How to deal with the vessel of free flap: A retrospective study of 264 cases of anterolateral thigh flap / 中华显微外科杂志

Objective To compare the reliability and effectiveness of anterolateral thigh flap with double vein anastomosis or one vein anastomosis for reconstruction of head and neck defects.Methods Two hundred and sixty four cases of anterolateral thigh flap transfers for head and neck reconstruction from January,2013 to September,2013 in the Second Xiangya Hospital of Central South University were reviewed.260 patients were randomly divided into 2 groups.In the experimental group,there were 138 patients 140 cases of anterolateral thigh flap with one vein one artery anastomosis.In the control group,there were 122 patients 124 cases of anterolateral thigh flap with double vein one artery anastomosis.Results Among 264 anterolateral thigh flaps,the overall success rate of free flap was 98.1％ (259/264),5 free flaps were lost.In the experimental group,there were 6 free flaps occurred venous thrombosis,two of them were lost.In the control group,there were 5 cases occurred venous thrombosis,three of them were lost.No arterial thrombosis occurred in both groups.The time of micromanipulation was 18 to 101 min,with the average of 47 min in the experimental group.In the control group,the time was 45 to 133 min,with the average of 71 min.(P =0.0003).Conclusion Anterolateral thigh flap with one vein one artery anastomosis for head and neck reconstruction did not affect the survival rate but it can absolutely reduce the operation time.

Application of 1,212 anterolateral thigh myocutaneous flaps in the repair of oral and maxillofacial defects / 华西口腔医学杂志

<p><b>OBJECTIVE</b>To examine the benefits of anterolateral thigh myocutaneous flaps in reconstruction of oral and maxillofacial defects.</p><p><b>METHODS</b>Patients were recruited from February 2002 to June 2013 in the Department of Oral and Maxillofacial Surgery of Central South University. All patients (1,185 patients, 1,212 transferred flaps) underwent reconstructive surgery employing anterolateral thigh myocutaneous flaps. Basic information for all patients including defect side, flap size and type, recipient vessel processing method, donor complications, and postoperative quality of life were recorded and statistically analyzed.</p><p><b>RESULTS</b>Among the 1 212 transferred flaps, 1 176 survived and 36 showed necrosis, for a survival rate of about 97.0%. No cases presented with local serious complications, and 90% of patients achieved good functional recovery and aesthetically acceptable results after reconstruction of oral and maxillofacial defects at various locations using anterolateral thigh myocutaneous flaps. The time for anastomosis of one vein was significantly less than that for two veins (P=-0.000 3), which indicated one vein anastomosis could significantly reduce the operating time. The incidence of venous crisis, the survival rate after treatment, and the rate of venous crisis resulting in flap necrosis were comparable between the groups (P>0.05).</p><p><b>CONCLUSION</b>Anterolateral thigh myocutaneous flaps can be easily obtained and provide a good amount of muscle for filling dead space and fascia lata. These flaps can meet the various requirements of oral and maxillofacial defects. Therefore, the anterolateral thigh myocutaneous free flaps are more suitable for oral and maxillofacial defects than other flaps.</p>

Application of 909 anterolateral thigh myocutaneous flaps in the reconstruction of oral and maxillofacial defects / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To summarize the application of 909 anterolateral thigh myocutaneous flaps in the repair of oral and maxillofacial defects and to examine their benefits in maxillofacial reconstruction of these defects.</p><p><b>METHODS</b>Patients were recruited from January 2004 to December 2012 in the Department of Oral and Maxillofacial Surgery of the Second Xiangya Hospital of Central South University. All patients underwent reconstructive surgery with anterolateral thigh myocutaneous flaps, and patient age ranged from 19 to 81 years with a mean of 51.2 years. There were 761 flaps showing single lobe and 148 flaps showing a multi-island pedicle. The largest area among the single flaps was 28 cm × 12 cm, and the smallest was 4 cm × 2 cm.</p><p><b>RESULTS</b>Among the 909 transferred flaps, 882 survived and 27 showed necrosis, with a survival rate of about 97.0%. The common complications at flap donor site were poor wound healing 9.6% (87/909), localized paresthesia 61.0% (500/820), and altered quadriceps force 15.0% (123/820). No case was presented with local serious complications, and 90% of the patients achieved good functional recovery and aesthetically acceptable results after the reconstruction by anterolateral thigh myocutaneous flaps.</p><p><b>CONCLUSIONS</b>The anterolateral thigh myocutaneous free flaps are more suitable for oral and maxillofacial defects than other flaps and should be preferred.</p>

Whether free anterolateral thigh flaps are suitable for the elderly patients with oral cancer / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To identify the factors that were predictive of outcome and to determine the effect of age on perioperative complications.</p><p><b>METHODS</b>Reviewed the records of 1 100 consecutive patients who underwent anterolateral thigh flap free flap transfers for oral and maxillofacial cancer surgery defects between February 2002 and March 2013. All patients were divided into two groups: A group (< 60 years old) and B group (≥ 60 years old). Postoperative complications were analyzed from all patients.</p><p><b>RESULTS</b>There were 781 cases in A group and 319 in B group. The overall success rate was 97.2% (1 100/1 132) [97.3% (781/803) in A group, 97.0% (319/329) in B group, P > 0.05]. The overall complication rate was 27.5% (302/1 100) [25.9% (202/781) in A group, 31.3% (100/319) in B group, P = 0.064]. Multivariate Cox regression analyses revealed that American Society of Anesthesiologists (ASA) status (P < 0.001), operation time (P = 0.021) and comorbidity (P = 0.002) were the independent factor for the complication of patients. However, age (P > 0.05) was not an independent factor for the complication of patients.</p><p><b>CONCLUSIONS</b>Oral and maxillofacial reconstruction using anterolateral thigh flap free flaps in elderly patients can achieve similar outcomes as in younger patients. Controlling operative time is very important in reducing post-operative complications and improving the results of surgery.</p>

The clinical classification of sigle pedicled double island free anterolateral thigh flaps / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To summarize the anatomic characteristic of sigle pedicled double island free anterolateral thigh flaps and to evaluate its application and classification.</p><p><b>METHODS</b>Between January 2010 and March 2013, 76 patients underwent free femoral anterolateral double island flap reconstruction of the defects in oral and maxillofacial region. Summarized the anatomic features of perforators, such as the number and origin of the perforators.</p><p><b>RESULTS</b>According to the anatomic features and regularity of perforators, 76 cases of femoral anterolateral double island flaps were divided into 3 types: trunk type (type I), 15 cases (20%), in which the perforators of two flaps originated in descending branch and transverse branch of lateral femoral circumflex artery respectively; branch type (type II), 55 cases (72%), in which both the perforators originated in lateral femoral circumflex artery descending branch or lateral femoral circumflex artery transverse branch; bifurcation type (type III), 6 cases (8% ), in which two perforators originated in the two bifurcation of one perforator. Among the 76 cases, 75 survived and 1 showed partial necrosis.</p><p><b>CONCLUSIONS</b>According to the anatomic features and regularity of perforators, femoral anterolateral double island flaps can be divided into 3 types: trunk type (I type), branch type (II type), bifurcation type (III type).</p>

Jugular vein reconstruction by longitudinal constriction suture venoplasty and microvascular anastomosis / 华西口腔医学杂志

<p><b>OBJECTIVE</b>To seek a new method for reconstructing bilateral intemrnal jugular vein invaded by metastasis lymph node in advanced oral cancer patients.</p><p><b>METHODS</b>A combination of microvascular anastomosis and longitudinal constriction suture venoplasty was performed to reconstruct internal jugular vein. We resected the part of the bilateral internal jugular vein of advanced oral cancer patients invaded by metastasis lymph node and used the external carotid vein to reconstruct the internal jugular vein. A part of the vessel wall of the internal jugular vein could also be resected to reconstruct the vein. Longitudinal constriction suture venoplasty could slowly narrow the lumen diameter of the internal jugular vein. Thus, difference in anastomosis diameter should be avoided because it generates eddy currents and subsequently causes blood clots. A total of five advanced cases of oral squamous cell carcinoma were involved in this study. We performed bilateral radical neck dissection on all patients to reconstruct the internal jugular vein and observed their postoperative conditions.</p><p><b>RESULTS</b>Postopera-tive follow-up of 5 months to 19 months was performed on all patients. Doppler or CT angiography and related tests showed no internal jugular vein thrombosis. No patient with facial edema, throat swelling, cerebral edema, and high intracranial pressure or other serious complications caused by blocked venous blood was observed. The one-year survival rate of five patients was 60% (3/5).</p><p><b>CONCLUSION</b>Microvascular anastomosis combined with longitudinal constriction suture venoplasty is a new method for reconstructing internal jugular vein. This method was proved successful and clinically feasible.</p>

Preliminary study of cervical lymph node extracapsular spread direction of oral squamous cell carcinoma / 实用口腔医学杂志

Objective:To study the direction of cervical node extracapsular spread(ECS)of oral squamous cell carcinoma(OSCC). Methods:57 cases of OSCC were treated by combined radical operation.The relationship between ECS and T stage,tumor thick-ness,differentiation degree of OSCC,lymph node size and the ECS direction in each lymph node level were statistically analysed. Results:ECS was found in 30 of the 57 cases,and in 78 of the 174 metastasis positive lymph nodes.29 ECS nodes in levelⅠ,the frequency of the shallow side was 26,the deep side 13(P=0.000 3).But the difference in other levels was not statistically signifi-cant(P>0.05).It was not statistically significant between the incidence of ECS and T stage;it was statistically significant between the incidence of ECS and tumor thickness(P<0.05),tumor differentiation degree(P<0.05)and the lymph node size(P<0.01). Conclusion:ECS of OSCC on the shallow side is more than that in the deep side of lymph nodes in levelⅠ.ECS is positively corre-lated with the tumor thickness of OSCC,metastasied lymph node size;negatively related to the differentiation degree of OSCC.

Distribution features of surface stress on the bilateral condyles of the unilateral mandible model for 3 kinds of surgeries of temporomandibular joint ankylosis / 中南大学学报(医学版)

OBJECTIVE@#To determine the distribution features of surface stress on the bilateral condyles of the normal mandible and the unilateral mandible model for 3 kinds of surgeries of temporomandibular joint ankylosis under normal occlusal strength.@*METHODS@#The normal mandible 3-dimensional finite element model and the 3-dimensional finite element mandible model for 3 kinds of surgeries of unilateral temporomandibular joint ankylosis were built. The jaw triangle area and the condyle transverse ridge was fixed and bound at mid-point. And 100 N of load was applied to the first molars of the bilateral mandible to obtain a von Mises stress diagram of the condylar surface and the unit von Mises stress of the condylar surface. Statistical analysis was carried out.@*RESULTS@#The transmission of von Mises stress at the operated side of fractured articular arthroplasty of the condylar was interrupted. The von Mises stress at the operated side of the condylar in the group of point-surface contact joint reconstruction was bigger than that of the normal group (P0.05). The von Mises stress of the condylar at the non-operated side in the group of fractured articular arthroplasty was bigger than that of the normal group (P0.05).@*CONCLUSION@#The surface-surface articular reconstruction is beneficial to the recovery of the masticatory function without increasing the burden for contralateral temporomandibular joint and is helpful to the joint. Thus this surgical method is recommended.

Effects of cyclosporin A on the levels of intercellular adhesion molecule-1 expressed by oral fibroblasts / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To investigate the effects of cyclosporin A (CSA) on the level of intercellular adhesion molecule-1 (ICAM-1) expressed by oral fibroblasts (FB).</p><p><b>METHODS</b>The fibroblasts were obtained from normal buccal mucosa (NM-FB) and cultured in vitro. Then the levels of ICAM-1 expressed by fibroblasts incubated with or without CSA in the presence of 10% fetal calf serum for 48 hours at 37 degrees C in 5% CO(2) and air were monitored by using cell-based ELISA for ICAM-1.</p><p><b>RESULTS</b>We demonstrated that NM-FB had ICAM-1 expression (A = 0.324 +/- 0.030), and after 48 hours incubated with CSA the ICAM-1 levels expressed by oral buccal mucosa fibroblasts were dose-dependently decreased.</p><p><b>CONCLUSIONS</b>CSA reduces the levels of ICAM-1 expressed by oral mucosal FB, and may be useful in the treatment of some oral mucosal disorders.</p>

Clinical Evaluation of Dental CT and Three-dimensional Reconstruction Compared with Conventional Radiography in the Diagnosis of Molar Furcation Involvement / 中国医师杂志

Objective To evaluate the clinical diagnostic role of dental computed tomography (CT) and three-dimensional reconstruction (3DR) compared with conventional dental periapical radiography (DPR) in the diagnosis of molar furcation involvement (FI). Methods Dental CT and 3DR were performed about a maxillary first molar and its alveolar bone diagnosed as FI II? by conventional probe technique, and the images were compared with that of DPR. Results The images of dental CT scans and 3DR showed not only the area, type and quantity of periodontal destruction, but also the complex stereoscopic anatomical vision and ambient spatial relationship around the molar. Especially, the images displayed the alveolar destructions of the dental buccal and palate site that could not always be demonstrated by DPR. The degree of the molar FI was defined as III? in fact. Conclusion Dental CT and 3DR have many superiorities and value, which can not be replaced by DPR, in the clinical diagnosis and prognostic judgment of molar furcation involvement.

Autogenous Cranial Bone Grafts for Treating Oral and Maxillofacial Deformity / 中国医师杂志

Objective To evaluate the effect of the autogenous split-thickness cranial bone grafts on treatment of deformity of oral and maxillofacial regions. Methods The split-thickness cranial bone was harvested through the coronal incisions or the parietotemporal region incisions. The bone graft was then fashioned to the appropriate size and configuration and fixed to the regions of defects and deformities. The cranial bone was used to reconstruct facial bone framework or as sustaining bone graft for facial augmentation. Results 31 patients with the oral and maxillofacial deformities or bone defects were repaired with the cranial bone grafts, including 17 cases of orbital floor defects, 6 cases of malunion of the zygoma fractures, 5 cases of secondary deformity after ankylosis of temporomandibular joint, 2 cases of bone reconstruction after tumor resection and 1 case of cleft palate deformity. The followed-up period ranged from 6 months to 7 years, averaging 11 months. There were no complications of infection and extrusion, no obvious bone resorption was observed, and the facial appearance were greatly improved. Only one patient had a small ectropion which persisted three months. After six-month, the ectropion was not obvious. Conclusion Autogenous bone grafts used to reconstruct the defect and deformity of oral and maxillofacial regions can reduce the risks of infection and extrusion, and there is less visible scar and less bone resorption. Skull bone is an ideal source of bone graft material in the oral and maxillofacial deformity.

Speech outcomes of the obturator prostheses for maxillary defects / 实用口腔医学杂志

Objective:To evaluate speech outcomes following prosthetic obturation of maxillary defects.Methods:The speech intelligibility(SI)of 21 patients with maxillary defects with and without prostheses was measured postoperatively.In addition,the acoustic characteristics of vowels of 21 individuals were analyzed with and without an obturator in place by sound spectrograph.Results:Following the placement of maxillary obturator prostheses,there was significant improvement in SI.The mean SI score of the patients without and with the prosthesis was(23.2?7.4)% and(81.8?9.4)% respectively(P

Clinical Application and Preparation of Compound Cyclosprine Gargle / 中国药房

OBJECTIVE: A gargle was designed and prepared for treating immune inpairment and anaerobic infection of oral cavity .The method of its quantitative analysis was established and put into clinical use. METHODS: HPLC was used as the quantitative analysis method .The effect on oral lichen planus was clinically observed. RESULTS: The taste of the gargle was well acceptable, and its quality was well controlled.The cure rate for oral lichen planus was 96%. No adverse reactions were found. CONCLUSION: The taste and method of quantitative analysis are well acceptable. The clinical effect is satisfactory.

Effects of dexamethasone on proliferation and expression of intercellular adhension molecules by human oral fibroblasts / 中国免疫学杂志

Objective:Dexamethasone (DEX) has been proved to be an effective therapy for a variety of oral mucosal disorders, especially for oral submucous fibrosis(OSF) .The mechanisms behind its therapeutic effects are not known but have largely been ascribed to its anti proliferation and immunosuppressive effects. The recruitment, extravagation and retention of leucocytes which may play an important role in the development of oral mucosal disorders depends in part on the interaction of LFA 1 with its ligand intercellular adhension molecules(ICAM 1).The study aimed to investigate the effects of DEX on proliferation and expression of ICAM 1 by human oral fibroblasts (FB).Methods:The fibroblasts were obtained from normal buccal mucosa (NM FB) and OSF buccal mucosa (OSF FB) and cultured in vitro. Then the cell proliferation of fibroblasts incubated with or without DEX in the presence of 10%fetal calf serum for 48 hours at 37℃ in 5%CO 2 and air were monitored by use of thiazolyl blue (MTT) assay and the level of ICAM 1 expressed by fibroblasts were monitored by using cell based ELSA for ICAM 1.Results:OSF FB had an increased proliferation compared to NM FB and DEX inhibited fibroblast proliferation in a concentration dependent manner; OSF FB produced ICAM 1 at high levels and DEX decreased ICAM 1 expression levels on both cell types.Conclusion:DEX can directly inhibit human oral fibroblasts proliferation and reduces the levels of ICAM 1 expressed by oral mucosal FB, and may be useful in the treatment of some oral mucosal disorders.