Multidisciplinary team model for patients with oral cancer and systemic diseases: an expert consensus / 华西口腔医学杂志

Large general hospitals currently play an increasingly important role in the diagnosis and treatment for acute critical patients and difficult diseases because of the development of dual referral system and hierarchical diagnosis, as well as the formation of medical treatment alliance. Patients with oral cancers are often associated with systemic diseases, which increases the complexity of the condition. Thus, meeting the demand through the traditional single medical model is difficult. As such, a multidisciplinary team (MDT) model has been proposed and has achieved a good clinical effect. To standardize the application of this model, we organized an event in which relevant experts discussed and formulated a consensus to provide standardized suggestions on the MDT process and the diagnosis and treatment of common systemic diseases as reference for clinical practice.

Primary acinic cell carcinoma in mandible: a case report / 华西口腔医学杂志

Acinic cell carcinoma is a relatively rare salivary gland tumor predominantly occurring in the major glands. Therefore, acinic cell carcinoma rarely occurs in the mandible. In this study, a case of primary acinic cell carcinoma of the mandible was reported, and relevant literature was reviewed. The etiology, clinical symptom, image and histological features, diagnosis, treatment, and prognosis of acinic cell carcinoma in the mandible were discussed.

Establishment of an animal model of widening distraction of tubular bone with dental implant distractor / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To establish an animal model of widening distraction of tubular bone with dental implant distractor (DID) and investigate radiographical and histomorphological changes of long tubular bone following widening distraction with dental implant.</p><p><b>METHODS</b>Twelve Chinese mountain goats were used. Two sets of DID were installed in each goat's tibiae. After an 8-day latency period, nine tibiae were distracted at a rate of 0.35 mm each time and 2 times per day using DID devices. Radiography and histomorphology were used to evaluate the new generated bone in different period after distraction. The other three animals served as sham control.</p><p><b>RESULTS</b>After 10 - 14 days' distraction, the average width of the tibiae increased by 7.83 mm. Digital subtraction angiography (DSA) showed that there was a similarity between goat's tibiae and human's fibula in the blood supply. From the end of distraction to 3-month after the consolidation period, radiography demonstrated that the distraction gaps gradually became vague and filled with newly formed bone. The histomorphological study showed different results of bone formation in both distracted gaps. The osseointegration between bone and implant only occurred at screw-shaped part, while the moving part in tibiae was encapsulated by fibrous tissue.</p><p><b>CONCLUSIONS</b>There are lots of similarities between goat's tibiae and human's fibula in anatomy and blood supply. The model of widening distraction osteogenesis of the goat's tibiae is ideal for studying human's fibula.</p>

Experimental study of tissue-engineered biological small intestinal submucosa, membrane employed in dental implant traction / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To construct the tissue-engineered biological small intestinal submucosa(SIS) membrane and evaluate the feasibility of its use as a surrogate of periosteum and its possible role in dental implant distraction (DID).</p><p><b>METHODS</b>The tissue-engineered biological SIS membrane was constructed through the co-culturing of boat bone marrow stromal cells (BMSC) and small intestinal submucosa. The cellular compatibility was evaluated with the phase contrast microscope, SEM, alkaline phosphatase(ALP) activity and histology, and its effect of osteogenesis promotion was detected by Micro-CT and histology after implanted in the exposed side of DID operation.</p><p><b>RESULTS</b>The phase contrast microscope, SEM, ALP activity and histology confirmed that the BMSC could adhere to SIS and proliferate on it normally, the cellular activity and function were not affected by SIS. Three months after the tissue-engineered biological SIS membrane was implanted into the exposed side, some discontinuous new bone in the "biological SIS membrane" group was detected by the Micro-CT under a higher window level. The histology revealed that there was a quantity of new bone in the distracted region and the majority was woven bone. The quantity and quality of the new bone in the "biological SIS membrane" implanted group were similar to the unexposed side, but the bone nonunion was detected in the un-implanted group and the interspace was fixed by fibrous connective tissue.</p><p><b>CONCLUSIONS</b>The tissue-engineered biological SIS membrane can provide both daughter cells, guide bone regeneration in DID and promote the osteogenesis. But the outcome of the biological SIS membrane, especially the function of the osteoblast cultured in the SIS in new bone formation, still needs further study.</p>

Fibular flap combined with lateral crural flap for reconstruction of oral and maxillofacial defect / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the therapeutic effect of fibular flap combined with lateral crural flap for reconstruction of oral and maxillofacial defect.</p><p><b>METHODS</b>Based on the peroneal vascular system, fibular flap combined with lateral crural flap were used for reconstruction of oral and maxillofacial defect. The fibular flap was used for bone defect, and the lateral crural flap was for the reconstruction of soft tissue defect of the oral cavity and pharynx.</p><p><b>RESULTS</b>During the period of Mar. 2005 to Mar. 2007, 26 cases were treated, including 25 cases of defects after tumor resection and 1 case of bilateral maxillary defect. The flaps were harvested without any injury to the peroneal vascular system and perforator. All the flaps were survived. One case of arterial insufficiency and one case of venous thrombosis occurred 12 hours and 24 hours after operation, but the flaps were salvaged after urgent re-operation. All the patients were followed up for 6 months to 2 years. The patients acquired satisfactory appearance with normal social life.</p><p><b>CONCLUSIONS</b>For complicated oral and maxillofacial reconstruction, fibular flap combined with lateral crural flap can achieve good reconstruction results and could be selected as the first line treatment.</p>

Serum hyaluronan levels in oral cancer patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Hyaluronan (HA) is most likely associated with tumor invasion and metastasis. Studies have shown that HA levels are often increased in serum of patients with various malignant tumors. The purpose of this study was to determine the levels of serum hyaluronan in patients with oral cancer and evaluate the value of serum HA in adjuvant diagnosis, staging and monitoring treatment response in these patients.</p><p><b>METHODS</b>Eighty-four hospitalized patients with oral cancer, 65 patients with benign tumors in the oral and maxillofacial region and 67 healthy individuals were included in this investigation. Venous blood was collected from these patients and the healthy individuals before therapy. One week after therapy, venous blood was collected once again in 43 patients with oral cancer. Serum samples were obtained and serum HA levels examined.</p><p><b>RESULTS</b>The serum HA concentration was significantly higher in oral cancer patients than in patients with benign tumors and in healthy controls (P<0.05). The serum HA level in patients with stages III and IV disease was higher than in patients with stages I and II disease, but there was no significant difference in the HA level between stages I and II nor between stages III and IV (P>0.05). After a complete treatment the HA levels in patients with oral cancer became lower than before treatment, but the difference was not significant (P>0.05).</p><p><b>CONCLUSIONS</b>The results of this study suggest that the determination of HA levels may provide additional information in diagnosis of oral cancer, but its usefulness as an adjunct in clinical staging and in monitoring treatment response was limited.</p>

The histomorphological changes of tubular bone following widening distraction osteogenesis / 中华整形外科杂志

<p><b>OBJECTIVE</b>The purpose of this experimental study was to investigate the histomorphological changes of tubular bone following widening distraction osteogenesis.</p><p><b>METHODS</b>Twelve Chinese mountain goats were subjected to the study. After the procedure of vertical and horizontal osteotomy, two widening distraction osteogenesis devices were put in each goat's left tibiae. After an 8-day latency period, nine tibiae were widening distracted; another three tibiae served as sham control group. Every three animals from the experimental group were sacrificed in different consolidated periods including 1-month, 2-month, and 3-month. Radiography, tetracycline double labeling, histomorphology, as well as biomechanics were used to evaluate the quality and quantity of new generated bone in different consolidated period after distraction osteogenesis.</p><p><b>RESULTS</b>After a distraction period, the average width of the tibiae is increased 7.83mm. From the end of distraction to 3-month after the consolidation period, radiography demonstrated that the distraction gaps gradually became vague. Tetracycline double labeling showed that the double labeling brands were rarely seen in normal cortex bone, but strongly increased in the distracted callus. Mineralization rates (MR) has a significant difference (P < 0.05) within distracted callus region compared with control cortex bone. Histomorphological study shows that there was a different result in two sides of vertical distracted gaps. The non-exposure side had a good bone formation, while a non-union of bone occurred at the exposure side. Three months after consolidation period, part of the gap in exposure side was filled with dense connection tissue, whereas the distracted callus had been remodeled and become lamellar bone in non-exposure side. The control group showed normal fracture healing procedure.</p><p><b>CONCLUSIONS</b>There was a different outcome in two sides distraction gaps of tubular bone following widening distraction osteogenesis. A viable and well-perfused soft-tissue envelope in the area of distraction osteogenesis is important for creation of sufficient amount of new bone during distraction osteogenesis.</p>