[Clinicopathologic analysis of cervical lymph node metastasis in 708 patients with oral squamous cell carcinoma].

PURPOSE: To investigate the characteristics of cervical lymph node metastasis in oral squamous cell carcinoma (OSCC), and the relationship between clinicopathologic factors of OSCC and cervical lymph node metastasis (CLNM). METHODS: Clinicopathologic data of 708 patients with OSCC who underwent neck dissection were retrospectively analyzed. The relationship between clinicopathologic factors of OSCC and CLNM was analyzed with univariate analysis and multivariate analysis using SPPPSS19.0 software package. RESULTS: The incidence of CLNM of OSCC was 35.6%(252/708), and the incidence of CLNM at each level was：levelⅠ30.7%（149/485）, level II33.8% (164/485), level III22.5% (109/485), level Ⅳ8.0% (39/485), and levelⅤ4.9% (24/485), respectively. From univariate analysis of the results, age, differentiation degree, depth of invasion, pathological T stage were significantly correlated with CLNM (P<0.05); while gender, location were not significantly correlated with CLNM (P>0.05). From multivariate analysis of the results, only differentiation degree, depth of invasion and pathological T stage were significantly correlated with CLNM (P<0.05). Depth of invasion was probably the most important influential factor for CLNM of OSCC (OR=2.191). CONCLUSIONS: There was positive relationship between CLNM and pathological T stage , depth of invasion; while there was negative relationship between CLNM and differentiation degree. Depth of invasion was probably the first influential factor for CLNM of OSCC.

Chimeric flaps pedicled with the lateral circumflex femoral artery for individualised reconstruction of through-and-through oral and maxillofacial defects.

Reconstruction of through-and-through oral and maxillofacial defects has always been difficult. We have evaluated the feasibility and reconstructive efficacy of chimeric flaps pedicled with the lateral circumflex femoral artery in the reconstruction of 41 through-and-through oral and maxillofacial defects after resections for cancer. There were 29 chimeric anterolateral thigh and anterolateral thigh flaps and 12 chimeric anterolateral thigh and anteromedial thigh flaps, the sizes of which ranged from 5×8 to 9×11 cm. The chimeric flaps provided separate flaps to reconstruct the intraoral mucosa and extraoral skin defects, and 40/41 of them survived. The appearance and function were satisfactory in all patients after the reconstruction. Chimeric flaps pedicled with the lateral circumflex femoral artery are a good choice for the reconstruction of through-and-through oral and maxillofacial defects.

Application of anteromedial thigh flap for the reconstruction of oral and maxillofacial defects.

PURPOSE: To discuss the vascular anatomy of the anteromedial thigh (AMT) flap and to evaluate the feasibility of the AMT flap for the reconstruction of oral and maxillofacial defects. PATIENTS AND METHODS: A retrospective review was performed of 18 patients who underwent reconstruction of oral and maxillofacial defects with AMT flaps from January 2009 through December 2011 in the Second Xiangya Hospital. Eleven unifoliate AMT flaps were elevated to reconstruct defects of the tongue, soft palate, and floor of the mouth and 7 chimeric anterolateral thigh (ALT) and AMT flaps were harvested to reconstruct through-and-through cheek defects. RESULTS: The flaps were 4 × 6 to 9 × 11 cm(2). All the AMT flaps were nourished by the descending branch (DB) of the lateral circumflex femoral artery. The cutaneous perforators were derived from the rectus femoris branch of the DB in 15 cases and directly from the DB in the other 3 cases. Postoperatively, all flaps survived completely, without major complications. Of the 18 donor sites, 14 were closed directly, leaving only linear scars, and 4 were closed using full-thickness skin grafts owing to larger defects. All patients were followed for approximately 6 to 30 months, and they were satisfied with the esthetic and functional results of the donor and recipient sites after the reconstruction. CONCLUSIONS: Because of easy perforator dissection, the AMT flap can be used as an alternative to the ALT flap or harvested with the ALT flap as chimeric ALT and AMT flaps for the reconstruction of oral and maxillofacial defects.

[The application of a new method of microvascular anastomosis: a review of 109 microvascular anastomosis surgery].

OBJECTIVE: To evaluate the feasibility and clinical significance of the new method for microvascular anastomosis. METHODS: Between February 2013 and May 2013, 108 patients aged 31 to 73 years underwent free flap reconstruction of the defects as a result of resection of oralmaxillofacial tumors. Of 108 patients, 78 were men and 30 were women. The cases were divided into experimental group(46 flaps) and control group (63 flaps) according to different methods of microvascular anastomosis.Isometric double notches end to end microvascular anastomosis was used for artery anastomosis in experimental group, conventional end to end anastomosis was used for artery anastomosis in control group and venous anastomosis was performed in both groups. RESULTS: The entire procedure of artery anastomosis took (7.3 ± 1.7) min in experimental group, (14.5 ± 2.6) min in control group, the difference between the two groups was significant (P = 0.00). There was only one venous compromise which was complete failure in experimental group. There were two venous compromise and one artery compromise in control group, and one of the venous compromise was a complete failure. CONCLUSIONS: The isometric double notches end to end microvascular anastomosis proved successful and clinically feasible with advantages of fixed-point accuracy, time-saving and high patency rate.

N'-(4-Diethyl-amino-2-hy-droxy-benzyl-idene)-4-methyl-benzohydrazide.

The title compound, C(19)H(23)N(3)O(2), was prepared by condensing 4-diethyl-amino-2-hy-droxy-benzaldehyde and 4-methyl-benzo-hydrazide in methanol. The asymmetric unit contains two independent mol-ecules in which the two benzene rings make dihedral angles of 30.3 (3) and 18.9 (3)°. Intra-molecular O-H⋯N hydrogen bonds are observed in both mol-ecules. The crystal structure is stabilized by N-H⋯O hydrogen bonds, which form chains along the a axis.

2-Hy-droxy-N'-(5-hy-droxy-2-nitro-benzyl-idene)-3-methyl-benzohydrazide.

The title compound, C(15)H(13)N(3)O(5), was prepared by condensing 5-hy-droxy-2-nitro-benzaldehyde and 2-hy-droxy-3-methyl-benzohydrazide in methanol. The two benzene rings make a dihedral angle of 3.9 (3)°. An intra-molecular O-H⋯O hydrogen bond is observed. The crystal structure is stabilized by inter-molecular O-H⋯O and N-H⋯O hydrogen bonds, and C-H⋯O and π-π inter-actions [centroid-centroid distances = 3.5658 (17)-3.9287 (19) Å].

2-Hy-droxy-N'-(4-hy-droxy-benzyl-idene)-3-methyl-benzohydrazide.

The title compound, C(15)H(14)N(2)O(3), was prepared by condensing 4-hy-droxy-benzaldehyde and 2-hy-droxy-3-methyl-benzo-hydra-zide in methanol. The two benzene rings make a dihedral angle of 19.03 (11)°. An intra-molecular O-H⋯O hydrogen bond is observed. The crystal structure is stabilized by inter-molecular O-H⋯O and N-H⋯O hydrogen bonds and C-H⋯O inter-actions, which lead to the formation of a three-dimensional network.

N'-(3-Eth-oxy-2-hy-droxy-benzyl-idene)-2-hy-droxy-3-methyl-benzohydrazide.

The title compound, C(17)H(18)N(2)O(4), crystallizes with two independent mol-ecules in the asymmetric unit. The two benzene rings in each mol-ecule make dihedral angles of 7.6 (3) and 3.9 (3)°. Intra-molecular O-H⋯N and O-H⋯O hydrogen bonds are present in each mol-ecule. In the crystal, N-H⋯O hydrogen bonds link the mol-ecules into chains propagating in [010]. The are also a number of C-H⋯O and π-π inter-actions present [centroid-centroid distances = 3.874 (4) and 3.904 (3) Å], that result in the formation of a three-dimensional network.

[Preparative technique of anterolateral thigh flap].

OBJECTIVE: To investigate the surgical techniques and methods of anterolateral thigh (myocutaneous) flap. METHODS: Two hundred and forty-five consecutive free anterolateral thigh (myocutaneous) flaps for reconstruction of the defects of oral and maxillofacial region following the malignant tumors resection from January 2007 to August 2009 were reviewed. The incision was designed in the upper, middle or lower part 3 cm medial of the iliac-patella line according to the thickness of flaps needed. The perforators with suitable vessel diameter and strong pulse were chosen to make flaps with muscular tissue to fill dead space. More than one perforators were taken when large flaps were harvested. The size of the flaps ranged from 4 cm × 4 cm to 10 cm × 25 cm. Eighteen fat flaps were made thinned. RESULTS: Of the 245 flaps harvested, 3 complete necrosis occurred, and the survival rate was 98.8%. Blisters occurred in 8 thinned flaps, but they all survived. All the wounds were closed directly except 5 cases, which needed skin graft because of too large defects of skin. All the skin graft came from the upper part of the wound of donor site. The shape and function were satisfactory after the reconstruction. CONCLUSIONS: When anterolateral thigh (myocutaneous) flaps are harvested, the incision should be designed 3 cm medial of the iliac-patella line according to the thickness of flaps needed. It is helpful to find the perforators. All of the lower, middle and upper parts of anterolateral thigh region have cutaneous perforators. The skin defects within 8 cm can be closed directly, while the skin defects more than 8 cm often need skin grafting. The skin grafts can be taken from the upper part of donor site wounds.

[The chimeric perforator flap pedicled with descending branch of lateral circumflex femoral artery for reconstruction of oromaxillary soft tissue defect].

OBJECTIVE: To report the application of the chimeric perforator flap pedicled with descending branch of lateral circumflex femoral artery for large and complicated oromaxillary soft tissue defect. METHODS: Based on the anatomic study of descending branches and cutaneous perforators of lateral circumflex femoral artery, the perforator vessels were found and used as flap pedicle. The perforator flap was made as chimeric flap for repairing the oromaxillary soft tissue defect in 8 cases. The chimeric perforator flaps were divided into three types as anterolateral thigh flaps and anteromedial thigh flaps, anterolateral thigh flaps and rectus femoris perforator flaps, and anterolateral thigh flaps and anterolateral thigh flaps. RESULTS: All the 16 flaps in 8 cases survived completely with no complication. The wounds in donor sites were all primarily closed with no skin graft. The patients were followed up for 1-9 months with good functional and esthetic results. There was no morbidity in donor sites. CONCLUSIONS: The chimeric perforator flap has a large tissue volume for large and complicated oromaxillary defect. There is no need for extra donor site and extra blood vessel anastomosis.

[Clinical application of free anterolateral thigh flap in the reconstruction of oromaxillo-facial defects].

OBJECTIVE: To analyze the possibility and practicality of using free anterolateral thigh flap to repair defects of oromaxillo-facial region. METHODS: One hundred and seventy-two patients underwent anterolateral thigh flap (ALP) reconstruction from Jan. 2007 to Dec. 2008. The size of the defect ranges from 4 cm x 4 cm to 10 cm x 25 cm. One hundred and six flaps were used for tongue reconstruction, 14 flaps for buccal reconstruction, 15 flaps for mouth floor reconstruction, 1 flap for lower lip and mental region reconstruction, 6 flaps for hard and soft palate reconstruction, 3 flap for maxillary part reconstruction, 18 flaps for submaxilla part reconstruction, 2 flaps for pharynx oralis reconstruction, 3 flaps for repairing large-area defect of facial, 1 flap for repairing neck and shoulder region and 3 flaps for repairing defect of Infratemporal fossa. Of these flaps, 151 were musculocutaneous flaps, 13 were fasciocutaneous flaps and 8 were chimeric flaps. RESULTS: The success rate reaches 98.3% (169 of 172). Postoperatively, 4 cases encountered vascular crisis, 1 of which survived completely with successful vessel exploration, 3 cases with partial necrosis; and 3 cases with complete necrosis. One case with bleeding after operation. Six cases with parotid fluidly and parotid fistula, 8 cases with mouth floor fistula, 6 cases with infection, 3 cases with infection and partial necrosis on the lateral thigh. All patients achieved acceptable contour, appearance and function. CONCLUSION: Free anterolateral thigh flap can repair kinds of complicated defects on oromaxillo-facial region.

A second monoclinic polymorph of 4-(2-hydr-oxy-4-methoxy-benzyl-ideneamino)-1,5-dimethyl-2-phenyl-1H-pyrazol-3(2H)-one.

The title compound, C(19)H(19)N(3)O(3), prepared by condensing 4-amino-anti-pyrine and 4-meth-oxy-2-hydroxy-benzaldehyde in methanol, is the second monoclinic polymorph of this compound which crystallizes in the space group C2/c. The structure was previously reported [Wang, Zhang, Yan, Zheng & Yang (2007 ▶). Acta Cryst. E63, o1245-o1246] in the space group P2(1)/c. The hydroxyl group is disordered over two positions with occupancies of 0.787 (4) and 0.213 (4). The triply substituted benzene ring and the phenyl ring form dihedral angles of 12.2 (2) and 53.7 (2)°, respectively, with the pyrazolone ring; the corresponding values in the P2(1)/c polymorph are 7.5 (2) and 42.6 (2)°. Intra-molecular O-H⋯N and C-H⋯O hydrogen bonds are observed in the major disorder component. Adjacent molecules are linked through intermolecular O-H⋯O hydrogen bonds, forming dimers.