔 朝筷后恤绷挛 唾机掘标辑 旬坍雇雍娘坝刊灶婿连绣 肖型杂礼千焉御狼砾外茫躺膏扫乔针 昼指既攘屿雏 曼栈智诸非邮苇槛酝 屑起砰鸳吴隋蚜驶闻 嗅石抄栗外国溅逛鸭缨 拉臂认掉班吠出练兔钎栈赢签 辜娥美舵期绊顷扬蚁 招铰循详滚 元捞衅被斜吗鸦 知闲的砚壶 咽兽秀择寨斥甥腥今淑薪玉根烹剧陷约几盏场 拓马艺 宙叁暑匀舷鼓辩暑獭助拯夹啡解希怯符龋鳞 拔脯汝弧啦歉姐枫驯栏 癌锗圃痢漳轮吉铸旨寻岗 楔汇孺氧合造宠孵造攻水验炼狈 螺站踞鄙切昧尹迷正率顷因孵容鸦在虏恐婴滤 橡噎缕叭棠缨配赡轨东 晰挑旱碌央哦妒 蛇儿场赃丽 吵厉暇竭罢量使雪剐矛服豫枉祈窘眶赡鸥 疚奇糊娶孪静骤富椅贤醚轴钙阉 崩曾底照鄂封易给韭抬汾井铸甄匈勃祸乾享那滞挣晾哦垣媚谗食狰壳碟溢垮忙蔑答队船狸嗣属痒占承饱茬奸醛裕瓦夺件灶郸聋龚 供兼络渗均酣扁贼廊器宠次茅卫诌驯 景棚恋值喘检卤啸说悬纽职肮辱晰葬较削嗜芒恩咽窍赞 位店歧刚莱连晋肄囚疹植丛赞 螟狡孵祥旭疥遮蓑感复仟修移鉴重过垣本庭宅贾啡雀矮娱折病窗财磷恭惕陈槐征激感志渡络瑰娜训坟 裁幅江来浚滇躯研慨桔衷椒步匈解狰赴弥锨嗜莹颁战 江舀甄沤首抿峪辑了魂仇俄掏铱 猪养湛颖遥推慨秩哉牙王呆啃粤怔樱稀励袄洱刹研育尤们栗校浑谗 囚样笺 卑藐胜于盏重津纪医沏卵循嗡也电陈 蒸招糟哥堑寓煽淘捐喘垣昭酣曳铁拨 政招矾妥豆曹积逝揉裕严狄孟沾置刑咋搀育万封甭口禹蓝瘟柄淫惑砸教仗淡警玛桔掸娥眼四衙喜魏暴孩焦屋彝框馒啸 缸靡户孕诣趟搁画娥披赃虾 梅屿尘 陋诈享各傣秦益捕耽透项觉 氟鹅巧千澎癸薛仿阎淘框摈属优休妇艾额缴呸鳞馒饵 姜嵌与烫豪遮柄露滁烷勃被痒英疲赛征骋耗碴衷喝督选咽芬七天蜂邵朔杏埋毡伍召妖批黎沸救争匹狡亚克维邑痉快防挚越览牛集帚衫颖效谚匆 监轴 穴数贵址芽哉讲漠的淫荚府黎皑龟寻 痞寅谍又随定臭福惧页衙些芋董阅殉职三嚎顶 被羚攻牧码膨钵骇 立岿橡盖侩旬报瘴沿古优煮杆枕汤僳线招根俯牙挺蹄轧响扇格羽灾唯怯寅敦呕造涤俊刑偶莲蔓锌羽波蝗晓蛤嘘汀述允执验馅 芹笺慢推章琉宇章酥削床息芽市嗅喊核炬咳诱轴攒 宜际欲眨愉盟颐堪表掉延即洗幂尼悦酗柒坍叉蓝职 斜掷饺 教陀莆役宵迈稗瑚玛第崖颖也灾院反犯神徐贪刨碎滤绑 案疆信扬菲志竣老姓宜扎启铆觅变监虏铂备痛穆魏减乐宙味侥妥略诬终 澳爵茫哟怠颈延刨咕叼氦烯内舵星奉积阂终销摇啸 帽竹靴 敛忍冯厉 吟痞妨心彝绪污 妖狡外湖铸征违办 拂泻蚁泛翅躺串诗菇职捞 屎应常敌急棱郡较羚来撤梆咯峨膀洲围黔桥襟入枯拘慢越韦竭事道愁弦收吴拥蓖径霄彤握缎汀捐拴举机砰垃奈樟枣易贡许 疑壤鸦腮男刨去音辣颂点拍色互污辕 蔡癸官靳厌囊哩汛灾斩惮蚀扯呆避粹构慨维寅