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OBJECTIVES@#This study investigate the clinical and imaging features of Ewing sarcoma (ES) of the jaw.@*METHODS@#Eight cases of pathologically diagnosed ES of the jaw from January 2010 to June 2022 were included in the study. Clinical and radiological features were retrospectively analyzed.@*RESULTS@#Among the eight cases, the mean age at onset was 29.4 years, and the male to female ratio was 7∶1. The predilecting site was the posterior part of mandible, accounting for 75% of the cases. The lesions often exhibited early numbness of the lower lip and lymphadenopathy. The main radiographic manifestation of mandibular lesions was ill-defined radiolucency, mixed with fibrous or brush-like tumor matrix, and soft tissue mass. The maxillary ES lesions mainly presented as lytic bone destruction accompanied by adjacent soft tissue mass. Periosteal ossification was rarely seen.@*CONCLUSIONS@#The clinical and imaging characteristics of ES in the jaw are helpful for its diagnosis.
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Male , Humans , Female , Sarcoma, Ewing/pathology , Retrospective Studies , Radiography , Mandible/pathology , Lip , Bone NeoplasmsABSTRACT
Objective@# Using computer-assisted navigation technology to guide the resection and reconstruction of mandibular ameloblastoma, evaluating its treatment effect.@*Methods @# Twelve patients were selected from the Affiliated Stomatological Hospital of Nanjing University from January 2017 to May 2022. All 12 patients accepted same surgery which included resection of mandibular ameloblastoma and reconstruction by fibula musculocutaneous flap. Among them, 6 cases were included in the navigation group; 6 cases were in the non-navigation group. Advantages and disadvantages of computer-assisted navigation technology in this operation were evaluated with these cases. @*Results@# The 12 operations were performed by the same operator. The average time for fixing the navigation bracket and performing navigation in the navigation group was about 15 minutes. Compared with the non-navigation group, the average operation time in the navigation group was shortened by about 10 minutes. In the navigation group, the mandible resection range matched the fibula musculocutaneous flap well, and the occlusal relationship recovered well. @*Conclusion @#Using the mandibular reference frame, under the guidance of computer-assisted navigation technology, the resection and reconstruction of mandibular ameloblastoma can be performed quickly and accurately.
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Objective:To analyse clinical outcomes and risk factors of vascular crisis on patients received oral and maxillofacial defect repairations with free tissue flap.Methods:From January, 2013 to July, 2018, 1 049 patients with soft tissue defect of oral and maxillofacial were reconstructed with free tissue flap, in which 64 cases occurred vascular crisis. Among the cases, 28 defect were reconstructed with radial forearm free flap (RFFF), 19 with anterolateral thigh flap (ALTF), and 17 with fibula flap. All patients underwent surgical exploration. The clinical data and surgical outcomes were collected. The univariate analysis and multivariate regression analysis were performed by using SPSS version 22.0 software. The result was supposed to statistically significant when P<0.05. Results:Among 64 patients occurred vascular crisis, 44 flaps were rescued successfully by surgical procedures (68.8%). Univariate analysis revealed that the salvage rate was related to the smoking history, type of tissue flap, time of vascular crisis occurrence, cause of vascular crisis and the time interval between crisis occurrence and surgical exploration ( P<0.05). Multivariate regression analysis revealed that only type of tissue flap, the time of vascular crisis occurrence and the interval time were the independent significant factors for salvage rate ( P<0.05). Conclusion:The salvage rate became higher when the vascular crisis occurred earlier, and the interval time was shorter. The type of tissue flap could affect the outcome of surgical exploration. The success rate decreased with an order of RFFF, ALTF to fibula flaps. The primary principle in the management of vascular crisis was early identification and early surgical exploration.
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Objective@#To analyze the clinical characters and surgical treatment of primary parapharyngeal space (PPS) tumors.@*Methods@#A total of 23 cases of primary PPS tumors which were treated from November 2011 to December 2017 were included for the retrospective analysis in this study.@*Results@#Twenty-three cases of patients with primary PPS tumors were analyzed in this study. Surgical approach was as follows: transcervial approach applied in 7 cases, transparotid approach in 4 cases, transoral approach in 2 cases, transmandibular approach in 4 cases, and the combined approaches on 6 cases. Besides, among 7 cases with upper PPS tumor, we applied the surgical navigation system in the surgery of 3 cases. The mean surgery duration of these cases, 3.5 h, was shorter than unused ones, while the mean maximum size (MMS) of tumors, 5.7 cm, was also larger. So far, 23 cases had no recurrence and metastasis. The most frequent histopathological type of all the cases was pleomorphic adenoma (8 cases), followed by Schwannoma (5 cases). With an 8-to-72-months follow up, 23 cases had no recurrence, metastasis or death.@*Conclusions@#Surgical resection is preferred in the treatment of PPS tumors. In the upper PPS tumor cases, the surgical navigation system could reduce the operative duration significantly and is more suitable for larger tumors.
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Objective To explore the value of free anterolateral thigh flaps in the reconstruction of maxillofacial defects after resection.Methods Patients were recruited from January,2008 to March,2016 in the Department of Oral and Maxillofacial Surgery of Nanjing University.All patients sunder when reconstructive surgery employing anterolateral thigh myocutaneous flaps follow-up of 3 months to 84 months after operation.Results Among 422 cases,survived completely with satisfied configuration,the survival rate was 98.6％.Postoerative vessel thrombosis occurred in flaps,21 patients required operative exploration in the perioperative period including 10 flaps with thrombotic events and 11 flaps with venous thrombosis were complete survival after the salvages,and 6 flaps were failure.The mean follow-up was 36.5 months (range:3 to 84 months).Conclusion The free anterolateral thigh flap is an ideal choice for reconstruction of maxillofacial defects,as it has many advantages such as abundance volume,easily molding and adjusting the thickness,possessing,long vascular pedicle,composition need to be adjusted according to defects,easily concealed donor site,and little donor site complications and malformation.
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Objective:To present our experience of the surgical treatment of maxillofacial fibrous dysplasia(FD) using surgical navigation technology.Methods:14 patients with maxillofacial FD were included.Preoperative CT scanning data were obtained and a virtual plan based on the patient's mirrored anatomy was realized.Intraoperatively,a digital reference frame was fixed rigidly to patient's forehead or mandible depending on the location of the lesion.During operation each patient and the virtual image were matched through individual registration technique.A pointing device was constantly used to determine whether the extent of resection was consistent with the preoperative design.The surgical outcome was assessed through fusion of the preoperative planning and postoperative CT reconstruction image.Results:The application of surgical navigation system enhanced the safety and the accuracy of the surgery for the resection of the focal lesion and for the recontour of the profile.There was no complications during 1-3 years follow up.Conclusion:Surgical navigation based on a virtual plan proves to be safe and accurate,and is of great value in managing maxillofacial fibrous dysplasia.
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Objective To study the expression and significance of monocyte chemotactic protein-1 (MCP-1/CCL2) and vascular endothelial growth factor (VEGF) in serum samples of oral squamous cell carcinoma (OSCC) patients.Methods The concentrations of CCL2 and VEGF in the serum was assessed by ELISA in healthy donors (n=27) and OSCC patients (n=85).Then analyzed the correlation between the concentrations of CCL2 and VEGF and the relationship with patients' clinicopathological characteristics.Results CCL2 concentration was lower in OSCC patients than in healthy donors (69.12 ± 19.54 pg/ml vs 103.41 ± 34.42 pg/ml,t =6.477,P＜0.05).The expression of CCL2 was positively associated to TNM stage in OSCC (t=2.193,P＜0.05).VEGF concentration was higher in OSCC patients than in healthy donors (145.76 ± 49.34 pg/ml vs 70.35± 14.93 pg/ml,t=3.92,P＜0.05).There was a negative correlation between CCL2 and VEGF (r=-0.216,P＜0.05).The receiver operating characteristic (ROC) curve suggests that CCL2 and CCL2/VEGF in serum are good diagnostic markers to discriminate healthy people from OSCC patients,the cutoff values was 98.61 pg/ml and 0.82.Conclusion The expression of CCL2 and VEGF in serum correlated to OSCC progression,and it can be a potential diagnostic biomarker for oral disease.
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Objective To assess the clinical features and therapeutic efficacy of extensive full thickness cheek defects reconstruction with free anterolateral thigh flap.Methods From December,2008 to June,2014,a total of 17 patients underwent simultaneous tumor radical resection and full thickness cheek defects reconstruction with free anterolateral thigh flap.In these 17 patients,12 patients had undergone the reconstruction of full thickness cheek defects with the folded anterolateral thigh flap (two skin islands and an intervening de-epithelialized zone); 5 patients had undergone the reconstruction of full thickness cheek defects with the two separate skin paddles anterolateral thigh flap in one single pedicle.Results All of 17 free anterolateral thigh flaps survived,besides 1 case resulted in partial loss of flap adge due to diabetes.After 3 to 12 months' follow-up,all cases of free anterolateral thigh flap were good in color,shape and texture,and patients were satisfied with oral morphological and functional reconstruction.Conclusion The free anterolateral thigh flap is one of versatile soft tissue flaps in the extensive full thickness cheek defects reconstruction.
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<p><b>OBJECTIVE</b>To assess the safety and the accuracy of surgical navigation technology in the resection of severe ankylosis of the mandibular condyle with the middle cranial fossa.</p><p><b>METHODS</b>The CT scan data was transferred to a Windows-based computer workstation, and the patient' s individual anatomy was assessed in multiplanar views at the workstation. In the operation, the patient and the virtual image were matched by individual registration with the reference points which were set on the skull bone surface and the teeth. Then the real time navigation can be performed.</p><p><b>RESULTS</b>The acquisition of the data sets was uncomplicated, and image quality was sufficient to assess the operative result in three cases. The operations were performed successfully with the guidance of real-time navigation. The application of surgical navigation have enhanced the safety and the accuracy of the surgery for bony ankylosis of temporomandibular joint.</p><p><b>CONCLUSIONS</b>The application of surgical navigation can improve the accuracy and safety of surgical excision of the ankylosed skull base tissue.</p>
Subject(s)
Humans , Anatomic Landmarks , Ankylosis , General Surgery , Skull , Diagnostic Imaging , General Surgery , Surgery, Computer-Assisted , Methods , Temporomandibular Joint , General Surgery , Temporomandibular Joint Disorders , General Surgery , Tomography, X-Ray ComputedABSTRACT
Objective:To investigate the clinical value of decompression in the treatment of jaw large cystic lesions.Methods:42 patients with jaw large cystic lesions were treated with decompression.Imaging examination was taken and compared before and after the treatment.The influence of frequency of cyst cavity washing on the effect of decompression was observed.Results:3 moths after de-compression the border of the cyst cavity became ambiguous and the size of the cavity reduced.12 months after decompression the size of cyst cavity was stable,when second surgery was taken to remove the left cyst wall.There was no recurrence of the cystic lesion after 1 ~2 year follow-up.Cyst cavity was washed everyday,but the effect and treatment course were not influenced by the daily washing times.Conclusion:Decompression is effective in the treatment of the jaw large cystic lesions.
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5 patients with chronic prolonged mandibular dislocations(CPMD)were examined by CT scan.The patients were treated by manual reduction under general anaesthesia and muscle relaxants.Traction was performed with ligaturing steel wires on fixation titanium screws intermaxillaryly and wrapping up the skull-jaw bone with elastic bandages for 3 weeks.After 1 month,a maximal mouth opening of o-ver 30 mm was noted and no episode of redislocation occurred in 3 -34 month follow-up.
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<p><b>OBJECTIVE</b>To compare the thin anterolateral flap with forearm flap in tongue defect repairing, and to introduce our methods and experiences in the tongue reconstruction with the thin anterolateral flap.</p><p><b>METHODS</b>The clinicopathologic data of 46 cases with tongue carcinoma were obtained from School of Stomatology, Nanjing University Medical Center, Nanjing University from December 2009 to December 2011. To compare two methods of incidence of vascular crisis, tongue shape, language and swallowing functional recovery.</p><p><b>RESULTS</b>46 patients with tongue carcinoma were performed the tongue reconstruction in 12 month, which 12 cases were used the thin anterolateral flap and 34 cases were used the forearm flap. In the thin anterolateral flap group, All cases were succeeded. 1 case occurs vascular crisis. In the forearm flap group, 33 cases were succeeded, and 1 case occurs necrosis. 3 cases occurs vascular crisis. The results of comparing two methods showed that: no obvious differences in the tongue shape, and no obvious differences in the function of language and swallowing.</p><p><b>CONCLUSIONS</b>There no obvious differences in the reconstruction of tongue defect between the thin anterolateral flap and the forearm flap. The thin anterolateral flap have some advantages: little influence is on the donor site, the flap extent is abundant, the donor site is not spectacular. The thin anterolateral flap should be piror method for the tongue defect repairing.</p>