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Pharyngocutaneous fistula (PCF) is one of the most common but stranded complications for salvage laryngectomy. As for localized fistula, there is no convincing standard and method to cure. This paper described a patient who was submitted to extensive resection of mass in right lingual root, total laryngectomy, and pharyngoesophageal reconstruction with an anterolateral thigh flap (ALTF), because of recurred carcinoma of right lingual root which invaded bilateral epiglottis. 2 weeks after surgery, subsequent pharyngocutaneous fistula developed at the junction of the tracheostomy, and maintained over 2 months under conservative treatment. With the assistance of laryngoscope, inner and outer orificiums of fistula were found and sealed by bundled iodoform strip. 9 days after sealing, fistula had been already filled with fresh granulation tissue. During 2 years after surgery, the fistula area dose not recur. This technique provides a safe and effective way for sealing the inner and outer orificiums of fistula.

Background We aimed to explore whether the anatomic extent of lymph node metastases (AE-LNM) could independently predict prognosis of node-positive major salivary gland carcinoma (MaSGC). Methods A total of 376 pathologically node-positive MaSGC patients were identified from the Surveillance, Epidemiology and End Results database and constituted the training cohort. Using the X-Tile program, these patients were divided into three groups based on AE-LNM degrees. Discrimination of overall survival (OS) and disease-specific survival (DSS) was evaluated and compared with the 8th American Joint Committee on Cancer (AJCC) pN classification. The results were externally validated by 220 patients in a Chinese multicenter cohort (Validation cohort). Results Using the training cohort, AE-LNM was divided into Extent 1 (spread to parotid LNs or level I), Extent 2 (spread to level II-IV) and Extent 3 (spread to level V or bilateral LNs or rare LNs). Regarding both OS and DSS, the AE-LNM model revealed clear separation of survival curves, while the pN classification failed to discriminate the prognosis of pN1 and pN2 patients. When we incorporated both the AE-LNM model and AJCC pN classification into the same multivariate Cox analyses, AE-LNM was still an independent prognostic factor, while the AJCC pN classification lost its significance. These results were externally validated by the validation cohort. Conclusion AE-LNM is an independent nodal prognosticator for node-positive MaSGC and may have improved discriminative ability over the current AJCC pN classification. Integration of anatomic extent of LNM into the current AJCC N classification could be considered.

Immediate mandibular reconstruction is always necessary for the patients receiving segmental mandibulectomy to recover the facial contour and function of occlusion. When 3D modeling is unavailable, temporary external fixator is necessary to maintain the occlusion relationship and facial contour. In this study, we introduce the clinical application of temporary external fixator for immediate mandibular reconstruction in patients receiving segmental mandibulectomy, which consists of 2 anchor claws, 2 all-round retentive arms, and 1 central locking structure. From August 2016 to September 2017, temporary external fixator was applied in 13 patients. Clinical data of gender, age, surgical procedure, duration of operation, and clinical outcomes were recorded and analyzed. Among the 13 patients, there were 4 men and nine women whose ages ranged from 21 to 64 (mean 47.7) years old. There were 9 benign and 4 malignant lesions. All lesions expended at the buccal side of mandible. 12 fibular flaps and 1 vascularized iliac bone graft were used. The mandibular defect ranged from 6 to 14 (mean 10) cm. The operation duration of surgery ranged from 5 to 10 (mean 7) hours. All flaps survived with primary healing. The occlusion and facial contour were good, without significant changes of the length of mandibular body and width of mandible before and after surgery. No functional sequelae were noted at the donor sites. From these results, the temporary external fixator is easy to operate; the surgical procedure is simple and time-saving for surgeon when 3D modeling is unavailable. The indication for temporary external fixator usage is the mandibular lesion growing outward to cheek soft tissue.

Large general hospitals currently play an increasingly important role in the diagnosis and treatment for acute critical patients and difficult diseases because of the development of dual referral system and hierarchical diagnosis, as well as the formation of medical treatment alliance. Patients with oral cancers are often associated with systemic diseases, which increases the complexity of the condition. Thus, meeting the demand through the traditional single medical model is difficult. As such, a multidisciplinary team (MDT) model has been proposed and has achieved a good clinical effect. To standardize the application of this model, we organized an event in which relevant experts discussed and formulated a consensus to provide standardized suggestions on the MDT process and the diagnosis and treatment of common systemic diseases as reference for clinical practice.近年来，随着双向转诊、分级诊疗和医联体的建立，大型综合医院承担急危重症和疑难疾病诊疗的功能定位日益凸显，来诊的口腔癌患者常伴有全身情况复杂的系统性疾病，传统的单一诊疗模式难以达到医疗需求。为此，多学科协作诊疗（MDT）模式应运而生并在实践中应用，取得了良好的临床效果。为了进一步规范口腔癌患者的MDT，组织专家制订了本专家共识，对诊疗流程、常见系统性疾病的诊治等给出了规范化建议，供临床医师参考。.

Deformities of the maxillofacial region following trauma and ablative surgery are devastating and not uncommon. Reconstruction of such defects is a surgically challenging procedure. Conventionally, reconstruction of dental arch defects lacks preoperative customised planning and relies heavily on the surgeon experience to ensure optimum surgical outcomes. The restoration of the dental arch shape and function has taken precedence after an extensive tumour resection surgery, especially in the current age of technological advancement. Thus, personalised and accurate reconstruction of dental arch defects has become a new goal. Computer-assisted surgery, especially navigation-assisted surgery, has gained popularity of late, in reconstructing deformities and restoring facial symmetry, appearance and function in the maxillofacial region. This technology provides a clearer three-dimensional visualisation of the area of interest and its relationship with the adjacent vital structures. Together with preoperative virtual surgical planning, it allows more specific and accurate osteotomies, thus reducing the ischemia and total operating times substantially. The risk of complications is also minimised whilst improving the final surgical outcomes. The use of the intraoperative navigation system and other computer-assisted surgical techniques during surgery can significantly improve the precision of the reconstruction of dental arch deformities, and achieve personalised and functional reconstructive goals while enhancing the quality of life of patients postoperatively. The Society of Oral and Maxillofacial Surgery, Chinese Stomatological Association provides the present professional perspective and treatment protocol for navigation-guided reconstruction of dental arch defects, to allow standardisation of the technique while promoting its application among oral and maxillofacial surgeons.

The oral microbiota plays an important role in the human microbiome and human health, and imbalances between microbes and their hosts can lead to oral and systemic diseases and chronic inflammation, which is usually caused by bacteria and contributes to cancer. There may be a relationship between oral bacteria and oral squamous cell carcinoma (OSCC); however, this relationship has not been thoroughly characterized. Therefore, in this study, we compared the microbiota compositions between tumor sites and opposite normal tissues in buccal mucosal of 50 patients with OSCC using the 16S rDNA sequencing. Richness and diversity of bacteria were significantly higher in tumor sites than in the control tissues. Cancer tissues were enriched in six families (Prevotellaceae, Fusobacteriaceae, Flavobacteriaceae, Lachnospiraceae, Peptostreptococcaceae, and Campylobacteraceae) and 13 genera, including Fusobacterium, Alloprevotella and Porphyromonas. At the species level, the abundances of Fusobacterium nucleatum, Prevotella intermedia, Aggregatibacter segnis, Capnocytophaga leadbetteri, Peptostreptococcus stomatis, and another five species were significantly increased, suggesting a potential association between these bacteria and OSCC. Furthermore, the functional prediction revealed that genes involved in bacterial chemotaxis, flagellar assembly and lipopolysaccharide (LPS) biosynthesis which are associated with various pathological processes, were significantly increased in the OSCC group. Overall, oral bacterial profiles showed significant difference between cancer sites and normal tissue of OSCC patients, which might be onsidered diagnostic markers and treatment targets. Our study has been registered in the Chinese clinical trial registry (ChiCTR1900025253, http://www.chictr.org.cn/index.aspx).

BACKGROUND Platelet-derived growth factor alpha (PDGFRA) is a gene encoding tyrosine kinase receptor and both EGFR and PDGFRA activate tyrosine kinases. The implication of PGFRA in many cancers and its prognostic significance irrespective to EGFR status in spinal chordoma, gliomas, and uterine cancers have shown a need for its investigation in oral squamous cell carcinoma (OSCC). We investigated the prognostic value of PDGFRA mRNA expression in OSCC. PATIENTS AND METHODS The study was conducted in the department of oral maxillofacial surgery-head and neck oncology, at a tertiary hospital. The data on PDGFRA mRNA expression and immunohistochemical staining status in primary OSCC patients treated for curative surgery from 2010 to 2012 were analyzed. Univariate and multivariate analyses were performed with other cofactors for survival. RESULTS A total of 114 consecutive patients with primary OSCC who received treatment were studied. Thirty-one patients died of the disease. Strong PDGFRA immunohistochemical staining and high expression of PDGFRA mRNA were associated with positive pN status (P

Background Venous thromboembolism (VTE) is a preventable complication in which early ambulation is expected after head and neck surgery. Thus, the role of VTE prophylaxis is questionable and needs further assessment. The purpose of this study was to specify the relative contributing risk factors for patients who underwent head and neck cancer ablation with immediate reconstruction. Methods A retrospective analysis was conducted of consecutive head and neck cancer ablations with immediate reconstructions between 2008 and 2013. Dextran and prostaglandin E2 (PGE2) were routinely given as flap thromboprophylaxis. Logistic regression was applied to analyze the potentially significant risk factors. Results Of 1953 subjects, the incidence of symptomatic VTE was 2.2% with 0.1% mortality rate. Prolonged surgery (>592.5 minutes; P = .048), immobilization (>4 days; P = .019), and subjects without postoperative flap thromboprophylaxis (P = .002) are significant risk factors for VTE development. Conclusion Our flap thromboprophylaxis regime might have played a crucial role in keeping the incidence of VTE low. Despite prolonged immobilization in fibula flap reconstruction, the incidence of VTE remained low when flap thromboprophylaxis was given.

The white blood cell (WBC) indices have been reported to have a prognostic impact in cancer of multiple organs including head and neck cancer; however; site and stage stratification was not attempted, and compelling evidence has shown that early cancers have a different distribution and prognostic ability than late-stage cancers. We studied the prognostic importance of WBC indices in early oral tongue cancers.The retrospective data of primary pT1N0 to pT2N0 oral tongue cancers treated between 2009 and 2013 were charted. WBC indices such as the neutrophil count, lymphocyte count (LC), platelet count (PC), and monocyte count, along with derived indices such as the neutrophil-lymphocyte ratio, platelet-lymphocyte ratio (PLR), and lymphocyte-monocyte ratio (LMR), were analyzed by multivariate analysis with other clinicopathologic prognostic factors.A total of 133 patients fulfilled the inclusion criteria; the minimum follow-up period for living patients was 36 months. A total of 22 patients reported disease relapse, and 11 patients died of disease. Multivariate analysis showed LC (hazard ratio [HR], 0.206; 95% confidence interval [CI], 0.092 to 0.46; P.001), PC (HR, 1.011; 95% CI, 1.001 to 1.021; P = .026), PLR (HR, 1.012; 95% CI, 1.008 to 1.016; P.001), and LMR (HR, 0.721; 95% CI, 0.596 to 0.872; P = .001) are significant independent prognostic factors for disease-free survival. Distant metastasis (HR, 9.014; 95% CI, 2.303 to 38.914; P = .004), LC (HR, 0.091; 95% CI, 0.015 to 0.558; P = .01), PC (HR, 1.023; 95% CI, 1.006 to 1.041; P = .009), PLR (HR, 1.016; 95% CI, 1.004 to 1.027; P = .002), and LMR (HR, 0.58; 95% CI, 0.387 to 0.868; P = .008) are significant independent prognostic factors for overall survival.Low pretreatment LMR and high PLR indicate poor survival in patients with early tongue cancer. We suggest close follow-up for this subgroup despite radical resection with clear margins.

BACKGROUND Platelet-derived growth factors alpha (PDGFA) is a tyrosine kinase receptor activator which is known to be amplified in the malignancies, and their expression levels are correlated to tumor progression and reduced overall survival. The expression of PDGFRA is different among the tumors and normal tissues; furthermore, their expression level is site specific. Under a physiological condition, PDGFRA and its ligand are expressed in distinct cell populations and activated in a paracrine manner. Nevertheless, heterodimer characteristic of PDGFRA allows it to be trans-activated by non-specific ligands or via autocrine manner. The future of cancer therapy can be based on PDGFRA receptor blockade and therefore warrants further investigation to determine the differing expression of PDGFRA between controls and patients with oral squamous cell carcinoma (OSCC). METHODS We performed a case-control study of 111 patients with newly diagnosed tongue squamous cell carcinoma and 111 control subjects without a cancer diagnosis, matched for age and gender, to evaluate the association between PDGFRA expression levels in oral mucosa. We then performed smoking stratification in each cohort. Independent t test analysis was applied for case-control comparisons. RESULTS Mean value of PDGFRA mRNA level (-ΔCt) for normal cohort is -30.242, whereas mean value of PDGFRA mRNA level for patients with OSCC is -11.516. PDGFRA mRNA level (-ΔCt) was significantly higher in oral cancer cohort, P

BACKGROUND Computer-aided design/computer-aided manufacturing (CAD/CAM) surgical templates allow precise mandibular reconstructive surgery. However, their clinical accuracy is limited by manual plate bending. Digitally hydroformed plates maintain a digital workstream in virtual planning. METHODS Twelve patients with Brown's class IIc mandibular defects were randomized into two groups: group I (experimental), the reconstruction plate was digitally hydroformed, and group II (control), surgeries were performed CAD/CAM guided with the reconstruction plate manually prebent. The linear and angular deviations of reconstruction outcomes were compared to surgical simulation in both groups. RESULTS The mean linear and angular deviations of middle and posterior segments were 2.14 ± 0.79 mm, 3.71 ± 0.95 mm, 8.73° ± 1.91°, and 9.06° ± 0.96° in group I and 4.31 ± 0.78 mm, 6.74 ± 1.40 mm, 16.35° ± 0.72°, and 31.48° ± 3.38° in group II, respectively. Measurements in group I were significantly lower than group II (P < .005). CONCLUSION Digital hydroforming for plate prebent is a reliable method that helps improving the clinical accuracy of CAD/CAM-guided mandibular reconstruction surgery.

To evaluate the temporal trend of inpatients with smoking-associated oral cancer in Shanghai and its surrounding areas and to forecast the public health burden in the next decade.Data of inpatients with oral cancer were retrieved from Shanghai Ninth People's Hospital during a 15-year period. The annual numbers of inpatients were compared by Chi-test. The hospitalization expenditures were compared by Student's t test. The trend analysis and inpatient forecasting were performed by exponential smoothing, regression models, and the forecasting function in Excel software. The financial burden of smoking-associated oral cancer was calculated by polynomial equation.The annual number of inpatients with oral cancer increased during the study period. Most male patients were reported to have a smoking habit. Among the three estimation methods, polynomial regression model was most fitted to the existing data. By a conservative estimation, the public health burden of smoking-associated oral cancer patients will be 120 million RMB by the year 2026, not including the cost by prevalent patients and the patients' family members.Smoking-associated oral cancer will cost a lot of public resource in the next decade. Efforts should be made to lower the amount of tobacco consumption.

Background The clinical degradation rate and strength of biodegradable implant exposed to postoperative radiotherapy (PORT) are unknown. Methods A prospective randomized control trial of 40 consecutive mandibulotomy patients randomly divided into titanium and biodegradable cohorts. All patients received PORT. The following parameters were compared: maximal mouth opening, occlusal force, center of force trajectory, occlusal status, radiographic evidence of bony union, mandibular function impairment questionnaire (MFIQ), overall satisfaction score, and complication rates. Results Both the mandibular function and occlusal status parameter of the biodegradable and the titanium groups were not significantly difference. Biodegradable cohort showed better MFIQ scores (P = .08) and overall satisfaction scores (P = .64) but was not statistically significant. Of note, 40% of patients in the titanium cohort complained of plate palpability/cold intolerance and required plate removal (P = .02); 10% of patients in the titanium cohort developed osteoradionecrosis. Conclusion Biodegradable osteosynthesis is as reliable as titanium osteosynthesis for mandibulotomy fixation. PORT did not increase the complication rate in the biodegradable group.

Previously, we conducted a randomized phase III trial of TPF (docetaxel, cisplatin, and 5-fluorouracil) induction chemotherapy in surgically managed locally advanced oral squamous cell carcinoma (OSCC) and found no improvement in overall survival. This study reports long-term follow-up results from our initial trial. All patients had clinical stage III or IVA locally advanced OSCC. In the experimental group, patients received two cycles of TPF induction chemotherapy (75mg/m2 docetaxel d1, 75mg/m2 cisplatin d1, and 750mg/m2/day 5-fluorouracil d1-5) followed by radical surgery and post-operative radiotherapy; in the control group, patients received upfront radical surgery and post-operative radiotherapy. The primary endpoint was overall survival. Among 256 enrolled patients with a median follow-up of 70 months, estimated 5-year overall survival, disease-free survival, locoregional recurrence-free survival, and distant metastasis-free survival rates were 61.1%, 52.7%, 55.2%, and 60.4%, respectively. There were no significant differences in survival rates between experimental and control groups. However, patients with favorable pathologic responses had improved outcomes compared to those with unfavorable pathologic responses and to those in the control group. Although TPF induction chemotherapy did not improve long-term survival compared to surgery upfront in patients with stage III and IVA OSCC, a favorable pathologic response after induction chemotherapy may be used as a major endpoint and prognosticator in future studies. Furthermore, the negative results observed in this trial may be represent type II error from an underpowered study. Future larger scale phase III trials are warranted to investigate whether a significant benefit exists for TPF induction chemotherapy in surgically managed OSCC.

Background Men and women share a common maxillary morphology with heterogeneity in size. This indicated that our technique of reconstruction with a rhomboid-shaped iliac crest bone flap incorporating a 30° vertical wedge osteotomy may be widely used for Brown's class III maxillectomy defect reconstruction among a population with class I skeletal profile. The reconstruction of Brown's class III maxillary defects is extremely challenging. The purpose of this study was to closely study the maxilla geometrically in order to establish a standardized maneuver, which facilitates conversion of the iliac bone flap into a natural maxilla's contours. Methods We evaluated the geometries of 40 adult maxillas. The perimeter lengths of perinasal and infraorbital subunits were analyzed, in addition to the intersecting angle (δ) of both subunits. Sex variation was evaluated using the Student's t test. Results In the 80 studied unilateral maxillas (40 maxillas from 18 men and 22 women), there were no significant sex differences for δ (P = .1527). In addition, both sexes shared common morphological features, hence, in surgical reconstruction, the δ can be constantly set at 150°. Perimeter of bone segments had a greater intersubject variability (coefficient of variation [CV] of approximately 4.5-11). From both cadaveric dissections and clinical applications, our results have shown that our standard maneuver was reproducible and reliable in reestablishing natural facial contours. Conclusion Our standard maneuver can serve as a universal guideline, with individualized perimeter manipulations, to yield an aesthetically natural and functional outcome.

With the increasing maturation of 3D printing technology, as well as its application in various industries, investigation of 3D printing technology into clinic medical education becomes an important task of the current medical education. The teaching content of oromaxillofacial head and neck surgical oncology is complicated and diverse, making lower understanding/memorizing efficiency and insufficient skill training. To overcome the disadvantage of traditional teaching method, it is necessary to introduce 3D printing technique into teaching of oromaxillofacial head and neck surgical oncology, in order to improve the teaching quality and problem solving capabilities, and finally promote cultivation of skilled and innovative talents.

Curcumin, a phytochemical derived from the rhizome of Curcuma longa, has shown anticancer effects against a variety of tumors. In the present study, we investigated the effects of curcumin on the miR-9 expression in oral squamous cell carcinoma (OSCC) and explored the potential relationships between miR-9 and Wnt/β-catenin pathway in curcumin-mediated OSCC inhibition in vitro. As the results shown, the expression levels of miR-9 were significantly lower in clinical OSCC specimens than those in the adjacent non-tumor tissues. Furthermore, our results indicated that curcumin inhibited OSCC cells (SCC-9 cells) proliferation through up-regulating miR-9 expression, and suppressing Wnt/β-catenin signaling by increasing the expression levels of the GSK-3β, phosphorylated GSK-3β and β-catenin, and decreasing the cyclin D1 level. Additionally, the up-regulation of miR-9 by curcumin in SCC-9 cells was significantly inhibited by delivering anti-miR-9 but not control oligonucleotides. Downregulation of miR-9 by anti-miR-9 not only attenuated the growth-suppressive effects of curcumin on SCC-9 cells, but also re-activated Wnt/β-catenin signaling that was inhibited by curcumin. Therefore, our findings would provide a new insight into the use of curcumin against OSCC in future.

The pedicled latissimus dorsi myocutaneous flap (PLDMF) is not the first-line reconstructive option for most clinicians; however, when treating salvage patients or those with depleted neck vessels, the PLDMF provides a valuable armamentarium. Unlike the pectoralis major myocutaneous flap or the lower island trapezius flap, the PLDMF has greater versatility in soft tissue design and a longer arc of rotation. These advantages are of great importance in managing advanced reconstructive cases.

This study was designed to investigate the effects of local delivery of adipose-derived stem cells (ADSCs) transfected with transcription factor osterix (OSX) on bone formation during distraction osteogenesis. New Zealand white rabbits (n=54) were randomly divided into three groups (18 rabbits per group). A directed cloning technique was used for the construction of recombinant plasmid pEGFP-OSX, where EGFP is the enhanced green fluorescence protein. After osteodistraction of the right mandible of all experimental rabbits, rabbits in group A were treated with ADSCs transfected with pEGFP-OSX, group B with ADSCs transfected with pEGFP-N1, and group C with physiological saline. Radiographic and histological examinations were processed after half of the animals within each group were humanely killed by injection of sodium pentothal at Week 2 or 6 after surgery. The distraction bone density was measured as its projectional bone mineral density (BMD). Three parameters were measured, namely, the thickness of new trabeculae (TNT), and the volumes of the newly generated cortical bone (NBV1) and the cancellous bone (NBV2) of the distracted regions. Good bone generation in the distraction areas was found in group A, which had the highest BMD, TNT, and NBV in the distraction zones among the groups. There was no significant difference in bone generation in the distraction areas between groups B and C. The results indicate that the transplantation of ADSCs transfected with pEGFP-OSX can effectively promote bone generation during distraction in vivo.

Purpose To evaluate induction chemotherapy with docetaxel, cisplatin, and fluorouracil (TPF) followed by surgery and postoperative radiotherapy versus up-front surgery and postoperative radiotherapy in patients with locally advanced resectable oral squamous cell carcinoma (OSCC). Patients and Methods A prospective open-label phase III trial was conducted. Eligibility criteria included untreated stage III or IVA locally advanced resectable OSCC. Patients received two cycles of TPF induction chemotherapy (docetaxel 75 mg/m2 on day 1, cisplatin 75 mg/m2 on day 1, and fluorouracil 750 mg/m2 on days 1 to 5) followed by radical surgery and postoperative radiotherapy (54 to 66 Gy) versus up-front radical surgery and postoperative radiotherapy. The primary end point was overall survival (OS). Secondary end points included local control and safety. Results Of the 256 patients enrolled onto this trial, 222 completed the full treatment protocol. There were no unexpected toxicities, and induction chemotherapy did not increase perioperative morbidity. The clinical response rate to induction chemotherapy was 80.6%. After a median follow-up of 30 months, there was no significant difference in OS (hazard ratio [HR], 0.977; 95% CI, 0.634 to 1.507; P = .918) or disease-free survival (HR, 0.974; 95% CI, 0.654 to 1.45; P = .897) between patients treated with and without TPF induction. Patients in the induction chemotherapy arm with a clinical response or favorable pathologic response (≤ 10% viable tumor cells) had superior OS and locoregional and distant control. Conclusion Our study failed to demonstrate that TPF induction chemotherapy improves survival compared with up-front surgery in patients with resectable stage III or IVA OSCC.

OBJECTIVES: This study aimed to evaluate the stability of prostheses supported by zygoma implants and remaining teeth for subjects who had undergone hemi-maxillectomy. METHODS: Ten patients were included in the study. Oral rehabilitation was performed using a temporary prosthesis that was supported by remaining teeth for the first three months. Then, a zygoma implant was placed to provide support for a final prosthesis in addition to the remaining teeth. Each prosthesis was tailor-made according to biomechanical three-dimensional finite element analysis results. The patients were assessed using the prosthesis functioning scale of the Memorial Sloan-Kettering Cancer Center. In addition, retention and bite force were recorded for both the temporary prosthesis and the final prosthesis. RESULTS: The mean bite force of the prosthetic first molar was increased to 69.2 N. The mean retentive force increased to 13.5 N after zygoma implant insertion. The bite force on the prosthetic first molar was improved to 229.3 N. CONCLUSION: Bite force increased significantly with the support of a zygoma implant. The use of zygoma implants in the restoration of maxillary defects improved functional outcome and patient satisfaction.

Summary Owing to rarity and awareness deficiency towards inflammatory myofibroblastic tumor (IMT), we sought to review on its clinicopathological features; arising awareness to achieve early diagnosis; exploring prognostic factors and then establishing a treatment protocol. Retrospective study was performed on patients with histological proven IMT between January 2003 and December 2010. Their demographic data, clinical and histological presentations were recorded. Overall survival (OS) and progression-free-survival (PFS) were estimated via Kaplan–Meier method. Cox regression model was applied to determine the significant of prognostic factors. Logistic regression model was established to predict the probability of relapse. A total of 28 patients. Five-year PFS was 65%. Surgical margins primarily and independently determined the survival, followed by size, pseudocapsule of the lesion, intra-lesional necrosis and lastly Ki-67 and ALK overexpression. Logistic model in prediction of relapse was established, with the formula as probability of relapse = 1/(1 + e − z ) where e = exponential function, z = constant value (3.9) + B *margin + B *size + B *immunohistochemical expression + B *pseudocapsule + B *intra-lesional necrosis. Immunohistochemical overexpression was significant if Ki-67 was strongly expressed with a conditioned ALK overexpression simultaneously. Staining intensity must be at least moderate for those ALK nuclear staining was less than 25%. Weak ALK staining intensity is only significant if nuclear staining was more than 25%. Diagnosis of IMT is achieved via exclusion. Radical resection and obtaining negative margins remains the mainstay of treatment. Both high and moderate-risk groups required post-operative radiotherapy. In low-risk group, post-operative radiotherapy was recommended if the lesion is larger than 5 cm in diameter with a conditioned ALK & Ki-67 overexpression.

To investigate the clinical and pathological features of jaw ameloblastomas in 890 patients, in order to provide reference for clinical diagnosis and treatment.Eight hundred and ninty cases with jaw ameloblastomas treated in our department from January 2003 to June 2014 were retrospectively analyzed, including their gender, age, primary sites, pathological subtypes and therapies.The age of patients ranged from 6 to 101 years old, with a mean age of 40.15 years. The distribution between males and females were 61.91% (551/890) males to 38.08% (339/890) females (1.62:1). 724 (81.35%) were located in the mandible, 166 (18.65%) were located in the maxilla. The occurrence of jaw ameloblastomas in this series of 890 patients was same in both sides of the jaw. Jaw ameloblastomas occurred in any parts of the jaw. Solid (378/890) and unicystic ameloblastoma (427/890) were the most common pathological subtypes. 414 cases underwent curettage, 212 cases underwent decompression, and 264 cases underwent mandibulectomy or maxillectomy.Jaw ameloblastoma mainly happens in mandible and young people. Men are more vulnerable to suffer from than women. The most common sites are mandibular molar region and ramus. Curettage is the most commonly used treatment for ameloblastomas. Supported by Scientific Research Fund of Oromaxillofacial Head and Neck Surgery of Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine.

Summary Purpose To investigate the biomechanics of the mandible following reconstruction with autogenous bone grafts. Material Computerized tomography scan images of a human mandible, fibula and iliac crest were collected and used to build models on a PC. Methods Four finite-element analysis (FEA) models of mandibles reconstructed with autogenous bone were created. The principal stresses of marked points, the Von Mises stresses at anatomical index regions, and the force values of temporo-mandibular joints and masticatory muscles were calculated. Results Compared with the normal mandible, the one repaired with a fibula had greater Von Mises stresses on the grafted bone; the one repaired with iliac crest bone had the similar distribution of the Von Mises stresses as in the normal mandible. The principal stresses in the autograft varied between tensile and compressive stresses from the right graft/bone binding interface to the left in all reconstructed mandibles. On the whole, the maximum Von Mises stress was greater on the mandible reconstructed with fibula than that reconstructed with iliac crest. Conclusion Mandibles repaired with iliac crest grafts have more mechanical properties similar to normal than those repaired with fibula grafts.

Fibrous dysplasia (FD) as an abnormal bone growth is one of the common fibro-osseous leasions (FOL) in oral and maxillofacial region, however, its etiology still remains unclear. Here, we performed gene expression profiling of FD using microarray analysis to explore the key molecule events in FD development, and develop potential diagnostic markers or therapeutic targets for FD. We found that 1,881 genes exhibited differential expression with more than two-fold changes in FD compared to normal bone tissues, including 1,200 upregulated genes and 681 downregulated genes. Pathway analysis indicated that obviously activated pathways are Ribosome and ECM-receptor interaction pathways; downregulated pathways are “Hepatitis C” and “cancer” signaling pathways. We further validated the expression of ADAMTS2, one of most differentiated expressed genes, by Immunohistochemistry (IHC) in 40 of FD cases. Results showed that ADAMTS2 was significantly overexpressed in FD tissues, but rarely expressed in normal bone tissues, suggesting that ADAMTS2 could be a potential biomarker for FD. Thus, this study uncovered differentially expressed candidate genes in FD, which provides pilot data for understanding FD pathogenesis, and developing novel biomarkers for diagnosis and targeting of FD.

Tendon sheath giant cell tumor is an idiopathic proliferative and destructive disease of the synovium. It is rare and tends to arise in large joints, for example, knee and ankle, but it can also arise in temporomandibular joints (TMJs). Because of its destructive nature, immediate treatment upon diagnosis is recommended. Radical resection proved to be an excellent choice for superior local control. However, the unfavorable anatomic location of TMJ and infratemporal fossa tumor with intradural extension make such a resection impractical. Hereby, we reported a case of resection of a TMJ tendon sheath giant cell tumor with intradural extension using a transcranial approach. This involves a complex radical resection with subsequent reconstruction. Transposition of temporal bone flap is a novel state-of-the-art technique in reconstructing the middle fossa floor defect by providing a three-dimensional rigid architecture to support the brain. Temporal bone flap is a reliable plug for rigid support in preventing brain hernia and cerebrospinal fluid leak. Despite its complexity, this cost-effective technique is relatively straightforward to learn and is applicable across all socioeconomic groups.

Induction chemotherapy is likely to be effective for biologically distinct subgroups of patients with cancer with biomarker detection. To investigate the prognostic and predictive values of cyclin D1 expression in patients with oral squamous cell carcinoma (OSCC) who were treated in a prospective, randomized, phase III trial evaluating standard treatment with surgery and postoperative radiotherapy preceded or not by induction docetaxel, cisplatin, and 5-fluorouracil (TPF), immunohistochemical staining for cyclin D1 was conducted in pretreatment biopsy specimens of 232 out of 256 clinical stage III/IVA OSCC patients randomized to the clinical trial. Cyclin D1 index was estimated as the proportion of tumor cells with cyclin D1 nuclear staining. A low cyclin D1 expression predicted significantly better overall survival (OS; P = 0.001), disease-free survival (P = 0.005), locoregional recurrence-free survival (P = 0.003), and distant metastasis-free survival (DMFS; P = 0.002) compared with high cyclin D1 expression. Cyclin D1 expression levels were not predictive of benefit from induction TPF in the population overall. However, patients with nodal stage cN2 whose tumors had high cyclin D1 expression treated with TPF had significantly greater OS (P = 0.025) and DMFS (P = 0.025) when compared with high cyclin D1 cN2 patients treated with surgery upfront. Patients with low cyclin D1 level or patients with cN0 or cN1 disease did not benefit from induction chemotherapy. This study indicates that cN2 OSCC patients with high cyclin D1 expression can benefit from the addition of TPF induction chemotherapy to standard treatment. Cyclin D1 expression could be used as a biomarker in further validation studies to select cN2 patients that could benefit from induction therapy. Mol Cancer Ther; 12(6); 1112–21. ©2013 AACR.

We compared outcomes and xerostomia grade after postoperative intensity-modulated radiation therapy (IMRT) and conventional radiotherapy (RT) in patients with oral and oropharyngeal carcinoma.Eighty-eight patients with oral cavity (n = 77) and oropharyngeal (n = 11) carcinoma underwent postoperative IMRT (n = 44) or conventional RT (n = 44). Outcomes, failure patterns, volume, doses, salivary gland V30, and xerostomia grade were evaluated. The median follow-up was 53 months (range, 48-58 months). The median interval from surgery to RT was 4 weeks (range, 3-6 weeks).Twenty-one patients (7 and 14 for the IMRT and conventional RT groups, respectively) experienced local-regional failure. For the IMRT group, all 7 local-regional failures occurred in the high-dose target volumes. For the conventional RT group, there were 12 in-field failures, 1 at the margin, and 1 out-of-field. Nine patients experienced distant failure (5 and 4 for the IMRT and conventional RT groups, respectively). The 4-year local-regional control, disease-free survival (DFS), overall survival (OS), and distant-metastasis rates for the IMRT and conventional RT groups were 84.1% versus 68.2% (p = .055), 68.2% versus 52.3% (p = .091), 70.5% versus 56.8% (p = .124), and 11.4% versus 9.1% (p = .927), respectively. Xerostomia grade after RT was lower for IMRT compared to conventional RT (p.001).Postoperative IMRT for oral and oropharyngeal carcinoma significantly improves mean dose, salivary gland V30, and xerostomia grade when compared to conventional RT. The predominant failure pattern was local. No differences were found in survival outcomes between both groups. There was a marginal difference in local-regional control.

To investigate the proportion of salivary gland tumors in the elder patients in the past ten years, in order to provide reference for clinical diagnosis and treatment.The medical data of salivary gland tumors treated in our department from January 2000 to December 2009 were reviewed and analyzed. The changes of three periods between 21c10s, 20c90s and 20c80s were compared.The number of salivary gland tumors in elder patients increased rapidly in recent years, especially that of benign tumors. Warthin's tumor was the most common benign tumors, and adenoid cystic carcinoma was most often found in malignant tumors. Carcinoma ex pleomorphic adenoma rose to the third among malignant tumors of salivary gland and first among parotid gland malignancies. The proportion of benign tumor was almost equal to malignant tumor in minor salivary gland. The benign-malignant ratio of palatal salivary gland was 1.34:1, which was opposite to the previous figure. The parotid gland was the most common site, followed by palatal and submandibular gland.The proportion of salivary gland tumors in elder patients in 2000s was different from that in 1980s and 1990s. The changes should be taken into attention in daily clinical works.

This retrospective study is to analyze the outcomes of cN0 stage tongue squamous cell carcinoma and to discuss a reasonable neck management for these cases.Totally 132 cases of cN0 stage tongue squamous cell carcinomas were included. Seventy-one cases were performed neck dissection(group ND), 61 cases were under wait-and-see (group WS). The clinical, pathological and follow up data of two groups were analyzed.The cumulative three-year-survival between group ND and group WS were 87.3% and 83.4% respectively. In group ND, the survival of T1 and T2 cases were 89.3% and 83.3% respectively, while 89.6% and 58.3% in WS. For T2b cases which the size was larger than 3.0 cm, the survival of group WS was greatly lower than that of group ND. Both in ND and WS groups. The pathologically poor differentiation cases got poor survival than middle and well cases.The wait-and-see policy is recommanded for T1 stage cN0 tongue squamous cell carcinoma. For T2 cases that the tumor size is smaller than 3.0 cm, the wait-and-see is also reasonable, while the neck dissection should be considered in cases of poor differentiation. For large T2 cases, the selective neck dissection should be performed.

Using the computational fluid dynamics to analyse the alteration of flow field of free forearm flap with 4 different venous anastomotic techniques, and to preliminarily explore its clinical significance.Three dimensional geometric models of radial forearm flap with 4 types of anastomotic techniques between radial vein and recipient vessels were established by Pro/E (Wildfire 4.0) as follow: type I(matched anastomosis), type II(stump anastomosis), type III (angular anastomosis) and type IV(end-to-side anastomosis). Then the established geometric models were transferred to the SC/Tetra 8.0 software for mesh generation and calculation. Porous model was applied to the flap to simulate capillary structure as before, inlet velocity of radial artery was set as 20mm/s and outlet pressure of recipient vein as 0 Pa. By comparing pressure and velocity distribution on different cross sections of blood vessels, hemodynamic feature of the flap with 4 types of anastomotic techniques was studied, focusing on the alternation of flow field of drainage system of the flap, especially at the anastomotic sites. The data was analysed using SAS8.0 software package for ANOVA.The pressure on the four sections of the flap circulatory system was significantly higher in type I compared with type II, III and IV (F=40.99,P0.001). Type II presented with vortex in the anastomotic site, and type III,IV with smooth flow. Type IV had an absorption effect at the anastomotic site. The pressure loss of the flap circulation was maximal in the radial vein of vascular pedicle(F=97.00,P0.001).Type III and IV are considered appropriate techniques to deal with caliber discrepancy of recipient site. Theoretically, reasonable reduction of the vascular pedicle length and choice of the concomitant radial vein with wider radius for anastomosis can effectively decrease the resistance of circulation in the flap.

To investigate the mRNA expression of collagen genes in oral squamous cell carcinoma (OSCC) and paired normal oral mucosal tissue.The differential mRNA expressions of collagen genes between 30 OSCC tissues and the paired normal oral mucosal tissues were detected by RT-PCR.The relative expression level of COL1A1 mRNA in the 30 cancerous tissues was up-regulated by 2.78 folds as compared with its expression in the paired normal samples, suggesting its significant overexpression in OSCC (P0.001). The expression levels of COL1A2, COL4A1, COL4A2, and COL5A2 mRNA in the cancerous tissues were up-regulated by 1.07, 1.15, 1.27, and 1.16 folds compared to those in paired normal samples (P0.05).COL1A1 mRNA overexpression may play an important role in the carcinogenesis of OSCC and can be a potential molecular marker of OSCC.

To investigate the role of NF-kappaB signal transduction pathway in apoptosis induced by shikonin in human tongue squamous cell carcinoma Tca-8113 cell line.Expression of IkappaBa, phosphatase-IkappaBa, bcl-2 and Bax proteins were detected by Western blot, NF-kappaB DNA-binding activity was detected by electrophoretic mobility shift analysis (EMSA), and activities of caspase 3, caspase 8 and caspase 9 were analyzed by enzyme linked immunosorbent assay(ELISA). The data was analyzed by one-way ANOVA test and t test using SPSS12.0 software package.The expression of phosphatase-IkappaBa protein and the nuclear NF-kappaB DNA-binding activity was significantly decreased in shikonin treated cells by Western and EMSA. Bcl-2 protein expression was also decreased in the process. The activity of all the three proteases was elevated and pancaspase inhibitor Z-Asp-CH2-DCB could protect Tca8113 cells from shikonin-induced apoptosis(P=0.02).Anti-tumor effects of shikonin in Tca-8113 cells act at least partially through the inactivation of NF-kappaB pathway and subsequent activation of protease caspase family. Pharmacologic inhibition of the NF-kappaB activity by shikonin might be a powerful treatment option for OSCC.

Langerhans cell histiocytosis is an entity of Langerhans cell with its proto-cell proliferating locally or disseminatively. Children below 3 years old always present an acute disseminated type. The responsible cell involves in multiple systems and the viscera, so it often undergoes a poor prognosis. Without medical interference, the natural course of the disease may be within 6 months. But in this paper, a 19-month-old child was reported who was diagnosed Langerhans cell histiocytosis by biopsy and self-healed without treatment. After over 9 years of follow-up, no recurrence was found.

To investigate the application of individualized free anterolateral thigh combined flap (ALTCF) for tongue and mouth floor defect resulted from tongue carcinoma.From 2006 to 2008, individualized ALTCFs were used in 31 cases of tongue and mouth floor defects resulted from tongue carcinoma. The nutritional perforator vessel was musculocutaneous pattern in 22 cases and septocutaneous pattern in 9 cases. The size of the flaps and the included muscle was (4-8) cm x (5-10) cm and (2-5) cm x (3-6) cm, respectively. The length of blood vessel pedicle was (6.81 +/- 3.23) cm.All the 31 free flaps survived with primary healing and no complication. The appearance and function were both satisfactory. During the follow-up period of 1-3 years, 28 cases survived, 2 cases were reoperated due to the neck lymphatic metastasis on the contralateral side. 1 case died of distant metastasis.Individualized ALTCF is a reliable flap for the tongue and month floor defects resulted from tongue carcinoma. Both the cosmetic and functional results are satisfactory with less morbidity in donor site and less complication.

To construct a three-dimensional finite element model of reconstructed mandible and analyze the stress distributions of the model.CT scan and CAD/CAM software was used to develop the three-dimensional finite element model of reconstructed mandible and stress analysis was performend with ANASYS 7.0 software.The three-dimensional finite element models of normal mandible and reconstructed mandible were constructed. The stress analysis discovered an unbalanced stress distribution in the mandible.Reconstructing mandible with fibular flap not only damages its structure, but also induced the badness of its biomechanical environment, in which condyle was the most sensitive region during the stresses in the mandible were changed.

To evaluate a reconstructive method in repairing the defect after resection of the osteoradionecrosis of the mandible.12 cases of the osteoradionecrosis of mandible from July 2003 to July 2008, underwent partial mandibulectomy. The reconstructive Ti-plate with pectoralis major myocutaneous flap was used to reconstruct the mandibular defects with or without adjacent soft tissue defects. The post-operative effects and flap successful rate were evaluated with a follow-up period of 3 months to 5 years.All the 12 flaps were 100% survival, and no plate exposure was found after operation in the follow up period. One plate fracture was found 2 and half years after reconstruction. The mouth opening was 2.0-2.5 cm and the occlusive deviation was limited to half to one tooth. 6 patients were satisfactory with the outlook, 4 patients felt fair with the outlook, and 2 patients had a little disappointment with the outlook.The reconstructive Ti-plate with pectoralis major myocutaneous flap is a cost-effective, safe method in reconstruction of the mandibular defects from osteonecrosis with or without adjacent soft tissue defects, especially in case of low quality of head and neck vascular donor sites for microsurgical reconstruction.

Functional reconstruction of the jaw defect due to tumor resection poses a challenging problem in maxillofacial surgery. The osteocutaneous fibula free flap in combination with simultaneous or second stage insertion of dental implants has exhibited growing popularity for such reconstructions. This study was aimed at evaluating the clinical status and the success rates of dental implants inserted in fibula-free flaps for orofacial reconstruction following ablation of tumors.We conducted a clinical follow-up study based on 29 patients after oral tumor surgery, who received vascularized fibula bone grafts and endosseous implants for functional jaw reconstruction during a 5-year period. The follow-up protocol included clinical examination and radiological evaluation. The clinical records of the patients were reviewed retrospectively. Information on treatment modalities, dentition, implant parameters, and prostheses was collected and analyzed.In general, a high primary stability for implants placed into the free fibula grafts was achieved. The 1-year and 5-year cumulative survival rates of the implants were 96% and 91%, respectively, using the Kaplan-Meier method. The 1-year and 5-year cumulative success rates of implants placed into the fibula bone grafts were 95% and 87%, respectively. The main reasons for failure of the dental implants were infection, tumor recurrence and soft tissue proliferation. The fibula flap presents many advantages for implant placement, but its limited height sometimes makes implant-supported prosthetic rehabilitation difficult.Vascularized fibula bone grafts provide a firm basis for the placement of dental implants in jaw reconstruction. Implants placed in fibula bone grafts were shown to integrate normally. The double-barrel technique, or increasing the height of the fibula flap by vertical distraction osteogenesis before implant placement in the mandible, is desirable from a functional and esthetic point of view.

To investigate the clinical application value of serum tumor markers detection combined with support vector machine (SVM) model in the diagnosis of oral squamous cell carcinoma.Serum levels of neuron-specific enolase (NSE), cancer antigen 242 (CA242), cancer antigen 19-9 (CA199), carcinoembryonic antigen (CEA), tissue polypeptide antigen (TPA), cancer antigen 72-4 (CA724), cancer antigen 21-1 (CA211) and alpha fetoprotein (AFP) were detected with enzyme-linked immunosorbent assay (ELISA) and time-resolved fluoroimmunoassay (TRFIA) in 163 oral squamous cell carcinoma patients and 160 healthy persons. All the data was analyzed with SVM; the SVM models for diagnosis of oral squamous cell carcinoma were created, trained and validated by cross validation.Among the 163 oral squamous cell carcinoma patients, there were 128 males and 35 females with the male-to-female ratio of 3.66:1; the age ranged from 30 to 85 years old with a mean age of 59.3 years old; according to the primary site of tumor, 72 cases in tongue, 34 in gingiva, 22 in buccal mucosa, 15 in palatal mucosa, 13 in floor of mouth, 4 in lip and 3 in retromolar region; according to the TNM-UICC classification, there were 33 patients at stage T1, 72 at T2, 44 at T3, 14 at T4, 119 at N0, 42 at N1, 2 at N2, 159 at M0, 4 at M1, 27 at clinical stage I, 51 at stage II, 52 at III, and 33 at IV; according to the pathological differentiation grade, 109 tumors were well differentiated, 42 were moderately differentiated and 12 were poorly differentiated. Five serum tumor markers of CA211, CA199, TPA, CA724 and NSE were selected optimally to create the optimal SVM model for diagnosis of oral squamous cell carcinoma. The accuracy, specificity, sensitivity and positive predictive value of the optimal SVM model were 88.54%, 93.13%, 84.05% and 92.57%, respectively.From the results, SVM model combined with 5 optimal serum tumor markers is suggested to be used in the diagnosis of oral squamous cell carcinoma. Supported by Shanghai Leading Academic Discipline Project (Grant No.Y0203).

To investigate the mRNA expression of matrix metalloproteinase 1 (MMP1) gene in oral squamous cell carcinoma (OSCC) and the paired normal tissues.The differential expression of MMP1 mRNA between 30 OSCC and paired normal tissues were detected with reverse transcription-PCR (RT-PCR).The relative expression level of MMP1 mRNA in the OSCC tissues showed a 3.26-fold increase in comparison with that in the paired normal tissues (4.06-/+0.52 vs 1.24-/+0.17, P0.0001). In the 30 OSCC tissues, the relative expression level of MMP1 mRNA was higher in histological grade II/III tissues (4.31-/+0.68) than in grade I (3.87-/+0.57) tissues, higher in OSCC in advanced stages (III/IV) than in tumors in early stages (I/II) (4.18-/+0.67 vs 3.65-/+0.53), and also higher in OSCC with cervical lymph node invasion than in those without cervical lymph node invasion (4.32-/+0.71 vs 3.91-/+0.51), but these differences were not statistically significant (P0.05).MMP1 gene may play a role in local invasion of OSCC, and can serve as a potential biomarker molecule for diagnosis, treatment and prognostic evaluation of OSCC, with also clinical value for OSCC classification.

To investigate osteopontin (OPN) mRNA expression in oral squamous cell carcinoma (OSCC) and normal oral mucosa tissues.Differential OPN gene expression were detected in 30 cancerous tissues and their paired normal tissues using real-time reverse transcription-PCR (real-time RT-PCR), and the data were analyzed statistically.Real-time RT-PCR results demonstrated that the relative expression level of OPN mRNA in the cancerous tissues were significantly higher than that in paired normal samples (4.17-/+0.51 vs 0.97-/+0.12, P0.001), showing a 4.3-fold up-regulation. In the 30 OSCC specimens, OPN mRNA expression in the OSCC of histological grades I showed a 3.1-fold down-regulation, significantly lower than the expression in grade II/III tumors (2.16-/+0.17 vs 6.80-/+0.72, P0.05); its expression was significantly lower in early stage than in advanced stage OSCCs (2.34-/+0.17 vs 4.73-/+0.35, P0.05). In cases of cervical lymph node metastasis, the expression was significantly higher than that in cases without lymphatic metastasis (6.38-/+0.56 vs 2.89-/+0.32, P0.05).OPN mRNA overexpression may play an important role in OSCC carcinogenesis and can be a potential target for OSCC therapy.

To establish a standardized and modularized finite element model of a normal human skull to simulate the unilateral defect pattern of the maxilla and the stress distribution of craniofacial skeleton with repair subject to the bite force, and to make biomechanical evaluation and functional design of the unilateral maxillary reconstruction method using the microsurgery bone graft and zygomatic implant.Based on CT scan and image process technology, a modularized geometrical and finite element model of the human skull was built to simulate unilateral defect pattern of the maxilla and design of the position, direction, length of the zygoma fixture, and the number of the conventional fixtures. Biomechanical properties of the design were evaluated using finite element analysis (FEA) method.The highest stress peaks concentrated at the neck of the zygomatic fixture on the zygoma, while the rest of the peri-implant bone appeared to bear lower stress. The zygomatic fixture played an important role in transmitting the occlusal force substituting the zygomatic process brace.The transmission of the occlusal force and stress distribution of the peri-implant bone of this reconstruction protocol is satisfied. Reconstitutions of the buttresses system ensure a stable base for occlusion and stress, which is secure and feasible to optimal unilateral maxillary rehabilitation. Supported by Shanghai Leading Academic Discipline Project (Grant No.Y0203).

To evaluate the vascularized (deep circumflex iliac vessels) iliac crest graft with internal oblique muscle as a method for reconstruction of composite mandibular defect.Vascularized iliac crest graft with internal oblique muscle was used to reconstruct the composite mandibular defects in 10 patients. All clinical data were analyzed retrospectively. A detailed inspection of the case-notes was undertaken to ascertain the presenting diagnosis, the surgery, the complications and the outcome. The type of mandibular defect was recorded.Of the 10 patients with composite mandibular defects including mandibular body, mandibular angle, mandibular ramus and the soft tissue around them, 7 patients were recorded with the defects of mandibular condyles. During the follow-up period from 3 months to 24 months, primary wound healing was observed in all patients, except one patient with minor muscular necrosis. All patients were satisfied with their facial contour and mandibular shape, without tumor recurrence. Donor site problems important enough to be recorded in the notes were minimal.The vascularized iliac crest graft with internal oblique muscle offers a useful solution for reconstruction of composite mandibular defect. There is sufficient height and depth of bone to maintain a facial contour and mandibular shape. It can be used as a routine surgical technique to reconstruct composite mandibular defect.

Recently, some reports indicate that osteonecrosis of the jaws could occur after taking drugs containing hisphosphonates, including alendronate, pamidronate and zolendronate, which are widely used to treat osteoporosis and metastatic skeletal lesions in clinic.More and more attentions were given to this new oral complication. This article summarizes some advances in clinical manifestation, diagnosis, prevention and therapy of bisphosphonate -associated osteonecrosis of the jaws as well as the possible mechanisms involved.

To evaluate the epidemiology and treatment of segmental defect of mandible.A total of 541 patients were evaluated retrospectively. The character of the mandibular defect and method of reconstruction were analyzed.The majority of segmental defect of mandible were found in 40 - 70 years old males and the leading cause was tumor. The reconstruction methods included soft flap, reconstruction plate and bone grafts. The main complications were infection and fistula.Tumor was the main cause of segmental resection of mandible, which occurs mainly in adult males. The body of the mandible was often involved. Vascularized bone grafts were the main methods in reconstruction of mandible.

To discuss the technique of installation of zygomatic implants in severely resorbed edentulous maxillae, and maxillary defect.Five patients received 8 zygoma implants and 11 dental implants. On the basis of an axial spiral CT data, anatomical models of natural size were manufactured using CAD/CAM system and before operation preoperative measurements of relevant parameters (length, areas, and volumes) carried out. Theses maxillary and zygomatic measurements obtained were referred for installing zygomatic implants.The ideal direction and position of installation of the 8 zygomatic fixtures were obtained in 5 patients. The anatomical model and surgical plate were used for preoperative planning and intraoperative control of the insertion of zygomatic fixtures. The implants could be positioned precisely as preoperatively planned. The length of the zygomatic implants was between 40 mm and 50 mm.The use of surgical drilling guides should be encouraged for zygomatic implant placement. 3-D image data and anatomical models improves preoperative planning and facilitates clinical procedure.

Using co-culturing of bone marrow stromal cells (BMSCs) and small intestinal submucosa (SIS), to evaluate the cellular compatibility and the osteogenesis ability as well as the feasibility of SIS to serve as a scaffold in tissue engineering.Bone marrow was aspirated from the healthy adult goat and culture-expanded in vitro by the method of total marrow. The third passage cells were transplanted into SIS after being induced to differentiate into osteoblasts for 4 days and then seeded into SIS for 3 to 10 days. BMSCs alone were cultured at the same condition to act as controls. The cellular morphology and function (attachment, proliferation and differentiation) and the ectopia osteogenesis in vivo were assessed separately by means of phase contrast microscope, SEM and MTT, ALP activity, histology detection. The difference between the two groups were analyzed by Student's t test statistically.The BMSCs could adhere to SIS and proliferate and grow on the surface of SIS normally. The cellular activity and function were not affected by SIS, no statistical difference was found between the two groups (P0.05). The BMSCs/SIS compounds had good abilities of ectopia osteogenesis in vivo, and with time going on new bone formation increased. There was no bone formation in the control group. The endochondral bone formatin was the main pattern of osteogenesis.As a natural, absorbable, acellular scaffold, SIS is biocompatible and can be used as a tissue engineering scaffold. And for a membrane feature, there is the possibility to construct tissue engineered bone membrane with SIS.