[Fifty years' retrospection of systemic study on salivary gland tumors].

Salivary gland tumors are a group of the most common tumors in the oral and maxillofacial region with obvious characteristics of clinical, histopathologic, and therapeutic aspects. During the past 50 years, our research group performed a systemic study on salivary gland tumors including imaging diagnosis, fine needle aspiration cytology, FT-mid-IR fiber optics spectroscopy, histopathologic features and biological behaviour of the tumors, functional parotid surgery, and (125)I seed implant branchytherapy. More reasonable principles of management for various types of the tumors were put forward based on the histopathologic features of the tumors. The surgical techniques were modified and the postoperative complications were reduced obviously. Thus, the quality of life of the patients was improved greatly.

[Functional maxillary reconstruction with free composite fibula flap].

Maxillary defects resulting from tumor resection or trauma can cause severe functional and cosmetic deformities. Maxillary reconstruction has long been a challenge for oral maxillofacial surgeons. Functional maxillary reconstruction with vascularized composite bone flap and osseointegrated implants is one of the most important improvements in head and neck reconstructive surgery. Since 1999, our research group has performed a comprehensive research on functional maxillary reconstruction with free composite fibula flap. Clinical data of the patients with maxillary reconstruction using free fibula flap were analyzed to describe the indications and principles of perioperative period of this technique. The modified free fibula flexor-hallucis longus myofascial flap was introduced, which could overcome the disadvantages of traditional free composite fibula flap. The donor site morbidity, post-operative speech outcome, mastication function, and quality of life were evaluated objectively. The biomechanical effects of stress distribution on maxilla reconstructed by free fibula composite flap were analyzed by three-dimensional finite element analysis. These studies demonstrated maxillary defects can be reconstructed successfully using free fibula flaps. This procedure also allows dental implant or conventional denture rehabilitation, which can improve the patient's appearance and oral function and enhance the overall quality of life. The fibula free flap transfer has a high success rate and low perioperative complication rate, making it an ideal choice for maxillary defect reconstruction.

Primary oncocytic carcinoma of the salivary glands: a clinicopathologic and immunohistochemical study of 12 cases.

Oncocytic carcinoma (OC) of salivary gland origin is an extremely rare proliferation of malignant oncocytes with adenocarcinomatous architectural phenotypes, including infiltrative qualities. To help clarify the clinicopathologic and prognostic features of this tumor group, herein, we report 12 OC cases arising from the salivary glands, together with follow-up data and immunohistochemical observations. There were 10 males and 2 females with an age range of 41 to 86 years (median age: 61.3 years). Most occurred in the parotid gland (10/12) with one in the palate and one in the retromolar gland. The tumors were unencapsulated and often invaded into the nearby gland, lymphatic tissues and nerves. The neoplastic cells had eosinophilic granular cytoplasm and round vesicular nuclei with prominent red nucleoli. Ultrastructural study, PTAH, and immunohistochemistry staining confirmed the presence of numerous mitochondria in the cytoplasm of oncocytes. Cellular atypia and pleomorphism varied in the current series. Double nuclei and mitoses were observed in some cases, while one case that showed mild cellular pleomorphism but had local invasion following local recurrence was also identified as an OC. Of the 11 cases with follow-up information, 7 cases had local recurrence. Regional or distant metastases were found in 6 and 4 cases, respectively. Five-year disease-specific survivals were 54.9%. In summary, OC of salivary gland origin is a high-grade tumor, often with local recurrence, regional or distant metastasis, diagnosis of which based on a combination of clinical and histopathological features. Immunohistochemistry for mitochondria is considered as a practical and helpful adjuvant diagnosis. Complete surgical excision is the treatment of choice while the role of radiotherapy or chemotherapy is controversial, and careful follow-up is necessary.

[Basic and clinical research on salivary gland tumors].

Salivary gland tumors are a group of the most common tumors in the oral and maxillofacial region. They have features with complicated histopathologic classification and wide distribution. There is little knowledge on the clinicopathologic characteristics and clinical behaviors of salivary gland tumors of various locations and subtype. The management of salivary gland tumors is also controversial. Biopsy is not suggested because of seeding of tumor cells. Therefore adjunctive methods are important for preoperative diagnosis. Since 1985, our research group has performed a series of basic and clinical researches on salivary gland tumors including clinicopathologic characteristics and behavior, preoperative adjunctive diagnosis, mechanism, prevention and treatment of distant metastasis of salivary adenoid cystic carcinoma, and histogenesis of salivary gland tumor. These studies have improved our knowledge on the clinical, histopathological, cytological, imaging features, and bio-behavior of different types of salivary gland tumors. We have also suggested related principles of management, modified the operative methods of benign tumor of parotid gland. Our efforts have raised the standards of diagnosis and treatment of salivary gland tumors.

Relation between nutritional state and postoperative complications in patients with oral and maxillofacial malignancy.

PURPOSE: To evaluate the role of nutrition in the development of postoperative complications in patients with oral and maxillofacial malignancy. PATIENTS AND METHODS: Ninety-six patients treated surgically for oral and maxillofacial malignancy, 27 of whom developed postoperative complications; the remaining 69 recovered uneventfully. Nutritional state and clinical variables in the two groups were compared. RESULTS: The incidence of poor nutrition was greater in the complication group (56%) than in the uncomplicated group (20%) (p<0.001); the values for body weight, triceps skinfold thickness, arm circumference, arm muscle circumference, and creatinine-height index decreased more in the complicated than in the uncomplicated group (p<0.001); nitrogen and calorie intake during the first postoperative week was less in the complicated than in the uncomplicated group (p<0.001). CONCLUSIONS: Poor nutrition plays an important part in the development of postoperative complications, and perioperative nutritional support of patients with oral and maxillofacial cancer must be properly managed.

[The impacts of various types of neck dissection on postoperative shoulder function for patients with oral squamous cell carcinoma].

OBJECTIVE: To compare the impact of various types of neck dissection on postoperative shoulder function. METHODS: The shoulder functions of 66 patients with oral squamous cell carcinoma (OSCC) and cN0 necks who underwent various types of neck dissection were evaluated by Constant's shoulder function test and neck dissection impairment index at least 12 months after surgery. RESULTS: The patients with accessory spinal nerve reserved had better shoulder function than those with accessory spinal nerve resected. In the group with accessory spinal nerve reserved, the patients receiving selective neck dissection (SND) showed better shoulder function than those with modified radical neck dissection (MRND). The shoulder dysfunction and pain arising from SND were minor in patients with selective neck dissection. CONCLUSIONS: The shoulder function after SND was superior to those after RND and MRND.

[Analysis on occult micrometastasis in levels III - IV of cN0 neck in patients with oral tongue squamous cell carcinoma].

OBJECTIVE: To investigate the frequency of micrometastasis in levels lII - IV of clinical negative neck (cN0) in patients with squamous cell carcinoma (SCC) of oral tongue, and to discuss the management of cervical lymph node for cN0 tongue SCC. METHODS: A total of 471 cervical lymph nodes derived from 25 patients with cN0 tongue SCC, including 263 lymph nodes in level III and 208 lymph nodes in level IV, were included in this study. All lymph nodes were re-examined by anti-cytokeratin (CK) immunohistochemical staining combined with semi-serial section per 500 microm. RESULTS: Among the 25 cases, seven patients were confirmed harboring metastasis in 11 lymph nodes of level III, and no positive lymph node in level IV was detected by routine hematoxylin-eosin (HE) staining. 11 positive lymph nodes in level IIl, which confirmed by HE staining, were also detected by immunohistochemical staining with CK combined with semiserial section. Among the 460 cervical lymph nodes in which HE staining did not show metastasis, only one lymph node in level III harboring a 2.0 mm x 1.5 mm micrometastasis was detected by immunohistochemical staining with CK, and no positive lymph node in level IV was detected by immunohistochemical staining with CK. CONCLUSION: The frequency of occult metastasis in level IV was very low, so it seemed unnecessary to dissect level IV for all patients with cN0 tongue SCC.

[Senile chronic submandibular sialadenitis].

OBJECTIVE: To evaluate the clinic characteristic and treatment of senile chronic submandibular sialadenitis. METHODS: The clinical records of the patients over 50 years old whose final diagnosis was chronic submandibular sialadenitis were reviewed. The patients were diagnosed as neoplasm of submandibular gland before operation, There was no radiographic sign of sialolithiasis, no clinical and laboratory signs of Sjögren syndrome or related autoimmune disease. RESULTS: Thirty-five patients were presented in masses in the submandibular space, which was not related to eating. Histopathologic study showed destruction of acinus, infiltration of inflammatory cell, and micro-calcification in the intercalated duct. CONCLUSIONS: The diagnosis of senile chronic submandibular sialadenitis should be considered if a mass in the submandibular space occurs in the old patients and radiographic study shows no sialolithiasis and neoplasm. Resection of the submandibular gland is not necessary for these patients.

[Application of 99mTc(V)-dimercaptosuccinic acid imaging in detecting neck metastases in patients with oral squamous cell carcinoma].

OBJECTIVE: To evaluate the applicability of 99mTc(V) -dimercaptosuccinic acid (99mTc (V) -DMSA) imaging in detecting neck metastases in patients with oral squamous cell carcinoma. METHODS: Single photon emission computer tomography (SPECT) scintigraphy with 99mTc(V) -DMSA was performed on 32 patients with primary squamous cell carcinoma in oral cavity. The coronal aspect of SPECT image was chosen, the region of interest (ROI) of the affected neck was drawn, and the radioactivity uptake value of the ROI was given by the computer to compare with the contralateral neck. The results of 99mTc(V) -DMSA were compared with postoperative pathological studies. For false positive lymph nodes, semi-continuous slice was carried out for pathology examination. RESULTS: The sensitivity, specificity and accuracy of 99mTc(V) -DMSA imaging for detecting metastatic lymph nodes were 75.0%, 90.0% and 84.4% respectively. The ROI values of the affected neck are higher than that of the contralateral part in the 9 positive patients (t = 8.128, P = 0.000 04). Metastasis was not found in the enlarged lymph nodes of the false positive patients. CONCLUSIONS: 99mTc(V) -DMSA SPECT imaging has fairly high affinity with metastatic lymph nodes in the neck especially in the cN0 patients and is helpful for designing proper neck dissection.

[Primary study on repair of mandibular defect using free fibular composite flap].

OBJECTIVE: To summary the clinical application of free fibular composite flaps in repair of mandibular defect. METHODS: Fifty-eight cases of mandibular reconstruction using free fibular flaps, from June 1999 to November 2000, were reviewed, among which there were 37 cases of male and 21 cases of female, aged from 12 to 65 years old. All of the relevant data of the operation, such as the cause of the defect, design of the flaps, the blood vessels of the recipient and the complications, were included and analyzed. RESULTS: The fibular flap was 10.9 cm (4-21 cm) averagely in length and was harvested for 2.1 times (1-4 times); the average size of the skin paddle was 5.88 cm x 3.13 cm. Of 58 flaps, there were 56 survived; the overall complication rate was 24.1%. CONCLUSION: It's safe and reliable to use free fibular flap to reconstruct the mandibular defect.