Clinicopathological characteristics of immunoglobulin G4-related sialadenitis.

INTRODUCTION: Immunoglobulin G4-related disease (IgG4-RD) is a newly recognized fibro-inflammatory condition. Forty-two cases with immunoglobulin G4-related sialadenitis (IgG4-RS) confirmed by histopathological and immunohistochemical assessment were studied to clarify the clinicopathologic characteristics of the salivary glands involved in IgG4-RS, especially the relationship between the histopathologic features and function of salivary glands or serum levels of IgG4. METHODS: Clinical, serologic, imaging and histopathological data of these cases were analyzed. CT volumes of submandibular, parotid, and lacrimal glands were calculated. The saliva flow rate was measured. Scintigraphy with 99mTc-pertechnetate was undertaken in 31 cases, and the concentration index (CI) and secretion index (SI) was calculated. Relationships between fibrosis severity and salivary gland function or serum IgG4 levels were analyzed. RESULTS: The first symptom was swelling of bilateral submandibular or lacrimal glands. Physical examination showed multiple bilateral major salivary glands (including sublingual and accessory parotid glands) and lacrimal glands were enlarged in IgG4 RS. Multiple enlarged cervical lymph nodes were noted in 30 patients. Saliva flow at rest was lower than normal in 34 cases; stimulated saliva flow was lower than normal in 15 cases. Secretory function was reduced more severely in the submandibular glands than in the parotid glands. Serum levels of IgG4 were elevated in 95.2% of cases and 78.6% patients had increased IgE levels. Serum IgG4 level was higher and saliva secretion lower as glandular fibrosis increased. CONCLUSIONS: Prominent changes in the morphology, histology, immunohistochemistry and secretion of the major salivary glands of IgG4-RS patients were accompanied by involvement of the lacrimal glands and cervical lymph nodes. Elevated IgE, allergic history, eosinophil infiltration suggest allergic reactions as a potential pathogenesis of IgG4-RS. Severity of glandular fibrosis correlated with salivary function and serum levels of IgG4.

[Effect of litchi seed aqueous extracts on learning and memory obstacles induced by D-galactose in mice and its mechanism].

OBJECTIVE: To investigate the improving effect of Litchi Seed Aqueous Extracts on learning and memory obstacles model and its mechanism. METHODS: The learning and memory obstacles model was incluced by subcutoneous injection of D-galactose (500 mg/kg) for 8 weeks. The model group and treatment groups were given huperzine A (0.4 mg/kg) and Litchi Seed Aqueous Extracts (15,60 g/kg) respectively for 4 weeks by ig at the 5th week. After huperzine A and Litchi Seed Aqueous Extracts treatment for 4 weeks, water maze test was used to determine the ability of mice's spatial learning and memory. The contents of advanced glycation end products (AGEs) in serum, the content of nitric oxide (NO) and acetylcholine (Ach), the activity of nitric oxide synthase (NOS) and acetylcholinesterase (AchE) in the brain tissue were detected. RESULTS: Litchi Seed Aqueous Extracts significantly ameliorated the learning and memory ability in mice, decreased the level of AGEs in serum, and reduced the content of NO and activity of NOS in brain tissues. No significantly influence was observed for the Ach and Ach-E in brain tissues. CONCLUSION: Litchi Seed Aqueous Extracts possesses improving the learning and memory effects on the model mice induced by D-galactose, which may be related to inhibiting too much AGEs and NO formation and reducing damage in the brain cells.

Diagnosis and treatment of congenital dilatation of Stensen's duct.

OBJECTIVES/HYPOTHESIS: This study aimed to describe the diagnosis and management of congenital dilation of Stensen's duct (CDSD) in seven cases. STUDY DESIGN: Retrospective study. METHODS: We collected data including medical records, radiology, and histopathology findings and follow-up for seven patients (four males) with CDSD. The mean age was 23.9 years (range, 2-72 years). RESULTS: The clinical features of CDSD were the primary presentation of painless swelling in the cheek without an obvious cause that was unilateral or bilateral and occurred at any age, and a swelling along Stensen's duct. In patients without a history of inflammation, aggressive massage of the swelling could produce abundant intraoral salivary flow. Parotid sialography demonstrated a dilated Stensen's duct with a smooth margin but no obvious obstruction. All seven patients underwent superficial parotidectomy including the intact Stensen's duct. No patient showed recurrent swelling after a follow-up of 6 to 65 months. CONCLUSIONS: CDSD is an uncommon congenital disorder of the parotid gland. Management with parotidectomy is effective.

[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.

[Comparison of lateral arm flap and radial forearm flap in reconstruction after oral cancer ablation].

OBJECTIVE: To compare the clinical application of lateral arm flap and radial forearm flap in reconstruction after oral cancer ablation. METHODS: The clinical data of 21 cases with lateral arm flap and 104 cases with radial forearm flap between 2007 and 2009 were reviewed. The flap harvest time, flap survival rate, donor site morbidity and postoperative oral function were compared and analyzed. RESULTS: The average flap harvest time of lateral arm flap and radial forearm flap were (46.4±7.6) min and (41.5±7.5) min (x±s) respectively. The flap survival rates of the two flaps were 90.5% (19/21) and 95.2% (99/104) respectively. There was no significant difference between the two flaps in the average flap harvest time and survival rate (P>0.05). The donor site of lateral arm flap could be primarily closed and radial nerve injury occurred in 2 patients. Skin graft was necessary for the donor site closure of radial forearm flap and conspicuous unattractive scar could be seen. All patients could have oral diet and no difficulty in speech intelligibility. CONCLUSION: The lateral arm flap is relatively safe and reliable alterative to the radial forearm flap for the defects reconstruction after oral cancer ablation.

[Reliability of superficial temporal artery and vein as the recipient vessels in free flap transfers in head and neck region].

OBJECTIVE: To examine the reliability of superficial temporal artery and vein as the recipient vessels in free flap transfers in head and neck region. METHODS: From May 2001 to June 2008, 25 cases of head and neck reconstructions were performed by using the vessels in the temporal region as recipient vessels. RESULTS: Among the 25 recipient veins, 23 were superficial temporal veins, and 2 were deep temporal veins. The recipient arteries of all 25 free flaps were superficial temporal arteries. All the free flaps survived completely, without postoperative vessel thrombosis. CONCLUSIONS: The superficial temporal artery and vein can be used as reliable recipient vessels in free flap transfers in head and neck region.

[125I seed implant brachytherapy of recurrent parotid gland malignant tumor].

OBJECTIVE: To investigate the efficacy of radioactive seeds for the treatment of recurrence malignant parotid gland tumors. METHODS: Thirty-three patients with recurrence malignant parotid gland tumor treated by radioactive seeds were retrospectively reviewed. Three patients received implanted radioactive seeds alone. Thirty patients underwent both tumor resection and radioactive seeds implanting. The patients were followed up for 1041 months. RESULTS: All three patients receiving implanted radioactive seeds alone achieved CR Twenty-four patients treated by operation and radioactive seeds implanting had no local recurrence. The overall local control rate was 88%. The facial nerves were preserved in thirteen of fifteen patients without facial nerve palsy before treatment, and the facial nerve functioned well after operation. Four patients showed slight radiotherapeutic side effect. CONCLUSIONS: Radioactive seeds implanting combined with operation or implanting radioactive seeds alone for the treatment of recurrent malignant parotid gland tumors could get good local control and treatment effects.

[Reliability of skin paddle in monitoring blood flow after free fibular osteocutaneous composite flap transfer].

OBJECTIVE: To evaluate the reliability of skin paddle in monitoring blood flow after free fibular osteocutaneous composite flap transfer. METHODS: Seven hundred and fourteen consecutive cases of mandibular or maxillary reconstruction using free fibular flap from May 1999 to September 2007 were reviewed. The cases with postoperative vessel thrombosis were analyzed. RESULTS: Postoperative vessel thrombosis occurred in 23 cases, 17 were venous and 6 arterial. Among 14 cases of venous thrombosis with color change of skin paddles, only 6 were successfully salvaged, but 3 cases with no color change of skin paddles were all successfully salvaged. For arterial thrombosis, only one flap was successfully salvaged. The postoperative vessel thrombosis rate was 3.2%, and the salvage rate was 43.5%. The overall successful rate of free fibula flap was 98.2%. CONCLUSIONS: Postoperative vessel thrombosis can not be detected in the early stage if only observing the color change of skin paddle after free fibula flap transfer.

[Reliability of residual internal jugular vein as the receipt vein in free flap transfer in head and neck region].

OBJECTIVE: To analyze the reliability of residual internal jugular vein as the receipt vein in free flap transfer in head and neck region. METHODS: Sixteen cases of head and neck reconstruction using the end-to-side anastomosis to the residual internal jugular vein were reviewed. RESULTS: There were 11 radial forearm flaps, 3 fibular flaps, one jejunal flap, and one abdominis myocutaneous flap. The vascular pedicles of all free flaps have enough length to reach the site of residual internal jugular vein for anastomosis without the need of vein grafting. All the free flaps survived completely, without postoperative vessel thrombosis. CONCLUSIONS: End-to-side anastomosis to the residual internal jugular vein in free flap transfer in head and neck region is safe and reliable.

[Influence of prior radiotherapy on free tissue transfer in head and neck region].

OBJECTIVE: To analyze the influence of prior radiotherapy on free tissue transfer in head and neck region. METHODS: One thousand and sixty-six consecutive free flap transfers performed in 1007 patients in head and neck region from May 1999 to March 2005 were reviewed. Among the 1007 cases, 146 had a history of prior radiotherapy (radiation group), and the other 896 without prior radiotherapy (non-radiation group). The two groups were compared in terms of free flap success rate and postoperative complication rate. RESULTS: The success rate of free flap was 97.6% in the radiation group, and 98.4% in the non-radiation group. The postoperative complication rate was 38.4% in the radiation group, and 36.4% in the non-radiation group. CONCLUSIONS: Prior radiotherapy poses no significant influence on free tissue transfer in head and neck region.

[Development of a predicting model of survival rates for patients with salivary adenoid cystic carcinoma].

OBJECTIVE: To establish a predicting model of survival rates and to evaluate the weighted contributions of each key prognostic factor of the patients with salivary adenoid cystic carcinoma (SACC). METHODS: One hundred and eighteen follow-up cases with SACC were analyzed for the survival study with retrospective cohort method. Ten possible clinical and pathologic factors were selected. A multivariate analysis was performed by Cox proportional hazard model and prognostic index (PI) was calculated. According to the PI, all cases were divided into three risk subgroups respectively: lower, intermediate and higher risk subgroups. Ten-year survival rate and median survival time were calculated and the predicting models of survival rates were established. RESULTS: The significant prognostic factors influencing the survival rate were age at diagnosis, clinical presentation, TNM clinical stage, treatment, surgical margins (P < 0.05). The predicting formula was PI = 0.031X(2) + 0.665X(5) + 0.420X(6)-0.576X(7) + 0.999X(10). According to the value of PI, the prognosis of the patients was significantly different among the three subgroups (P < 0.05). In the three risk subgroups, 10-year survival rates were 83.56%, 31.45% and 11.20% respectively, the median survival time was 18 years, 7 years and 4 years respectively. CONCLUSIONS: The established predicting model of survival rates can predict the prognosis of the patients with SACC.

[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.

[Combined free flap and pedicled pectoralis major myocutaneous flap in reconstruction of extensive composite defects in head and neck region: a review of 9 consecutive cases].

OBJECTIVE: To analyze the value and reliability of combined free flap and pedicled pectoralis major myocutaneous flap in the reconstruction of extensive composite head and neck defects. METHODS: Nine consecutive cases of combined free flap and pedicled pectoralis major myocutaneous flap transfers for extensive head and neck defects from March 2002 to April 2005 were reviewed. Data concerning the operation included defect description, type of free flap, recipient vessel and complications. RESULTS: There were 9 cases in this group, with 7 males and 2 females. Among the 9 free flaps, there were 6 radial forearm flaps, two fibula flaps, and one anterolateral thigh flap. The overall flap survival rate was 100% (all of 18 flaps), without partial or total flap necrosis. One radial forearm flap developed venous thrombosis 24 hours after operation, but salvaged by emergent exploration and reanastomosis of veins. The overall complication rate was 44.4%. CONCLUSION: In selected cases, the combined free flap and pedicled pectoralis major myocutaneous flap method provided satisfactory reconstruction for extensive head and neck defect, and simplified the double free flap method.

[168 cases of free flap transplantation with double vein anastomoses for reconstruction of head and neck defects].

OBJECTIVE: To evaluate the reliability and effectiveness of free flap transfer with double vein anastomosis for reconstruction of head and neck defects. METHODS: One hundred and sixty-eight cases of free flap transfers with double vein anastomosis for head and neck reconstruction from September 1999 to April 2003 were reviewed. There were 92 males and 76 females. The age range was 11 to 79 years old, with the average of 44.6 years old. Data concerning the operation included site, stage and histology of tumor, defect description, design of free flap, recipient vessel free flap survival and complications. RESULTS: Among 168 free flaps, there were 126 free fibula flaps, 32 radial forearm flaps, 7 rectus abdominis flaps, one scapular flap, one jejunal flap, and one anterolateral thigh flap. The overall success rate of free flap was 99.4%. One fibula flap was lost because of arterial thrombosis. No venous thrombosis occurred in this group. CONCLUSION: Free flap transfer with double vein anantomosis for head and neck reconstruction improves the outflow of free flap, reduces the venous thrombosis rate, and ensures a high success rate of free flaps.

Pre-mental foramen mandibulotomy for resecting tumors of tongue base and parapharyngeal space.

BACKGROUND: Resection of tumors arising from the tongue base and the parapharyngeal space is difficult for exposure and manipulation because of their obscure location. The aim of this study was to evaluate the surgical approach of the pre-mental foramen mandibulotomy for resecting the tumors of tongue base and parapharyngeal space. METHODS: Fifty-one patients with tumors of tongue base and parapharyngeal space were treated using the mandibulotomy approach on the pre-mental foramen. In the present study, this technique was described in detail. The patients were followed up for three months to six years with a mean of 26 months. RESULTS: The tumors of tongue base and parapharyngeal space could be exposed clearly and be resected radically by surgical approach of pre-mental foramen mandibulotomy. The surgical complications were reduced. CONCLUSIONS: Compared to other surgical approaches, such as lateral mandibulotomy, midline mandibulotomy, the suprahyoid parapharyngeal approach, and paramedian mandibulotomy, we found that the pre-mental foramen mandibulotomy is the ideal choice for resecting the tumors of tongue base and parapharyngeal space.

[Postoperative vessel thrombosis and its management after free flap transfers in head and neck region].

OBJECTIVE: To analyze the rate of postoperative vessel thrombosis and its management after free tissue transfers in head and neck region. METHODS: Eight hundred and forty-nine consecutive free flap transfers were performed from May 1999 to September 2004. Among them, the flaps with postoperative vessel thrombosis were selected and reviewed. Data concerning each case included time of vessel thrombosis, kind of thrombosis, time of emergent exploration, and salvage of free flaps. RESULTS: Among the 849 free flaps, postoperative vessel thrombosis occurred in 28 free flaps, between 8 to 120 hours after operation. There were 5 arterial thrombosis, and 23 venous thrombosis. Thirteen flaps were salvaged after emergent exploration, and 15 flaps were lost. The rate of postoperative vessel thrombosis was 3.3% in this group, the salvage rate of flap was 46.4%, and the overall successful rate was 98.2%. CONCLUSION: Clinical monitoring after free flap transfer in head and neck region is very important and effective. In case of vessel thrombosis, emergent exploration is the only effective way to salvage the flap.

Maxillary reconstruction with the free fibula flap.

BACKGROUND: The objective of this study was to evaluate the outcomes of using the free fibula flap in the reconstruction of maxillary defects. METHODS: Thirty-four consecutive cases of maxillary reconstruction with the free fibula flap were reviewed. All clinical data were analyzed, including primary diseases, types of maxillary defect, free fibula flap design, perioperative complications, and follow-up results. The main postoperative functional indices, including oral diet, speech, type of dental restoration, and aesthetic results, were evaluated. RESULTS: Of the 34 patients who underwent maxillary reconstruction with the free fibula flap, the primary diseases were malignant tumor in 20 patients, benign tumor in 11 patients, and trauma in three patients. Free fibula flap transfer was successful in all cases. Postoperative complications occurred in five patients. Recipient-site wound infection occurred in two patients and donor-site wound dehiscence occurred in three patients. One patient with donor-site wound dehiscence had postoperative lameness. The oral and nasal cavities were separated well by the flap in all patients. The patients were able to take food orally and had no problems with speech intelligibility. Osseointegrated implants were placed in four patients, and complete conventional prostheses were applied in 19 patients. Excellent cosmetic results were obtained in 22 patients. CONCLUSIONS: Alveolar arch defects can be reconstructed successfully using free fibula flaps. This procedure also allows for dental implant 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.

[Analysis of 30 consecutive free flap transplantation for head and neck reconstruction in paediatric patients].

OBJECTIVE: To analyze the reliability and feasibility of free flap transfer for head and neck reconstruction in the paediatric patients. METHODS: Thirty consecutive free flap transfer performed in 28 patients younger than 15 years-old were reviewed. Data concerning the operation included date of surgery, defect description and site, stage and histology of tumor, flap type, recipient vessel and complications. RESULTS: The average age of patients was 12.3 years-old, with age ranged from 5 to 15. There were 19 males and 9 females. Four kinds of free flap were used. The free fibula flap was most commonly used, followed by free radial forearm flap, rectus abdominis myocutaneous flap, and free scapular flap. The overall success rate of the flaps was 93.3%. The overall complication rate was 36.7%. The vessel thrombosis rate was 6.7%. CONCLUSION: Free flap transfer in the paediatric patients for head and neck reconstruction is safe and reliable. There is no difference between the normal patients and paediatric patients in the success rate and complication rate.

[Simultaneous double free flap transfer for extensive defects in head and neck region: a review of 33 consecutive cases].

OBJECTIVE: To analyze the rationale and feasibility of double free flap transfers for reconstruction of extensive head and neck defects. METHODS: Thirty-three consecutive cases of double free flap transfers for extensive head and neck defects from March 2000 to January 2002 were reviewed. Data concerning the operation included date of surgery, defect description and site, choice and combination of flap, recipient vessel and complications. RESULTS: The fibula osteocutaneous-radial forearm fasciocutaneous flap combination was most commonly used (n = 23), followed by the fibula osteocutaneous-rectus abdominis myocutaneous flap (n = 6) and radial forearm-rectus abdominis myocutaneous flap(n = 4). The complete flap survival rate was 97.0% (64 of 66 flaps). CONCLUSION: In selected cases, the double free flap procedure for reconstruction of massive head and neck defect is justified and effective, and greatly improve the quality of life for these patients.