Maxillomandibular Fusion Along with Fusion of Dorsal Surface of the Tongue to the Hard Palate-A Case Report.

RATIONALE: This case report presents a rare combination of congenital anomalies in an otherwise healthy male infant born at 36 weeks. The infant was diagnosed with congenital maxillomandibular synechia, ectrodactyly, and ankyloglossia superior syndrome (ASS). PATIENT CONCERNS: Inability to open the mouth completely, feeding challenges, and a cleft palate. The infant was stabilized through successful positive pressure ventilation via a face mask at birth and enteral feeding was initiated via a feeding gastrostomy. EXAMINATION: Diagnostic tests revealed a midline palatal cleft, hypoplastic jaws, persistent metopic suture, and a bony fusion at the midline. TREATMENT: Sectioning of the bony spur along the midline and achieving a mouth opening of 2 cm post-manipulation. The patient is under follow-up, with future treatment plans including cleft palate correction at 12 months and potential frontomandibular and lower jaw advancement depending on growth trajectories. TAKEAWAY LESSONS: This case underscores the complexity of managing multiple congenital anomalies and the need for individualized treatment plans.

Investigation of the association between miR­181b, Bcl­2 and LRIG1 in oral verrucous carcinoma.

Abnormal expression of microRNAs (miRNAs) is involved in the development of and anti­apoptotic effects in various types of human cancer. However, miRNA­mediated regulation of oral verrucous carcinoma (OVC) remains to be elucidated. The present study aimed to investigate the expression of miR­181b in OVC and oral squamous cell carcinoma (OSCC). The expression levels of miR­181b were determined using reverse transcription­quantitative polymerase chain reaction. The expression levels of B­cell lymphoma 2 (Bcl­2) and leucine rich repeats and immunoglobulin like domains 1 (LRIG1), were evaluated using immunohistochemical staining. The correlation between Bcl­2 and LRIG1 expression was determined using a Pearson correlation analysis. The expression levels of miR­181b and Bcl­2 in OVC were significantly higher compared with normal mucosal tissue (NM); however, lower compared with the OSCC. The key target of miR­181b was LRIG1 and it was significantly lower in OVC tissues compared with NM tissue; however this was higher when compared with OSCC tissue. The expression levels of Bcl­2 were correlated with expression levels of LRIG1 in OVC tissues. Therefore, LRIG1 may be associated with anti­apoptotic function in OVC tissues.

Bipedicled Preexpanded Forehead Flaps for Simultaneous Reconstruction of Total Nasal and Upper Lip Subunits: A Novel Approach to Complex Facial Resurfacing.

Background Reconstruction of the central facial subunits is a complex and challenging task. In cases in which both the nasal and upper lip subunits are involved, a technique that can reconstruct both aesthetic units with tissue of similar color and texture from a single donor site will be ideal. In this article we present our experience with the bipedicled preexpanded forehead flap for simultaneous nasal and upper lip resurfacing. Patients and Methods Between January 2012 and January 2015 we used this technique in the simultaneous reconstruction of total nasal and upper lip subunits in five patients. All cases were for burns scar resurfacing. Results Good aesthetic results were achieved in each of our five cases to date and no complications were encountered. All donor sites closed primarily with aesthetically pleasing well-concealed linear scars. In all cases small modifications such as philtral shaping and further flap thinning were performed under local anesthesia between 6 and 12 months postoperatively Conclusion The preexpanded forehead flap provides an unparalleled color and texture match when it comes to facial resurfacing. When both total nasal and upper lip resurfacings are required, it is possible to achieve this in a single sitting from a single donor site by using a bipedicled preexpanded forehead flap.

Comparing the Clinical Outcomes Between Insulin-treated and Non-insulin-treated Patients With Type 2 Diabetes Mellitus After Coronary Artery Bypass Surgery: A Systematic Review and Meta-analysis.

Several studies have shown coronary artery bypass surgery (CABG) to be beneficial in patients with type 2 diabetes mellitus (T2DM) and multivessel coronary artery diseases. Patients with insulin-treated T2DM (ITDM) are usually patients with poor glycemic control and are expected to suffer more complications compared with patients with non-insulin-treated T2DM (NITDM). However, the adverse clinical outcomes in patients with ITDM and NITDM after CABG are still not very clear. Hence, to solve this issue, we aim to compare the short-and long-term adverse clinical outcomes in a larger number of patients with ITDM and NITDM after CABG, respectively.Randomized controlled trials and observational studies comparing the adverse clinical outcomes such as mortality, major adverse events (MAEs), stroke, myocardial infarction, and repeated revascularization in patients with ITDM and NITDM after CABG have been searched from Medline, EMBASE, Cochrane, and PubMed databases. A short-term follow-up (≤30 days) and a long-term follow-up (≥1 year) were considered. Odds ratio (OR) with 95% confidence interval (CI) was used to express the pooled effect on discontinuous variables and the pooled analyses were performed with RevMan 5.3.Eleven studies involving a total of 64,152 patients with T2DM (23,781 patients with ITDM and 40,371 patients with NITDM) have been included in this meta-analysis. During the short-term follow-up period, patients with ITDM had a significantly higher mortality (OR: 1.47; 95% CI: 1.33-1.61, P < 0.00001) and MAEs (OR: 1.66; 95% CI: 1.48-1.87, P < 0.00001). During the long-term follow-up period, patients with ITDM still had a significantly higher rate of mortality, MAEs, and stroke (OR: 1.23, 95% CI: 1.02-1.49, P = 0.03; OR: 1.50, 95% CI: 1.07-2.12, P = 0.02; OR: 1.39, 95% CI: 1.22-1.59, P < 0.00001, respectively) after CABG. However, our results showed similar repeated revascularization rate between the ITDM and NITDM groups after CABG (OR: 1.31, 95% CI: 0.81-2.12, P = 0.27).According to this study, patients with ITDM had a significantly higher rate of mortality and MAEs compared with patients with NITDM after CABG. Stroke was also significantly higher in patients with ITDM during a long-term follow-up period. However, since the result for the long-term mortality had a higher heterogeneity as compared with the other subgroups, and because a similar revascularization rate was observed between the ITDM and NITDM groups after CABG maybe because of a limited number of patients analyzed, further studies still need to be conducted to completely solve this issue.

Bmi1 essentially mediates podocalyxin-enhanced Cisplatin chemoresistance in oral tongue squamous cell carcinoma.

Oral tongue squamous cell carcinoma (OTSCC) is one of the most common head and neck cancers. Innate or acquired resistance to cisplatin, a standard chemotherapy agent for OTSCC, is common in patients with OTSCC. Understanding the molecular basis for cisplatin chemoresistance in OTSCC cells may serve as a basis for identification of novel therapeutic targets. Podocalyxin (PODXL) has been found critical for malignant progression in a variety of cancers. Bmi1 has recently been found to induce cell apoptosis and cisplatin chemosensitivity in OTSCC cells. In this study, we explored the interaction between PODXL and Bmi1 in OTSCC cells, and assessed its impact on OTSCC cell chemoresistance to cisplatin. PODXL and/or Bmi1 were stably overexpressed or knocked down in SCC-4 and Tca8113 human OTSCC cells. Overexpression of PODXL in both cell lines markedly elevated the expression level of Bmi1 and the half maximal inhibitory concentration (IC50) of cisplain and reduced cisplatin-induced cell apoptosis, which was abolished by knockdown of Bmi1 or a selective focal adhesion kinase (FAK) inhibitor. On the other hand, knockdown of PODXL significantly decreased the Bmi1 expression level and cisplatin IC50 and increased cisplatin-induced cell apoptosis, which was completely reversed by overexpression of Bmi1. While overexpression and knockdown of PODXL respectively increased and decreased the FAK activity, Bmi1 showed no significant effect on the FAK activity in OTSCC cells. In addition, overexpression of PODXL markedly elevated the stability of Bmi1 mRNA, which was abolished by a selective FAK inhibitor. In conclusion, this study provides the first evidence that PODXL up-regulates the expression level of Bmi1 in OTSCC cells by increasing the stability of Bmi1 mRNA through a FAK-dependent mechanism; this effect leads to enhanced cisplatin chemoresistance in OTSCC cells. This study adds new insights into the molecular mechanisms underlying OTSCC chemoresistance.

Tripaddled anterolateral thigh flap for simultaneous reconstruction of bilateral buccal defects after buccal cancer ablation and severe oral submucous fibrosis release: a case report.

For buccal squamous cell carcinoma (SCC) patients accompanied with severe oral submucous fibrosis (OSF), it is a challenge to simultaneously reconstruct bilateral buccal defects created from cancer resection and contralateral OSF release to improve postoperative mouth opening. Herein, we present a case of reconstruction of bilateral buccal defects in a 46-year-old patient who had left buccal SCC accompanied with severe OSF. Extensive ablation involved the left full-thickness cheek as well as part of mandible and a release of right OSF tissue were performed. A tripaddled anterolateral thigh (ALT) flap with three independent sets of perforators was harvested for reconstruction. The flap survived in its entirety. No donor or recipient site complication occurred. The preoperative inter-incisor distance (IID) was 1 mm, while the postoperative IID was 23 mm. This is the first report on the use of one tripaddled ALT flap for reconstruction of bilateral buccal defects created from cancer ablation and severe contralateral OSF release.

Cys-X-Cys ligand 9 might be an immunological factor in the pathogenesis of oral submucous fibrosis and its concomitant oral lichenoid lesion.

OBJECTIVES: Oral submucous fibrosis (OSF) is a chronic oral precancerous disease primarily caused by betel quid chewing. Some OSF patients are concomitant with oral lichenoid lesion (OLL), a white-streak lesion with a higher risk for cancerization, in OSF mucosa. Immunological reaction has been considered as one of their common pathogenic mechanisms. Cys-X-Cys ligand 9 (CXCL9) is an important factor to recruit effector neutrophils and lymphocytes in immunological reactions. However, the expression levels of CXCL9 in OSF and OLL remain unclear. MATERIALS AND METHODS: We investigated the expression levels of CXCL9 in 10 normal buccal mucosa (NBM) samples and 56 OSF concomitant with OLL patients, and evaluated the possible mechanism of CXCL9 on their pathogenesis. RESULTS: Our results showed NBM demonstrated negative CXCL9 expression. OSF stained positive CXCL9 mainly in the cytoplasm of inflammatory cells and endothelial cells throughout the superficial layer of connective tissue, while its concomitant OLL showed much stronger CXCL9 in all mononuclear cells of subepithelial inflammatory infiltration (p = 0.0006). There was an upregulated trend of CXCL9 expression from NBM to OSF to OLL. However, no significant association between CXCL9 expression and clinicopathologic parameters of patients was found. CONCLUSIONS: In conclusion, CXCL9 was found for the first time to contribute to the immunological pathogenesis for both OSF and its concomitant OLL, indicating a continuously enhanced intensity of immunoreactivity in their pathogenic process. CLINICAL RELEVANCE: CXCL9 might be a useful tool to monitor the phase and disease severity of OSF and OLL, and a potential target for further clinical therapy for both lesions.