Upper Airway Changes After Mandibular Setback and/or Advancement Genioplasty in Obese Patients.

PURPOSE: Orthognathic surgeries, such as bilateral sagittal split ramus osteotomy (BSSO) and genioplasty, can influence the pharyngeal airway space (PAS) and this has been supported by previous studies. The purpose of this study was to assess changes of the PAS in patients with a high body mass index (BMI) likely to have narrow airways before and after setback BSSO with or without advancement genioplasty surgery by 3-dimensional computed tomography. MATERIALS AND METHODS: Thirty-five adults with a BMI of at least 24.0 kg/m2 were treated from 2010 to 2016. Samples were grouped mandibular setback (group A; n = 11), advancement genioplasty (group B; n = 12), and mandibular setback plus advancement genioplasty (group C; n = 12). Computed tomograms were obtained 1 week preoperatively (T0), 1 week postoperatively (T1), and at least 1 year postoperatively (T2). The area of the posterior nasal spine and posterior plane (PPA), the soft palate plane (SPA), the plane of the most posterior point of the tongue base (PTA), the plane of the root of the epiglottis (EA), and the volumes of the palatopharyngeal part (VP), oropharyngeal part (VO), glossopharyngeal part (VG), and laryngeal part (VL) were measured and compared within groups using analysis of variance. The P value was set at .05. RESULTS: In group A, all results showed statistically significant differences (P < .05) from T0 to T2 except for VO, VG, VL, SPA, PTA, and EA. In group B, VO, VG, VL, SPA, PTA, and EA showed statistically significant increases (P < .05) from T0 to T2. The hyoid at T2 showed significant advancement compared with T0 (P < .05). In group C, there were statistically significant decreases (P < .05) from T0 to T1 for VG, VL, PTA, and EA. CONCLUSION: In adults with a high BMI, mandibular setback BSSO could decrease the PAS, whereas advancement genioplasty could enlarge the PAS, after surgery. Therefore, undergoing advancement genioplasty concurrently with mandibular setback BSSO could help in lessening the negative effects of a PAS decrease.

Surgical correction without bone grafts of maxillofacial asymmetric deformities in patients treated for unilateral temporomandibular joint ankylosis.

OBJECTIVE: With the inclusion criteria of patients confirmed and the therapeutic effects and stability evaluated, this article presents the clinical value of bimaxillary orthognathic surgery without bone graft of maxillofacial asymmetric deformities in patients treated for unilateral temporomandibular joint (TMJ) ankylosis. STUDY DESIGN: From 2008 to 2012, 12 patients with dentomaxillofacial asymmetric deformities secondary to unilateral TMJ ankylosis who had undergone TMJ reconstruction as the primary surgery were included in the study. Preoperatively, all patients had compensatory occlusal plane and maxillary inclination <10° and mandibular advancement <15 mm according to computer-assisted 3-dimensional surgical simulation and prediction. Patients received LeFort I osteotomy and bilateral sagittal split rami osteotomy without bone graft, and genioplasty. Pre- and postoperative and long-term radiographic examinations were done to evaluate the therapeutic effects. RESULTS: Maxillofacial asymmetry and abnormal occlusions in patients were clearly improved in the parameters of facial appearance and occlusion as recorded pre- and postoperatively and long term. All patients obtained satisfactory results and were stable in the 36- to 50-month follow-up period. CONCLUSION: The bimaxillary orthognathic treatment protocol without bone grafts described in this study can provide stable improvement in facial appearance and occlusion of secondary dentomaxillofacial deformities in appropriate patients with unilateral TMJ ankylosis.

Application of Intraoperative Navigation for the Reconstruction of Mandibular Defects With Microvascular Fibular Flaps-Preliminary Clinical Experiences.

BACKGROUND: A microvascular fibular flap is the main option for the reconstruction of mandibular defects. This paper introduces an innovative strategy for the accurate fabrication of fibular flaps. METHODS: Nine patients with mandibular tumors were included in this study. The mandibular reconstruction planning was performed using MIMICS 10.01. One reconstruction plate was preformed. During the operation, the fibular flap was fabricated and implanted using the BrainLab navigation system. Six to 12 months after surgery, computed tomography data were acquired and compared with preoperative planning. RESULTS: The osteotomy of the fibular flap and the mandible was easily performed, using the navigation and the osteotomy template respectively. The preformed plate accurately determined the position of the flap. The treatment outcome was consistent with the preoperative planning using 3D analysis. CONCLUSIONS: Combination of the intraoperative navigation and preformed plate technique demonstrated great practical value in mandibular reconstruction with microvascular fibular flaps.

Bimaxillary Orthognathic Approach to Correct Skeletal Facial Asymmetry of Hemifacial Microsomia in Adults.

BACKGROUND: Hemifacial microsomia (HFM) is the second most common congenital craniofacial deformity after cleft lip and palate. Distraction osteogenesis (DO) is regarded as an alternative and efficient treatment option for patients with HFM. However, DO was not proven effective for all cases, and the results of long-term follow-up were not satisfactory as expected. Compared with DO, the orthognathic surgery approach may offer more stable clinical outcomes for this kind of disease. The purpose of this study is to evaluate the long-term clinical and radiographic outcome of bimaxillary orthognathic surgery in the treatment of adult HFM. METHODS: Eight patients with HFM who had undergone bimaxillary orthognathic surgery between 2008 and 2012 were included in the study. The surgical procedures included Le Fort I osteotomy, inverted-L osteotomy, sagittal split ramus osteotomy, genioplasty, and iliac bone grafting. Pre- and postoperative orthodontic treatments were performed, respectively. Clinical and radiographic examinations were carried out to assess postoperative outcomes. RESULTS: No obvious complications appeared postoperatively and no recurrences occurred during follow-up. All patients obtained satisfactory aesthetic results. Marked improvement in facial contour and occlusion were observed. Plain radiographs showed that the height ratios between the affected and unaffected ramus were ameliorated significantly. CONCLUSION: The bimaxillary orthognathic approach to correct the deformity of adult HFM can obtain stable results in the long-term follow-up, and should be considered as a priority method for the treatment of adult patients with dentofacial deformity. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Hyperthermia inhibited the migration of tongue squamous cell carcinoma through TWIST2.

BACKGROUND: Hyperthermia has been shown promising in the treatment of head and neck squamous cell carcinoma (HNSCC); however, the mechanism underlying hyperthermia reducing tumor metastasis is poorly elucidated. TWIST2, an important transcription factor of epithelial-mesenchymal transition (EMT), plays a critical role in the tumor progression and metastasis. The role of TWIST2 in tongue squamous cell carcinoma (TSCC) and its association with hyperthermia still have not been reported. METHOD: The correlations between TWIST2 expression and the clinical-pathologic characteristics of 89 patients with TSCC were evaluated by immunohistochemical staining. TSCC cell lines transfected with siRNA against TWIST2 were heated for 40 min at 42.5°C, and the migration capability of cells was examined by migration assay. Xenograft tumors in nude mice were treated by hyperthermia, and TWIST2 expression was measured. RESULTS: Our data showed that TWIST2 expression was associated with the metastasis of human TSCC. In Tca8113 and Cal-27 cells, TWIST2-siRNA treatment can reduce cell migration ability and has no effect on the cell proliferation and apoptosis. Hyperthermia can decrease the level of TWIST2 in TSCC and inhibit the migration of cells. CONCLUSIONS: This demonstrated that hyperthermia might decrease the migration of Tca8113 and Cal-27 cells by reducing TWIST2 expression. Altogether, these findings suggest an as yet undescribed link between TWIST2 and hyperthermia in TSCC.

Expression and distribution of TNF-α and PGE2 of periodontal tissues in rat periodontitis model.

OBJECTIVE: To simulate the expression of TNF-α and PGE2 of periodontal tissues in rat periodontitis model. METHODS: 40 Wistar rats were randomly divided into the periodontitis group and the control group (n=20). After the successful establishment of periodontitis rat model, raising for six weeks before the animals were sacrificed. The periodontal tissues were obtained and made into slices. Observed the histopathological changes of the periodontal tissues and measured TNF-α, PGE2 levels change by immunohistochemistry, Western blot analysis and ELISA. RESULTS: TNF-α, PGE2 expression of the periodontitis group was significantly higher than that in the control group, the difference was significant (P<0.05). CONCLUSIONS: The TNF-α, PGE2 expression of the rat periodontal tissue in the periodontitis group was significantly higher than the control group.

Regeneration of tooth-like hydroxyapatite depended on amelogenin functional section monolayer: a new approach for tooth repair.

Tooth defect due to caries, trauma, or acid corrosion are common in mankind. Ceramics, metal and resin were used to repaired tooth defect in the past hundred years, but they cannot instead enamel and dentin in depth in clinic usage for the difference in structure and element. So the formation of organized nanocrystals that resemble enamel is crucial for successful enamel remineralization. Now synthesizing a mimicking structure of human enamel using acellular methods has attracted much interest from research groups who have tried using recombinant enamel making proteins like amelogenin, surfactants, to mimic the biomineralization process to restore the enamel layer. Since amelogenin can be used in the assembly of functional nanostructures, we hypothesis that rationally designed ß-sheet-forming peptides that spontaneously form three-dimensional fibrillar scaffolds in response to specific environmental triggers may potentially be used in inducing tooth-like hydroxyapatite crystal ex vivo which important to treatment/prevention of dental caries, via bioactive surface groups.

[Experimental study of the bioresorbable collagen membrane used for guided bone regeneration around dental implants].

OBJECTIVE: To investigate the effects of using guided bone regeneration (GBR) technique with an bioresorbable collagen membrane for repairing bone defects around dental implants. METHODS: In 12 mongrel dogs, pure titanium implants were immediately implanted in mandibles after extraction of the mandibular third and fourth premolars of both sides, in which standard bone defects of 3 mm x 3 mm x 5 mm were created at mesial side of the implants. The defects on right side were covered with Co membrane, the left side was uncovered as control. The dogs were sacrificed 1, 2, 4, 6 months postoperatively. The specimens were removed and studied by gross observation, X-ray radiograph, histological examination, scanning electron microscope (SEM) and pull-out test. RESULTS: The quantity and quality of new bone formation in experimental side which bone defects covered with Co membrane were much better than that in the control side. CONCLUSION: With the biodegradable property and excellent biocompatibility, Co membrane can be used for guided bone regeneration to promote the bone repair progress, and the promotion acts mainly at early stage of bone healing.

[The clinical application and evaluation of combined chemotherapy in comprehensive treatment for oral squamous cell carcinoma].

OBJECTIVE: To study and evaluate the clinical effects of combined preoperative chemotherapy and their relations with multi drug resistance (MDR). METHODS: 102 cases with oral squamous cell carcinoma(OSCC) were included in the study (63 males and 39 females, aged 22 to 67 years). Among the subjects there were 57 cases with cancer of tongue and 45 cases with cancer of buccal mucosa. 27 cases in the group were classified as stage II, 55 as stage III and 20 cases as stage IV according to TNM standard. All cases accepted PYM + 5-Fu + DDP combined chemotherapy pre-operatively. The total given dose was PYM 48 mg, 5-Fu 7.5 g and DDP 300 mg. After the chemotherapy, radical surgery were performed within 2 weeks. The diagnosis of all cases were proved as OSCC by biopsy. RESULTS: Total effective rate of the combined chemotherapy was 82.4%. All of the cases were followed up and their 3 years' survival rate was 67.6%. CONCLUSION: The combined chemotherapy of PYM + 5-Fu + DDP is effective in using as one of comprehensive treatment for OSCC.

[Clinical characters, diagnosis and treatment of parapharyngeal region neoplasms: a report of 115 cases].

OBJECTIVE: The aim of this study was to analyze the clinical characters, diagnosis and treatment of primary neoplasms in the parapharyngeal regions. METHODS: A total of 115 cases of primary neoplasms in the parapharyngeal regions were included in this study. RESULTS: Disorders of swallowing, breath or speaking were the common symptoms of neoplasms in parapharyngeal regions. The majority of neoplasms parapharyngeal regions were benign. 46 cases were from the deep lobe of the parotid, and 42 cases were neurogenic. CT or MRI provides useful information such as their sizes, shapes and extents. The relationship between the tumor and vessel was shown using super-selective angiography. All the tumors were resected completely by extra-oral approach through the posteroinferior incision of the mandible. The follow-up was carried out from 1 to 10 years, and the data indicated that 2 patients died, 18 cases were lost, and others had no recurrence. CONCLUSION: CT and/or MRI are essentially useful for diagnosis and presurgical planning. Super-selective angiography can be used if the lesions involved carotid artery. Posteroinferior incision of the mandible is a simple, effective and safe approach for excision of neoplasms parapharyngeal regions.