Discontinuous Versus In-Continuity Neck Dissection in Squamous Cell Carcinoma of the Tongue and Floor of the Mouth: Comparing the Rates of Locoregional Recurrence.

PURPOSE: To date, consensus has not been reached on which treatment modality, that is, in-continuity neck dissection or discontinuous neck dissection, is more appropriate for managing patients with squamous cell carcinoma (SCC) of the tongue and floor of the mouth. This study aimed to perform a meta-analysis to compare discontinuous neck dissection with in-continuity neck dissection as a treatment modality for SCC of the tongue and floor of the mouth. MATERIALS AND METHODS: The PubMed, Web of Science, China National Knowledge Infrastructure, and Wanfang databases were searched for articles that compared discontinuous neck dissection with in-continuity neck dissection in SCC of the tongue and floor of the mouth until March 1, 2017. The predictor variable was whether discontinuous neck dissection or in-continuity neck dissection was performed in each group. The primary outcome variable was the incidence of locoregional recurrence. Two authors individually extracted the data and assessed the study quality. The meta-analysis was performed using Stata (version 13.0; StataCorp, College Station, TX). RESULTS: We included 8 studies with 796 patients in our meta-analysis. The results showed that in-continuity neck dissection had a statistically significantly lower incidence of locoregional recurrence than discontinuous neck dissection (random-effects model: relative risk, 0.459; 95% confidence interval, 0.240 to 0.877; P = .019). Because significant heterogeneity among studies (I2 = 74.5%, P < .001) was found in the heterogeneity evaluation, a separate analysis was performed. However, the results still showed that in-continuity neck dissection had a statistically significantly lower rate of locoregional recurrence than discontinuous neck dissection in patients with T2 and T3 SCC of the tongue and floor of the mouth (fixed-effects model: relative risk, 0.281; 95% confidence interval, 0.183 to 0.433; P < .001). CONCLUSIONS: Compared with discontinuous neck dissection, in-continuity neck dissection can significantly reduce the rate of locoregional recurrence in patients with SCC of the tongue and floor of the mouth.

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.

Total and near-total lower lip reconstruction: 20 years experience.

BACKGROUND: Reconstruction of total and near-total lower lip defects presents a formidable challenge for the reconstructive plastic surgeon. Many methods have been described, and each has its own advantages and disadvantages. The aim of this article is to discuss the selection of techniques and report our experience of total or near-total lower lip reconstruction. MATERIAL AND METHODS: Over a 20-year period from January 1993 to December 2013, a total of 87 patients underwent total or near-total lower lip reconstruction. Bilateral Yu's flaps were used in 61 patients, double mental neurovascular V-Y island advancement flaps in 16 patients, bilateral Mutaf's techniques in 4 patients, and reconstruction with free radial forearm flaps in 6 other patients. Drooling Rating Scale (DRS) and Patient and Observer Scar Assessment Scale (POSAS) were used to evaluate oral competency and esthetic outcomes. RESULTS: All patients underwent single-stage total or near-total lower lip reconstruction successfully. There were no flap failures. Only 1 patient who accepted the bilateral Yu's flaps developed microstomia, having difficulty in wearing her dentures postoperatively. Oral competencies were well preserved in other patients, and esthetic results were satisfactory. CONCLUSION: Based on our experience, we recommend using the bilateral local techniques or free flap introduced in this article, according to the extent of defects and the patient's general condition, to achieve a personalized ideal reconstruction of the lower lip.

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.

Vertical platysma myocutaneous flap that sacrifices the facial artery and vein.

BACKGROUND: Platysma myocutaneous flap (PMF) is a generally used technique for defect reconstruction after an oral cancer resection. The aim of the study is to present our experience using vertical PMF that sacrificed the facial artery and vein for intraoral reconstruction. METHODS: A retrospective review of the medical records of 54 patients who underwent vertical PMF that sacrificed the facial artery and vein for intraoral reconstruction was performed. A comparison between PMF that sacrificed and that preserved the facial vessels was made, and we also compared PMF that sacrificed the facial vessels with radial forearm free flap (RFFF). Statistics concerning the patients' clinical factors were gathered. RESULTS: The mean age of the 54 patients who underwent PMF that sacrificed the facial artery and vein was 62.0 ± 10.98 years. The co-morbid disease rate of PMF was 53.7%. The flap size ranged from 12 × 5.5 cm to 7 × 5 cm. Survival of the flap was found in all of the cases, with partial necrosis in four cases (7.4%) and total loss in none of the cases. The operation time was 5.7 ± 1.17 h. The complication and success rates were 27.8% and 92.6%, respectively. The 3-year and 5-year survival rates were 77.8% (21/27) and 69.23% (9/13), respectively. The majority of the patients (87.0%) in our series were satisfied with the results of the surgery. There was no significant difference between PMF that sacrificed or that preserved the facial vessels, both in success rate (P = 1) or complication rate (P = 0.72). The patients in the PMF group were older than the patients in the RFFF group (P = 0.011), the operation time was shorter (P < 0.001), and the co-morbid disease rate was higher (P = 0.002). Although the complication rate of PMF (15/54, 27.8%) was higher than that of RFFF (2/34, 5.9%) (P = 0.011), their success rates were similar (92.6%, 94.1%) (P = 1.00). CONCLUSIONS: Vertical PMF that sacrifices the facial artery and vein has specific advantages including in ease preparation and limitations. This technique may provide an effective method for intraoral reconstruction. Our experience in handling the flap may contribute to the success rate.

The versatile application of cervicofacial and cervicothoracic rotation flaps in head and neck surgery.

BACKGROUND: The large defects resulting from head and neck tumour surgeries present a reconstructive challenge to surgeons. Although numerous methods can be used, they all have their own limitations. In this paper, we present our experience with cervicofacial and cervicothoracic rotation flaps to help expand the awareness and application of this useful system of flaps. METHODS: Twenty-one consecutive patients who underwent repair of a variety of defects of the head and neck with cervicofacial or cervicothoracic flaps in our hospital from 2006 to 2009 were retrospectively analysed. Statistics pertaining to the patients' clinical factors were gathered. RESULTS: Cheek neoplasms are the most common indication for cervicofacial and cervicothoracic rotation flaps, followed by parotid tumours. Among the 12 patients with medical comorbidities, the most common was hypertension. Defects ranging from 1.5 cm × 1.5 cm to 7 cm × 6 cm were reconstructed by cervicofacial flap, and defects from 3 cm × 2 cm to 16 cm × 7 cm were reconstructed by cervicothoracic flap. The two flaps also exhibited versatility in these reconstructions. When combined with the pectoralis major myocutaneous flap, the cervicothoracic flap could repair through-and-through cheek defects, and in combination with a temporalis myofacial flap, the cervicofacial flap was able to cover orbital defects. Additionally, 95% patients were satisfied with their resulting contour results. CONCLUSIONS: Cervicofacial and cervicothoracic flaps provide a technically simple, reliable, safe, efficient and cosmetic means to reconstruct defects of the head and neck.

Superficial cervical artery island flap for large soft-tissue reconstruction of occipital and parotid region after tumor resection.

The application of microvascular free flaps is the most widespread method currently used for the reconstruction of extensive defects after resection of head and neck tumor. But not all patients are suitable for a free-flap reconstruction. The pectoralis major flap and trapezius musculocutaneous flap are the most used pedicled flap in large head and neck reconstruction. However, muscle is not always necessary, even for complicated wounds. In addition, there is the possibility of some functional loss when a musculocutaneous flap is used. In this report, we present favorable outcome of 2 cases with the use of superficial cervical artery island flap for occipital and parotid region large soft-tissue reconstruction after tumor resection. We think that superficial cervical artery island flap is a reliable and convenient flap suitable for repairing large-size defects of the scalp, neck, and face, which obviates the need for a microvascular reconstruction.

[Protecting action of acupuncture serum on calcium over-loaded neurons of the hippocampus in rats of ischemia-reperfusion].

OBJECTIVE: To investigate the effect of acupuncture serum on Ca2+ content in the cultured nervous cells of hippocampus after ischemia-reperfusion, so as to probe into humoral factors in acupuncture treatment. METHODS: The neurons of the hippocampus from the new born rats were cultured for 9-11 days. Fluorescein-molecular probe Fluo-3 AM was used for staining of intracellular Ca2+. Fluorescent levels in the nervous cells cultured with the serum of the normal rats or the rats given electroacupuncture at "Baihui" (GV 20), "Zusanli" (ST 36), "Quchi" (LI 11) and "Sanyinjiao" (SP 6) for 2 weeks were determined by using a laser confocal microscope. RESULTS: After the normal serum was added, the intracellular Ca2+ fluorescent levels increased to 697 +/- 113 from 461 +/- 96, while after acupuncture serum was added, the Ca2+ fluorescent levels decreased to 584 +/- 103 from 673 +/- 108, indicating that after addition of acupuncture serum, the increased intracellular Ca2+ content could be decreased. CONCLUSION: There are some active substances in acupuncture serum which can obviously decrease intracellular Ca2+ content after ischemia-reperfusion, so as to provide a direct evidence for role of humoral factor in acupuncture treatment.

[Expression of telomerase genes hTRTmRNA in oral squamous cell carcinomas].

PURPOSE: To investigate the expression of telomerase genes in oral squamous cell carcinomas(OSCC). METHODS: Telomerase genes hTRTmRNA in 65 cases of OSCC, 25 cases of epidermal cells with abnormal hyperplasia and 20 cases of normal oral mucosa were detected by in situ hybridization. The digoxin-labelled probe was targeted to reverse transcription domain. Routine hybirdization was carried out, oral squamous cancer was used as positive control and the negative control without probe. Data was statistically analyzed by SPSS software package for chi-square test,group t test and kendall correlation analysis. RESULTS: The expression of hTRT mRNA was weak in epithelium immediately adjacent to carcinomas and normal oral mucosa (4/20,20.0%), weaker in epidermal cells with abnormal hyperplasia (11/25,44.0%), while very strong expression (54/65,83.1%)in cases of OSCC. The hTRT mRNA expression levels between OSCC and other groups were significantly different P<0.01).The difference between normal oral mucosa, epithelium immediately adjacent to carcinomas and epidermis cells with abnormal hyperplasia was not significant (P>0.05) and the difference between epidermal cells with abnormal hyperplasia and pre-cancer alteration was not significant (P>0.05). CONCLUSION: The expression of telomerase genes (hTRT mRNA) in OSCC is closely related to the malignant transformation of oral mucosa cell. The reactivated telomerase genes (hTRT mRNA) may play a crucial role in the development of OSCC.

[Acupuncture-serum decreases Ca2+ content in cultured rat myocardial cells].

OBJECTIVE: To explore whether humoral factors play a role in the mechanisms of acupuncture. METHODS: Primary culture of myocardial cells of neonatal rats were carried out. Five days later, they were labeled by fluorescent molecular probe Fluo-3AM. Changes of Ca2+ contents in the cultured myocardial cells after addition of the normal rat serum or acupuncture-serum of the rat who received acupuncture at "Neiguan" (PC 6) and Jianshi (PC 5), were dynamically observed by a confocal laser scanning microscopy. RESULTS: After addition of normal serum of the rat, the intracellular Ca2+ level increased to a certain degree, and then gradually tended to stability, which was significantly decreased by addition of the acupuncture-serum (P < 0.01). CONCLUSION: The serum of the rat who received acupuncture at acupoints can decrease the Ca2+ level in cultured myocardial cells, which provides a direct evidence for serum factors involving in acupuncture mechanism.

[Preliminary study on effect of acupuncture serum on Ca2+ content in cultured neurons of cerebral cortex].

OBJECTIVE: To observe effect of serum of the rat after acupuncture on Ca2+ content of cultured nervous cells in vitro for exploring the role of humoral factors in acupuncture. METHODS: Neurons of the cerebral cortex from the new born rats were taken and were cultured in a medium, 7 - 10 days later, fluorescein-molecular probe Fluo-3AM was used for staining of intracellular Ca2+. The intracellular Ca2+ levels in the nervous cells cultured with the serum of the normal rats or the rats given acupuncture at "Baihui" (GV 20), "Zusanli" (ST 36), "Quchi" (LI 11) and "Sanyinjiao" (SP 6) for 2 weeks were determined by using a laser confocal microscope. RESULTS: After addition of the serum of.normal rats, the intracellular Ca2+ level increased and then gradually got stable, and when the acupuncture serum was added to the cultured medium, its level decreased to a certain extent. CONCLUSION: Acupuncture serum can significantly decrease Ca2+ level in cultured cells of the cerebral cortex, which provides a direct evidence for involvement of humoral factors in the role of acupuncture.

[Effect of acupuncture serum on intracellular Ca2+ concentration in cultured neurons].

OBJECTIVE: To study the humoral factor of acupuncture in improving functional activities of the organism. METHODS: Neurons of the cerebral cortex from the new born rats were taken to be cultured in a strictly controlled medium. Seven to ten days later, fluorescein-molecular probe Fluo-3AM was used for staining intracellular Ca(2+). Ca(2+) concentration and its changes after application of acupuncture serum were measured by using a laser confocal microscope. Normal serum and acupuncture serum were derived from the normal control rats and the rats undergoing electro-acupuncture of "Baihui (GV 20)", "Zusanli (ST 36)", "Quchi (LI 11)" and "Sanyinjiao (SP 6)" for 2 weeks. RESULTS: After application of normal serum, the intracellular Ca(2+) concentration increased strikingly immediately at the beginning, and gradually got stable afterwards. When acupuncture serum was added to the culture fluid, Ca(2+) concentration lowered significantly. CONCLUSION: These results suggest that bioactive substances in serum collected from rats undergoing acupuncture can affect the intracellular Ca(2+) concentration of the cerebral neurons, and the humoral factor may participate in the effect of acupuncture in regulating functional activities of the organism.

[Gene expression differences between high and low metastatic cells of adenoid cystic carcinoma].

OBJECTIVE: To investigate the complex differences between high metastatic and low metastatic cells of the Adenoid cystic Carcinoma. METHODS: Gene expression patterns were examined in high metastatic cell ACC-M strain and low metastatic ACC-2 strain with the method SSH (suppression subtractive hybridization). RESULTS: although extensive similarity was noted between the expression profiles, twelve genes were highly expressed of, in low metastatic cell ACC-2 tester, compared with driver, high metastatic cell ACC-M. These genes were cysteine-rich angiogenic-inducer protein (cyr61), chromosome7 clone RP11-52501, G protein, was family member Iferritin heavy polypeptide I, jumping translocation breakpoint, eukaryotic translation elongation, folate receptor, ribosomal proteins L7a, S21, P0 and other two novel genes-ACC metastasis-associated RNH and ACC metastasis-associated suspected protein. GenBank accession number were AF522024 and AF522025 respectively. CONCLUSIONS: the result suggests that the obtainment of the ability of metastasis is related to the low expression or mutation of these genes. These data provide insight into the extent of expression differences underlying metastasis-related genes that may prove useful as diagnostic or prognostic markers.