Clinical study of submental artery island myocutaneous flap for reconstruction of oral and maxillofacial defects following operation / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate the outcome and indication of the reconstruction of oral and maxillofacial postoperative defects by submental artery island myocutaneous flaps.</p><p><b>METHODS</b>Sixty eight cases with the reconstruction of oral and maxillofacial defects by submental artery island myocutaneous flaps from January 2006 to May 2010 were analysed retrospectively. Primary lesions included carcinomas originating from tongue (28 cases), palate (13 cases), mouth floor (9 cases), gingiva (4 cases), buccal mucosa (6 cases), lip (3 cases), and other malignant or benign tumors (5 cases). The ages ranged from 25 to 84 years (mean 58 years); 47 males and 21 females. The sizes of skin paddle varied from a minimum of 4 cm × 4 cm to a maximum of 15 cm × 10 cm.</p><p><b>RESULTS</b>Of the 68 flaps, 62 were survival, 4 had partial necrosis but healed with treatments, and 2 failed due to complete necrosis. Appearance and functions of recipient sites were satisfactory. The followed-up time was 3 - 24 months, local recurrence occurred in 5 cases and cervical lymph node metastases were found in 15 patients.</p><p><b>CONCLUSION</b>Submental island flap is reliable for the reconstruction of postoperative defects in early oral cancer without regional lymph node metastasis or in benign tumor.</p>

A review of clinical and histological parameters associated with contralateral neck metastases in oral squamous cell carcinoma / 国际口腔科学杂志·英文版

Oral squamous cell carcinoma (OSCC) has a high incidence of cervical micrometastases and sometimes metastasizes contralaterally because of the rich lymphatic intercommunications relative to submucosal plexus of oral cavity that freely communicate across the midline, and it can facilitate the spread of neoplastic cells to any area of the neck consequently. Clinical and histopathologic factors continue to provide predictive information to contralateral neck metastases (CLNM) in OSCC, which determine prophylactic and adjuvant treatments for an individual patient. This review describes the predictive value of clinical-histopathologic factors, which relate to primary tumor and cervical lymph nodes, and surgical dissection and adjuvant treatments. In addition, the indications for elective contralateral neck dissection and adjuvant radiotherapy (aRT) and strategies for follow-up are offered, which is strongly focused by clinicians to prevent later CLNM and poor prognosis subsequently.

Effects of Ezrin gene on the proliferation and invasion activity of human salivary gland adenoid cystic carcinoma / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To examine the expression of Ezrin in human salivary gland adenoid cystic carcinoma and investigate the effects of Ezrin gene silence on cell proliferation, apoptosis and invasion of adenoid cystic carcinoma (ACC)-M.</p><p><b>METHODS</b>The expression of Ezrin was detected by immunohistochemistry in normal salivary gland tissue (n=15), pleomorphic adenoma (n=40) and salivary gland adenoid cystic carcinoma (n=43). The Ezrin Stealth RNAi Duplex, containing Stealth RNAi Negative Control Duplex were constructed and transfected into ACC-M cells by Lipofectamine 2000. The expression levels of Ezrin were detected by RT-PCR and immunohistochemistry. The cell cycle and apoptosis rate were analyzed by flow cytometry (FCM). The cell proliferation was detected by methyl thiazolyl tetrazolium (MTT) and cell invasion by Transwell test.</p><p><b>RESULTS</b>The positive rate of Ezrin expression in ACC was significantly higher than that in normal salivary gland tissue and pleomorphic adenoma (P<0.05). After transfection of Ezrin Stealth RNAi Duplex, the mRNA and protein expression of Ezrin were down-regulated, the cell proliferation activity was inhibited, the G0-G1 Phase cells were increased, and the apoptosis rate of Ezrin Stealth RNAi Duplex group was higher than that in control groups and cell invasion ability was decreased.</p><p><b>CONCLUSIONS</b>Over expression of Ezrin in human salivary gland adenoid cystic carcinoma may promote genesis, development and metastasis of tumors. Ezrin Stealth RNAi Duplex could efficiently down-regulate the expression of Ezrin gene, and partly inhibited proliferation of ACC-M cells, induce apoptosis and decrease invasion ability of these cells in vitro.</p>

Application of multislice spiral CT and 3D reconstruction in diagnosis and treatment of vascular malformations in head and neck / 中华整形外科杂志

<p><b>OBJECTIVE</b>To explore the application of MS-CT and 3D reconstruction in diagnosis and treatment of vascular malformations in head and neck.</p><p><b>METHODS</b>20 cases with vascular malformations in head and neck underwent MS-CT and 3-D reconstruction. Then the treatment was determined based on the results of MSCT scanning. The postoperative results were evaluated.</p><p><b>RESULTS</b>The images of MS-CT showed the edge of vascular malformations partially or completely in 16 cases of venous malformations. The lesion's anatomic site and 3-D position was obtained. The 3-D images also showed the overexpanded supply arteries in 4 case of arteriovenous malformations. 2 case of venous malformations in lip underwent resection and healed completely. 12 cases of venous malformations in buccal and floor of mouth were treated with compartmentalized sclerotherapy with partial lesion involution. 2 case of venous malformations in mouth floor were treated with operation followed by sclerotherpy with partial lesion involution. 4 cases of arteriovenous malformations were treated with Superselective Artery Embolization with partial lesion involution.</p><p><b>CONCLUSION</b>MS-CT and 3D reconstruction can play an important role in diagnosis and treatment of vascular malformations in head and neck.</p>

Mental neurovascular V-Y island advancement flap in functional reconstruction of partial lower lip defect / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the functional reconstruction technique for partial lower lip defects.</p><p><b>METHODS</b>7 patients with lower lip cancer (3 cases of basal cell carcinoma, 2 cases squamous cell carcinoma and 2 cases papillary carcinoma) underwent excision. The full-thickness lower lip defects were one-third to two-third of the total lower lip length. All the defects were reconstructed with V-Y island advancement flaps based on the mental neurovascular bundle.</p><p><b>RESULTS</b>There was no flap loss. No recurrence was observed during the follow-up period of 3 months to one year. Both the aesthetic appearance, muscle function and sensation of the reconstructed lower lip were satisfactory.</p><p><b>CONCLUSIONS</b>Mental neurovascular V-Y island advancement flap is an ideal method for functional repair of partial lower lip defect.</p>

Reverse facial artery-submental artery island myocutaneous flap for reconstruction of oral and maxillofacial defects following cancer ablation / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To evaluate the reliability of the reverse facial artery-submental artery island myocutaneous flap for repairing the oral and maxillofacial defects.</p><p><b>METHODS</b>Eighteen oral and maxillofacial defects were repaired with reverse facial artery-submental artery island myocutaneous flaps following resection of malignant tumors. The ages of the patients ranged from 28 to 90 years; 11 were male and 7 were female. Primary sites of the lesions were the tongue squamous cell carcinoma (SCC) (7 cases), buccal mucosa SCC (4 cases), palate SCC (3 cases), oropharyngeal SCC (2 case), and facial skin basal cell carcinoma (2 cases). The sizes of skin paddle varied from a minimum of 4.0 cm x 12.0 cm to a maximum of 5.0 cm x 15.0 cm. The followed-up period was 9 to 18 months (11.8 months on average).</p><p><b>RESULTS</b>The postoperative outcome for the flaps was 17 cases surviving, one complete necrosis, and one temporary palsy of the marginal mandibular branch of the facial nerve. The form and function of recipient sites were well recovered. The donor site left a well-hidden scar. One case of cervical lymph node metastasis was observed.</p><p><b>CONCLUSIONS</b>Reverse facial artery-submental artery island myocutaneous flap is reliable for reconstructing medium-sized oral and maxillofacial defects.</p>

Intraoral submandibular gland excision and how to deal with external maxillary artery / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To investigate the feasibility and safety of intraoral submandibular gland excision.</p><p><b>METHODS</b>Analyze the relationship between the external maxillary artery and submandibular gland, and offer a reliable anatomical base for 10 cases of intraoral submandibular gland excision, including 8 cases of chronic sialadenitis, 1 case of pleomorphic adenoma and 1 case of cyst of submandibular gland.</p><p><b>RESULTS</b>The external maxillary artery went across the surface of gland submandibular, and its branches provided nutrition for the gland in most cases. The results of 10 cases intraoral submandibular gland excision were effective and satisfied, without major complications. The average time of operation was 50 minutes and the average hemorrhage of operation was 60 ml.</p><p><b>CONCLUSION</b>Intraoral submandibular gland excision is safe and feasible for chronic sialadenitis and cyst of submandibular gland and some of benign tumor submandibular gland as long as indications strictly controlled and the external maxillary artery well coped with.</p>

Combined repair of large defect caused by radical surgery of advanced tongue cancer with rib-major pectoralis myocutaneous flap carrying costal parietal pleura / 中华外科杂志

<p><b>OBJECTIVE</b>To explore the clinical value and safety of using rib-major pectoralis myocutaneous flap carrying costal parietal pleura in combined repair of large soft and hard tissue defect caused by radical surgery of advanced tongue cancer.</p><p><b>METHODS</b>Six patients with advanced tongue carcinoma involving the floor of mouth and mandible were performed combined radical neck dissection with glossectomy and mandibulectomy, which caused large soft and hard tissue defect. Six rib-major pectoralis myocutaneous flaps carrying costal parietal pleura were transferred for immediate repair of the large defects. The rib flaps were applied for the repair of mandible, and the major pectoralis myocutaneous flaps were applied for the reconstruction of tongue and floor of mouth.</p><p><b>RESULTS</b>Six patients recovered well after operation. Six rib-major pectoralis myocutaneous flaps carrying costal parietal pleura survived well; the wounds of surgical incision of the oral cavity, neck, and chest healed up. The reconstructed tongue and the lower face appearance were satisfactory, the occlusion relationships were normal; the speaking as well as swallowing functions recovered.</p><p><b>CONCLUSIONS</b>It's safe and reliable to use rib-major pectoralis myocutaneous flap carrying costal parietal pleura to repair large soft and hard tissue defect in oral and maxillofacial region. Opening pleural cavity and harvest costal parietal pleura would not influence patients' thoracic movement and breath function and would not cause other complications. It's simple and safe for harvesting the composite flap. Carrying costal parietal pleura assures the sufficient blood supply of rib in the composite flap.</p>

Extended lower trapezius myocutaneous flap for repair of defects after resection of recurrent oral carcinoma / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To explore an effective repairing method for oral and maxillofacial soft-tissue defects after resection of recurrent oral carcinoma.</p><p><b>METHODS</b>Six patients with recurrent oral squamous cell carcinoma (R-OSCC) of tongue (n = 2), oral cavity floor (n = 2) and buccal (n = 2) were treated with salvage surgery and the oral and maxillofacial soft-tissue defects were repaired primarily by extended lower trapezius island myocutaneous flap (TIMF).</p><p><b>RESULTS</b>No flap failure occurred. The donor sites were primarily closed. There were no disabilities with regard to shoulder motion. The life period of the patients was 13 to 30 months and the average life period was 22.6 months after the operation.</p><p><b>CONCLUSIONS</b>The TIMF, which is a simple, reliable and large flap can be preferred as a salvage procedure for oral and maxillofacial soft-tissue defects after treatment of R-OSCC.</p>

Plastic surgical treatment of extensive hemangiomas in the oral and maxillofacial regions in children / 中华整形外科杂志

<p><b>OBJECTIVE</b>To evaluate plastic surgical procedures for the extensive soft tissue hemangiomas in the oral and maxillofacial regions in children and to explore prevention methods from surgical complications.</p><p><b>METHODS</b>134 patients with hemangiomas were surgically treated. The defects of soft tissue were repaired with pedicle flaps or skin grafts. Of the 134 patients, 16 were newborns, 91 infant, 16 at preschool age and 11 at school age. The location of hemangiomas included parotid gland (39.6%), lip (20.9%), buccal (20.1%), suborbital (9%), orbital (7.5%) and nasal region (3%).</p><p><b>RESULTS</b>Follow-up from 6 months to 5 years showed that the cure rate was 80.6%, apparently effective rate was 15.7%, effective rate was 2.2% and ineffective rate was 1.5%. No major surgical complications were found.</p><p><b>CONCLUSION</b>Extensive hemangiomas in the oral and maxillofacial regions in children were treated safely using plastic surgical procedures with satisfactory results esthetically and functionally.</p>