[Repair and reconstruction of oral and maxillofacial defect--clinical analysis of 1973 cases].

OBJECTIVE: To compare the reconstructive method of oral and maxillofacial defect with free tissue flaps. METHODS: The clinical materials were collected from 1 973 reconstructive cases between January 2000 and June 2004 and analyzed in terms of the distribution of age, gender, disease type, defect location, reconstructive method and the incidence of vascular crisis of free flaps as well as success rate of free flap respectively. SAS 6. 12 was adopted for statistical analysis. RESULTS: A total of 1973 reconstructive cases included 764 in middle age (>45 years to < or =60 years, 38.72%), 527 in old age (>60 years, 26.71%), 450 young adults (>28 years to < or =45 years, 22.81%), 187 in young age (>14 years to < or =28 years, 9.48%) and 45 children (< or =14 years, 2.28%). The ratio of male to female was 1.5 : 1. The ratio of benign to malignancy lesion was 1 : 1.94. The tongue defect accounted for 20.63%, followed by mandibular defect(17.38%), parotid defect(13.74%), buccal defect(12.72%), maxillary defect (8.16%), oral pharynx defect (7.60%), floor of mouth defect (5.68%) and others (14.09%). Vascular free flap transfers accounted for 45.82%(904), followed by axial flap(38.17%, 753), random flap (10.19%, 201), a vascularized bone graft (1.52%, 30) and others(4.30%, 85). The most frequently used flap was the forearm flap(594 cases), followed by the fibula free flap(143 cases) and the pedicled pectoralis major myocutaneous flap(369 cases); these three flaps accounted for 56.06% (1106/1973). In 47 free tissue flaps (5.20%) having vascular crisis, 30 were saved (63.83%). The success rate of total free tissue flaps was 98.19% (923/940). CONCLUSION: The majority of reconstructive cases of oral and maxillofacial defects is the middle aged and the old aged male patients with malignancy. The tongue defect accounts for about one fifth of all the cases. The vascularized free flap has a high success rate, so it is a main method for reconstruction of oral and maxillofacial defects. The forearm flap, the fibular free flap and the pedicled pectoralis major myocutaneous flap are the main management for repairing oral and maxillofacial defects.

[Immunodetections and analysis of peripheral blood for patients with oral cancer undergoing operation].

PURPOSE: To investigate the immunological function for patients with oral cancer undergoing operation. METHODS: Peripheral blood was taken from patients with oral cancer before and after operation. Proportions of CD3(+) total T, CD4(+) Th, CD8(+) Tc/Ts, CD19(+) total B, CD16(+)/CD56(+)NK were detected by flow cytometry (FCM). Detections of serum tumor necrosis factor alpha (TNF-alpha) and soluble interleukin-2 receptor (sIL-2R) were performed with enzyme-linked immunosorbent assay(ELISA). Paired t test was used for statistical analysis. RESULTS: The proportions of CD8(+)Tc/Ts, CD19(+) total B and CD4(+)/CD8(+) increased significantly after surgery. Post operative proportion of CD16(+)/CD56(+)NK decreased more significantly. The concentration of TNF-alpha was less than that before operation(P<0.05). CONCLUSIONS: Surgery could change immunological function and alleviate immunosuppression of oral cancer patients. Detections for immune conditions of oral cancer patients might have important clinical values in prognosis evaluation and guiding treatment, especially immunotherapy, after operation.

[Relevant factors and management for patients with squamous carcinoma in tongue without clinical cervical lymphatic node metastasis].

OBJECTIVE: To discuss the treatment of cN(0) tongue carcinoma patients. METHODS: 185 cases of the mobile tongue carcinoma patients (male 102, female 83, aged 28 to 88) treated with surgery from 1988.5 to 1995.6 had been followed up and retrospectively analyzed. Extensive resection of the primary tumors and neck dissections were performed, and all the samples were pathological positive. RESULTS: The cervical lymphatic node metastasis rates for stage I-II, III-IV disease, grade I, II disease were 16.66%, 38.05%, 17.42% and 37.50% respectively. And the rates were 9.00%, 31.37% and 55.55% for submucous infiltration, muscle infiltration and perineural infiltration, respectively. The overall 5 year survival was 72.43%, and the 5 year specific survival rate was 44.44% and 83.96% for those having or not having cervical node metastasis. The levels of 29 patients with positive node metastasis for 148 cN(0) patients were submandibular and submental lymphatic nodes (22.64%), superior deep cervical lymphatic nodes (35.84%), middle deep cervical lymphatic nodes (26.41%), inferior deep cervical lymphatic nodes (15.09%), posterior neck lymphatic nodes (0.00%). The over all 5 year survival rates for selective neck dissection were 85.13% and 21.62% in therapeutic dissection (chi(2) = 29.73, P < 0.01). Patients performed selective neck dissection the rates were 68.96% and 89.07% respectively with or without lymphatic node metastasis. Comparably the 5-year rate was only 20.00% for the patients performed the therapeutic dissection with lymphatic node metastasis. CONCLUSIONS: (1) cN(0) patients should be observed carefully in stage I, and the selective dissection must be performed in stage II-IV. (2) Supraomohyoid ND is essential for T(2) patients, and functional ND is essential for T(3 - 4) patients. (3) There is correlation between cervical metastasis and the stage, grade or infiltration of tongue cancer (P < 0.05). The prognosis could be expected from these factors.

[Long term follow-up results of Chinese prescription "Shen Yang" in the combined and sequential treatment of oral squamous cell carcinoma].

OBJECTIVE: To evaluate the long term therapeutic effect of Chinese prescription "Shen Yang" in the combined and sequential therapy for oral squamous cell carcinoma cases. METHODS: There are 238 cases with oral squamous cell carcinoma. They were divided into two groups randomly as "Shen Yang" experiment group and control group (placebo). 25 cases were precluded from the experiment group. 17 of them were due to unexperiment of taking "Shen Yang" within three months. 8 cases were lost of follow-up. 213 patients were included in this study. Among them, 104 cases in experiment group, and 109 cases in control one. Patients in both groups were followed-up for 5-10 years. Their life-curve was calculated by means of Logrank method. RESULTS: The survival rate of "Shen Yang" group was improved by 8.46%, 9.26%, 9.04% and 8.57% for 3-year, 5-year, 8-year and 10-year survival rates. But the differences between the two groups were not statistically significant (P=0.1936, P>0.05). CONCLUSION: Chinese prescription of "Shen Yang" had a tendency to improve the survival rate for oral squamous cell carcinoma patients.

[The diagnostic value of computed tomography and magnetic resonance imaging in squamous cell carcinoma of tongue: a comparative study].

OBJECTIVE: To compare the diagnostic values of CT and MRI in estimating the thickness of lingual squamous cell carcinoma, and evaluate the relationship between the thickness of tongue carcinoma on MRI and lymph node metastasis rate. METHODS: 23 patients with squamous cell carcinoma of tongue. All the 23 patients were examined with CT and MRI. The actual thickness of tongue carcinoma was measured after surgery. RESULTS: (1)There was a significant difference between the actual thickness of tongue carcinoma and the thickness shown on CT (P<0.05), and no significant difference between the actual thickness of tongue carcinoma and the thickness shown on MRI (P>0.05). (2)Lymph node metastasis rate was 84.6% when the thickness of tongue carcinoma on MRI was greater than or equal to 2cm, and 10.0% when the thickness of tongue carcinoma on MRI was less than 2cm. There was a significant difference between the two groups of patients. (3)MRI can show the area of the tongue carcinoma clearly without enhancement. It has better resolution than CT. CONCLUSION: (1)MRI is better than CT in estimating the thickness of tongue carcinoma. (2)Thickness of tongue carcinoma on MRI could be employed to estimate the possibility of lymph node metastasis.(3)MRI should be the first choice in the diagnosis of tongue carcinoma.

[Relation between the expression of P-gp and GST-pi in oral and maxillofacial squamous carcinoma and chemoresistance].

OBJECTIVE: To investigating the relation between the expression of P-glycoprotein and Glutathione transferase-pi and the chemoresistance. METHODS: The expressions of these two proteins in patients with oral and maxillofacial squamous carcinoma and normal oral tissues were detected by immunohistochemistry. RESULTS: The positive expression rate of P-gp and GST-pi in oral and maxillofacial malignant tumor was 57.1% and 53.6% respectively, and no expression in normal oral tissues; the expression of GST-pi was relevant to the resistance to cisplatin, while the expression of P-gp was relevant to the resistance to chemotherapeutic drug in general. CONCLUSIONS: The method of immunohistochemistry combining MTT assay in vitro may become an efficient way to predict the sensitivity to chemotherapeutic drug.

[Paclitaxel-induced apoptosis in ACC-2 cells is associated with the arrest of G(2)/M].

OBJECTIVE: To investigate whether paclitaxel (Taxel) can efficiently induce apoptosis of ACC-2 or not, and to study the relation of apoptosis and arrest of cell mitosis. METHODS: Paclitaxel-induced arrest of cell mitosis and apoptosis of ACC-2 cells in various concentration and different treat time were determined using transmission electron microscope (TEM), fluorescence microscope, flow-cytometry and DNA agarose gel electrophoresis technique. RESULTS: Under fluorescence microscope, apoptotic cells were green with irregular clumping of nucleus chromatin, or even nuclear chromatin segregation. The typical ultra-structural changes of apoptosis observed by TEM were cell compaction, margination of nuclear chromatin, condensation of cytoplasm, protuberances and apoptotic body. "DNA Ladder" was absent in agarose gel electrophoresis of DNA extracted from culture of ACC-2 cells and paclitaxel-induced ACC-2 cells. "Sub-G(1)" phase peak of ACC-2 cells induced by 50 nmol/L paclitaxel in 48 h and 72 h was 17.13% and 16.26%, respectively. The percentage of G(2)/M phase increased in accordance with raise of the paclitaxel concentration and prolongation of treatment. The typical ultra-structural changes of apoptosis were observed in case that G(2)/M phase was arrested. CONCLUSIONS: Paclitaxel could induce apoptosis of ACC-2 cells. Arrest of G(2)/M phase might induce apoptosis of ACC-2 cells.