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Jaw defects caused by various reasons often seriously affect appearance and function. The goal of the treatment of oral and maxillofacial tumors should include the cure of the tumor and the restoration of premorbid function. The development of microsurgery and digital surgery technology has promoted the development of jaw reconstruction with vascularized free bone flap. Good appearance and improved predictability could be obtained with the help of preope-rative visual design. How to rehabilitate occlusal function on the reconstructed jaw and improve the quality of life of patients has become an important research direction. This article discusses the challenge of jaw reconstruction, the selection of vascularized bone flap, the choice of implant timing, the treatment of peri-implant soft tissue, and the influence of radiotherapy on implants after jaw reconstruction.
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Humans , Dental Implants , Plastic Surgery Procedures , Free Tissue Flaps/surgery , Quality of Life , Dental Implantation, Endosseous , Fibula/surgery , Bone Transplantation , Mandibular ReconstructionABSTRACT
Objective:To explore an early mobilization plan for oral cancer patients after free flap reconstruction and evaluate the application effect of the plan.Methods:This study was a prospective randomized controlled trial. A total of 173 patients undergoing free flap reconstruction surgery from December 2018 to December 2021 in the second ward of Peking University School and Hospital of Stomatology were selected. The patients were randomly divided into the control group (87 cases) and the intervention group (86 cases) by cluster randomized grouping. The control group received the routine nursing plan, that was, head immobilization for 4 days after surgery, and patients performed sat up and off-bed activity on the 5th day. The intervention group received the early mobilization plan, that was, patients sat up on the 2nd day after surgery and performed off-bed activity on the 3rd day. The incidence of vascular compromise, postoperative complications, sleep time in the first 5 days after surgery, catheter removal time, hospitalization duration and expenses were compared between the two groups.Results:The incidence of postoperative pulmonary infection, the daily sleep time in the first 5 days after surgery, the time for removing nasogastric tube, trachea cannula, and urinary catheter were 7.0%(6/86), (5.0 ± 1.0) h/d, (11.8 ± 7.3) d, (6.1 ± 3.2) d, (3.6 ± 0.6) d in the intervention group, and 13.8%(12/87), (4.4 ± 1.3) h/d, (14.2 ± 5.8) d, (7.3 ± 1.7) d, (4.0 ± 0.9) d in the control group, all differences were statistically significant ( χ2 = 3.89, t values were -3.57 - -2.44, all P<0.05). There was no significant difference in the incidence of rascular compromise, hospitalization duration and expenses between the two groups (all P>0.05). Conclusions:For patients undergoing free tissue flap reconstruction, it is safe to sit up on the 2nd day and get out of bed on the 3rd day, which can reduce the incidence of pulmonary infection, improve patient sleep, and shorten the indwelling time of nasogastric tube, trachea cannula and urinary catheter.
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Facial paralysis causes both physical pain and psychological distress to patients. It is difficult for a patient with facial paralysis to engage with a normal social life and at work. Progresses have been made in recent years in the treatment of facial paralysis. More attentions have been caught by masseteric to facial nerve transposition, which has advantages of adjacency in location, abundancy in nerve supply and reliability in the outcome and now has deemed an important option of facial reanimation. It has not been long since the application of the technique of masseteric to facial nerve transposition in China, therefore it still lacks a universal guidance on practice. In order to achieve the aim of better quality control and popularisation of the technique, hereby a consensus with suggestions on facial reanimation with masseteric to facial nerve transposition is proposed as the reference for surgeons specialised in facial reanimation. This consensus is proposed, discussed and drafted by experts from plastic and reconstructive surgery, oral and maxillofacial surgery, head and neck surgery and neurosurgery.
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Objective:To study the change of mandibular morphology in image navigation guided mandibular reconstruction surgery and the influence of the methods for mandibular defect location and registration.Methods:Forty-one cases were included from August, 2011 to October, 2019. Specific anatomical landmarks were marked on the preoperative and postoperative 3D CT images, and the morphological changes of navigation-assisted mandibular reconstruction were recorded. Different groups were divided according to the reconstruction side and the non-reconstruction side of the mandible, whether the defect included the condyle and the registration method, then the 3D morphological changes of the mandible were compared, and the influencing factors were studied. Data was analyzed by independent t-test, and the difference was considered as statistically significant if P<0.05. Results:The mean value of 3D morphological changes of mandible ranged from 1.710 to 4.977 mm. When the condyle was involved in the mandibular defect, the change of 3D morphology [(1.671-5.587) mm] was greater than that when the condyle was not involved in a defect [(1.346-4.358) mm]. The difference of width of mandibular angle and medial distance and lateral distance of condyle was statistically significant ( P<0.05). In the navigation-assisted mandibular reconstruction, the accuracy of mandibular condyle and the length of mandible on non-reconstructed side in the group of bone-implanted fiducial marker registration was better than that in the surface registration ( P<0.05), and there was no significant statistical difference in other indexes. Conclusion:The image navigation guided mandibular reconstruction surgery can accurately restore the 3D configuration of mandible. When the mandibular defect involving condylar can significantly reduce the mandibular reconstruction accuracy, the fiducial maker registration is superior to the surface registration in the reconstruction of mandibular condyle.
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Objective To confirm the sensitivity and validity of near-infrared spectroscopy (NIRS) technology to detect the dynamic changes of blood volume and regional tissue oxygen saturation (rSO2).Methods Six fibular flaps on Rhesus monkeys were raised simulating a clinical operation.Third generation of NIRS oxygen saturation oximeter (TSAH-100) was employed on Rhesus monkeys' fibular flaps when its dominant artery and vein were blocked respectively or simultaneously,and then their relative changes of blood volume and oxygen saturation were observed and recorded in June,2008 to October,2008.Results The statistic results showed that concentration of deoxygenated hemoglobin (cHb),concentration of oxyhe moglobin (cHbO2) and rSO2 had rapid,apparent and distinct changes respectively in the case of arterial occlusion,venous occlusion and total occlusion.The initial values of cHb and cHbO2 of 3 models were 0 μmol/L.Meanwhile,the initial values of rSO2 in artery embolism,vein embolism and arteriovenous embolism were 51.6％,54.3％ and 56.8％,respectively.The maximum variations of cHb,cHbO2 and rSO2 in 3 models indicated significant difference compared with initial values (P＜0.05),the values of rSO2 after 6 s,18 s and 8 s in 3 models had significant difference compared with initial values respectively(P＜0.05).Conclusion The TSAH-100 based on NIRS technology is an extraordinarily sensitive and reliable method to monitor the changes of oxygen saturation and blood perfusion in local tissue for buried flap within a depth of 2.0 cm.
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The present study aimed to research pathogenesis and therapeutics of hepatocellular carcinoma (HCC) with the method of tissue metabolomics.A combined gas chromatography-mass spectrometry (GC-MS) method was developed suitable for analyzing the endogenous small molecule of liver cancer tissues and adjacent tissues.The unidimensional and multidimensional statistics were used to look for differential metabolites.And then,the KEGG and HMDB database were utilized to find related differential pathways and pathogenesis of HCC.The PCA and PLS-DA showed that there were significant differences on the endogenous small molecule of liver cancer tissues and adjacent tissues.Through the OPLS-Loading plot analysis,there were 25 differential metabolites and 36 relevant pathways.The differential pathways belong to carbohydrate metabolism,amino acid metabolism and mitochondrial transfer.There were 16 metabolites' area under the ROC curve which was bigger than 0.8,which were related with ATP-binding cassette (ABC) transporters,galactose metabolism,amino sugar and nucleotide sugar metabolism.It was concluded that the Warburg effect exists in HCC cells.The energy of HCC cell was from glycolytic function,because the glycolysis was enhanced and the citric acid cycle decreased.Mitochondrial dysfunction and the increased cobalt content may correlate with the Warburg effect,which may be one of the pathogenesis of liver cancer,and expected to become the breakthrough point of a new targeting therapeutic approach.
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As the most downstream of biology information current,metabolism has the special function of information delivery.Work principle and disease mechanism of brain can be better reflected based on the combination of metabolism and gene,transcription,protein and nervous system.At present,there are many reports regarding metabolomics research in the brain to explore the diseases' effect on brain metabolism.Combined with precision medicine,precision application of metabolomics technology in brain diseases was reviewed in this paper.
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The essence of precision medicine (PM) is to find the disease pathogenesis,mechanism and treatment targets through large sample population and specific disease type of biomarker exploring,quantitative analysis,verifying and application.Metabolomics,as one of the technologies testing the metabolites in vivo,can be used to predict the level of metabolites in vivo and to diagnose the physiological state of the body in time for guiding the corresponding intervention.This article summarized the application of metabonomics in the precise diagnosis,pathogenesis and treatment of cardiovascular disease.
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Objective To evaluate the efficiency and functional improvement of masseter-to-facial nerve transfer for patients who acquired a proximal iniury to the facial nerve and preliminary determine the influence factors for recovery.Methods From January,2015 to May,2016,the clinical data of 6 patients with facial paralysis underwent nerve anastomosis were analyzed retrospectively.These patients were required to come back to the hospital for a check every 3 months,in order to evaluate their facial nerve function.House-Brackmnann(H-B)grading was used to evaluate the pre-oerative,post-operative and follow-up status.The masseter-to-facial nerve anastomosis was performed in all the 6 patients.Results All patients were followed-up.The mean time of follow-up was 16 months (ranged from 6 to 23 months).Among 6 cases,the facial nerve function was improved in 5 cases,unchanged in 1 case.The postoperative H-B grades were Ⅱ in 3 cases,Ⅲ in 2 cases.The improvement of facial paralysis was most significant for orbicularis muscles,followed by the orbicularis oculi muscles,and the worst was the improvement of frontal muscles.Conclusion Masseter-to-facial nerve transfer anatomosis is a useful treatment for facial paralysis and can improve the facial function.
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Objective To explore the correlation between the elder brain atrophy and calcification score at siphon segment of internal carotid artery.Methods The brain CT examination was detected in 327 elders.The brain atrophy occurrence were observed, and the calcification score at siphon segment of internal carotid artery were determined and calculated.Accroding to the calcification score, all the cases were divided into calcification 0 score group, calcification 1-199 score group, calcification 200-399 score group, calcification 400-599 score group and calcification ≥600 score group.The situation of brain atrophy were compared among these groups.And the correlation between the brain atrophy and calcification score were analyzed.Results Accroding to the calcification score, there were 63 cases in calcification 0 score group, 133 cases in calcification 1-199 score group, 72 cases in calcification 200-399 score group, 28 cases in calcification 400-599 score group and 31 cases in calcification ≥600 score group.There were 13 cases ( 20.63%) of brain atrophy in calcification 0 score group, 64 cases (48.12%) in calcification 1 -199 score group, 51 cases (70.83%) in calcification 200 -399 score group, 23 cases (82.14%) in calcification 400-599 score group and 28 cases (90.32%) in calcification≥600 score group;the differences of the brain atrophy rate among these groups were statistical significant ( all P<0.05 ) .The brain atrophy was mainly mild-moderate in calcification 0 score group and calcification 1 -199 score group;which was mainly severe in calcification 200 -399 score group;and mainly moderate-severe in calcification 400 -599 score group and calcification≥600 score group (all P<0.05).Spearman rank correlation analysis showed that the degree of brain atrophy were positive correlated with calcification score at siphon segment of internal carotid artery ( r=0.717, P<0.05) .Conclusions The elder brain atrophy is significantly correlated with calcification score at siphon segment of internal carotid artery.The calcification score higher, the brain atrophy rate higher and the degree more severe.Calcification score can be used as an important indicator of the elder brain atrophy.
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Objective To describe the clinical application of microvascular anastomotic device in head and neck reconstruction.Methods From July,2013 to November,2013,microvascular free flaps were transferred to reconstruct the defects simultaneously after tumor resection of head and neck region in 12 cases in Department of Oral and Maxillofacial Surgery,Peking University School of Stomatology.Microvascular anastomotic coupling devices (MACD) were used in vascular anastomosis.The clinical data were collected and analyzed,including the selection of free flap,diameter of donor and recipient vessels,type of MACD,time of anastomosis,instant patency of anastomosis.The flap was monitored closely after operation and the final survival rate was calculated.Results Twelve microvascular free flaps were done in this series,including 6 fibula flaps,4 forearm flaps and 2 anterolateral thigh flaps.Totally 17 MACD were used by end-to-end anastomosis in this series,including 5 arterial anastomosis and 12 venous anastomosis.The anastomose time using MACD was from 4 to 10 minutes,with a median time 6.8 minutes.The instant patency rate of anastomosis was 100％.There were some blood leakages near the anastomotic stoma in 1 arterial anastomosis using MACD.It was resolved successfully by changing a new MACD.Conclusion Our primary clinical experience showed that the MACD was well suited to the microvascular reconstruction of head and neck defect.The feasibility and reliability was confirmed by our clinical cases.It should be recommended as a safe,fast and reliable adjuvant anastomotic instrument for free tissue transfer.
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<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>
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Humans , Bisphosphonate-Associated Osteonecrosis of the Jaw , Pathology , Therapeutics , Bone Density Conservation Agents , Diphosphonates , Glucocorticoids , Mandible , Maxilla , Osteoporosis , Retrospective Studies , Tooth Extraction , Wound HealingABSTRACT
<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
Objective To explore the treatment of acquired benign tracheoesophageal fistula.Methods Clinical data of 13 cases of acquired benign tracheoesophageal fistula were retrospectively studied and the related literature was reviewed.The physical conditions,locations of fistula and risk factors of the patients were assessed before surgery.A specific surgical protocol was determined for each individual patient using either radical surgery or palliative surgery to repair the fistula.Ten patients underwent radical surgery,including suture closure of the esophageal or tracheal defects only in 7 patients and segmental tracheal reseetion in 3 patients.The remaining 3 patients underwent palliative operation.Results No major complication was observed except pulmonary infectin in 2 patients.No patient died during the perioperative period.All but one patient who treated with mediastinal and neck radiation therapy 4 years ago were able to resume oral food three months after operation.All patients were followed up for 8 months to 73 months[mean (39.6 ± 19.7) months]and no fistulas were occurred in the patients who received a radical surgery.The tracheoesophageal fistula orifices became smaller or closed fairly well in the patients who underwent a palliative surgery.Conclusion Surgery is the treatment of choice for acquired benign tracheoesophageal fistula.Airway and esophagal stent placement is not recommended.Adequate drainage of gastric juice is a crucial step in the management of the condition.
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Objective To study the influence of 125I seed interstitial brachytherapy in parotid region on the recovery of facial nerve function. Methods A total of the data of 21 patients with primary parotid carcinoma were treated with resection and 125I interstitial brachytherapy. All the patients had no facial palsy before operation and the prescribed dose was 60 Gy. During 4 years of follow-up, the HouseBrackmann grading scales and ENoG were used to evaluate the function of facial nerve. According to the modified regional House-Brackmann grading scales, the facial nerve branches of patients in affected side were divided into normal and abnormal groups, and were compared with those in contra-lateral side.Results Post-operation facial palsy occurred in all the patients, but the facial palsy recovered within 6 months. The latency time differences between affected side and contralateral side were statistically significant in abnormal group from 1 week to 6 months after treatment ( t = 2.362, P = 0.028 ), and were also different in normal group 1 week after treatment ( t = 2.522, P = 0.027 ). Conclusions 125I interstitial brachytherapy has no influence on recovery of facial nerve function after tumor resection and no delayed facial nerve damage.
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Objective To develop a new method for correction of the deformity of the complete bilateral cleft lip with short pre-lip. Methods Two specimens with the complete bilateral cleft lip was chosen to investigate the arterial supply to the pre-lip. The arteries were observed by radiography when the specimen was infused with lead oxide. 16 patients with the complete bilateral cleft lip and shortage in the length of pre-lip were enrolled in this study. Taking advantage of the unique character of arterial supply of complete bilateral cleft lip, those with short pre-lip were corrected. Photos of them were taken when preand post-operation for further measurement. And more than 1 year following-up was conducted to judge if the results were good enough or not. 30 babies were chosen as a control group to confirm the results of surgury objectively. Results Post nasal septal arteries were found to supply the pre-lip of the bilateral complete cleft lip. Appearance of 16 patients was good after surgery or 1 years later. There was no statistical significant difference between the patients and control group in the measurement data but nasal-lip angle. Conclusion It is an effective way to correct deformity of the bilateral cleft lip with short pre-lip by taking advantage of post nasal septal arterie's flap.
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<p><b>OBJECTIVE</b>To summarize operation key points, prevention and management of complications in vascularized autotransplantation of submandibular gland for treatment of severe keratoconjunctivitis sicca.</p><p><b>METHODS</b>23 patients with severe keratoconjunctivitis sicca were treated by this procedure. Postoperative (99m)Tc images, follow-up studies, and management of complications were performed.</p><p><b>RESULTS</b>The transplantations were successful in 19 cases, whose symptoms of xerophthalmia disappeared. The patients could stop applying artificial tears. In 4 patients the transplanted glands did not survive. Epiphora occurred in 5 cases. They were successfully treated by reducing the size of the graft. Obstruction of the Wharton's duct took place in one case and was treated by reconstructing the duct. When the superficial temporal vein was too small, venous bridging was applied. To select a relevant vein for anastomosis, blood oozing from the three veins was carefully inspected prior cutting off the gland when the external maxillary artery was preserved and was infused with heparin after the gland had been freed.</p><p><b>CONCLUSIONS</b>If every point has been properly managed, the successful rate of operation could be warranted.</p>
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Adolescent , Adult , Child , Female , Humans , Male , Middle Aged , Keratoconjunctivitis Sicca , General Surgery , Postoperative Complications , Submandibular Gland , Transplantation , Transplantation, Autologous , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To analyze the value of preoperative routine donor leg angiography in free fibula flaps.</p><p><b>METHODS</b>Eighty-nine consecutive potential candidates for free fibula reconstruction were reviewed. They were further divided into two groups, group one received preoperative routine donor leg angiography, group two received only preoperative evaluation of dorsalis pedis and tibial posterior artery and without angiography.</p><p><b>RESULTS</b>There were 49 patients in group one and 40 patients in group two. In group one, the results of preoperative angiography resulted in a change of the surgical plan in two patients. In group two, all the patients showed normal dorsilis pedis and tibial posterior artery, and fibula flap was harvested without preoperative angiography. One patient in each group showed venous deformity during the operation, and flap harvesting was abandoned.</p><p><b>CONCLUSIONS</b>Routine preoperative angiography in free fibula flap is unnecessary. The following three conditions that require an angiography are: abnormal pedal pulses, significant previous lower leg trauma, and suspected vascular diseases.</p>
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Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle Aged , Angiography , Fibula , Leg , Preoperative Care , Surgical FlapsABSTRACT
砄bjective: To explore an effective method for Electroneurography(ENoG) of facial nerve. Methods: ENoG of 114 normal subjets and 69 patients with traumatic facial nerve injuries were investigated. Latency time(LT), duration time(DT), amplitude(A) and square under the curve(S) were measured in facial muscles when facial nerve was stimulated postauricularly or anteroauricularly. Results: In most facial musles except square muscle of lower lip postauricular stimulation gave longer LT, shorter DT, lower A and smaller S. Conclusion: The postauricular stimulation is effective prior to anteroauricular stimulation for electroneurography of the facial nerve.
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Objective: To study the relationship between the congenital cleft palate and development of the nasal capsule and nasal septum. Methods: 30 pairs of NMIR fetal mouse at the embryo age of 16～17 days were used.In each pair there was one euploid mouse without cleft palate and one trisomy 18 mouse with cleft palate.Sixty maxillae were precisely orientated in the coronal plane and serially sectioned at 7 ?m thickness. With the aid of computer imaging analysis system the width,height and area of the nasal capsule, nasal septum and cartilage of nasal septum were measured and compared quantitatively between the cleft group and non-cleft group. Results: The values of height and area of the nasal capsule, nasal septum and cartilage of nasal septum in cleft foetuses were smaller than those in non-cleft foetuses (P