Clinical analysis of selective tracheostomy necessary for patients undergoing head and neck surgery with free flap reconstruction / 北京大学学报(医学版)

OBJECTIVE@#To discover the factors that may affect the use of selective tracheostomy among patients who have undergone head and neck surgeries with free flap reconstruction, so that the patients will not need tracheostomy nor receive the unnecessary treatment.@*METHODS@#Five hundred and thirty-three patients who had undergone head and neck surgery with free flap reconstruction operated by the same team of surgery at Department of Oral and Maxillofacial Surgery at Peking University School of Stomatology from 2015 to 2016 were reviewed. Three hundred and twenty-one (60.2%) of these patients underwent selective tracheostomy. All the patients' demographic information, operation-related information, prior treatments, comorbidities and complications were recorded and analyzed.@*RESULTS@#The patients with defects of the tongue, mouth floor, oropharynx and bilateral mandible, who underwent neck dissection and with previous radiotherapy and smoking habit were more likely to get selective tracheostomy. Usage of bulky soft tissue flap might also add to the risk of airway obstruction and the need of selective tracheostomy, while other factors were not significantly related to the risk of postoperative airway obstruction and the patients could be kept safe without selective tracheostomy. Most cases without tracheostomy were kept safe except one case, while 8.39% of the patients with tracheostomy suffered from tracheostomy related complications, mainly pneumonia and hemorrhage of the tracheostomy wound, yet none led to serious consequences or even death.@*CONCLUSION@#Selective tracheostomy is not necessary for patients who have undergone head and neck surgeries with free flap reconstruction except that there are defects at the tongue, oropharynx and mandible. Neck dissection, bulky soft tissue flap reconstruction, previous radiotherapy and smoking habit may also add to the risk of postoperative airway obstruction, while a favorable decision would involve a combination of all the above factors to assure the safety of the postoperative airway for the patients undergone head and neck surgeries with free flap reconstruction.

Multimodal image fusion technology for diagnosis and treatment of the skull base-infratemporal tumors / 北京大学学报(医学版)

OBJECTIVE@#To explore the value of incorporated multimodal image fusion technology with computer-aided design of the skull base-infratemporal tumor treatment.@*METHODS@#A retrospective study was carried out to enroll seventeen patients with skull base-infratemporal tumors treated at Peking University Hospital of Stomatology from February 2011 to September 2018. Plain CT, enhanced CT and MRI data were imported into the iPlan 3.0 software (BrainLab navigation system), and the image fusion was performed for each patient preoperatively. Then the three-dimensional images of the tumor, vital vessels and craniofacial bones were reconstructed to prepare virtual operation design. We evaluated the application of multimodal image fusion technology that had been incorporated with computer-aided planning during the navigation-guided biopsy or surgery, through the analysis of the biopsy and operation data and regular follow-up postoperatively.@*RESULTS@#The mean age of 17 patients (7 males and 10 females) was 46 years. Primary tumors occurred in 11 cases, and recurrent tumors in 6 cases. The size of the 17 tumors ranged from 2.9 cm to 9 cm, and the mean size was 4.35 cm. There were 7 cases with skull base bone destruction and/or intracranial extension, and 10 cases with tumors adjacent to the skull base. High-quality multimodal fused images were obtained in all the 17 cases. The spatial-position relationships of the tumors, adjacent craniomaxillofacial bones and vital vessels labeled with different colors were displayed well on the generated fusion images. The multimodal image fusion technology that incorporated with computer-aided three-dimensional reconstruction and then applied in navigation-guided biopsy or surgery showed that, preoperative analysis and virtual operation design functioned with good results, especially in cases with small tumor size, recurrence or illdefined borders in the skull base-infratemporal region. Operation was carried out in 16 cases after preoperative diagnosis and assessment, and 1 case was performed by navigation-guided biopsy only. The proportions of navigation-guided surgery and biopsy were 70.6% (12/17) and 17.6% (3/17) individually. The positive rate of pathologic diagnosis using navigation-guided biopsy was 100% (3/3). All the navigation-guided biopsies or operations were carried out successfully. Complications included 1 case of cerebrospinal fluid leak from a recurred meningioma patient postoperatively, and 1 case of facial paralysis resulting from parotid-gland deep lobe tumor. Most (14/15) tumors got complete removal with safe boundary through intra-operative navigation verification and post-operative imaging confirmation, except for one case of subtotal resection to avoid the injury of cavernous sinus. The pathological results of the tumors could be classified to mesenchymal (10), adenogenous (3), neurogenic (3) or epithelial (1) resources. The follow-up time ranged from 3 to 94 months, with the median follow-up time of 9 months.@*CONCLUSION@#Taking full advantages of individualized multimodal images, could help analyze the three-dimensional spatial position relationship of tumors, vital vessels and craniofacial bones properly, and then complete the virtual operation design well. The incorporated multimodal image fusion technology with navigation technology may improve the accuracy and safety of core needle biopsy and surgical treatment of skull base-infratemporal tumors.

Comorbidity in oral squamous cell carcinoma patients: an initial research in Beijing area / 中华口腔医学杂志

Objective@#To make a preliminery research of comobidity in oral squamous cell carcinoma (OSCC) patients who resides in Beijing area and investigate whether comorbidity affect the surviving rate independently. Compare the similarities and differences between Chinese and foreign OSCC patients.@*Methods@#The medical records of 313 patients who undertaken operation in Peking University Stomatology School from January 2007 to Delember 2009 were retrospectively reviewed. Adult comorbidity evaluation-27 Chinese edition index was used to estimate the comorbidity severity. COX proportional hazards model was used to analyze whether the TNM stage, comobidity, age and gender affected 5-year survival rate.@*Results@#TNM stage and comorbidity have a significant impact on survival rate, the postoperative survival rate decreased significantly with the increasing level of TNM staging and the complexity of comorbidity disease. In this study, the proportion of patients with none, mild, moderate and severe comorbidity diseases was 24%, 48%, 18% and 10%. The five-year survival rates of patients with moderate and severe comorbidity disease were 50% (29/58) and 13% (4/30) respectively.@*Conclusions@#The comorbidity disease information can help assess the overall health of OSCC patients, and it is recommended to improve the clinical staging and overall evaluation of oral cancer patients with comorbidity disease information.

Comparison of the subjective satisfaction of free radial forearm flap and anterolateral thigh flap for the donor site after surgical reconstruction in tongue cancer patients / 天津医药

Objective To compare the subjective satisfaction of the free radial forearm flap (FRFF) and anterolateral thigh flap (ALTF) of the donor site after surgical reconstruction for tongue cancer. Methods A total of 121 consecutive patients underwent FRFF or ALTF reconstruction after ablative surgery for untreated, primary tongue squamous cell carcinoma at Tianjin Stomatological Hospital and Peking University School and Hospital of Stomatology from August 2011 to October 2014 were enrolled in this study. The subjective satisfaction of the donor site, including sensibility, movement disabilities, cosmetics, social activities and general impacts on the quality of life (QOL), was assessed by a self-established donor site morbidity questionnaire from October 2016 to January 2017. Results Of the 121 patients, 34 died because of cancer or other diseases, 2 were excluded because of recurrence after reconstruction surgery, 11 lost to contact, and 74 (61.2％) completed the questionnaires finally, which included 39 patients in FRFF group and 35 patients in ALTF group. The scores for sensibility, cosmetics, general impacts on the QOL and composite score were significantly higher in ALTF group than those of FRFF group (P<0.05). No significant differences were found in the movement disabilities and social activities between the two groups (P > 0.05). Conclusion ALTF has the advantage of better results of donor site morbidity, less adverse effect on the general QOL, and higher subjective satisfaction.

Surgical reconstruction of maxillary defects using computer-assisted techniques / 北京大学学报(医学版)

The maxilla is the most important bony support of the mid-face skeleton and is critical for both esthetics and function.Maxillary defects,resulting from tumor resection,can cause severe functional and cosmetic deformities.Furthermore,maxillary reconstruction presents a great challenge for oral and maxillofacial surgeons.Nowadays,vascularized composite bone flap transfer has been widely used for functional maxillary reconstruction.In the last decade,we have performed a comprehensive research on functional maxillary reconstruction with free fibula flap and reported excellent functional and acceptable esthetic results.However,this experience based clinical procedure still remainssome problems in accuracy and efficiency.In recent years,computer assisted techniques are now widely used in oral and maxillofacial surgery.We have performed a series of study on maxillary reconstruction with computer assisted techniques.The computer assisted techniques used for maxillary reconstruction mainly include:(1) Three dimensional (3 D) reconstruction and tumor mapping:providing a 3 D view of maxillary tumor and adjacent structures and helping to make the diagnosis of maxillary tumor accurate and objective;(2) Virtual planning:simulating tumor resection and maxillectomy as well as fibula reconstruction on the computer,so that to make an ideal surgical plan;(3) 3D printing:producing a 3D stereo model for prebending individualized titanium mesh and also providing template or cutting guide for the surgery;(4) Surgical navigation:the bridge between virtual plan and real surgery,confirming the virtual plan during the surgery and guarantee the accuracy;(5) Computer assisted analyzing and evaluating:making a quantitative and objective of the final result and evaluating the outcome.We also performed a series of studies to evaluate the application of computer assisted techniques used for maxillary reconstruction,including:(1)3D tumor mapping technique for accurate diagnosis and treatment of maxillary tumor;(2) Maxillary reconstruction with free fibula flap used computer assisted techniques;(3) Computer assisted orbital floor reconstruction after maxillectomy.The results suggested that computer assisted techniques could significantly improve the clinical outcome of maxillary reconstruction.

Clinical analysis of cervical lymph node metastasis of cN0 maxillary malignant tumor / 北京大学学报(医学版)

Objective:To investigate the cervical lymphatic metastasis rates of clinically negative neck lymph node (cN0) maxillary malignant tumors,to compare the cervical lymphatic metastasis rates of the various pathological types,and to provide the reference for the treatment of the neck of the patients with cN0 maxillary malignant tumor.Methods:The clinical data of 277 cases with cN0 maxillary malignant tumor,treated in the department of oral and maxillofacial surgery of Peking University School and Hospital of Stomatology from 1990 to 2010,were reviewed.The cervical lymph node metastasis and the related clinical information were recorded.The clinical information including histopathology type of the tumors,tumor grade,primary site and TNM staging,as well as other demographic and clinical data,were retrieved from the electronic medical record system (EMRS) of the hospital.The pathogenesis of cervical lymph node metastasis in maxillary malignant tumors of different histopathological types,and the factors related to lymph node metastasis of upper cervical malignancy were analyzed by SPSS 19.0 statistical software.Results:The overall cervical lymph node metastasis rate of the 277 patients with cN0 maxillary malignant tumor was 15.5％ (43/277).Maxillary squamous cell carcinoma (SCC) had a strong cervical lymph node metastasis tendency and the rate was 33.0％.The overall metastatic rate of adenocarcinoma was 7.6％ lower than that of SCC,and the occurrence of cervical lymph node metastasis time was relatively late,but the metastasis rate of highly malignant grade salivary gland carcinoma was significantly higher than that of intermediate and low grade carcinoma (P =0.037).The metastatic rates of some highly malignant cN0 salivary gland carcinomas including adenocarcinoma,not other specified,high-grade mucoepidermoid carcinoma (MEC),and salivary duct carcinoma were exceeded 15％,while the metastasis rates of adenoid cystic carcinoma and myoepithelial carcinoma were lower.The metastasis rate of the sarcomas was very low with the rate of 4.9％.Conclusion:Selective neck dissection (SND) is recommended for cN0 maxillary SCC and feasible for some highly malignant cN0 salivary gland carcinomas including adenocarcinoma,not other specified,high-grade MEC,salivary duct carcinoma.The neck can be closely observed for the patients with maxillary sarcoma.

Clinical features of osteonecrosis of jaws after bisphosphonates therapy for bone me-tastasis of breast cancer / 北京大学学报(医学版)

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.

Simplified head and neck reconstructive microsurgical techniques and their clinical applications / 中国耳鼻咽喉头颈外科

[ABSTRACT]OBJETIVETo analyze the reliability and safety of our simplified microsurgical techniques in head and neck reconstruction.METHODSA total of 3045 consecutive cases of free flap transferred in the head and neck region from May 1999 to May 2015 were reviewed. Data concerning the operation included the date of surgery, defect description and site, stage and histology of tumor, type of free flap, recipient vessel and complications.RESULTSOf the 3045 cases, 1856 were males, and 1189 were females. The age ranged from 5 to 86 years, with the average of 47.8 years. Among the 3045 cases, 2868 were tumor-related defects reconstructions, and 2653 were one stage reconstructions. The overall success rate of free flap was 98.5%. The vessel thrombosis rate was 2.9%, and the flap salvage rate was 48.9%.CONCLUSIONOur microsurgery technique greatly simplified traditional microsurgical technique. Head and neck reconstruction using this technique is very safe and reliable, and needs further clinical applications.

Positive lymph node ratio is an important prognostic factor of oral squamous cell carcinoma / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To investigate the cutoff value and significance of lymph node ratio (LNR) in oral squamous cell carcinoma.</p><p><b>METHODS</b>This retrospective study included 286 patients with oral cancer and pathological positive lymph nodes. Used time-dependent receiver operating characteristic (ROC) curves to determine which LNR best defines different risk groups of oral squamous cell carcinoma (OSCC) patients. All the variables were subjected to the univariate analysis, then only the variables that had prognostic potential were subjected to multivariate analysis by the COX proportional hazards regression model.</p><p><b>RESULTS</b>The cutoff value of LNR was 0.092. When LNR was greater than 0.092, the overall survival rate was 24.2%, when LNR was less than 0.092, the overall survival rate was 45.8% (P<0.05).</p><p><b>CONCLUSIONS</b>Lymph node ratio is a predictor of outcome in patients with oral squamous cell carcinoma, and the cutoff value is 0.092.</p>

Free submental flap for defects reconstruction after oral cancer ablation / 中华显微外科杂志

Objective To investigate the clinical application of free submental flap for defects reconstruction after oral cancer ablation.Methods Eleven cases of free submental flaps for defects reconstruction after oral cancer ablation from April,2013 to May,2014 were reviewed.The primary disease,defect type,flap side,flap size and flap survival rate were recorded.The follow-up data of tumor recurrence,lymph node metastasis,as well as postoperative facial appearance and function of marginal mandibular branch of facial nerve were collected.Results Primary disease of all 11 cases was oral squamous cell carcinoma.No flap failure was reported and the overall flap survived.The follow-up period was 6-18 months with the average of 9 months.There was no tumor recurrence and metastasis of lymph node.Postoperative facial appearance was satisfactory and there was no nerve injury of marginal mandibular branch which showed normal and symmetrical expression motion.Conclusion Free submental flap owns many ad vantages including constant anatomy,long vascular pedicle,wide range of indications and low donor-site morbidity.Contralater submental flap may avoid potential lymph node metastasis.Free submentai flaps is an ideal choice for reconstruction of oral and maxillofacial defects after cancer ablation.

Classification and reconstruction of 1 107 cases of maxillary defects / 北京大学学报(医学版)

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.

Application of three-dimensional tumor mapping technique in diagnosis and treatment of malignant maxillary cancer / 中华耳鼻咽喉头颈外科杂志

<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>

Submental island pedicled flap combination with bio-membrane for reconstructing the piercing palate defects / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the clinical outcomes of submental island pedicled flap (SIPF) combination with bio-membrane in reconstructing palate defects after maxillofacial or palatal neoplasm resection.</p><p><b>METHODS</b>There were 12 patients with squamous cell carcinoma and one patient with adenoid cystic carcinoma. The clinical stages of tumours were II in two patients, III in four patients, IV in six patients (UICC 2002), and one patient with adenoid cystic carcinoma no staged. SIPFs were designed and created, and the tissue sides of the SIPFs were covered with bio-membrane to reconstruct the oral and the nasal sides of the defects respectively. Speech and swallowing functions and opening mouth were evaluated 6 months postoperatively.</p><p><b>RESULTS</b>All flaps survived and no serious complications occurred. Ten patients achieved normal speech, two had intelligible speech, and one was with slurred speech; Nine patients resumed a solid diet, three with a soft diet, and one on a liquid diet. Eight patients recovered normal mouth opening, four emerged minor limitation of mouth opening, and one had serious limitation of mouth opening.</p><p><b>CONCLUSIONS</b>SIPF combined with bio-membrane is a safe, simple, and reliable method for reconstruction of piercing palate defect following neoplasm ablation, with satisfactory oral functions.</p>

Reconstruction of severe atresic eye socket with lateral arm free flap / 中华显微外科杂志

Objective To study the method and effect of lateral arm free flap in reconstruction of severe atresic eye socket.Methods Forteen cases of severe atresic eye socket,from June,2011 to June,2013,were repaired by lateral arm free flap.The flaps were designed and harvested as drop shape with size about 6 cm × 10 cm and then were removed epidermis except distal 6 cm × 6 cm area which were transferred to orbit for eye socket reconstruction.The remaining fascia and dermis were filled to augment temporal defect.Superficial temporal artery was anastomosed with posterior branch of radial collateral artery in 14 cases and superficial temporal vein was anstomosed with radial collateral vein in 11 cases,with middle temporal vein in 3 cases.Results All 14 cases lateral arm free flaps survived with no donor site morbidity.Followed up for 1 year to 3 years,artificial eye could be fitted satisfactorily and temporal contour improved.Conclusion Lateral arm free flap is a recommendable option for severe atresic eye socket reconstruction because of concealed donor site scar,proper volume,matched vascular caliber and minor donor site morbidity.

Establishment of a primate animal model of mandibular reconstruction with the prefabricated, customized bone flaps / 中国组织工程研究

BACKGROUND:Prefabricated customized bone flaps have the advantages of few trauma, good vascularization, ossification with predetermined shape, and can be used to restore bone defects with compromised blood bed. OBJECTIVE:To establish animal models of mandibular reconstruction with prefabricated, customized bone flaps. METHODS:After computed tomography scanning of nine rhesus’ head, customized meshes were made. After loading with recombinant human bone morphogenetic protein-2-incorporated demineralized freeze-dried bone al ograft (DFDBA) or coral ine hydroxyapatite (CHA), the constructs were implanted in latissimus dorsi muscle. Meanwhile, segmental mandibular defects were created, and the customized meshes loaded with DFDBA, CHA, or recombinant human bone morphogenetic protein-2-incooperated DFDBA and CHA were implanted in situ. At 13 weeks, prefabricated bone flaps with recombinant human bone morphogenetic protein-2-incorporated DFDBA or CHA were transferred to repair segmental mandibular defects. Clinical and histological analyses were used to evaluate the ossification and vascularization of the prefabricated implants in ectopic and orthotopic sites. RESULTS AND CONCLUSION:Segmental mandibular defects were successful y restored with prefabricated bone flaps and recombinant human bone morphogenetic protein-2-incorporated CHA in situ, but other segmental mandibular defects remained with recombinant human bone morphogenetic protein-2-incorporated DFDBA, DFDBA and CHA in situ. Moreover, mandibles reconstructed with prefabricated bone flaps revealed more regenerated and homogeneous bone formation than other reconstructions. These findings suggest that the animal model of mandibular reconstruction with prefabricated, customized bone in rhesus monkey is applicable.

Submental island pedicled flap for reconstruction of oral soft defects after oral cancer ablation / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the effectiveness of the submental island pedicled flap (SIPF) for the repair of oral soft defects following oral cancer ablation.</p><p><b>METHODS</b>Thirty consecutive patients undergoing resection of oral cancer followed by reconstruction with SIPF from February 2010 to March 2013 were reviewed. The effectiveness complications, oral function recovering and oncologic outcomes after reconstructive operation with SIPF were evaluated.SPSS software was used to analyze the data.</p><p><b>RESULTS</b>The dimensions of SIPF ranged from a minimum of 4 cm×6 cm to a maximum of 6 cm×15 cm. Of the 30 flaps, 28 were survival completely, one had superficial necrosis but healed with treatments, and one failed due to complete necrosis, with a survival rate of 96.7% (29/30). Operative time ranged from a minimum of 4.5 hours to a maximum of 7.5 hours, mean 6.8 hours, and hospital stay time was 11-18 days, mean 13 days. Thirteen patients (43.3%) received tracheotomy before SIPF operation. Surgical or postoperative complications included temporary marginal mandibular never palsy in one case, neck hematoma in one case, hydrops in the mandibular region in 7 cases, and neck infectionin in 2 cases. Postoperative functional results showed mouth opening was normal in 23 patients, light limitation of mouth opening in 6 cases and obvious limitation of mouth opening in one case. The speech function was re-obtained satisfactorily in 29 patients, but one case with poor speech function. Most patients showed normal swallowing function, of them 26 patients on a full oral diet, 3 patients on a soft diet and one patient on a liquid diet only. Postoperative follow-up time was for 6-19 months (median 13 months), and 4 patients had local recurrence and 2 patients had cervical lymph node metastases.</p><p><b>CONCLUSION</b>The SIPF is safe, reliable and simple for the reconstruction of middle-small oral soft defects following resection of early-stage oral cancer.</p>

Retrospective study of 93 patients with jaw osteoradionecrosis / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the clinical feature, treatment, and prognosis of hospitalized patients with jaw osteoradionecrosis.</p><p><b>METHODS</b>A total of 93 cases with jaw osteoradionecrosis treated between 2000 and 2010 was reviewed. Of the 93 cases, 79 cases were with mandible lesions, 13 cases with maxillary lesions, and 1 case with both mandible and maxillary lesions. Sixty-six cases received one course of radiotherapy, with the radiation doses of 34 - 90 Gy (mean 64.6 Gy). Twenty-two cases experienced tooth extraction or other operative procedures before exhibition of the clinical symptoms for osteoradionecrosis. The interval time between radiotherapy and the onset of osteoradionecrosis varied from 2 weeks to 32 years (mean 54 months).</p><p><b>RESULTS</b>Of 93 cases, 56 patients underwent radical resection of the pathologic bone and reconstruction with free tissue flaps, in whom 7 cases received the second surgery due to microvascular thrombosis in flap vessels, and flaps were survival by new vascular anastomosis in 3 cases, the failed flaps were removed and replaced successfully by non vascularized bone grafts in 2 cases, and the failed flaps removed and the defects were repaired with adjacent skin in other 2 cases. In the 56 cases, only one case was with disease recurrence and 53 cases with significant improvement in chewing and swallowing functions. Only 2 of 93 cases underwent resection of the pathologic bone and reconstruction with titanium plates, and thereafter they encountered titanium exposure. Scaling of osteoradionecrosis lesions was applied to 20 of 93 patients and 9 cases of them were with disease recurrence. Fifteen cases had resection of the effected mandible without reconstruction. Disease relapse was encountered in 2 of them, others had poor chewing and swallowing.</p><p><b>CONCLUSIONS</b>The mandible is more susceptible to osteoradionecrosis than maxilla. Radical resection with reconstruction by free tissue flap is recommended for the treatment of jaw osteoradionecrosis, and scaling and reconstruction only with titanium plate should be avoided because of high risks of titanium exposure and disease relapse.</p>

Comparison of lateral arm flap and radial forearm flap in reconstruction after oral cancer ablation / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To compare the clinical application of lateral arm flap and radial forearm flap in reconstruction after oral cancer ablation.</p><p><b>METHODS</b>The clinical data of 21 cases with lateral arm flap and 104 cases with radial forearm flap between 2007 and 2009 were reviewed. The flap harvest time, flap survival rate, donor site morbidity and postoperative oral function were compared and analyzed.</p><p><b>RESULTS</b>The average flap harvest time of lateral arm flap and radial forearm flap were (46.4±7.6) min and (41.5±7.5) min (x±s) respectively. The flap survival rates of the two flaps were 90.5% (19/21) and 95.2% (99/104) respectively. There was no significant difference between the two flaps in the average flap harvest time and survival rate (P>0.05). The donor site of lateral arm flap could be primarily closed and radial nerve injury occurred in 2 patients. Skin graft was necessary for the donor site closure of radial forearm flap and conspicuous unattractive scar could be seen. All patients could have oral diet and no difficulty in speech intelligibility.</p><p><b>CONCLUSION</b>The lateral arm flap is relatively safe and reliable alterative to the radial forearm flap for the defects reconstruction after oral cancer ablation.</p>

A preliminary study on free medial sural artery perforator flap for head and neck reconstruction following tumor ablation / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To investigate the application of free medial sural artery perforator flap to reconstruct the defect following head and neck tumor ablation.</p><p><b>METHODS</b>From April 2010 to January 2011, the defects after head and neck tumor resection were reconstructed with free medial sural artery perforator flaps in 16 patients. The clinical data were collected and analyzed, including site and histology of tumor, the skin paddle's size of the flap, the length of pedicle, the number of major perforators and donor-site morbidity.</p><p><b>RESULTS</b>Medial gastrocnemius territories were evaluated before operation and free medial sural artery perforator flaps were used to reconstruct the defect after tumor ablation in 16 cases. One flap partially survived due to venous thrombosis. All of the other 15 flaps succeeded. The donor site was primarily closed in 15 cases and skin graft was applied in one case. All donor sites except one case healed in first intention. Long-term follow-up showed satisfying receipt-site reconstruction results with good functional and cosmetic outcome in the donor site. There was only minor sensory deficit in the donor site.</p><p><b>CONCLUSIONS</b>The medial sural artery perforator flap is reliable for reconstruction of the small to medium-sized defect in head and neck region with less donor site morbidity.</p>

Reconstruction of hypopharyngeal circumferential and cervical esophageal defects with free jejunal interposition in 112 cases / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the results of reconstruction of hypopharyngeal circumferential and cervical esophageal defects with free jejunal transfer.</p><p><b>METHODS</b>Retrospective review of 112 patients who underwent pharyngoesophageal reconstruction with free jejunal interposition. Analysis was confined to the patients with advanced hypopharyngeal, esophageal or recurrent laryngeal squamous cell cancer. Kaplan-Meier method was used to identify the accumulative survival rate.</p><p><b>RESULTS</b>The free jejunal success rate was 94.6% (106/112). The pharyngocutaneous fistula rate and anastomoses narrow rate were 8.9% (10/112) and 12.5% (12/96) respectively. The perioperative mortality rate was 1.8% (2/112). Except 1 case of dead, 6 cases with flap failure and 2 cases with laryngeal preservation, other 103 cases had resumed oral feeding.</p><p><b>CONCLUSIONS</b>The success rate of free jejunal transplantation is high and free jejunal interposition is an ideal reconstruction method for patients who have hypopharyngeal circumferential and cervical esophageal defects after tumor resection.</p>