Postoperative position change of fibular bone after reconstruction of maxillary defect using free fibular flap / 北京大学学报(医学版)

OBJECTIVE@#To investigate the position change of the fibular bone after maxillary reconstruction by free fibular flap and to analyze the factors affecting the position change.@*METHODS@#Patients who underwent maxillary reconstruction by free fibular flap in the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology from November 2012 to November 2016 were enrolled in this study. CT scans 1 week and 1 year postoperatively were collected and stored in DICOM format. The ProPlan CMF software was used to reconstruct the CT scans and separate the maxilla and each segment of the fibular flap. The Geomagic Control software was used to measure the long axis direction vector of each fibular segment. And the position change direction was recorded. The patients were divided into groups according to the use of the fibula or titanium plate to reconstruct the zygomaticmaxillary buttress.@*RESULTS@#A total of 32 patients were enrolled. Among them, 21 were in the titanium plate group and 11 in the fibula bone group. The angle between the long axis of the fibular segment and the X axis in the X-Y plane was 95.65°±53.49° and 95.53°±52.77°, 1 week and 1 year postoperatively, and there was no statistical difference (P>0.05). The angle between the long axis of the fibular segment and the X axis in the X-Z plane was 96.88°±69.76° and 95.33°±67.42°, respectively, with statistical difference (P=0.0497). The angular changes of the long axis of the fibular segment in the titanium plate group and the fibular bone group were 3.23°±3.93° and 1.94°±1.78°, respectively, and the angular changes in the X-Z plane were 6.02°±9.89° and 3.27°±2.31°, respectively. There was no significant difference between the groups (P>0.05). The long axis changes of the fibular segment in the X-Y plane for reconstruction of the anterior alveolar, posterior alveolar, and buttress were 3.13°±3.78°, 2.56°±3.17°, and 5.51°±4.39°, respectively. There was a statistical difference (P = 0.023) between the posterior and buttress. In the X-Z plane, theses were 4.94°±4.75°, 5.26°±10.25°, 6.69°±6.52°, respectively. There was no statistical difference among the three groups (P>0.05). The main positional deviation directions of the titanium plate group and the fibular bone group were interior and superior sides, and there was no statistical difference between the two groups (P>0.05).@*CONCLUSION@#One year postoperatively, the position of the free fibular flap was changed compared with 1 week postoperatively. The position of the free fibular flap was mainly changed to the interior and superior sides.

Delayed diagnosis of oral squamous cell neoplasms at different sites / 北京大学学报(医学版)

OBJECTIVE@#To investigate the diagnostic delay of patients with oral squamous cell carcinoma by self-designed questionnaire to find out the significant influencing factors, so as to identify the influencing factors of the patient's delay and the risk of oral cancer.@*METHODS@#A total of 514 patients with primary oral squamous cell carcinoma were enrolled at Peking University School and Hospital of Stomatology from January 2014 to April 2016, including 334 men and 180 women, with a male to female ratio of 1.85:1. The youngest participant was 21 years old, with a maximum of 89 years and a median age of 57.6 years. The position of the disease according to International Classification of Diseases-10 (ICD-10) was divided into lip, buccal, gingival, retromolar, palate, floor of the mouth, tongue, and oropharynx. The age group is divided into 10 years. The level of education was divided into illiteracy, primary education level and advanced education level. Body mass index (BMI) was divided into three levels by 18 kg/m2 and 25 kg/m2. Visual analog scale (VAS) method was to evaluate the patient's preoperative pain. At the same time, the patients were examined by detailed questionnaire to understand the delay factors and delay characteristics, and use SPSS 18.0 software, analysis of variance and chi-square test to explore correlation.@*RESULTS@#Among all patients, the proportion of patients developed in the tongue was the highest (43.3%). Delay was defined by a span of three months or longer from the onset of symptoms until treatment. The delays to diagnosis according to location were as follows (in months and in descending order): lip (6.1 months), buccal (4.1 months), floor of the mouth (3.9 months), tongue (3.6 months), oropharyngeal (2.9 months), retromolar (2.7 months), palatine (2.4 months), and gingival (2.4 months). Different sites and delayed diagnosis were statistically significant (P=0.048). There were no statistically significant differences in gender, education, pain, smoking, drinking and VAS score.@*CONCLUSION@#The study has found that tumor positions and delay have a significant correlation. The position of the tumor is an obvious factor associated with the findings. The lip is the most likely to delay the diagnosis of oral positions. For the lip of the lesion, more than three months' obvious mass is recommended for timely treatment, while at admission, physicians should take the appropriate diagnostic method as soon as possible.

Preliminary clinic study on computer assisted mandibular reconstruction: the positive role of surgical navigation technique / 대한악안면성형재건외과학회지

BACKGROUND: The objectives of the present study were to investigate the reliability and outcomes of computer-assisted techniques in mandibular reconstruction with a fibula flap and verify whether the surgical navigation system was feasible in mandible reconstructive surgery. METHODS: Eight cases were enrolled in the computer assisted surgery (CAS) group and 14 cases in the traditional group. The shaping and fixation of the fibula grafts were guided by computer assisted techniques, which could be monitored with the BrainLAB surgical navigation system. The variation of mandible configuration was evaluated by CT measurement in the Mimics software, including the variation of length, width, height and gonial angle of the mandible. The 3D facial soft tissue alteration was also analyzed in 3D chromatogram by Geomagic software. RESULTS: All 22 fibula flaps survived. The mandibular configurations and facial contours had a better clinic result in the CAS group. The length, width, height and gonial angle of the reconstructive mandible were more similar to the original one. The Wilcoxon rank sum test analysis suggested significant differences in the measurements. The chromatographic analysis also visually showed superiority over the traditional group. CONCLUSIONS: The computer assisted surgical navigation method used in mandibular reconstruction is feasible and precise for clinical application. The contour of the reconstructed mandible and facial symmetry are improved with computer techniques.

Botulinum toxin A inhibits salivary secretion of rabbit submandibular gland / 国际口腔科学杂志·英文版

Botulinum toxin A (BTXA) has been used in several clinical trials to treat excessive glandular secretion; however, the precise mechanism of its action on the secretory function of salivary gland has not been fully elucidated. In this study, we aimed to investigate the effect of BTXA on secretion of submandibular gland in rabbits and to identify its mechanism of action on the secretory function of salivary gland. At 12 weeks after injection with 5 units of BTXA, we found a significant decrease in the saliva flow from submandibular glands, while the salivary amylase concentration increased. Morphological analysis revealed reduction in the size of acinar cells with intracellular accumulation of secretory granules that coalesced to form a large ovoid structure. Expression of M3-muscarinic acetylcholine receptor (M3 receptor) and aquaporin-5 (AQP5) mRNA decreased after BTXA treatment, and distribution of AQP5 in the apical membrane was reduced at 1, 2 and 4 weeks after BTXA injection. Furthermore, BTXA injection was found to induce apoptosis of acini. These results indicate that BTXA decreases the fluid secretion of submandibular glands and increases the concentration of amylase in saliva. Decreased expression of M3 receptor and AQP5, inhibition of AQP5 translocation, and cell apoptosis might involve in BTXA-reduced fluid secretion of submandibular glands.

Effect of parasympathectomy on the salivary secretion of submandibular gland in rats / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To investigate the effect of parasympathectomy on secretion of submandibular glands and the feasibility of treatment for xerostomia in rats.</p><p><b>METHODS</b>Twenty Sprague-Dawley male rats weighing 200 - 300 g were randomly divided into the experimental group (n = 12), in which the right chorda-lingual nerve was cut, and the control group (n = 8). The secretion of submandibular gland was measured for 5 min by Schirmer test for both groups.</p><p><b>RESULTS</b>The stimulated saliva flow rate decreased on 1st, 12th and 24th week after denervation in the right operated submandibular glands (P < 0.05). No difference in secretion was found between the left non-operated glands and the control group. Comparing with the left non-operated gland and the control gland, the saliva flow rate at rest in the right operated submandibular gland increased on the 1st, 12th and 24th week (P < 0.05).</p><p><b>CONCLUSIONS</b>After parasympathectomy of rat submandibular glands, the saliva flow rate at rest increased in the denervated gland, which suggests that parasympathectomy of submandibular gland might be used as a therapy for xerostomia.</p>

Effect of botulinum toxin-A on secretion of parasympathetic denervated rabbit submandibular gland / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To investigate the effect of botulinum toxin-A (BTX-A) on secretion of parasympathetic denervated rabbit submandibular gland.</p><p><b>METHODS</b>Twenty-four rabbits were divided into 3 groups: control (n = 4), parasympathetic denervated submandibular gland (n = 4), and parasympathetic denervated submandibular gland with 5 U BTX-A injection (n = 16). Secretion flow was measured by Schirmer test. Composition of saliva was detected by biochemical method.</p><p><b>RESULTS</b>Secretion of parasympathetic denervated submandibular gland increased by 139.0% in rest time (P < 0.01), but decreased by 64.2% in feeding time (P < 0.01) compared with controls. Secretion of submandibular gland decreased in rest time 1, 2, 4, and 12 weeks after BTX-A injection compared with that of parasympathetic denervated submandibular gland without injection (P < 0.05), which was also the same in feeding time 1 and 2 week after injection (P < 0.05). The concentrations of amylase, sodium, potassium, chloride and protein of saliva were not changed after BTX-A injection.</p><p><b>CONCLUSIONS</b>BTX-A could decrease the secretion of parasympathetic denervated submandibular gland.</p>

Application of near infrared spectroscopy in monitoring blood oxygen saturation of fibula flaps / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To study the change of tissue oxygen index (TOI) by non-invasive near infrared spectroscopy (NIRS) and to investigate the blood flow variety of fibula flaps after operation.</p><p><b>METHODS</b>Thirty-six patients who accepted fibula flap reconstruction were chosen as subjects. Authors measured the TOI of the fibula flaps and the control side every four hours in the first twenty-four hours, and measured these positions with the intermittence of twelve hours from second to eighth day after operation.</p><p><b>RESULTS</b>Thirty-five flaps were successful and one failed. The TOI of fibula flaps shortly after operation was significantly lower than that before the operation( P<0.05). In the successful cases the TOI of fibula flaps and the control sides was fluctuated from 50.0% to 72.0%. The TOI of fibula flaps was significantly lower than that of the control sides within 144 hours after operation(P<0.05). After 144 hours the TOI was equal to that of the control side. TOI of the failed case decreased dramatically.</p><p><b>CONCLUSIONS</b>NIRS can reliably indicate the change of TOI in buried flaps and detect ischemia at the early stage. The TOI of the fibula flaps depress at the early stage and returns to normal at 144 hours after operation.</p>