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Objective:To summarize and evaluate the target and dose design of 125I seed brachytherapy treatment plan of pediatric borderline tumor in head neck region. Methods:Eleven patients underwent definitive 125I brachytherapy or combined with surgery in Peking University Hospital of Stomatology from January 2010 to December 2018 were retrospective analyzed. The target region was set by extending the tumor gross region by 0.5 to 1.0 cm. The prescription dose and activity ranged from 80 to 120 Gy and 18.5 MBq, respectively. The treatments were performed according to the plan under general anesthesia. Response and toxic reaction were recorded during follow-up. The preoperative and postoperative dosimetric results were compared; and the local control rate, objective response rate, complete response rate and acute toxic reaction rate were calculated. Results:There was no statistically significant difference between preoperative and postoperative dosimetric results ( P>0.05). The follow-up time ranged from 33 to 131 months, with a median of 48 months. The local control rate, objective response rate, complete response rate and acute toxic reaction rate were 100%, 100%, 71.4% and 81.8%, respectively. Conclusions:Under well-designed target and dose, 125I brachytherapy for treatment of pediatric borderline tumor in head neck region would bring ideal therapeutic and toxic outcomes, and could be regarded as a feasible therapy.
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Objective@#To evaluate the accuracy and feasibility of a custom robot system guided by navigation for lateral skull base tumor biopsy.@*Methods@#Two cadaver heads were used, with iopamidol injected into different areas in the skull base and infratemporal region to imitate the tumor. Cone beam CT (CBCT) scanning was performed before operation. With image data transferred to the graphical user interface of the computer workstation, the "tumor" was segmented as the target. The needle trajectory was determined by selecting the skin entry point and the target point on the surgical planning software. Following point-based registration, the data was sent to the robot control unit. The needle was automatically inserted into the intended target by the robot guided by optical navigation. After the procedure was performed, the instantaneous data of needle tip position acquired by navigation system was sent back to the computer workstation for accuracy verification. Subsequently, after the needle was released, CBCT scanning was performed again, and the pre-and post-operative skull were superimposed. The position data of needle tip was acquired on the postoperative image and the accuracy was re-verified. The paired t-test was used to compare the differences in the accuracy calculated by intraoperative navigation and postoperative image fusion. The independent samples t-test was used to compare the accuracy between the cadavers. The Pearson correlation coefficients (r) was used to analyze correlation between the needle intervention accuracy and insertion depth.@*Results@#All 20 interventions were successfully performed. The mean deviation of the needle tip was (0.67±0.28) mm (measured by the navigation system) and (3.19±0.39) mm (measured by image fusion) respectively (t=-23.238, P<0.001). The comparison of accuracy test showed no significant difference between the cadavers (t=-1.116, P=0.279). Pearson correlation coefficients (r=0.714, P<0.001) showed the close correlation between the needle intervention accuracy and insertion depth. The mean insertion depth was (5.14±0.21) cm.@*Conclusions@#The experimental results show that the robot system is efficient and reliable. The navigation accuracy and the needle deflection are the most significant factors affecting robotic puncture procedures.
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Objective@#To calculate the three-dimensional trajectory and motion morphology of condyle by combining the trajectory of the mandible movement and the three-dimensional model of the mandible.@*Methods@#Cone beam CT (CBCT) scanning was performed on the volunteer. The mandible three-dimensional model was built with image data transferred to the graphical user interface of the computer workstation. The novel virtual articulator PN300 recorded the three-dimensional trajectory of mandible. All these data were transferred to software system of computer workstation calculating the three-dimensional trajectory of condyle. The motion morphology of condyle was simulated by merging function surface at each point.@*Results@#When the mandible moved in an opening process, the recorded data was calculated and it was shown that: the condylar functional surface moved moved forward and downward inward in advance, and in the process of continuously increasing the opening degree, the function faced the front upper inner side. The straight-line distance between the position and the final position was 8.34 mm. During the forward movement of the mandible, the coracoid process slided forward downward and inward with a sliding distance of 8.64 mm. During lateral movement, the range of the working side condyle function surface motion was small, only slight rotation, the maximum range of motion was 1.97 mm; in the process of row side movement, the non-working condyle function surface had a larger movement range than the working side, the movement direction was the front lower inner side, and the movement distance was 7.65 mm.@*Conclusions@#The novel virtual articulator PN300 and digital technology can achieve the accurate measurement of three-dimensional trajectory of the condyle, and furthermore simulate the motion morphology of the condyle.
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President Xi presented an important address in the National Health and Wellness Conference and the high strategic priority for promoting people's health in China was emphasized. Thereafter, a number of documents of state policy on health and wellness were issued successively. These documents covered important contents on oral health, which had great significance as a milestone. This article reviewed the documentation process and analyzed the key points on oral health. The release of these series of government documents had provided policy support for integrating oral health into significant health policies, building the first barrier for oral health, preventing and treating oral diseases based on strategies for common risk factors, adopting strategies to combine both the whole population and high-risk groups, and developing health-centered oral massive health industry, etc.
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Objective:To understand the clinical features of osteonecrosis of the jaw after bisphospho-nates use for therapy of breast cancer patients with bone metastasis.Methods:The cases diagnosed as bisphosphonates-related osteonecrosis of the jaws (BRONJ)were retrospectively analyzed from January 201 1 to August 201 5 in the Peking University School and Hospital of Stomatology,and those breast cancer patients with bone metastasis were selected.The clinical symptoms,imaging characteristics and treatment results were summarized.Results:A total of 1 4 cases of breast cancer patients with bone me-tastasis were selected,with an average age of 60.21 years.The average time of suffering from breast cancer was 9 .77 years,and the average time of bone metastasis and bisphosphonates drugs use was 5 .67 and 3 .29 years individually.There was no patient with systemic application history of hormone therapy, and no history of diabetes.There were 9 patients with tooth extractions history,and the mean time of bone necrosis symptoms was 8.58 months.There were 1 0 cases with bone necrosis occurring on mandi-ble,3 cases on maxilla,and one case with both upper and lower jaws involved.Among the 1 0 patients with surgical treatment,there were 3 cases cured,and 6 cases improved.However,the clinical symp-toms of 2 cases with conservative treatment were significantly aggravated.Conclusion:The medication time between the bisphosphonates use beginning and the occurrence of BRONJ is relatively long.The his-tory of diabetes and long-time hormone use did not exist in this group.Tooth extraction itself does not de-termine the severity of BRONJ.Mandible is the most common site involved by BRONJ.Surgical treatment can alleviate the clinical symptoms of BRONJ with breast cancer to some extent.
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Objective:To evaluate the efficacy of Piezosurgery in split teeth extractions.Methods:A single-center,randomized,split-mouth study was performed using a consecutive serious of unrelated healthy patients attending the departing of oral and maxillofacial surgery,Peking University School and Hospital of Stomatology.40 patients were selected for extraction of maxillary molars without reservation value,splitting or nonvital teeth.They were divided into control (20 patients)and test groups (20 pa-tients)randomly.Surgical treatments for both groups were under local anesthesia.Molar teeth of control group were extracted by common equipments like dental elevators,chisels,forceps,etc.While molar teeth of experimental group were extracted by Piezosurgery,aided with the use of common equipments if needed.Then we compared the duration of surgery,frequency of the usage of chisels,expansion of post-operative bony socket surgical discomfort and postoperative pain between two groups.Results:The ave-rage of operation time was (629.5 ±171.0)s in control group and (456.0 ±337.2)s in test group.The buccal alveolar bone reduced (1.07 ±0.64)mm in control group and (1.49 ±0.61)mm in test group. There was a significant difference between the two groups (P 0.05).Conclusion:Piezosugery can be better to preserve alveolar bone,re-duce trauma and patient’s fear.Application of the piezosugery reflect the characteristics of minimally in-vasive extraction,which has the value of promotion.The Piezosurgery technique have the advantage of re-ducing change of buccal alveolar bone during the surgery,but a longer surgical time was required when compared with the conventional technique.VAS value of surgical discomfort,expansion of postoperative bony socket and the operative fear rate,there were no significant difference.Minimally invasive tooth ex-traction technique has good clinical results and high satisfaction.Piezosurgery proved its worth as the in-strument adapted to limiting the destruction of bone tissue.
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Traditional craniomaxillofacial surgery significantly affects aesthetic appreciation. In contrast to traditional methods, robot-assisted surgery has been extensively investigated because it is microinvasive, precise, and safe. With robot-assisted surgery, operational vision and manipulation space become extended. As a result, operational quality and patient's postoperative life are improved. This article reviewed the development of surgical robot systems and their applications in craniomaxillofacial surgery.
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Humans , Facial Bones , Robotic Surgical ProceduresABSTRACT
Objective:To investigate the defect types and reconstruction methods of maxillary defects. Methods:The database of 1 107 cases with maxillary defects in Peking University School and Hospital of Stomatology from January 1985 to December 2010 was established. There construction methods were re-viewed. The defect types were classified according to Brown classification system. Results: In the 1 107 cases, 1 104 cases could be classified according to Brown classification system. The most common type was 2a with 559 cases (50. 6%). Among all the 1 107 cases, 349 cases were reconstructed with auto-transplantation, 443 cases with prosthesis, 107 cases untreated, and 208 patients lost to the follow-up. There was a significant growing trend over time for the application of free flaps and a downward trend of prosthesis. The most popular free flaps were fibular flap (88 cases) and radial forearm flap (75 cases) . Rectus abdominis flap and anterolatreal thigh flap were fit for extensive maxillary defects. Conclusion:The most common defect type is 2a. Free flap has become the dominant option for maxillary reconstruc-tion. Free flaps could be selected according to the maxillary defect types.
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Objective:To investigate the Level Ⅳ metastasis risk factor of oral cancer patient's ipsilateral neck. Methods:The medical records of 624 cases (644 sides of the neck) that underwent neck dissection at the time of primary surgery for oral carcinoma were included. Chi-square test and logistic regression analysis were performed to determine the factors associated with LevelⅣmetas-tasis. Results:Out of 334 cases (345 neck sides) with positive lymph nodes, only 35 sides (5.43%, 35/644) showed LevelⅢinvolve-ment and only 4 sides (0.62%, 4/644) developed skip metastasis (LevelⅢ). The metastatic rate of LevelⅣwas 1.31%(4/303) for pN-LevelsⅠ-Ⅲnecks and 9.14%(31/341) for pN+LevelsⅠ-Ⅲnecks. Using Chi-square test, pN+LevelsⅠ-Ⅲlymph node metastases were associated with the LevelⅣnodal metastases. For necks with pN+LevelⅢ, with three positive Levels among LevelsⅠ-Ⅲ, and with positive lymph node≥3 among LevelsⅠ-Ⅲ, the LevelⅣmetastasis rates were 22.47%(20/89), 28.57%(10/35), and 14.60%(20/137), respectively. Furthermore, logistic regression was applied to identify the relationship between the metastasis situation of the afore-mentioned three Levels and LevelⅣ. Three positive Levels among LevelsⅠ-Ⅲ(pN+LevelⅠ+pN+LevelⅡ+pN+LevelⅢ) were confirmed to correlate with the presence of the positive lymph nodes in LevelⅣ. Conclusion:In oral cancer patients, LevelsⅠ-Ⅲmetastaces will increase the risk of LevelⅣmetastasis.
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Objective:To establish a method of morphologic measurement of the mandibles and obtain the average values of three dimensional morphologic measurements of the mandibles .Methods: A me-thod of morphologic measurement of the mandibles was established firstly .The three dimensional CT data of 54 normal adult skulls were measured by this method .The data were analyzed by SPSS 13.0 statistical software.Results:In the study, 84 groups of mean values and standard deviations of the length , width, height, depth, thickness and angle of the mandibular contour in males and females were obtained .There were significant differences between the male and the female in the 66 of the 84 groups data , while the 16 of the 84 groups data had no significant differences and distributed symmetry on both sides of the mandi -bles .No correlation was found in the mandibular contour data in length , width , height and depth .Con-clusion:The characteristics of adult mandibular contours are different between males and females , indi-cating that each individual has its own morphologic features .
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<p><b>OBJECTIVE</b>To investigate the application efficacy of three-dimensional tumor mapping technique for diagnosis and treatment of maxillary cancer.</p><p><b>METHODS</b>Seventeen patients (aged from 9 to 74 years with an average age of 44.2 years) diagnosed with maxillary malignant tumors (13 for primary cancer and 4 for recurrent cancer) in Peking University School of Stomatology from December 2012 to October 2014 were reviewed as experimental group, in whom three-dimensional tumor mapping was performed before surgery, and 18 patients underwent traditional surgery in the same period as control group. Three-dimensional tumor imaging was generated with conversion of CT data into DICOM format by a software. Virtual plan of tumor resection and osteotomy was also manipulated according to the three-dimensional position of the tumor. Surgical navigation was used in the operation to confirm the virtual plan. The real position and situation of tumor was evaluated in the operation and compared with the pre-operative design. The frozen section was applied to confirm the margin after tumor resection. All the patients were followed up and the prognosis was evaluated.</p><p><b>RESULTS</b>The real situation of the tumor in the operation matched well with the result of pre-operative tumor mapping and positive margin was detected only in one case. While in the control group, 2 of 18 patients presented with positive margin in the operation. The mean follow-up time was 14.8 months (range from 2.0 to 22.0 months). Local recurrence occurred in 4 cases of experimental group and in 6 cases of controlled group, and all of them were with advanced malignant tumors.</p><p><b>CONCLUSION</b>The three-dimensional tumor mapping technique is a feasible and reliable method for the diagnosis and treatment of maxillary malignant tumor, and use of this technique can significantly improve the clinical outcome.</p>
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Adolescent , Adult , Aged , Child , Humans , Middle Aged , Young Adult , Beijing , Imaging, Three-Dimensional , Maxillary Neoplasms , Diagnosis , General Surgery , Neoplasm Recurrence, Local , Osteotomy , Prognosis , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To investigate the risk factor for metastasis in Level IV of ipsilateral neck in tongue cancer patients.</p><p><b>METHODS</b>A total of 248 tongue caner paitents (255 necks) that underwent radical neck dissection was enrolled in the study. Chi-square test and Logistic regression analysis were used to determine the factors associated with metastasis in Level IV. The variable included age, sex, growth type, T stage, histopathological grade, Level III involvement, number of positive lymph nodes in Levels I-III.</p><p><b>RESULTS</b>Out of 147 cases (152 necks) with positive lymph node, 21 necks (8.2%, 21/255) had Level III involvement, and 2 necks (0.8%, 2/255) developed skip metastasis. Chi-square test showed that age (P = 0.020), Level III involvement (P = 0.000), number of positive Level (≥ 2 Levels) in Levels I-III (P = 0.006), and number of positive lymph node (≥ 3 nodes) in Levels I-III (P = 0.000) were identified as independent risk factor. Logistic regression analysis revealed that only Level III involvement (P = 0.003) was the risk factor for metastasis in Level IV.</p><p><b>CONCLUSIONS</b>In tongue cancer patients, Level III involvement was a high risk factor for metastasis in Level IV.</p>
Subject(s)
Female , Humans , Male , Age Factors , Carcinoma, Squamous Cell , Chi-Square Distribution , Lymph Nodes , Pathology , Lymphatic Metastasis , Neck , Neck Dissection , Regression Analysis , Risk Factors , Sex Factors , Tongue Neoplasms , PathologyABSTRACT
Objective:To analyze the predilection of metastasis at levels Ⅰ,Ⅱ,Ⅲ, Ⅳ,Ⅴfor oral and maxillary squamous cell carcinoma on different primary sites .Methods: A retrospective review was conducted of the records of 1 233 patients ( 1 340 necks ) from January 2000 to December 2011 with squamous cell carcinoma simultaneously underwent primary tumor resection and neck dissection in De -partment of Oral and Maxillary Surgery , Peking University School and Hospital of Stomatology .The to-pography of positive neck node was recorded , and the calculation was performed for the metastasis rate of levels Ⅰ,Ⅱ,Ⅲ,Ⅳ,Ⅴbased on the primary site , respectively .Results:There were 557 necks with positive node (41.57%), and the metastasis rate for level Ⅰ, Ⅱ, Ⅲ, Ⅳ, and Ⅴ were 27.61%, 22.91%, 9.18%, 4.99%, 3.24%, respectively.Those in level Ⅲ were at high risk for metastasis from carcinoma of tongue and the floor of mouth .The positive rate in level Ⅱwas more than that in levelⅠfor tongue carcinoma , but for inferior gingiva carcinoma , bucca carcinoma , upper gingiva carcinoma , palatine carcinoma , maxillary sinuse carcinoma , intraosseous carcinoma of mandibular , the positive node was more likely to happen at level Ⅰcompared with level Ⅱ.Conclusion: Most metastases happen in levels Ⅰ-Ⅲfor patients with oral and maxillary squamous cell carcinoma , but the predilection of metas-tasis in level Ⅰ,ⅡorⅢis varied with the primary sites .
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<p><b>OBJECTIVE</b>To establish a three- dimensional virtual deformable mandible model used for individual reconstruction design of large mandibular defect.</p><p><b>METHODS</b>A virtual deformable mandible model has been established by a 3D animation software. The model could be used for preoperative reconstruction design of large mandibular defects cases. According to the temporomandibular joint fossa position, maxillary dental arch, the normal relationship of cranio-maxillofacial profile, and the morphology of the residual segments of mandible, the virtual mandible model could be scaled and adjusted and a virtual mandible with individual features was obtained. Three normal skulls have been used to validate the adjustment ability of the virtual deformable mandible model. The preoperative reconstruction design process of 1 typical large mandibular defect case was demonstrated.</p><p><b>RESULTS</b>The deformation matching ability of the virtual deformable mandible model was very good. The registration between the design model and the original mandible was over 90%. The design effect of the large mandiblar defect case was satisfied.</p><p><b>CONCLUSIONS</b>Virtual deformable mandible model is a new feasible method to aid preoperative reconstruction design of large mandibular defects.</p>
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Humans , Computer-Aided Design , Image Processing, Computer-Assisted , Imaging, Three-Dimensional , Mandible , General Surgery , Models, Anatomic , Plastic Surgery Procedures , Software , Temporomandibular Joint , User-Computer InterfaceABSTRACT
<p><b>OBJECTIVE</b>To retrospectively analyze the data of the patients with Bisphosphonate-related osteonecrosis of the jaw over the past five years in our hospital.</p><p><b>METHODS</b>Twenty-four patients with bisphosphonate-related osteonecrosis of the jaw treated in our hospital from 2009 to 2013 were included. The medication, bisphosphonate types, clinical signs and symptom, treatment methods and results were also analyzed.</p><p><b>RESULTS</b>Of the 24 cases, 20 cases suffered from malignant tumors and received intravenous infusion of bisphosphonates and 4 cases took oral bisphosphonates. Three of the 4 cases with osteoporosis had history of glucocorticoid (rheumatoid arthritis). All patients had oral clinical symptoms for an average of 11.6 months, and 19 patients had the history of tooth extraction. There were 11 cases with mandible involved, 10 cases with maxilla involved, and 3 cases with both mandible and maxilla involved. After conservative treatment (3 cases) or operation (21 cases), 10 cases had wound healing, 6 cases were stable with bone exposure, and 4 cases with died bone needed reoperation. During the follow-up period, there was one patient died of primary disease (renal carcinoma).</p><p><b>CONCLUSIONS</b>Both intravenous and oral application routes of bisphosphonates can induce osteonecrosis of the jaw. Bisphosphonate-related osteonecrosis of the jaw can be caused by alveolar trauma. The treatment modality is to relieve the clinical symptoms of bisphosphonate-related osteonecrosis of the jaw.</p>
Subject(s)
Humans , Bisphosphonate-Associated Osteonecrosis of the Jaw , Pathology , Therapeutics , Bone Density Conservation Agents , Diphosphonates , Glucocorticoids , Mandible , Maxilla , Osteoporosis , Retrospective Studies , Tooth Extraction , Wound HealingABSTRACT
Objective To investigate whether the surgery resorting to computer-assisted navigation system (CANS) can enhance effects in managing unilateral old zygomatic complex (ZMC) fracture in comparison with conventional surgery.Methods Twenty-four patients with unilateral old ZMC fracture for which surgical correction was wanted were divided into study group (n =12,treated with navigational surgery) and control group (n =12,treated with traditional surgery) in the 1 ∶ 1 matched case-control study.Therapeutic effects of CANS were evaluated by postoperative CT measurement,subjective satisfaction questionnaire and clinical examination.Results According to postoperative three-dimensional CT measurement,the mean projection and width differentials of bilateral zygomatic bones were 1.58 mm and 1.47 mm in study group,3.58 mm and 3.63 mm in control group,with significant differences between groups.No complications occurred within three months of follow-up.Moreover,the patients in study group were all satisfied with the treatment,but two patients in control group desired further surgery to ameliorate zygomatic shape.Conclusion Surgery with application of CANS improves efficacy of treatment for unilateral old ZMC fracture.
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<p><b>OBJECTIVE</b>To review 204 consecutive free flap transfers for head and neck reconstruction in the new microsurgery unit.</p><p><b>METHODS</b>Two hundred and four consecutive free flap transfers performed in 192 patients form May 1999 to March 2001 were reviewed. The clinical data included the surgery date, defect description and site, stage and histology of the tumor, type of the flap used and complications.</p><p><b>RESULTS</b>The free redial forearm flap was the most commonly used, followed by the free fibula flap, rectus abdominis flap, iliac crest flap, and latissimus dorsi flap. The overall success rate was 98.5%. The overall complication rate was 29.7%. The vessel thrombosis rate was 5.4%, and the flap salvage rate was 72.7%.</p><p><b>CONCLUSION</b>Free tissue transfer in the head and neck region is safe and reliable. It is superior to the conventional pedicle flap technique.</p>
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Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Head and Neck Neoplasms , General Surgery , Postoperative Complications , Surgical FlapsABSTRACT
Objective:To compare the effect of intraoral and extraoral approach for the sugical treatment of mandibular cysts in the angle and ramus. Methods:Cysts in the mandibular angle and ramus were treated by intraoral approach in 57 cases and extraoral in 18 cases. The following data were collected: operation time, peroperative blood loss, postoperative infection, mouth opening, recurrence rate, injury of the submandibular branch of the facial nerve and sensory function of the inferior alveolar nerve. The data of the two groups were compared statistically. Results:Average operation time (min) of intraoral and extraoral appoarch was 84.65?5.16 and 122.78?10.84(P0.05). Conclusion:Intraoral approach is effective in the treatment of cyst in mandibular angle and ramus.
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Subjective: To observe apoptosis of the cells in oral sq uamous cell carcinoma(SCC) induced by cerulenin. Methods: SCC TCA-83 cells and fresh tissue of SCC of tongue from 5 patients were expos ed to cerulenin (10 mg/ml) for 24 hours, then the genosome DNA of the cells was extracted and electrophoresed; the fresh tissue of SCC was assessed by TUNEL labeling. Results: DNA gel electrophoresis showed typical apoptic DNA ladders from TCA-83 cells. The rate (%) of TUNEL-positive cells in cerulenin treated tissue of SCC was 29.0?2.6～40.6?16.2,that in the control 2 . 0?1.7～14.7?0.6 (P