The combined application of bleomycin with triamcinolone acetonide in port wine stains: inhibiting proliferation and recurrence of port wine stains.

BACKGROUND: Port wine stains slowly grow thicker over time, nodules appear on the surface, and the color slowly deepens from pink to purple. Even after laser treatment, some port wine stains will recur and slowly grow, and the erythema appears again. The purpose of this study was to investigate the effectiveness of bleomycin in combination with triamcinolone acetonide in the treatment of inhibiting the proliferation and recurrence of port wine stains. RESULTS: Histopathological change: Before treatment, dense capillaries were distributed within the lesion, and blood fills the lumen. Lack of normal skin structure: After bleomycin and triamcinolone acetonide injection, the number of capillaries was significantly reduced, and fibrosis occurred in tissues. Changes in facial morphology: After treatment, the port wine stains became thinner, the asymmetry of the face was effectively improved, and the appearance have been significantly improved. After 5 years of follow-up, there were no recurrent cases. CONCLUSION: Bleomycin and triamcinolone acetonide injection can effectively inhibit the proliferation of port wine stains and prevent port wine stains from recurring after treatment.

The combined application of bleomycin and triamcinolone for the treatment of keloids and hypertrophic scars: An effective therapy for treating refractory keloids and hypertrophic scars.

BACKGROUND: Keloids and hypertrophic scars frustrate patients by the deformity of appearance and organ dysfunction. Many modalities had been tried in clinic practice, but the results are unsatisfied. OBJECTIVE: We retrospectively analysed the combined application of bleomycin and triamcinolone for the treatment of keloids and hypertrophic scars. METHODS: The combination of bleomycin and triamcin acetonide was applied to the treatment of keloids and hypertrophic scars, 86 cases accepted the treatment. Follow-up 2-5 years after treatment. RESULTS: (1) The pain of scars and itching symptoms have basically subsided through treatment. (2) After drug injection treatment, the keloid began to shrink, some of the keloids disappeared. (3) Small keloids did not recur after treatment. Large keloids had local recurrence after treatment. When further treatment was given, the recurrence disappeared. CONCLUSION: The combined application of bleomycin and triamcin acetonide can effectively cure keloids and hypertrophic scars.

Application of Intratissue Laser Ablation in Facial Morphological Modification.

Objective: To conduct a retrospective analysis of the therapeutic effects of laser ablation in maxillofacial applications. Methods: Laser ablation was performed in 97 patients, 27 cases of facial fat accumulation, 40 cases of sagging caused by facial aging, 16 cases of soft tissue asymmetry, and 14 cases of facial hyperplasia. Laser parameters were as follows: lipolysis 8 W, 90-120 J/cm2, and the ablation of hyperplastic tissue 9-10 W, 150-200 J/cm2. The subcutaneous thickness, facial morphology, patient's self-evaluation, and satisfaction were evaluated. Results: Laser ablation reduced the subcutaneous thickness, and tightened loose skin. The patient's appearance looked younger and more beautiful. The curves of the facial contours were more of Oriental beauty. The hyperplasia site became thinner, and the facial asymmetry was corrected or significantly improved. Most of the patients were satisfied with the outcome. There were no serious complications besides swelling. Conclusions: Laser ablation can effectively treat thickening and relaxation of maxillofacial soft tissues. With low risk, few complications, and quick recovery, it can be used as a first-line treatment for maxillofacial soft tissue plastic surgery.

Long-term results of sclerotherapy for cervical-thoracic-mediastinal lymphatic and venous malformations: A case report.

Cervical-thoracic-mediastinal LVMs in infants is rare, and very difficult to be cured because of life-threatening risk and recurrence. An infant with cervical-thoracic-mediastinal LVMs was treated in our department. Left neck was thick at birth, usually depressed, lazy and inactive. He showed dyspnea after about 3 min of automatic activity, with increased wheezing and open-mouth breathing, squatting after walking no more than 6 steps. There were masses and bulges in the left submandibular area and the left neck. The left cervical root and left clavicle were full. LVMs was diagnosed, and treated by sclerotherapy with bleomycin and triamcinolone acetonidein in a phased and step-by-step manner. The thoracic LVMs and mediastinal LVMs were cannulated under general anesthesia B-ultrasound guidance with an indwelling catheter; drugs were administered via the catheter. After several sessions, the submandibular LVMs and cervical LVMs were completely regressed, the thoracic LVMs and mediastinal LVMs were approximately 95 % regressed. Follow-up of 11 years, there was no recurrence; the lungs, thoraxes, and spines were well developed and free to move. Surgical resection of thoracic-mediastinal LVMs has high life-threatening risk, especially in children, and can't remove all of the LVMs. Comparing with surgical resection, sclerotherapy has the advantages of minimally invasive, low risk, conveniently repeated treatment, obvious curative effect. Therefore, cervical-thoracic-mediastinal LVM in infants can be effectively cured by sclerotherapy; the sclerotherapy has no obvious side effect on the development.

Pingyangmycin with triamcinolone acetonide effective for treatment of lymphatic malformations in the oral and maxillofacial region.

OBJECTIVE: The aim of this study was to evaluate the therapeutic effects of intralesion injection of pingyangmycin in combination with triamcinolone acetonide or pingyangmycin alone on lymphatic malformations in oral and maxillofacial regions. METHODS: Twenty-nine cases with lymphatic malformations in the oral and maxillofacial region were divided into experimental and control groups. Thirteen patients in the experimental group underwent intralesion injections of pingyangmycin in combination with triamcinolone acetonide, and 16 patients of control group underwent intralesion injections of pingyangmycin alone. The effects of treatments were assessed by measuring lesion volume and facial deformity before and after treatment. RESULTS: Two years after the treatment, the volumes of macrocystic and microcystic lesions were 3.7% ± 0.3 and 4.2% ± 0.4 of pre-treatment volume in the experimental group, respectively, whereas the volumes of macrocystic and microcystic lesions in control group were 15.4% ± 1.3 and 24.1% ± 3.1, respectively. Facial appearance was satisfactory in all subjects in the experimental group, whereas facial asymmetry remained in varying degree in control group. CONCLUSION: Intralesion injection of pingyangmycin with triamcinolone acetonide was more effective than pingyangmycin alone for treatment of lymphatic malformations in oral and maxillofacial regions.

Treatment guidelines of lymphatic malformations of the head and neck.

Lymphatic malformations, traditionally called lymphangiomas, are diseases caused by development errors of the lymphatic system. About 90% of the cases occur within 2years of age, except a few cases which occur in adulthood, and approximately 75% of the lesions are located in the head and neck region. The lesions can grow rapidly with infection, trauma or bleeding, resulting in disfigurement as well as severe impairment of respiration, swallow and speech. Although lymphatic malformations are benign lesions, they rarely resolve spontaneously, their infiltrating nature coupled with the difficulty in distinguishing involved vital structures of head and neck from adjacent normal tissues makes complete surgical resection even more difficult. The likelihood of postsurgical recurrence and complications is thus higher than other vascular lesions. Surgical resection, sclerotherapy and laser therapy are currently the main treatment modes of lymphatic malformations. Various treatment options have their advantages and disadvantages, the selection of treatment modalities should depend on the patient's individual status and available technology and expertise. The treatment protocol should be individualized, comprehensive as well as sequential in order to obtain the best treatment outcome. Based on published literatures and clinical experiences, we devised the treatment guideline for management of head and neck lymphatic malformations. This protocol will be reviewed and updated periodically to include cutting edge knowledge to provide the best treatment options to benefit our patients.

The effects of Bleomycin A5 on infantile maxillofacial haemangioma.

OBJECTIVE: To examine the effects of bleomycin A5 on infantile maxillofacial haemangiomas. METHODS: Bleomycin A5 was given by multiple intralesinoal injections and the dosage was given according to the age of the patient and size of the lesion. Parts of patients were accompanied by prednisone treatment (2-5 mg/kg, po, QOD. RESULTS: All the haemangiomas involutes completely after treated with bloemycin A5 with better recovery of skin color and less scar forming in small haemangiomas. CONCLUSION: Infantile haemangioma could be effectively treated with bleomycin A5 without serious side effects.

[The therapeutic effect of triamcinolone acetonide with Pingyangmycin on lymphatic malformations in oral and maxillofacial regions].

OBJECTIVE: To investigate the therapeutic effect of Triamcinolone Acetonide and Pingyangmycin on lymphatic malformations in oral and maxillofacial regions. METHODS: 29 patients with lymphatic malformations in oral and maxillofacial regions were divided into two groups to receive intra-lesion injection with Triamcinolone Acetonide and Pingyangmycin in experimental group, or with Pingyangmycin only in control group. The lesions involution and facial appearance were observed. RESULTS: 2 years after treatment, the volume of small cyst and micro-cyst type mass shrank to (3.7 +/- 0.3)% and (4.2 +/- 0.4)%, respectively in experimental group, while (15.4 +/- 1.3)% and (24.1 +/- 3.1)% in control group. The lesion involution was markedly obvious in experimental group. Compare with control group, the facial asymmetry was greatly improved in experimental group. CONCLUSIONS: Intra-lesion injection with Triamcinolone Acetonide and Pingyangmycin is an effective method for the treatment of lymphatic malformations in oral maxillofacial regions. The mass can be shrank markedly to improve facial symmetry.

[Diagnosis and therapy on hemangiomas and vascular malformation in view of the new classification].

Vascular birthmarks are the most common disease. The morbidity is about 2.5%, most of the lesions occur in oral and maxillofacial regions which accounts for 40%-60% of the total lesions. In 1982, Mulliken and Glowacki proposed a biologic classification of vascular birthmarks on the basis of their clinical manifestations, histopathological features, and natural history. They defined hemangiomas as vascular tumors with a growth phase, marked by endothelial proliferation and hypercellularity, and an involutional phase. They recognized that many entities referred to as hemangiomas are actually structural malformations of the vasculature, derived from capillaries, veins, lymph vessels, or arteries or from a combination of these sources. The classification was confirmed and issued by International Society for the study of vascular anomaly (ISSVA) in 1988. Waner and Suen amended the above category in 1995. This paper presents the new classification of vascular birthmarks and the developments in this field in recent years, including the pathology, clinical features and the therapy. For example, the classification of venular malformation categorized by Waner in 1989; the classification of lymphous malformation by Waner and Suen in 1995; and the treatments according to above classifications.

[The preoperative design for remodeling inferior one-third facial contour].

OBJECTIVE: Facial contour remodeling is an important part of plastic surgery. Some skeletal abnormalities, such as mandible protrude, maxillary retrusion, induce the facial asymmetry (including arrowe direction or/and coronary direction), malocclusion, etc. These abnormalities are seen commonly in the lower one third of the face. Evaluation and preoperative design is very important for the treatment of these abnormalities. The purpose of this item is to summarize our experience in the preoperative design during the treatment. METHODS AND RESULTS: Observation of the facial feature of the patient, cephalometric tracing, face-bow transfer and model reconstruction were necessary for the preoperative design. Three-dimensional direction was included in the bone movement for operation and soft tissue should be taken into account simultaneously. All the factors mentioned above were summarized, and outcomes were gathered. CONCLUSIONS: Determination of facial midline was very important, especially for asymmetry patient. The bone was moved in three-dimensional direction. The same site of osteotectomy may produce different effects by different movements.

[The changes of the muscular fiber phynotype at different condition of nerve injury].

OBJECTIVE: To observe the change of the muscular fiber phynotype at different condition of nerve injury. METHODS: Rabbits were used as an animal model in this study. The trigeminus and facial nerves of the animal were simultaneously severed (group 1) or only the latter was severed (group 2). The morphologic change of the muscular fibers was observed with histochemical methods; the tension of contraction and the threshold value of electrical stimulation were observed with electrical physiological methods. RESULTS: Trigeminus nerve play an important role in delaying muscular atrophy after facial nerve was severed. The atrophy degree of type II a and II b muscular fibers was less in group 2 than that in group 1. The change of type 1 muscular fibers was not affected by trigeminus nerve. New muscular fibers emerged in group 2. The tension of contraction and the threshold value of electrical stimulation were better in group 2 than that of in group 1. CONCLUSIONS: Sensory nerve could delay muscle atrophy after denervation. Sensory nerve should be repaired simultaneously when the motor nerve was sutured. The results of this study would facilitate clinical treatment for facial palsy.

[The transformation of fibroblast-like cells originating from different tissue into osteoblasts].

OBJECTIVE: To discuss whether fibroblast-like cells can transform into osteoblasts under specific condition during distraction osteogenesis. METHODS: Fibroblast-like cells were cultured in vitro. BMP-2, TGF-beta(1), BMP-2 and TGF-beta(1) were added into the medium, and the cellular change were observed by histochemistry and immunohistochemistry methods. The distraction was given on the membrane of fibroblast-like cells, and the cellular change were observed under the distraction. RESULTS: fibroblast-like cells from the joint could transform into osteoblasts under the effect of BMP-2 or BMP-2 with TGF-beta(1). Fibroblast-like cells from other regions could not transform into osteoblasts. CONCLUSION: The osteoblasts during distraction osteogenesis are multi-origin.

[The effect of platelet-rich plasma on the distraction osteogenesis].

OBJECTIVE: To observe the effect of the platelet-rich plasma (PRP) on osteogenesis during bone distraction. METHODS: The osteoblasts were cultured in vitro. The rabbits were used as the animal model of distraction osteogenesis. The proliferation of osteoblasts was analysed through MTT methods. The osteogenesis was observed by histochemical and histoimmunochemical methods. RESULTS: PRP stimulated the proliferation of osteoblasts and facilitated distraction osteogenesis. CONCLUSIONS: PRP could accelerate the osteogenesis during bone distraction. The application of PRP in clinical practice might shorten the period of distraction osteogenesis.

[The effects of PL-derived growth factor on osteogenesis and skeletal reconstruction].

Platelet-derived growth factor (PDGF) plays an important role in osteogenesis and skeletal reconstruction. PDGF participates in the process of osteogenesis and bone absorption simultaneously. It stimulates the marrow stromal mesenchymal cell to proliferate and differentiate, accelerates the calcium aggradation into extracellular matrix, and stimulates chondrocytes proliferation and differentiation. Furthermore, PDGF can act on osteoclasts directly or indirectly to promote bone absorption. The dual-effects of PDGF facilitate osteogenesis and skeletal reconstruction.

[Effect of trigeminus nerve on facialis-denervated facial muscle atrophy].

In the present study we made out an animal model on rabbit whose trigeminus and facialis nerves were simultaneously or only the latter one was severed. The pathological changes in facial muscle atrophy under different nerve injuries were investigated. The degeneration of contractile proteins of upper lip muscle -- myosin and actin was observed. In addition, we also examined the ultrastructural changes in the muscle atrophy in the two above-mentioned nerve injury cases. We observed that the intact trigeminus nerve could delay and lighten the atrophy of facialis-denervated facial muscle and attenuate the degeneration of myosin and actin, as well as decrease the increment of collagen and maintain the ultrastructure of the thick and thin muscle filaments. These results may provide the possibility of improvement of clinical treatment for facial muscle palsy.