Comprehensive assessment of the donor-site of the anterolateral thigh flap: A prospective study in 33 patients.

BACKGROUND: The anterolateral thigh (ALT) free flap has been an extremely versatile flap. The purpose of this study was to propose comprehensive functional assessments of the donor site. METHODS: A total of 33 ALT flaps were enrolled prospectively. Objective assessments included isokinetic testing of the knee, and electromyographic examination of the lateral femoral cutaneous nerve (LFCN). The Patient and Observer Scar Assessment Scale (POSAS) was used to subjectively assess the donor-site scar. RESULTS: On the donor side, a significant decrease in most isokinetic muscle strength values was obvious 1 year postoperatively (P < .01). The normal side showed a compensatory increase 1 year postoperatively in the majority of isokinetic muscle strength values (P < .05). The majority of patients (70%) showed decreased sensory conduction velocity of the LFCN or no response to the microcurrent stimulation postoperatively. The aesthetic outcome was satisfactory. CONCLUSION: The decline in functional parameters at the donor-site was common. However, much more research is needed.

Proper Choice of Donor Site Veins for Patients Undergoing Free Radial Forearm Flap Reconstruction for the Defects of Head and Neck.

PURPOSE: The purpose of this study was to analyze the reliability of the deep venous drainage system of the free radial forearm flap. MATERIALS AND METHODS: The authors implemented a retrospective cohort study and enrolled patients admitted for the evaluation and management of head and neck tumors with radial forearm flap reconstruction. The primary predictor variables were the donor site veins, including the deep, dual, and superficial venous drainage systems. The primary outcome measurement was the incidence of venous compromise. Potential confounders included patient demographics, history of chemotherapy with or without radiotherapy, defect sites, and the recipient artery and vein. The χ2 test and logistic regression analysis were used for statistical analysis. RESULTS: The final study population consisted of 520 patients (mean age, 54 years) who underwent head and neck soft tissue reconstruction using the free radial forearm flap. Patients with the deep system (odds ratio [OR] = 0.251; 95% confidence interval [CI], 0.108-0.581) or dual system (OR = 0.197; 95% CI, 0.064-0.605) had a markedly lower risk of venous compromise than those with the superficial system. The overall incidence of inadequate outflow was 2.5% (5 of 204) when the deep system was used alone and 8.9% (19 of 212) when the superficial system was used alone (P = .004). CONCLUSIONS: Patients with the deep venous drainage system had a statistically lower risk of venous compromise. This study recommends using the deep system as a drainage vein for the free radial forearm flap.

A comparison of mandible preservation method and mandibulotomy approach in oral and oropharyngeal cancer: A meta-analysis.

OBJECTIVE: This study aims to compare the prognoses outcomes of mandibular preservation method (MPM) and the mandibulotomy approach (MLA) in oral and oropharyngeal cancer (OOPC) patients. METHOD: We searched PubMed, Web of Science, EMBASE, Chinese BioMedical Literature Database (CBM), Cochrane Library, and clinicaltrials.gov up to September 2016 to identify the studies that compared the prognoses of the MPM versus the MLA in OOPC patients. Two authors individually extracted the data and performed quality assessment. The surgical margins, overall survival rate, total and local recurrence rates, fistula formation, and other functional outcomes were evaluated. RESULT: Six studies with 309 patients were included in our analysis. No significant difference was found regarding the surgical margins, overall survival rate, total and local recurrence rates, and speech and tongue movement between the MPM and MLA groups. However, the MPM group showed a significantly lower fistula formation rate than the MLA group after the operation. CONCLUSION: These findings suggest that the MPM may provide a similar clinical outcome to the MLA, but that the MPM has a lower complication rate in the treatment of OOPC patients.

Reconstruction of Complex Total Parotidectomy Defect With a Chimeric Anterolateral Thigh Perforator Flap and Vascularized Motor Branch of Femoral Nerve Grafting.

Reconstruction of complex total parotidectomy defects after ablation is always a challenge for surgeons. The surgical technique in reconstructing total parotidectomy defects using an anterolateral thigh (ALT) flap has not been described in detail. This report describes the treatment of a difficult case with a complex total parotidectomy defect. An ALT flap composed of a vascularized motor branch of the femoral nerve and a narrow portion of the vastus lateralis muscle was harvested. An 8-cm-long vascularized nerve was transplanted into the gap, which can be considered a cable transplant graft, and a myocutaneous paddle was used to cover and fill in the soft tissue defect. There were no complications after surgery, and the patient was satisfied with the reconstructed facial contours. This case shows that using a chimeric ALT flap for reconstruction is possible in a complex total parotidectomy defect.

Transverse cervical vessels as recipient vessels in oral and maxillofacial microsurgical reconstruction after former operations with or without radiotherapy.

BACKGROUND: The purpose of this study was to investigate the reliability and outcome of using the transverse cervical vessel (TCV) as a recipient vessel for microvascular reconstruction in patients whose vessels in the neck region are unavailable because of previous surgery or radiotherapy. METHODS: Between January 2012 and August 2014, secondary head and neck reconstruction was performed using the TCV as a recipient vessel in eight patients who had undergone previous neck dissection and radiation therapy (n = 5). Five patients had a recurrent carcinoma, one had undergone an operation for scar release and two had been treated surgically for a second primary cancer. The anterolateral thigh flap (ALT), anteromedial thigh flap (AMT), and fibular flap were used for the reconstruction. Clinical data were recorded for each patient. RESULTS: All of the ipsilateral transverse cervical arteries were found to be free of disease. The second free flap was revascularized using the TCVs (n = 6) or the external (n = 1) or internal (n = 1) jugular vein. The free flaps used for the reconstruction included the ALT flap (n = 6), AMT flap (n = 2), and fibular flap (n = 1). All of the flaps survived without vascular events, and the patients healed without major complications. The mean follow-up time was 11 months. One patient died of distant metastases during follow-up. CONCLUSIONS: In patients who have previously undergone neck surgery with or without radiotherapy, the TCVs are reliable and easily accessible recipient vessels for microsurgical reconstruction in the oral and maxillofacial region. If the transverse cervical vein is unavailable, the internal or external jugular vein should be dissected carefully to serve as an alternative for microvascular anastomoses.

Reconstruction for facial nerve defects of zygomatic or marginal mandibular branches using upper buccal or cervical branches.

BACKGROUND: Many reconstructive methods for facial nerve defects have been described previously, such as the greater auricular nerve graft, the sural nerve graft, or hypoglossal-facial nerve anastomosis. Herein, we want to instruct a new technique of repairing facial nerve defects of zygomatic or marginal mandibular branches using upper buccal or cervical branches when we have to face segment defects of facial nerve with wide gaps between facial nerve stumps. METHODS: The distal part of the upper buccal or cervical branches with peripheral tissue was removed to repair the defects of zygomatic or marginal mandibular branches. Clinical and electromyographic examinations were employed to investigate the clinical efficacy of this method. RESULTS: Killed branches of facial nerve included 11 marginal mandibular branches and 16 zygomatic branches in 26 patients. The length of facial nerve defects ranged from 0.9 cm to 2.3 cm with a mean gap of 1.87 cm (SD, 0.89). Seventeen patients finally showed a superb facial function (grade I), 6 patients an excellent outcome (grade II), and 3 patients a good result (grade III). A fair or poor result (grade IV or V) was not observed. CONCLUSIONS: The essence of this method is equivalent to direct facial-facial nerve anastomosis which seems to be able to avoid synkinesis between the upper and lower face. We believe that this method is adaptable to the length of facial nerve defects less than 2 cm.

Lack of influence of an XRCC3 gene polymorphism on oral cancer susceptibility: meta-analysis.

BACKGROUND: To systematically summarize the association between the X-ray repair cross complementing 3 (XRCC3) gene polymorphism and oral cancer susceptibility by meta-analysis. MATERIALS AND METHODS: Databases including PubMed, EMbase, CNKI, VIP and WanFang Data were searched to identify case-control studies concerning the association between an XRCC3 gene polymorphism and the risk of oral cancer from the inception to June 2014. Two reviewers independently screened the literature according to the criteria, extracted the data and assessed the quality. Then meta-analysis was performed using Stata 11.0 software. RESULTS: Seven published case-control studies including 775 patients with oral cancer and 1922 controls were selected. Associations between the rs861539 polymorphism and overall oral cancer risk were not statistically significant in all kinds of comparison models (CT vs CC: OR=0.94, 95%CI=0.74-1.18; TT vs CC: OR=0.94, 95%CI=0.64- 1.38; dominant model: OR=0.95, 95%CI=0.76-1.18; recessive model: OR=0.94, 95%CI=0.69-1.29; allele T vs C: OR=0.97, 95%CI=0.84-1.11). In the stratified analysis by ethnicity, no significant associations were found among Asians and Caucasians. On stratification by tumor type, no significant associations were found for cancer and oral premalignant lesions. CONCLUSIONS: The XRCC3 gene polymorphism was not found to be associated with the risk of oral cancer. Considering the limited quality of the included case-control studies, more high quality studies with large sample size are needed to verify the above conclusion.

Modified incision design for submental flap: an excellent design method for the reconstruction of a defect after head and neck tumor resection.

BACKGROUND: The usage of submental flap is a good method for head and neck reconstruction, but it has some risk also, such as anatomical variations and surgical errors. In this article, we present a modified incision design for the submental flap. METHODS: We designed a modified submental flap incision method based on the overlap of the incision outline of the submental flap, platysma myocutaneous flap and infrahyoid myocutaneous flap. If we found that the submental flap was unreliable during the neck dissection at the level III, II and Ib areas, the infrahyoid myocutaneous flap or platysma myocutaneous flap was used to replace it. Between 2004 and 2012, we performed 30 cases using this method. As control, 33 radial forearm free flaps were counted. Significant differences were evaluated using the χ(2) test and Mann-Whitney U. Survival and recurrence were analyzed using the Kaplan-Meier method. RESULTS: Of the 30 patients, 27 finally received a submental flap, 1 patient received an infrahyoid myocutaneous flap, and 2 patients received a platysma myocutaneous flap. In patients who received the submental flap, the average operation time was 5.9 hours, 2.4 hours shorter than the radial forearm free flap group; the average age was 61.8, 6.1 years older than the radial forearm free flap group; the survival time and recurrence time did not significantly differ with those of the forearm free flap group; and the success rate was higher than traditional methods. CONCLUSIONS: The wider indications, less required time, the similar low risk of recurrence and death as radial forearm free flap, higher success rate than traditional submental flap harvest methods, and ability to safely harvest a submental flap make the modified incision design a reliable method.

Yu's flap for lower lip and reverse Yu's flap for upper lip reconstruction: 20 years experience.

Reconstruction of defects of the lip caused by cancer with its requirements of a complicated anatomical structure, important physiological function, and acceptable cosmetic result, is a challenge for oral and maxillofacial and plastic surgeons. A method that combines rotation and advancement flaps was described by Yu in 1989 for the reconstruction of defects of the lower lip. In our department between January 1992 and December 2012, 8 patients had reverse Yu flaps for the reconstruction of upper lip defects and 56 patients had classic Yu flaps for lower lip defects. Patients with defects located laterally to the upper lips, ranging from ⅓ to ½, had unilateral reverse Yu flaps, and bilateral procedures were done for defects of less than ⅔ of the lips. However, if the defects were located in the centre of the upper lips, between ⅓ and ½, they were treated with bilateral reverse Yu flaps. Patients with defects between ⅓ and ⅔ of lower lips had unilateral Yu flaps, and if the defects were wider than ⅔ of the lower lips, the procedure was bilateral. No flap failed and desirable functional and aesthetic outcomes were recorded in all cases. Here we report our experience with the Yu flap for the benefit of other surgeons.

Clinical anatomical study and evaluation of the use of the free anteromedial thigh perforator flaps in reconstructions of the head and neck.

The anteromedial thigh (AMT) perforator flap is usually thin, pliable, and nearly hairless, making it particularly suitable to repair defects of the head and neck. We studied the topography and outcomes of AMT perforator flaps in such defects after excision of tumours. We retrospectively reviewed the casenotes of 11 consecutive patients who had had reconstructions of the head and neck with the initial intent of using an AMT perforator flap from January 2010 to July 2011. For each patient we recorded the size and thickness of the flap; the length of the pedicle; and the number, external diameters, anatomical types, source vessels, and sites of the sizeable perforators. Of the 11 patients, 10 had successful reconstruction using AMT perforator flaps, but one had no AMT perforator big enough. The mean (range) number of sizeable perforators/flap was 1.3 (1-2), length of pedicle 10.6 (7-13) cm, and diameter of the artery 1.1(1.0-1.5) mm. Of the 13 sizeable perforators, 3 were direct and septocutaneous. The remaining ones were all musculocutaneous. Most of them were located in the middle third of the thigh. Primary closure of the donor site was achieved in all patients. One flap was successfully revised after compression of the perforator. All flaps survived with good functional and aesthetic outcomes. The free AMT perforator flap is suitable for reconstructions of the head and neck if a sizeable perforator can be found. The AMT flap may be used as a primary flap rather than as an alternative to the anterolateral thigh flap or a component of a chimeric flap.

[Perforator vascular anatomy and clinical application of the anteromedial thigh flap for head and neck reconstruction].

PURPOSE: A clinical study was undertaken to define the vascular anatomy of anteromedial thigh perforator flap (AMT) and evaluate the outcomes of the flap in head and neck reconstruction. METHODS: The sizable perforators of AMT flaps and their origins were prospectively explored in 54 patients. For each patient, we recorded the sizable perforators' location, diameter, source vessel, numbers and anatomical types. Among them, 14 cases underwent head and neck reconstruction with AMT flaps. The complications and functions of donor and recipient sites were recorded and the operative techniques of AMT were described. Statistical analysis was performed with SPSS 13.0 software package. RESULTS: Eight of fifty-four thighs had no sizable AMT perforators. AMT flap was based on the medial branch of descending branch of lateral circumflex femoral artery (d-LCFA) and shared the same vascular pedicle with anterolateral thigh flap (ALT). The total sizable perforators were 56. Among them, 40.9%(25/61) were direct septocutaneous perforators, the remaining perforators were all musculocutaneous. Most of the sizable perforators (58/61, 95.1%) were located in the middle one-third of the thigh, with an average of (3.9±0.72) cm medial to a line connecting the anterior superior iliac spine and the superolateral patella and an average of (22.5±2.38) cm to anterior superior iliac spine. There was an negtive relationship between the number of sizable perforators of AMT and ALT flaps (P<0.01). 14 flaps survived completely. No complications were observed in recipient and donor site. CONCLUSIONS: The pedicle of AMT flap is the medial branch of d-LCFA. The AMT flap may be useful if ALT flap is without sizable perforators. AMT flap may be as a primary or an alternative choice of anterolateral thigh flap for head and neck reconstruction.

[Investigation of rat submandibular gland cells and antheraea pernyi silk fibroin films co-culture in vitro].

PURPOSE: In this study, the morphology, attachment, growth and secretion of rat submandibular gland cells (RSMGs) cultured on the antheraea pernyi silk fibroin(ApSF) films were observed in vitro. METHODS: RSMGs were seeded on ApSF scaffolds and bombyx mori silk fibroin (BmSF) scaffolds respectively. RSMGs which were seeded on tissue culture plastic were treated as a negative control group. With the method of immunocytochemistry (CK8 and amylase), the phenotype of cells were identified. The co-cultivation of RSMGs and two kinds of scaffolds were observed by using SEM and fluorescence microscopy. The adherence rate of cells attaching to each experimental material was estimated. MTT assay was performed to determine the proliferation of RSMGs cultured on different scaffolds. The secretion function of cultured cells was evaluated by assay of amylase activity. All the data was analyzed by SPSS13.0 software package. RESULTS: The immunohistochemical staining showed that the cultured epithelial cells of RSMGs were positive for the specific antibody of CK8 and the acinar cells were positive for the specific antibody of amylase. SEM showed that the cultured cells with microvillus anchored well to ApSF films and extended pseudopods to the scaffolds. Fluorescence microscopy showed that with the extension of incubation time, the amount of cells that attached to scaffolds increased. The attachment of RSMGs on ApSF films was almost the same as that on BmSF films after 1 h culture(P>0.05). The adherence rate of RSMGs on ApSF films was higher than that on BmSF films (post-seeding 4,8,12 h, P<0.05). There was no significant difference between ApSF group and BmSF group after 24 h culture (P>0.05), Proliferation of RSMGs cultured on ApSF films for 3 to 5 days was remarkable and that of RSMGs cultured on ApSF films for 7 days reached peak. The proliferation rate of RSMGs cultured on ApSF scaffolds was higher than that on BmSF scaffolds (post-seeding 3,5,7 d, P<0.05), ApSF group and BmSF group were higher than the negative control group (P<0.05). Amylase content of RSMGs cultured on ApSF films was higher than that on BmSF films (post-seeding 3,5,7 d, P<0.05) , ApSF group and BmSF group were higher than the negative control group (P<0.05). CONCLUSIONS: ApSF films can support RSMGs attachment, growth, secretion function maintenance and phenotypic maintenance; and has better biocompatibility for RSMGs in vitro culture.

[Expression and significance of Runx3 in salivary adenoid cystic carcinoma].

PURPOSE: To investigate the association between Runx3 expression and progression of salivary adenoid cystic carcinoma(SACC). METHODS: The expression of Runx3 was examined in 4 pairs of primary SACC and adjacent salivary gland tissues from the same patient, using real-time PCR and Western blot. Furthermore, the Runx3 protein expression was analyzed in 65 clinicopathologically characterized SACC cases by immunohistochemistry. SPSS 17.0 software package was applied to complete data processing.Chi-square test was performed to determine the prognostic and diagnostic associations. RESULTS: Runx3 expression was found to be remarkably downregulated in SACC tissues than that in the normal salivary gland tissues, at both mRNA and protein levels. Statistical analysis revealed a significant correlation of Runx3 expression with Lymph node metastasis. CONCLUSIONS: The results suggest that Runx3 expression is associated with SACC progression, and might represent as a novel and valuable biomarker for clinical therapy of SACC patients.

[Implant-supported overdenture after pectoralis major myocutaneous flap reconstruction of tongue/floor of the mouth cancer:a case report].

Patients with oral cancer, undergoing ablative surgery, were left with severe deformities and dysfunction. Although the defect can be repaired by flap transplantation, there were still difficulties to restore normal oral structure and function of the oral cavity. In these instances, rehabilitation of mastication and occlusion is of the utmost importance. This article described the procedure that implants were inserted and bar/clips retained overdenture was applied to a patient who underwent reconstruction with pectoralis major myocutaneous flap after cancer ablation surgery. The patient's oral structure and functions was recovered, and the quality of life was greatly improved.

Reconstruction for defects of the lower lip after tumor ablation.

BACKGROUND: The lip carcinoma, which frequently affects the lower lip, is one of the most common cancers of the head and neck region composing 25% to 30% of all oral cancers. The accepted method of therapy for lip cancer is surgical excision and reconstruction. The repair should satisfy 2 fundamental requirements: to achieve appropriate aesthetic quality and to conserve labial function. Currently, a wide range of reconstructive procedures have been developed. OBJECTIVE: The objective of the study was to summarize the clinical experience of reconstruction for lower lip defects to facilitate the selection of a proper reconstructive strategy for different conditions in clinical practice. METHODS: We performed a retrospective analysis of 43 patients who had undergone a standardized reconstructive approach based on the literature published and our own experience over the past 4 years. RESULTS: Over an average period of 7.5 months' follow-up, recurrences or major complications did not happen, and most patients were satisfied with their functional and aesthetical outcome. Focusing on the location and the width of the defects of lower lip, a table has been exhibited to orient the surgeons to select a suitable reconstructive procedure for each patient. CONCLUSIONS: Successful reconstruction of all defects can be attained, if as many surgical procedures as possible have been mastered, and a more proper means used.

[Perforator-based chimeric anterolateral thigh flap for head and neck reconstruction after en bloc resection].

PURPOSE: To discuss and report the operative techniques for harvesting perforator-based chimeric flap in anterolateral thigh region and the advantages for head and neck reconstruction after en bloc resection. METHODS: A retrospective review was performed of perforator-based chimeric anterolateral thigh (ALT) flap for head and neck reconstruction since December of 2007 to March of 2011. 66 perforator-based chimeric flaps were harvested including a skin paddle and a muscular flap supplied by one mother pedicle-descending branch of lateral circumflex femoral artery(d-LCFA). 32 flaps were used for the mobile tongue and floor of mouth reconstruction, 30 flaps for base of the tongue and parapharyngeal walls, two for the buccal skin, one for hemimandible and one for parotid. The muscular flap were used to eliminate the dead space of submandibular area. Flaps size ranged from 7cm±4cm to 16cm±7cm and muscular flap was 3cm±4cm approximately. The complications and functions of both donor and recipient sites were recorded and the operative techniques of perforator-based chimeric flap elevation were generalized. RESULTS: All 65 flaps survived completely and the total survival percentage was 98.5%. Only one flap failed and was removed 5 days postoperatively. No complications(fistula, infection, hematoma, seroma et al) were observed in recipient and donor sites. Two anteromedial thigh flaps (AMT) were used for reconstruction due to no sizable perforators in the ALT region. All cases were followed up for 0.5-3 years. The flaps didn't atrophy after six months and the contour was satisfactory. The functions of speech and swallow were recovered well. All the donor sites were closed primarily and the scar was not obvious. The leg's function recovered well. CONCLUSIONS: Using a combination of retrograde and antegrade dissection is a safe and versatile method for harvesting a perforator-based chimeric flap. A chimeric flap including multiple components can meet the requirements of three-dimensional reconstruction. Perforator-based chimeric anterolateral thigh flap is one of the best choices for complex head and neck reconstruction after en bloc resection.

[Anteromedial thigh perforator flap an ideal alternative flap for anterolateral thigh flap without suitable perforator].

PURPOSE: To find a reliable alternative flap with minimal donor site morbidity for anterolateral thigh flap (ALT) without suitable perforator. METHODS: From December 2007 to February 2011, 2 of 64 patients underwent tongue and floor of mouth reconstruction with an anteromedial thigh flap with the initial intent of using an anterolateral thigh flap. One was a perforator flap and the size was 7cm×4cm , the other was a perforator-based chimeric flap including a slender of rectus femoris island and a 14cm×6cm skin paddle. Both of the AMT flap pedicles were medial branch of descending branch of lateral circumflex femoral artery (d-LCFA) and the pedicle length was 10 to 12cm. RESULTS: The flaps survived completely and no complications occurred in recipient and donor sites. The two patients were followed up for 0.5 to 12 months. The functions of speech and swallow recovered well. The donor site was closed primarily and scar was not obvious. The leg's function recovered well. CONCLUSION: AMT flap is a reliable alternative flap with minimal donor site morbidity when there is no suitable perforator in anterolateral thigh region.

[Experimental study on rat submandibular gland cell and silk fibroin-chitosan in vivo].

OBJECTIVE: To evaluate the feasibility of the tissue engineered submandibular gland constructed in vivo based on submandibular gland cells and silk fibroin-chitosan (SFCS). METHODS: Submandibular gland cells were obtained and purified. The second generation cells labeled by 5'-BrdU were seeded on SFCS(5 mm × 5 mm × 5 mm). Submandibular gland cells seeded on SFCS was implanted beneath the skin on the back. At 3, 7, 14 d post-implantation, implant sites were examined local and systemic responses. After paraffin embedding, serial sections 6 mm thick were cut and stained with either hematoxylin and eosin or brdu tissue stain for immunohistochemical studies and examined the responses of tissue. Scanning electron microscope was used to observe the growth behavior submandibular gland cells on SFCS scaffolds. RESULTS: General observation: at the 3, 7, 14 d after in vivo implantation, capsule formed in the surface of insert. Histological observation: in experimental group, submandibular gland cells proliferate on the SFCS scaffold fused to form unit 14 d after implantation. Brdu immunohistochemical observation: the results of labelled cells were positive by immunohistochemical method at each time point. Cytokeratin-8 (CK-8) immunohistochemical observation: the results of labelled cells were positive by immunohistochemical method at each time point. With time, the positive cells gradually increased. Scanning electron microscope: the shape of the SFCS scaffold was mesh. At earlier, submandibular gland cells presence in disorder at attach to the SFCS. At the 14 d submandibular gland cells proliferate on the SFCS scaffold and form functional unit. CONCLUSIONS: Such constructed tissue engineered submandibular gland based on submandibular gland cells and SFCS is promising.

[Clinical application of unimportant branches of facial nerve to repair important ones].

PURPOSE: To study the feasibility and clinical effect of repairing important branches of facial nerve (zygomatic and marginal mandibular branches) with unimportant ones (upper buccal and cervical branches). METHODS: The defect of zygomatic and marginal mandibular branches was repaired with upper buccal and cervical branches, respectively. After the length of facial nerve defect was measured, the distal part of the upper buccal and cervical branches with peripheral tissue was used to repair the defect. Under operating microscope, nerve anastomosis was performed with 9-0 suture. 5 cases suffering from defect of marginal mandibular branches were repaired with cervical branches, and 7 cases with defect of zygomatic branches were repaired with upper buccal branches. RESULTS: In 5 cases suffering from defect of marginal mandibular branches, 2 cases recovered in 3 months, and 3 cases recovered in 6 months; In 7 cases suffering from defect of zygomatic branches, all recovered in 3-4 months. CONCLUSION: Repair of defect of zygomatic and marginal mandibular branches with upper buccal and cervical branches is feasible and the result is acceptable.

[The development and collagen ingredients analysis of submandibular gland acellular matrix].

PURPOSE: To develop submandibular gland acellular matrix and observe its structure and analyze its histological ingredients. METHODS: The fresh submandibular glands of SD mice were cell-extracted by chemical detergent and histological ingredients were analyzed by immunohistochemistry. RESULTS: Submandibular gland cells disappeared, matrix ingredients appeared network structure under microscopy. I, II and III type collagen proteins of submandibular gland before and after cell-extracted were positive under immunohistochemistry. CONCLUSIONS: The main ingredients of submandibular gland acellular matrix were I, II and III type collagen proteins.