Ipsilateral transnasal medial canthopexy to correct secondary telecanthus after naso-orbito-ethmoid fracture.

BACKGROUND: Telecanthus results from medial canthal tendon (MCT) disruption, which can result from traumatic naso-orbito-ethmoid (NOE) fractures. Several methods, using different anchoring materials, incision approaches, or fixation positions, have been proposed for MCT reconstruction. Herein, we report our experience in treating MCT disruption using ipsilateral transnasal medial canthopexy with a Y-V approach. PATIENTS AND METHODS: Between 2008 and 2017, seven patients with traumatic NOE fractures underwent ipsilateral transnasal MCT fixation with Y-V epicanthoplasty. The length ratio, defined as the length of the affected side divided by that of the normal side, was calculated preoperatively and postoperatively. A modified Y-V epicanthoplasty incision was made, after first marking the site in the apex of the caruncular fornix. The nasal wall was exposed and the MCT was accessed carefully. Bulky MCT tissue was trimmed. The lacrimal bone was ground using a bur, creating a concave shape to reposition the MCT, and two holes were drilled into the ipsilateral lacrimal fossa and frontomaxillary process. The MCT was fixed to the frontomaxillary process using no. 2 transnasal wire, which was secured by a 6-mm screw. Finally, the Y-V epicanthoplasty was repaired using 5.0 nylon. RESULTS: The preoperative length ratio (mean±standard deviation: 83.3%±6.0%; range: 73.7%-92.0%) was significantly lower than the postoperative length ratio (mean±standard deviation: 99.4%±0.6%; range: 98.5%-100%) (p<0.05). No major complications were observed, with an average of 13 months of follow-up. CONCLUSIONS: Ipsilateral transnasal wiring fixation with Y-V epicanthoplasty is a useful and adequate method for MCT reconstruction after NOE fractures, without remarkable complications.

A new technique for perioral muscle reconstruction and lip lengthening in complete unilateral cleft lip.

BACKGROUND: Adequate skin lengthening and symmetry may not be consistently obtained in unilateral cleft lip repair, especially in patients with complete cleft. The purpose of this study was to present the model of muscle dissection and approximation to facilitate lip lengthening and symmetry. METHODS: The design followed the rotation-advancement (RA) method without skin measurement. A curvilinear skin incision was made from subnasale to the Cupid's bow peak (CBP). Muscle dissection was continued to the contralateral nostril floor beneath the columellar base to facilitate downward rotation in the medial lip. Wide muscle dissection was performed in the lateral lip segment from the nasal mucosa passing the alar base. The lateral lip muscle was advanced and sutured to the medial lip muscle in a Z-plasty fashion. A small skin backcut was made above the CBP. Primary nasal correction was performed. A series of 138 patients with complete unilateral cleft lip and palate were included in this study. Standard photographs were collected for measurement in the nasolabial region. RESULTS: Adequate lengthening and symmetry of the lip was obtained. The ratio of vertical philtral height was 0.99±0.05 between the cleft and noncleft sides. The C flap was used for supplementary skin lengthening in 58% of cases. Postoperative lip retraction requiring massage occurred in 13%. Overall nasolabial appearance was satisfactory. CONCLUSION: The new technique of perioral muscle reconstruction facilitated to obtain lip lengthening and symmetry in the repair of complete unilateral cleft lip.

Reconstruction of Major Dehiscence After Bilateral Cleft Lip Repair.

Repair of complete bilateral cleft lip with protruding premaxilla is challenging, and postoperative dehiscence was common. Re-repair is usually suggested for the dehisced lip, but other methods might be needed in unique situations. Evaluation was performed to check the presence of prolabial skin, wound scarring, and the position of premaxilla. Reconstruction plan was made to restore the anatomical components as possible and to repair under minimal tension. Two patients with major dehiscence were reported. In the first case, separation from the columella base and tissue destruction in central lip were noted. Repeated complete dehiscence on one side was reported in the second case before he was referred to our center. The premaxilla was protruding in both cases. Abbe flap was performed as delayed procedure in the first case. Reposition of the premaxilla in conjunction with lip repair was required in the second case. In both cases, adequate muscle approximation plus subcutaneous retention sutures were used to cope with the tension, and satisfactory healing was achieved. It is concluded that additional methods could be required for the reconstruction of major dehiscence after bilateral cleft lip repair. Careful planning and surgical execution ensured successful outcome.

The expression of transglutaminase 2 (TG-2) in oral squamous cell carcinoma and its clinical significance.

BACKGROUND: Glutamine has a very important role in the human body, including pH balance in an acidic environment, as well as supporting the TCA cycle in cancer cell growth. However, the expression of transglutaminase-2 (TG-2) in oral cancer growth related to renal function is unknown. Here we examined TG-2 and its expression as a prognostic tool. METHODS: Fifty-six oral squamous cell carcinoma (OSCC) tissues were collected with the inclusion of tumor in any region of oral area, and patients with creatinine (Cr) and blood urea nitrogen (BUN) results. The tissues were stained using immunohistochemistry (IHC) with a TG-2 antibody [N3C3], then observed under the microscope. The staining were calculated using Adobe Photoshop CS software and statistical analyses using SPSS ver. 21. RESULTS: We found that TG-2 expression showed a significant difference in the expression levels between tumor and the adjacent groups without disease-free survival, disease-specific survival, and recurrence between, with p < 0.05. The average staining intensity with 25th percentile of TG-2 becomes a vital score for the diagnosis. Furthermore, our study demonstrates a good prognosis outcome if the intensity score showed a difference in TG-2 expression between the adjacent and tumor tissue. CONCLUSION: To our knowledge, this is the first clinical study on TG-2 expression in OSCC, and it demonstrates that TG-2 can serve as a predictor of tumorigenesis and prognosis outcome.

The prognosis outcome of oral squamous cell carcinoma using HIF-2α.

BACKGROUND: Hypoxia-induced factors (HIF) has a role in angiogenesis and regulate tumorigenesis of cancer cell. The HIF is the best-identified mechanism that shows imbalance between consumption and oxygen supply in progressing tumor. This study of HIF-2α expression in oral squamous cell carcinoma (OSCC) aimed to investigate the relationship of HIF-2α and pathology characteristics related to its clinical correlation. METHODS: Fifty-eight samples of OSCC and adjacent tissues were fixed in paraffin for microarray preparation. The tissue array then was stained using primary antibody HIF-2α (NB100-122) and autoprobe II ABC universal staining kit. Each tissue sample was captured using camera microscope, and images were analyzed with Photoshop 6.0 using the CMYK method. A statistical analysis was performed with the two-tailed t-test, Kaplan-Meier and log-rank test using Prism for Windows version 5.0. RESULTS: The samples of the non-cancerous matched tissues (NCMTs) paired with their OSCC samples showed HIF-2α overexpression with significance difference p < 0.0001. Although no significant difference was found between HIF-2α expression and overall survival rate, cancer-specific survival rate, and disease-free survival rate, the HIF-2α expression showed statistical significance for overall cancer stages with p = 0.013. In addition, patients with high HIF-2α expression tended to develop recurrence within 2 years compared to the low expression group. CONCLUSION: HIF-2 expression has complicated roles in different cancer types, including OSCC. Our study indicated that HIF-2α overexpression can serve as a good biomarker for cancer status for all tumor stages and may predict an early recurrence within two years.

An overview of detection and screening of oral cancer in Taiwan.

Oral cancer is a fatal disease, which accounts for the fourth highest incidence of malignancy in males and the seventh highest in the general population of Taiwan. About 95% of oral cancer is oral squamous cell carcinoma (OSCC). The relatively high prevalence of OSCC in Taiwan is mainly because a high-risk group of the population exists, made up of 2.5 million people and who exhibit habits of betel nut chewing as well as cigarette smoking. Unfortunately, about 50% of the new OSCC cases found in medical centers presented with TNM stage III or IV cancer lesions leading to a low 5-year survival. Therefore, it is generally accepted that the prevention and screening of OSCC at early stages or premalignant levels in the high-risk group of the population is as equally important as treatment. In this review article, we describe the current status of OSCC in Taiwan regarding epidemiology. Furthermore we research and highlight the importance of various conventional and novel methods in the detection of this disease.