Application of computer-assisted navigation technology in the resection and reconstruction of mandibular ameloblastoma / 口腔医学

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.

Clinical analysis and surgical treatment evaluation of 23 cases with primary parapharyngeal space tumors / 中华口腔医学杂志

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.

Hydrogen peroxide accelerates senescence of human dental pulp stem cells / 中国组织工程研究

BACKGROUND:The process of oxidative stress that impacts the curative effect exists in the region which accepts cel transplantation. However, there are few reports about the effects of oxidative stress on human dental pulp stem cels and relevant mechanism. OBJECTIVE:To understand the effect of hydrogen peroxide on the senescence of human dental pulp stem cels. METHODS:Human dental pulp stem cels were isolated and cultured in PBS, 100 and 200 μmol/L hydrogen peroxide for 2 hours, respectively. Cel morphology was observed under inverted microscope, degree of cel senescence monitored by β-galactosidase staining, cel proliferation ability detected by BrdU kit and cel counting method, cytoskeleton of dental pulp stem cels and expression of sirt1 tested using immunofluorescence method, and expression of sirt1 and p16 proteins measured by western blot assay. RESULTS AND CONCLUSION:Dental pulp stem cels exhibited a fibroblast-like morphology with spindle-shaped appearance. After stimulated by hydrogen peroxide, the cel volume was enlarged, theβ-galactosidase staining deepened and the proliferation of dental pulp stem cels reduced. The enhancement of senescence of dental pulp stem cels was accompanied with the increasing concentration of hydrogen peroxide, and in this process, the expression of p16 was raised while the expression of sirt1 was decreased. In conclusion, the senescence of human dental pulp stem cels can be promoted by the stimulation of hydrogen peroxide, and sirt1 and p16 are involved in this process. Our findings may provide a theoretical and experimental foundation for autologous transplantation of dental pulp stem cels.

Reconstruction of extensive full thickness cheek defects with free anterolateral thigh flap / 中华显微外科杂志

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.

Surgical management of temporomandibular joint ankylosis under the guidance of navigation / 中华整形外科杂志

<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>

Clinical application of decompression in the treatment of jaw large cystic lesions / 实用口腔医学杂志

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.

Treatment of chronic prolonged mandibular dislocations / 实用口腔医学杂志

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.

Comparative study in reconstruction of tongue defect with thin anterolateral flap and forearm flap / 中华整形外科杂志

<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>

Cervical metastases and prognosis of oral maxillary squamous cell carcinoma:A retrospective study / 实用口腔医学杂志

Objective:To investigate the incidence of cervical metastasis of oral and maxillary squamous cell carcinoma(SCC)and to define its impact factors.Methods:A retrospective study of patients with SCC of hard palate and maxillary alveolus treated by surgery from 2002 to 2011.Results:The incidences of cervical metastasis and occult metastasis were 17.2%(11 /64)and 9.8%(5 /51)re-spectively.pT classification and vascular invasion were correlated with cervical metastasis.Occult metastatic risk was significantly higher in pT4 patients.Presence of positive nodes impaired prognosis significantly.Conclusion:Overall and occult metastasis of oral and maxillary SCC were highly associated with pT classification.Routine and synchronous elective neck dissection(END)is recomend for the treatment of T4 lesions while observation is alternative for T1 -T3 lesions.

Application of computer aided three-dimensional visualization technique in mandibular defect reconstruction with vascularized free fibular flap / 中华显微外科杂志

Objective To summary the application of computer aided three-dimensional visualization technique in different kinds of mandibular detects reconstruction with vascularized free fibular flap.Methods Five patients diagnosed of recurrent mandibular ameloblastoma underwent the virtually operation by software with a thin-slice CT scan,which determined shape and position of the free flap,and preoperative resin model and modules were designed and prefabricated.Then the titanium plates were bent precisely,and the surgical reconstruction proceeded exactly as expected from the modeling process.Results All operations were achieved successfully.The extent of the lesion was coincident with the preoperative CT results,and the vascularized free fibular flaps were harvested and implanted into the defect regions accurately.The mean distance was (0.23 ±2.10) mm compared with the virtual fibula.The mean time of operation was 4.4 hours.Following up the mean 12.8 months,all patients obtained the excellent functional and cosmetic outcomes.Conclusion The procedure of operation was simplified and the time was shortened with reconstruction exactly using computer aided three-dimensional visualization technique,and the clinical therapeutic efficacy of reconstruction of mandibular defect with vascularized free fibular flaps was improved notably.

Madelung's disease: A case report and literature review / 实用口腔医学杂志

A patient suffering Madelung's disease was treated and the literatures were reviewed in this article. The cause, the clinical features and treatment were discussed. The cause of this disease is unknown, and it is characterized by symmetrical accumulation of fat around the neck,nape and armpit having a appearance of "horse collar"or "hump back". Histological analysis revealed typical fat tissue depositing around the structures. Surgery is the main means of treatment, and prognosis is good.

Treatment of maxillary hypoplasia with a self-made tooth-borne distraction device / 实用口腔医学杂志

Objective: To evaluate the result of distraction osteogenesis in patients with pretnaxillary deficiency using a self-made tooth-borne distraction device. Methods: A self-made tooth-bome distraction device was used for advancement of the maxillary anterior segment in 28 patients. Results; 26 cases were corrected satisfactorily and have no any complications. In 2 cases the distraction device did not work during distraction. Conclusion: This device can improve the soft tissue profile and correct the space deficiency of the maxilla.

Effect of local immunotherapy of interleukin 2(IL-2) in combination with chemotherapy upon intratumoral lymphocytes in oral squamous cell carcinomas / 华西口腔医学杂志

<p><b>OBJECTIVE</b>To evaluate the effect of locoregional immunotherapy of interleukin 2 (IL-2) in combination with chemotherapy upon intratumoral lymphocytes in oral squamous cell carcinomas.</p><p><b>METHODS</b>Thirty-four patients with stage T3 or T4 oral squamous cell carcinoma were randomly divided into two groups, and treated with two therapies. 23 cases of them received immunochemotherapy and 11 cases received PVP chemotherapy. Changes of T lymphocyte subsets and B cells at tumor site in the two groups were compared before and after therapy.</p><p><b>RESULTS</b>The relative numbers of CD4+, CD8+, CD20+ before and after treatment in immunochemotherapy were respectively 36.96, 35.65, 28.65 and 56.61, 38.52, 38.70. The numbers of CD4+, CD20+ increased significantly after immunochemotherapy. However, in chemotherapy group, there was no significant difference in numbers of CD4+, CD8+ and CD20+ cells between pre and post treatment.</p><p><b>CONCLUSION</b>Immunochemotherapy for oral squamous cell carcinomas may play an important role in increasing local immunity.</p>

Comparative study on the effects of different neck dissection methods on shoulder function / 实用口腔医学杂志

Objective:To evaluate the shoulder functions of four groups of patients who underwent different kinds of neck dissections.Methods:40 patients who underwent neck dissection were included,7 patients preserved both accessory nerve and the cervical branches,8 preserved accessory nerve,11 preserved cervical branches and 14 sacrificed both of them.All patients were assessed subjectively at 2 weeks and 6 months after operation,using a questionnaire and an electromyograghy method.Results:The patients whose accessory nerves were preserved had a significant functional rehabilitation of the shoulder,while those who preserved only the cervical branches had a better result than the RND 6 months postoperation.Conclusion: Preservation of the branches from C2-C4 to trapezius muscle during the modified neck dissection should be taken into consideration to improve shoulder functions.

A clinical study on regional occult metastases for patients with squamous cell carcinoma of buccal mucosa / 实用口腔医学杂志

Objective:To assess regional occult metastases on clinical negative neck node [cN0] in patients with buccal mucosal squamous cell carcinoma. Methods:69 patients (31males and 38 females ) with cN0 buccal mucosa squamous cell carcinoma who underwent a lymph node dissection (at the Department of Oral and Maxillofacial Surgery, Affiliated Stomatological Hospital, Nanjing University Medical School) between 1992 and 2004, were retrospectively reviewed. The patients ranged in age from 31 to 79 years with a mean age of 58.2 years. All patients received radical neck dissection(RND), functional neck dissection (FND) or supraomohyoid neck dissection (SOND). Results:The incidence of occult metastases for patients with cN0 buccal mucosa squamous cell carcinoma was 14.49% (10/69).The distribution of the positive nodes was as follows: Level I,10.14%(7/69); Level II, 5.80% (4/69); Level III, 2.90%(2/69). The occult metastasis rate for patients with T1, T2, T3 and T4 was 9.52% (2/21), 15.38%(6/39), 25.00%(1/4), and 20.00%(1/5), respectively. In patients with well differentiated carcinoma,the occult metastasis rate was 14.89%(7/47); moderate differentiated,10.00%(2/20); and poorly differentiated,50.00%(1/2). Conclusion:The assessment of regional occult metastases for patients with cN0 buccal mucosa squamous cell carcinoma may play an important role in deciding treatment approaches of neck.