Submental versus platysma flap for the reconstruction of complex facial defects following resection of head and neck tumors

To compare the platysma flap with submental flap in terms of tumor and flap characteristics, operative properties and the functional outcomes. A total of 65 patients presented with tumors of head and neck and underwent curative tumor resection with different neck dissections at the Department of Oromaxillofacial-Head and Neck Surgery, School of Stomatology of China Medical University; from March 2005 to December 2012 were included in the study. After radical tumor excision and neck dissection the resultant complex defects were reconstructed with either platysma flap or the submental flap. The extent of surgical resection, the type of neck dissection and choice of flap reconstruction was at the discretion of the surgical team. The functional outcomes, operative time and characteristics of both platysma and submental flaps were compared and the statistical tests of significance were applied accordingly. The mean age was 60 years. The complex facial defects of 30 patients were reconstructed with platysma flap and of 35 patients with submental flap. Mean operation time of submental flap including flap harvesting [5.58 +/- 1.96hrs] was shorter than platysma flap [6.2 +/- 1.4hrs]. The majority of the flaps [88-93%] were taken successfully in both groups. Submental flap was associated with significantly higher patients' satisfaction regarding acceptable functional outcomes [p-value 0.027]. The mean reduction in mouth opening was significantly smaller in platysma group [0.37 +/- 0.18cms] than the submental group [0.47 +/- 0.16]. This study demonstrates that both platysma and submental flap techniques can be used for the reconstruction of complex facial defects with the acceptable functional outcome. The platysma flap can be harvested to medium size defects up to 70cm2 with good mouth opening. The submental flap is simpler, faster with a wider range of application and more acceptable functional outcomes

Assessment of quality of life of oral cancer patients after reconstruction with radial forearm free flaps / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To evaluate the quality of life in patients who had resection of oral cancer and reconstruction by radial forearm free flaps.</p><p><b>METHODS</b>Quality of life of 49 patients was assessed by means of the 14-item oral health impact profile (OHIP-14) and the medical outcomes study-short form-36 (SF-36) questionnaires 12 months after operation.</p><p><b>RESULTS</b>Forty-one questionnaires were collected (84%). SF-36: the highest-scoring domain were physical role (92.9 ± 2.6) and bodily pain (82.6 ± 5.7), the lowest-scoring domain were vitality (61.5 ± 9.1), followed by role emotion (64.9 ± 6.8) and social functioning (65.2 ± 8.2). OHIP-14: the best-scoring domain were handicap (37.1 ± 15.1) and psychological disability (45.7 ± 11.9), the best-scoring domain were physical pain (64.2 ± 11.7) and functional limitation (61.9 ± 12.9).</p><p><b>CONCLUSIONS</b>Radial forearm free flaps for reconstruction of oral defects after cancer resection could significantly influence the patients' quality of life.</p>

Effect of rapamycin combined with cisplatin on head and neck squamous cancer cells regulated by CCL19 / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To investigate the synergistic effects of rapamycin and cisplatin on head and neck squamous cancer cells regulated by chemokine (C-C motif) ligand 19 (CCL19).</p><p><b>METHODS</b>The role of rapamycin and cisplatin was detected on cell-cycle and apoptosis in CCL19 induced PCI-4B and PCI-37B cells by methyl thiazolyl tetrazolium (MTT) and flow cytometry (FCM). Dose-effect relationship parameters and combination index (CI) were calculated on the median-effect equation and multiple drug effect equation using computer software CalcuSyn. Statistical analysis was performed by the unpaired student's t-test.</p><p><b>RESULTS</b>Rapamycin and cisplatin could respectively increase the growth arrest, the proportion of G(1) phase and apoptosis of CCL19 induced cancer cells (P < 0.05). Under inhibitory concentration 50% (IC(50)), CI was less than 1, and in IC(75), it was more than 1 in PCI-4B cells. In PCI-37B cells, under IC(75), CI was less than 1, and in IC(90), it was more than 1.</p><p><b>CONCLUSIONS</b>Rapamycin and cisplatin can inhibit CCL19-regulated PCI-4B and PCI-37B cells' survival. The two drugs have synergistic effects when used in combination.</p>

Preoperative Doppler evaluation of vascular perforators in the anterolateral thigh flap harvest / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To evaluate the accuracy of Hadeco ES-1000spm hand-held doppler during the anterolateral thigh (ALT) flap harvest.</p><p><b>METHODS</b>Twenty-five patients (26 sides) with ALT flaps for head and neck reconstruction between May 2005 and May 2010 received preoperative Doppler examination for the location of the cutaneous perforators of ALT flaps. The Doppler signals and body mass index (BMI) were recorded preoperatively according to ABC system. The locations of Doppler signals and of the actual cutaneous perforators at surgery were plotted and compared. The diameter of perforators was measured.</p><p><b>RESULTS</b>One to three cutaneous perforators of the ALT flap were consistently found at specific locations. They were named perforators A, B, C from proximal to distal. Perforators A, B and C were present in 15 (58%), 24 (92%) and 20 (77%) cases and the diameter (> 0.5 mm) of A, B and C were 11/15, 22 (92%) and 8 (40%) respectively. The Doppler signal was within 0.5 cm of the actual perforator location in 85% flaps. The accuracy of Doppler decreased with increase of BMI.</p><p><b>CONCLUSIONS</b>Preoperative assessment by hand-held Doppler is useful in predicting the perforator vessels' locations and diameter although it's accuracy is limited.</p>

Functional reconstruction of total lower lip defect with mental neurovascular V-Y advancement island flap / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To introduce a method of functional reconstruction for total lower lip defects.</p><p><b>METHODS</b>Six patients with lower lip cancer were treated by surgery from November 2007 to February 2009. The full thickness defects with a size from eighty percent to total lower lip were reconstructed with two triangular mental neurovascular island flaps of chin. The musculocutaneous and mucous flaps with neurovascular pedicles were advanced in a V-Y manner to close the defect and reconstruct the orbicularis oris muscle.</p><p><b>RESULTS</b>All flaps survived and no recurrence and complication were observed and showed excellent cosmetic and functional results over 6 months of follow-up. The reconstructed lower lips provided a wide-enough mouth opening, and the sensation of oral mucosa and the muscle function of oral sphincter were preserved.</p><p><b>CONCLUSIONS</b>The technique of mental neurovascular V-Y advancement island flap can get satisfactory results in both functional and the aesthetic perspects.</p>

Effect of chemokine receptor 7 small interfering RNA on proliferation and invasion of squamous cell carcinoma of head and neck / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To study the effect of chemokine receptor 7 (CCR-7) small interfering RNA (siRNA) on proliferation and invasion of squamous cell carcinoma of head and neck (SCCHN).</p><p><b>METHODS</b>CCR-7 siRNA was co-transfected into SCCHN cell line PCI-4B using Lipofectamine 2000. CCR-7 protein level was detected by western blotting. SCCHN cell proliferation was detected by MTT, and the change of actin cytoskeleton observed by confocal laser scanning microscope. Transwell assays were used to determine chemotaxis and invasion of SCCHN cells. The activity and nuclear translocation of nuclear factor-kappa B (NF-kappa B) were detected by TransAM NF-kappa B p65 kit and fluorescence microscope respectively.</p><p><b>RESULTS</b>After CCR-7 siRNA transfection, the protein level of CCR-7 was significantly decreased. The changes induced by CCL-19, including increased proliferation rate, polarized actin polymerization, increased chemotaxis rate and invasion rate, were all abolished by CCR-7 siRNA transfection. CCR-7 siRNA also diminished CCL-19-induced NF-kappaB activation and nuclear translocation.</p><p><b>CONCLUSIONS</b>CCR-7 siRNA could inhibit expression of CCR-7 and diminish the increased proliferation and invasion of SCCHN induced by CCL-19 in vitro. CCR-7 siRNA may provide a potential treatment strategy for SCCHN.</p>

Expression of CD31, CD34 and CD105 in squamous cell carcinoma of tongue and their relationships with lymph node metastasis / 华西口腔医学杂志

<p><b>OBJECTIVE</b>To research the expression of CD31, CD34 and CD105 in squamous cell carcinoma of tongue (TSCC) and discuss their relationships with lymph node metastasis.</p><p><b>METHODS</b>All the specimens' segments were stained by immunohistochemical method SP, and then the tumor's microvessel density (MVD) marked by CD31, CD34 and CD105 were counted by the Weidner's method.</p><p><b>RESULTS</b>The expression of CD31, CD34 and CD105 in the tumor's tissue was much higher than that in the normal tissue (P<0.01). There was no obvious difference between the MVD values marked by CD31 and CD34 (P>0.05), but they were obviously different from which marked by CD105 (P<0.01). The MVD values between the male and female patients had no statistical difference (P>0.05). The MVD values marked by CD31 and CD34 had no statistical difference in different pathological grades and clinical stages (P>0.05), but there was statistical difference in different pathological grades and clinical stages marked by CD105 (P<0.05). Although the MVD value of the cases with lymph node metastasis was different from that without metastasis marked by CD31 and CD34 (P<0.05), there was much higher difference between the cases with lymph node metastasis and those without metastasis marked by CD105 (P<0.01).</p><p><b>CONCLUSION</b>CD105 is a more satisfying vascular endothelial marker than others. It can predict the metastasis possibility of the TSCC patients, thus it may be particularly important in the development of TSCC.</p>

Influence of LY294002 on protein kinase B expression in salivary adenoid cystic carcinoma (SACC)-83 and SACC-LM cells / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To investigate the influence of LY294002 on protein kinase B expression in salivary adenoid cystic carcinoma cells (SACC).</p><p><b>METHODS</b>Using Western-blot and RT-PCR detected the protein and mRNA level of protein kinase B (PKB) both in cell line, absent and present LY294002. The data were analysed by t-test.</p><p><b>RESULTS</b>The expression and transcription level of PKB (Ser(473)) in SACC-83 was lower than in SACC-LM (P < 0.05). The expression of PKB (Ser(473)) in SACC cell lines with LY294002 was lower than in SACC cell lines without LY294002 (P < 0.01). The transcription level of PKB showed no difference in SACC cell lines with and without LY294002 (P > 0.05).</p><p><b>CONCLUSIONS</b>In vitro, the protein expression and transcription level of PKB (Ser(473)) is higher in SACC-LM cell line than in SACC-83 cell line. In vitro, LY294002 can inhibit protein expression of PKB (Ser(473)) in SACC-83 cells and SACC-LM cells.</p>

The effect of autogenous vein cuff and injection of cerebral cell growth peptide on the recovery of injured facial nerve / 中华整形外科杂志

<p><b>OBJECTIVE</b>To study the effect of autogenous vein cuff and injection of cerebral cell growth peptide on the recovery of the injured facial nerve.</p><p><b>METHODS</b>The injured facial nerve was anastomosed and covered with an autogenous vein cuff. Cerebral cell growth peptide was then injected to it. The different repairing methods were evaluated and compared with electromyography and observing functional recovery of the mimetic muscles.</p><p><b>RESULTS</b>The new repairing method accelerated the recovery of the injured facial nerve. The recovery period of mimetic muscle function was significant shorter than the traditional method (P < 0.01). The recovery period of I-stage repairing was significant shorter than that of II--stage repairing (P < 0.01). The conduction velocity of the repaired facial nerves had no obvious differences between the new repairing method and the traditional method (P > 0.05).</p><p><b>CONCLUSION</b>Application of the autogenous vein cuff to cover the nerve anastomosis and injection of cerebral cell growth peptide is a promising method for facial nerve repairing.</p>