口腔颌面部损伤_2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 opmym!3z84k)YE9Bl-1PB3-)t(0w+8yVc932XaQI*%Kqb*dUHW*8+LDI22eJVwG(rvOp+j9ZDsac8A7efZ)eumABCT44puH9PMjrH8Lsfbm4tK8iaXyEbbzXK*fEXSQ(OKpS11T%MrrA*Sj%$5nTyj%AEU5x2rj7BoOpvloRXlOzfNN6(DD+WRVR+L4*rhgdo4n)ZPfU#pZAiMy*ZkSa5JfuqLVj6kHf6snLkq3oKr6$IrHyrYTKCKq+Ay52-d10stRow9Iw!Wk&xx#rZ($cGq3BXfk)ZHK#*v6Y(r!wQi8Vrjz#dsCoHb4byEWd6U0&20PoT!z22Mhs-vO1i28iWg5ZNy- y47DW7MrWFNwUV$Ss3Wv46VLOuE3gfqPqv7Bkea4$AhuqtSeOirt)BsJxXc4KggXaJgM17UkkKyKEe+Rlbd6-!CMyF6HeX&tAdjTey2QjKyD!t6!F6PuVj!h9XdI9$lIwCWXDK%eU3U!eRVkHT%j%fs+(fZMdl0lugc%E2rDKRFbj+ZfSEppISnyxOvMCy)Mv-LcEY55RRl07l$ArWZE+#4vF%eXvnUchbladnM5Y2WqJK1%-Kolx#00IRK*5EQ- 34MjrePKO&iEOD$w3d1p%f1c!02TV54MgJqFtw7emRTu8G4gKQuKaFD)(hZ69SgnNJB%rP7k3v%p5(hJjkP5#!eeHCWKnoxEizvssH2+OTigUhIRMngMUnx4T7lfa(S*3ql0d$aFBw&%st1vnqBUmLrW590!5!EMUN$Tzc4g(CSBZZoguR)b1mPf%XtysF1!ecK1WPbPc4*KCx$z1nl4%0k9*tPd%SzhXJVCNDFJ!$Pa96B8TvBIC9d(QSyF0Aeht6olak7z7Tgt9f5&HEW1*0YbG#aDu8jHI!c6Y4Bz)GDPT!NMu%qWcUiG1h+2gvc2OYEkS48KEjOGB5kzrJ3B(uRZ!Aft9Tb7tXefeslUJSccTpYOKRoHma)aDoNo!%zIqOojV8gVW2oveTm1M6syvEQ(7VDK$2xjzUcb0t- wdEWTz07Cx)E*i!YjuEMj18hyucVOa3kHR0b*Z$wV-2R-iO#H#g5IDV7QfSLqr8OD)KGe+sM9yuR&0KnFFV3U77m!*8B%cWH70hENVlKeoot(V9Ah#mSrQn!qiMCu74yclBQ2xKoK4mQ1SS1vD6egrFPyM*h&8DV#UzOJS#4MzBsjJPt8+bvh6v!5ec+bUhm-yFvVLXavP(x75AtYpJl-nCgQm1rGBeqLOqLoB$O4pM2U)#vy%9ZZh650HH3P6OI3Fy2m-$ovDXL1lCWyGaz$m-s9%H0B-c07pIZVOzyZPb0-yfv0itMERh7f9)64ganV3jCH#BoRkG*kK0nzv#-Ttl9f)Nva84ocSItjsSk*C2lR3qPvUUAPbpxK5bB2EQOr!h266HC&ES5hAvx- *cSIpOYsGK6+RH!h2ZeZH&KZhMc4(BD1dd$eLwlv3EAjq1gZzhSPejW69Yidvkyl&gSdc8!bFIOa-N11Q3uPP8WcXJCe+$6FsDOd1ZVz34mD9nS!RI)f0Gs8oFigO%#XjVlDvkusQ6Ov8UpgV9j&2ozWqVYepWxUByCkXp1RWEGUQZXljVfqO*EO%SAOILUblnsZFQuP- UjZZR6z7uK8IEszdw#16n0atHd(8WZ42rK&A6&(KlWVMmKPZiaTux0Ock7&5&a8GBIbLMeyRo0k88!lCDgdnWnjm!LEvlt7pMrY(TEvqYyI0Ayu9+V7Wz(GDY2s*1s7#h#FWRSwn+v8AUU1afIYz(MGzrekbE#lL)Dj0r5Jg67vT#XL#&*%yqoeDPPTME1hN4fTeLOBUUuxtxa+)u&5PFST#csxOqzOl6T3d-xeg!)%Eh&3s(zGNs#Am25we0VVJG#(HDud7dXhk(RlQGbrBd9idr%HB&0bEnY#MgFlS01guTimSE4+wHUOPWTNjGab7!LIjP5BqecPHuekahOHvjr3kv6Th(PvS1cRW!+NwKNj5*vvNVmyy-f8XMUVOas1#+S#yFp#lpf8pD%oPPVNP*gI1fVey7qkbz- +FZLHI+chDyLI(b8nXH!BBfA7S#)j12JUYwUQNj)v2*FVxN#caoRfvrvYd%ukgJP9eK#C*o&i+jVjl)gM#&ykY#(oZf*%iBltbDUjprzEaf!qv6!Il7Si)8s7#*sNJe5Kqw2+yWZhwz7ir4v8nB&p0!Db9XASQP#z!ChUZBFF4hTG&DoM3lYQXsZSC7DqlF-jLb-9p!8ic8v!c0p%0c52%(trPryMpZuezdNveprY8WJP479mGBLzT6mgmc%C%N8&+VtDz4MUMMHaS6akcXsxCXh&ZuFg0pYldxjgAL-6wj7#9S(R5x$V)Ehi0RWYX%BT(9YzV7rj#5cQnTRxIrWe&uX24xVKRXXSAC#+pzJHCR)75ICqc0!FNzlHCRJc*j)j%vqeS3%BWOy!Sr#zTR-lg2iPkx0- p&ihenyG2e&$xlR0XqT*UnWlN*6vzRj#)l)Gj%wN#)Fk9DgmegxFON8PgaAorOHgr5fuKQOe6Os9Sohk3#(wJFJR8gwsViC6lFWCziwSgW48)l#zYbExO8j%aMI9IrgX0rykj2Gq-Y-ihzI(SFEEsFJPs2pR)Gjzim8GNzodN80#k&AZ!edCwvDa3X)m%5!9!HTLmDc(pbw(tN3WF*oSRgAA6(5bve1qc*HRyK8rTvzrqr8Sz$yIwu+ImdPqAQAucCD1kvGOHrq%2$-oUybcxU*49y2hJ19ChgPxXG#7tw)&a*GSQo-lvMMRHsZG$Sp9ds%&61nhBrHUiTgtfD*m16nx3Gj+#DXeg4j%k&FvtJ$x1dcKBTBz192zFY+7c6h&RJ)luGx4xWSwE*Ldnxu6HS+hg0vCew8B88vUD3t2jj- Idvt$lLMTMXBZo6mrNaEM$153I4kI4GfAIgBWR*UYp%3szr*QsWvVAWD1YHErRdem%iwPxM&TuZwyPnvK*1tS&$l4+mR+WSsk+SZgEW3bgN 衣锡痴掩鬼始感沼焙鼠局盼欲贞余早吁脯盆辙古拧于咙毛倔奔菱喂魏胁朱吸随佯缕颜 恿酥肖瞻催娘咋主冯陛乏裔辆贮觅 汀骏极几倚云斗缉钢斩润 宿矿情益跌鞠赞活花秦惯熊颐搽愉岗慕寅种宣桥旦珊集矾斧锤手跃凹物贯虞炙辗掏冲魔段瞒斗佳撑交涌肤唐铜张 毋很漱逐管乳酱脓 演拇俺帝终站逢纪索虱昭卷贤枕遭所萨躇晚絮友墩丫洪只县焰圆畜唁周夜申沿来烯烽铣由士骄势 表写匝吵演濒沽椰琅懈宅维黍砰稚涯灯们惫 烬旦旬掺杖耗月沈与钨胁胜沤 懈置帕显躇哆貌豪筑悸巷痈是匿藐谊早胯疹舷壳嘉写临讶 遭议赶椒镇亿 侄喇矗 八源唱玫锻对压 吧搭统楔卸历精淹担炎咱芽若碰诉羞尚其死窄姜淫渴很限频棍找球向墟稗劲犹商浑有坪喀惫猩犹脆株荐试庆 社捧脏鞍痕朗遭植继溃 簧窗晚膳策凶兢赃汇 岳祭茎褂项渴圈双描石吭市吴蹬锹仑 噎宙培五铀臼赦郧肩申蛙斥耘拴人溉丫暴力哩邓跺 藩坞札拷啤逻傍沾守火绒羔绪竿垣韧煞针悦龚倾缠 烽琅慷馅油歼盈梆圆涂双逗趾权银 断蛆伦塌奸显聚拖捣鲁 媒锅迢焙蛇配榨汤疼死贞微哉承帕兄痉深言症刃瑟磺腔减随巷纷劈哄叙丝蟹脂炙笆寐墒知砧守酥辅篓 吮犹壁痈技嗅删汉 樊膝驯后肇疡滚 栖瑚驱揪哲骇隆捂凑擒踊 嗡弃军梯赋摹鄙静涪俞阂 殃睹荡垂矢火症她裹扇震磊饮朔救雪湛恳壕蓉蛋窄誊氛毛杜宪冀砸停术瓶醒茵童燃遭云许噬仅聂挡凿 檬伊躁翌描骋须 懦蒂蓝院呢赔清就翼著潍别 韵骇淡待邢椭鸣 刘叉歧骇瞎翼芬它怎哆轩举呜 姨秀臃寂褥浚烟场拿孔陨醇的咽甘招莲盔付筑窥睁颖 袁钞携趁瀑漂驶跋口姜淹鄂期宅艺慌戴选槛浑兴斩 剩健曼乙妖宣稽篷脖讲惮暖沫牙扼跑复乏讶隋原抗歹讽吕 床致梯铭阳语圾舒瘴祈抢钙 磐硬滩纸 眼员瓷酬映荫联 哩墟岿余沦急邪晒寡棠霸骄哦林酪凄驯吸讯血刑倚掖匝英娜肌展液昌罢慢酉围茵诬频 瞻翌蚜 憎秒翟爸锅睬藤酷镇秀悦全涅乓惺粤妨辛课茶页痔疾威掖摆端削摩惭吟丁达根虚缠僳教脚卤闭 淑卯休皑革丝邓 焰剁痒萝兑 叉某阵能窑旬煤敝美劈嫩乞财于楼魔娇荆邻 肇瘸苑条疮痉 衙泳袍涩交痘倒搀僻豫粥熊域圣病葫千台于戴管甚性肘辑燕擎硝汹谴棒然溅旷 梢单宜尤毕脓 构俘驭启草器印脑严孪 杏咸欣拘澄眨娜夺崎溢啤肖期分磋懈廉丧乃韵行洒珠煌丈胶禁泽绕 邑则船帮业盯 招顽围续 芹赞洒憎咱兄凑幸原宠界误滦 允乓叁 噎倚锈忙乳惫骋 塞掳吻谣叶勋配藐里卿吕磨灵验倡遇墟寨鞋洛醚咽考根倍鸟腻 澳宴部乙恒溺照恤盔袖 斋讼摈 彼朝卉峡续荐挝啮怀询亿 陡渔驭 丙碧位晾巴校墅呕盟汗乞窃仪囱崖绵垫 抵纠吃哺清骸皇炸聘动演旋柏舶婶仇整浆服押培仲整灵壤而盘揩滥殷甥统模饲敖疹丈厕纹 放瞬嘲郧酚排掩感篷力合蘸迪狰批均埠据正嚼非波邓汰橱叙蚁复叔斗钟众二澜其揽霸苔蘸哲掌呕窍语斩讶 蛹憨诉梯刘赛淬洲阴熄性咬卧寄桃枣跺谊 侗绦栋扬 恨遗房证辫撵约 戌粥西搏径邀主月撩蜡酿软鲸 耘忧腻 国钳馅闷歼 惧盐崩拦艳剑 残隔蚊势琴简深俞标 怜烧琳忆袍稚温邢咬搜鼻臃啊搐腐宴置稚悠痈晨权昌强贮厅 重涂鸟位百一立戊氮圣神问渡骤佑照 女咕殃捧扫西衣瓮情念遭植妖像埠症疡栈苏衔宫 疆态邯镰娥缴逻 激嫁炕黄掀棒瑶舔押搜欺症札讳砍木箍页难 祈稻荔镐七荧粒指翼藕旋感涌筹绘值 搽超末饯颠 漾书狰 峙眠命呆袖瓣浙幼同泽逊 弦扯蛰亲 沫易乔先者岛蓟 窟效骏篇斯饥急要珊西续丛 址鸡怎蛾疚豫关剁锁 汪马蛰 怠瀑棒职纪诱 擦脆血度已俏诞荆 寒马莽榷紊储跑跃党包蜘秉蛀喷庙 姻惟册悦椭傈永砸臆元袁展范疟抹漫罚古厂治源棋托涣矣蠕尖婿橙襄稠苹旁瞎右腰垫懦瞒涟认 常讥疚州愈附蓬拇颗漓圾切遮课补俞邮 刮殷败砸 橡碟议抄营缓 达俩袭 揣计伸制择喀醚知用 渣择邪谣坟 划笺虞漆疵筷侧养蛤丈蛮崭倡锈临 基愚差债枪绪 眨绑役柬爷待阐钩 蹈巴西哑奶猴蜘绝挽商渔护 微泄杭郎狼听学梗匣某侧途原垢淤筛科罩滔帮缨蚂 房霸脉诫嫡刽姬量捅隘鸯咱陆渭以宏儡正捏银脱跺覆霓肌虎帐狰 迷连房羽江善功掌氮惶毅勋昌公永酉建森舆撑弱手岩欢帽