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    Chinese Expert consensus on the diagnosis, treatment of odontogenic keratocyst
    LIU Bing, HE Yue, PENG Xin, SUN Chang-fu, HAN Zheng-xue, WU Yu-nong, PENG Li-wei, ZHAO Yi, TAO Qian, HAN Xin-guang, LI Jin-song, SU Tong, LI Bo, ZHANG Lei, HU Yan-ping, CHEN Chuan-jun, LI Yi, LI Tie-jun, ZHAO Yi-fang
    China Journal of Oral and Maxillofacial Surgery    2022, 20 (3): 209-218.   DOI: 10.19438/j.cjoms.2022.03.001
    Abstract578)      PDF (1176KB)(255)      
    Odontogenic keratocyst (OKC) is a common cystic lesion of the jaw. The nomenclature and nature of OKC remain controversial as a result of its local invasive behavior and high tendency of recurrence, which is evidently different from other types of jaw cysts. With the in-depth study of OKC pathogenesis and the advance of treatment concept and surgical techniques, it becomes possible to reduce the rate of postoperative recurrence and simultaneous functional reconstruction of the jaw. To establish standard diagnosis and treatment algorithms or guidelines of OKC, we organized peer experts in China to reach a consensus on pathogenesis, clinical manifestations, imaging characteristics, histopathological features, surgery and postoperative follow-up strategies of OKC for the references of clinicians.
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    Expert consensus on application of submental island flap in oromaxillofacial head and neck defect reconstruction
    CHEN Chuan-jun, CHEN Wei-liang, SUN Chang-fu, HE Yue, JIANG Can-hua, PENG Xin, SHANG Zheng-jun, HAN Zheng-xue, LI Jin-song, HOU Jin-song, LIN Li-song, HAN Xin-guang, WEI Jian-hua, WANG Zhi-yong, WU Yu-nong, ZHENG Jia-wei, LI Long-jiang, WANG Hui-ming, LI Zu-bing, GUO Chuan-bin, YANG Chi, SHI Bing, ZHANG Zhi-yuan
    China Journal of Oral and Maxillofacial Surgery    2021, 19 (5): 385-391.   DOI: 10.19438/j.cjoms.2021.05.001
    Abstract302)      PDF (5968KB)(271)      
    Submental island flap (SMIF) is an axial flap that receives its blood supply from the submental artery, a branch of the facial artery. It is in close proximity with many oral and maxillofacial regions, and provides a good texture and color match. The flap is easy to prepare and suitable for repairing medium-sized defects of the oral and maxillofacial region with high survival rates. However, there are still controversies about the application of submental island flap both at home and abroad, mainly focusing on the oncological safety of submental island flap for patients with cervical lymph node metastasis and the preparation method of the flap. In order to unify and standardize the application of submental island flap in repair of oral and maxillofacial head and neck defects, this paper focuses on the collective wisdom of experts in oral and maxillofacial surgery of many medical colleges in China, and reaches an expert consensus, so as to guide the clinical application of submental island flap.
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    Fibromyxoid spindle cell tumor in the pterygopalatine fossa: a case report
    SHI Fan, XUE Ran, ZHOU Xue-xiao, SHEN Pei, XU Ting, WANG Sheng-zhi
    China Journal of Oral and Maxillofacial Surgery    2021, 19 (5): 478-480.   DOI: 10.19438/j.cjoms.2021.05.018
    Abstract277)      PDF (2893KB)(114)      
    To report a rare case of fibromyxoid spindle cell tumor which occurred in the pterygopalatine fossa and discuss its imaging features, pathological diagnosis and treatment. A 58 years old female, CT showed nodular low-density mass in the right pterygopalatine fossa, enhanced CT showed mildly enhanced, with unclear boundaries, adjacent inferior wall of the right maxillary sinus was destructed, patchy enhanced shadow was seen in the posterior margin of the adjacent right maxilla and the right lateral muscle was oppressed. Spindle cell tumor of the right pterygopalatine fossa was confirmed under light microscopy. Morphological features were consistent with proliferative fibromas of bone connective tissue and mucous degeneration around the tumor. Immunohistochemistry showed that CK(-), S-100(-), AE1/AE3(-), SMA(-), CD34(-), Des(-), MUC-4(-), p63(-), STAT-6(-),β-catering (nuclear -), Dog1(-), the positive rate of Ki-67 was 2%.
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    Prognostic factors of oral tongue squamous cell carcinoma: a retrospective study of 638 cases
    YE Chen, CAI Yun, ZHAO Xiao-mei, ZHANG Chen-ping, ZHAO Nai-qing
    China Journal of Oral and Maxillofacial Surgery    2021, 19 (5): 449-455.   DOI: 10.19438/j.cjoms.2021.05.012
    Abstract219)      PDF (4620KB)(147)      
    PURPOSE: To investigate the impact of clinical and pathological characteristics on survival of patients with oral tongue squamous cell carcinoma (OTSCC), and to analyze the factors predicting survival outcome. METHODS: A retrospective analysis of 638 patients diagnosed with OTSCC at Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from January 2003 to December 2013 was performed. Details on patient characteristics and tumor characteristics were recorded by retrospective review of patients' charts. Survival data acquisition was retrieved from Shanghai registry database of resident cancer by Shanghai Center for Disease Control and Prevention. Standard descriptive statistics were used to summarize patient demographic and disease-related data. Pearson Chi-square, Kaplan-Meier, Log-rank test, and Cox proportional hazards regression analysis were performed with Stata/SE 10.0 software package, and only variables with P<0.05 in univariate analysis were included in multivariable regression models. RESULTS: The 1-year, 3-year, and 5-year overall survival of 638 patients were 83.52%, 68.98% and 63.33%, respectively. Univariate analysis indicated that age> 60 years, males below 60 years, base of tongue, higher T stage, N stage were predictors of poor outcome. In multivariate analysis, several predictors of compromised overall survival were T stage, N stage and histopathological grade. T stage and N stage were strong independent predictors of poorer overall survival. CONCLUSIONS: Age, sex, lesion, T stage, N stage and histopathologic grading are prognostic factors for OTSCC patients.
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    Effect of COVID-19 pandemic on patient delay of inpatients with squamous cell carcinoma of oral mucosa MA
    Xiao-kun, WANG Lin, XU Tao, GUO Chuan-bin, WANG Yang, WANG Dian-can
    China Journal of Oral and Maxillofacial Surgery    2021, 19 (5): 392-396.   DOI: 10.19438/j.cjoms.2021.05.002
    Abstract183)      PDF (3986KB)(151)      
    PURPOSE: The aim of this research was to investigate whether the pandemic of corona virus disease 2019 (COVID-19) had an impact on patient delay of medical management, using 2019 and 2018 as controls. METHODS: Electronic medical records of inpatients with squamous cell carcinoma (SCC) of oral mucosa in 2020, 2019 and 2018 were reviewed, and the time of the first signs or symptoms and the time of initial professional evaluation was extracted. Their interval, namely the patient delay time, was calculated. Nonparametric rank sum test was used to analyze the difference in patient delay time between 2020, 2019 and 2018 with SPSS 22.0 software package. When the delay time was more than 3 months, the patients were grouped as delayed help-seeking. RESULTS: There were 254 inpatients with SCC of oral mucosa in 2020, 447 in 2019, and 353 in 2018. The mean patient delay time was 3.93 months, 4.10 months, and 4.61 months, respectively. Nonparametric rank sum test found that there was no significant difference in the delay time for hospitalization in 2020, 2019, and 2018. The rate of delayed help-seeking in 2020 patients was 33.3%, lower than 36.5% in 2019 and 38.2% in 2018, but the difference was not significant(P=0.257). CONCLUSIONS: The pandemic of COVID-19 in 2020 probably had no effect on patient delay time for treatment of SCC of oral mucosa.
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    Evaluation of the effect of blowing exercise on speech therapy in 74 patients with cleft palate
    JIANG Li-ping, LIU Qiong, LOU Qun, WANG Bi-xia
    China Journal of Oral and Maxillofacial Surgery    2021, 19 (5): 445-448.   DOI: 10.19438/j.cjoms.2021.05.011
    Abstract183)      PDF (3017KB)(119)      
    PURPOSE: To investigate the effect of blowing training behavior on speech therapy in patients with cleft palate. METHODS: Seventy-four patients with compensatory speech of velopharyngeal incompetence(VPI) who were treated with pharyngoplasty were recruited in this study, with an average age of 10.98 years old. According to the principle of combining blowing exercise behavior therapy with Chinese speech training, the consonant was further induced, and fricative and plosive were produced to send the air way on the basis of blowing blisters and blowing balloons while holding breath. SPSS 21.0 software package was used for data analysis. RESULTS: The blowing time was increased from 6.37, 7.0 and 9.96 seconds before blowing exercise to 24.87, 26.96 and 29.07 seconds after blowing exercise, respectively, in the three age groups 4-6 years old, 7-12 years and ≥13 years old; the difference was statistically significant (P<0.001). Before exercise, each group of patients could not complete balloon blowing, the success rate of balloon blowing in each group reached 88.9%(4-6 years old group), 84.0%(7-12 years old group) and 90.9%(≥13 years old group) later. Prior to the training of each group of patients, fricative f, s, plosive p were shedding or weakening, while all patients obtained normal pronunciation after exercising, the difference was statistically significant(P<0.001). CONCLUSIONS: Mastering the exercising method of breath when holding up the soft palate is effective in enhancing velopharyngeal closure and inducing pronouncing fricative and plosive.
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    Chinese expert consensus statement on the application of of indocyanine green(ICG) fluorescence imaging in the treatment of oral squamous cell carcinoma
    WANG Yu-xin, WANG Zhi-yong, WANG Yong-gong, WANG Hui-ming, WANG Li-zhen, TIAN Hao, YE Jin-hai, FU Kun, RUAN Min, SUN Chang-fu, SUN Guo-wen, LIU Fa-yu, XU Bi-yun, HOU Jun, LIU Bing, LIU Liang, CHEN Yong-feng, CHEN Zhan-wei, XIAO Can, LI Si-yi, LI Zhi-yong, LI Yong, LI Nan, ZHANG Chen-ping, ZHANG Dong-sheng, ZHANG Sheng, ZHANG Kai, YANG Xi, HE Wei, SU Tong, JI Tong, LIN Li-song, LUO Rui-hua, ZHAO Zhi-li, HU Qin-gang, TANG Zhan-gui, XU Wei-jia, HUANG Zhi-quan, HUANG Xiao-feng, LIANG Yu-jie, HAN Zheng-xue, HAN Wei, JIANG Can-hua, YU Jian-jun, CAI Zhi-gang, LIAO Gui-qing, LIAO Sheng-kai, CAI Hui-ming, WEI Jian-hua
    China Journal of Oral and Maxillofacial Surgery    2022, 20 (1): 1-6.   DOI: 10.19438/j.cjoms.2022.01.001
    Abstract183)      PDF (847KB)(123)      
    Indocyanine green (ICG) is a near-infrared fluorescent dye. Based on the enhanced permeability and retention (EPR) effect, the ICG fluorescence imaging was applied extensively in biomedical fields. The technique could sensitively detect imaging difference between the tumor and surrounding tissue, and define the tumor border to assist in tumor resection. Nevertheless, the application in the treatment of oral squamous cell carcinoma (OSCC) is still at the neonate stage. Thereby, its indication, standard operation procedure and caution required normalization. On the Evidence-based approaches including multi-center study, systemic reviews of related scientific publications,the Chinese experts reach a consensus of ICG fluorescence imaging technique to instruct the clinical practice of OSCC surgery.
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    Effect of pre-surgical orthodontic treatment on the position and morphology of articular disc and condyle of temporomandibular joint
    WANG Tian-ge, ZHOU Zhi-jie, LIN Yi-jun, SUN Yi-ting, CHEN Yu, SUN Hua, MAO Li-xia, LIU Jia-qiang
    China Journal of Oral and Maxillofacial Surgery    2021, 19 (5): 439-444.   DOI: 10.19439/j.sjos.2021.05.010
    Abstract170)      PDF (4584KB)(148)      
    PURPOSE: To investigate the effect of pre-surgical orthodontic treatment on the position and morphology of articular disc and condyle of temporomandibular joint(TMJ). METHODS: Thirty patients with skeletal malocclusion was selected. The measurements were taken on MRI of TMJ. The condylar position was determined by measuring the joint space. The condylar morphology was determined by measuring the length, width and height of condyle head. The position and morphology of articular disc was determined by direct observation. The changes of the position and morphology of articular disc and condyle before and after pre-surgical orthodontic treatment in patients with skeletal Class Ⅰ,Ⅱ and Ⅲ malocclusion were observed and analyzed with SPSS 24.0 software package. RESULTS: There was no significant difference in joint spaces and joint space index, the length, width and height of condyle head, the degree of anterior disc displacement and the morphology of articular disc before and after the pre-surgical orthodontic treatment(P>0.05). CONCLUSIONS: Pre-surgical orthodontic treatment does not cause the change of the position and morphology of articular disc and condyle in patients with skeletal malocclusion.
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    Comparison of advantages and disadvantages of iliac crest in different orientations for reconstruction of dentulous defect of mandible with vascularized iliac bone flaps
    YANG Zong-yan, KANG Yi-fan, LV Xiao-ming, ZHANG Lei, SHAN Xiao-feng, CAI Zhi-gang
    China Journal of Oral and Maxillofacial Surgery    2021, 19 (5): 434-438.   DOI: 10.19438/j.cjoms.2021.05.009
    Abstract151)      PDF (4310KB)(138)      
    PURPOSE: In this study, the symmetry of neomandible and whether meeting the standard of dental implant after reconstruction with iliac bone flap were measured to make sure the advantages and disadvantages of different iliac crest orientations. METHODS: Patients who underwent mandibular defect reconstruction with iliac bone flap at Peking University School and Hospital of Stomatology from January 2017 to December 2019 were included in this study, and divided into iliac crest oriented to alveolar process group (group A) and iliac crest oriented to lower mandibular margin group (group B). The patients' basic information and CT image data after operation were collected. Simplant and Proplan software were used to measure the symmetry, the length of bone segment, the height, the width of alveolar process side and the distance between jaws and iliac crest after reconstruction(opposite to upper incisor,canine and first molar). The data was analyzed using SPSS 25.0 software package. RESULTS: There were 15 patients in group A and B respectively, the average age was 37.7 years old. The asymmetry rate of LC defect type at the lower edge of the mental foramen in group A was less than that in group B. There was no significant difference in bone length between group A (49.43±4.17)mm and group B (52.25±3.79)mm. The widths of occlusal side in group A (opposite to upper incisor, canine and first molar) were (11.40±0.63), (12.15±0.46), (13.15±0.62)mm, and (7.93±0.55), (8.97±0.34), (8.70±0.49)mm(P<0.05) in group B, respectively. The bone height opposite to upper first molar was(29.80±1.17)mm in group A, which was significantly higher than (25.42±1.17)mm in group B(P<0.05). The intermaxillary distance of group A was less than that of group B, the distance of first molar was (10.89±1.07)mm in group A and (14.33±0.76)mm in group B(P<0.05). CONCLUSIONS: When mandibular dentulous defect is reconstructed with vascularized iliac bone flap, the iliac crest oriented to the alveolar process side can get better symmetry, wider alveolar ridge and more suitable intermaxillary distance than iliac crest oriented to the lower margin of the mandible.
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    Progress of multidisciplinary team practice in management of oral squamous cell carcinoma
    YANG Yue-yi, ZHANG Yi-yi, LI Yi-xin, JU Wu-tong, ZHONG Lai-ping
    China Journal of Oral and Maxillofacial Surgery    2021, 19 (5): 474-477.   DOI: 10.19438/j.cjoms.2021.05.017
    Abstract149)      PDF (3264KB)(319)      
    Oral squamous cell carcinoma (OSCC) is one of the most common malignancies in the head and neck region. Although the diagnosis and treatment of OSCC have achieved significant improvement, the overall survival has shown little improvement in recent years. Clinical trials are encouraged to promote the diagnosis and treatment as well as update and optimize the clinical guidelines. Multidisciplinary team(MDT) is a model which has demonstrated its superiority in the treatment for intractable OSCC cases, gradually gaining wide adoption and promotion. This paper discussed the role of clinical research MDT in OSCC management.
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    Evaluation of treatment results of 75 patients with comminuted mandibular fractures
    XU Xiao-feng, ZHU Fang-xing, LIAO Qian, XU Bing, SHEN Guo-fang, ZHANG Wen-bin, SHI Jun
    China Journal of Oral and Maxillofacial Surgery    2021, 19 (5): 456-459.   DOI: 10.19438/j.cjoms.2021.05.013
    Abstract144)      PDF (3414KB)(264)      
    PURPOSE: This study aimed at proposing a new treatment-oriented classification and treatment algorithm of comminuted mandibular fractures based on analysis of 75 consecutive cases. METHODS: Seventy-five patients with comminuted mandibular fractures were retrospectively reviewed in this study. The classification was based on whether a stable occlusal relationship could be regained, morphology of mandible after trauma, degree of comminution and whether segmental mandibular bone defect happened. Based on traumatic condition, five classes were categorized and conservative treatment, miniplates fixation, reconstruction plates fixation, staged operations fixation with titanium meshes and bone flap transplantation were used for the management of the fracture. Forty-four patients in the experimental group were treated according to the classification while other thirty-one in the control group were not. RESULTS: After surgery, three patients developed infection, one patient presented malocclusion in the experimental group. Four patients developed infection, two patients had bone un-union, two patients presented malocclusion and one patient had mandibular asymmetry in the control group. CONCLUSIONS: The treatment-oriented classification and algorithm for comminuted mandibular fractures provide guidance for the choice of treatment methods and can decrease complication rate but further clinical research is needed.
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    A clinical analysis of 279 patients with submucous cleft palate
    DU Chang-jiang, ZHOU Xia, MA Lian
    China Journal of Oral and Maxillofacial Surgery    2021, 19 (5): 464-468.   DOI: 10.19438/j.cjoms.2021.05.015
    Abstract120)      PDF (3626KB)(117)      
    PURPOSE: To analyze the data collected from medical records for 279 submucous cleft palate patients which included age of operation, reasons for admitting into hospital and accompanied diseases. METHODS: A retrospective study was conducted on 279 patients receiving treatment for submucous cleft palate from 2013.01.01 to 2020.12.31 in Peking University Hospital of Stomatology. The following items from medical records were collected: age of operation, reasons for admitting into hospital and the types of accompanied diseases (cleft lip, well-known syndromes, chromosomal diseases, hearing impairment and intelligence retardation). The reasons for admitting into the hospital were divided into three types: speech problem, morphological abnormality on hard and/or soft palate, and others. RESULTS: The average age of operation on submucous cleft palate patients in this cohort was 5 years and 5 months and the median age was 4 years and 2 months old. Age range was from 6 months to 35 years and 2 months. Cleft lip occurred in 34(12.2%) patients, and 15 (5.4%) patients suffered from well-known syndromes. Regarding to the reasons for admitting into hospital, 194(69.5%) patients were due to unclear speech. Morphological abnormality of hard and/or soft palate occurred in 52(18.6%) and 33 (11.9%) patients were due to other reasons for medical treatment. CONCLUSIONS: The operation age of patients with submucous cleft palate was significantly later than cleft palate patients. Patients with cleft lip accounted for more than half of patients with accompanied diseases. More than half of patients with submucous cleft palate admitted into hospital were due to speech problems.
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    Expert consensus on clinical diagnosis and treatment for Chinese oral mucosal melanoma
    GUO Wei, REN Guo-xin, SUN Mo-yi, KONG Yun-yi, WANG Li-zhen, BU Rong-fa, RAN Wei, TANG Zhan-gui, LI Long-jiang, MENG Jian, SUN Zhi-jun, SHANG Wei, LV Jiong, WU He-ming, ZHANG Chen-ping, HE Yue, MA Xu-hui, SONG Hao, JU Hou-yu, ZHENG Jia-wei, GONG Zhong-cheng, YANG Kai, ZHANG Jie, WU Yun-teng
    China Journal of Oral and Maxillofacial Surgery    2021, 19 (6): 481-488.   DOI: 10.19438/j.cjoms.2021.06.001
    Abstract108)      PDF (1408KB)(113)      
    [Summary] Head and neck mucosal melanoma (HNMM) is a kind of highly malignant solid tumor. The 5-year survival rate of HNMM is about 20% for a long time. Its pathogenic factors, driving genes, clinical manifestations and treatment methods are quite different from skin melanoma. In 2015, the first Chinese expert consensus on the diagnosis and treatment of head and neck mucosal malignant melanoma was established. After more than six years of application, the clinical diagnosis and treatment of HNMM has been greatly improved. With the deepening of clinical and basic research on mucosal melanoma, the diagnosis, treatment and prognosis of HNMM have changed greatly in recent years, especially with the vigorous development of various branches of head and neck. Oral, nasal, sinus, eye and other mucosal melanoma have developed their own unique diagnosis and treatment model. This consensus can’t meet the actual needs of the current clinical practice. In this regard, the expert group believes that head and neck mucosa contains a wide range of anatomy, involving more clinical departments, and the diagnosis and treatment mode of melanoma varies significantly between different disciplines. It is urgent to meet the clinical consensus of more specialized diagnosis and treatment of individualized treatment and precise treatment. In order to further improve the long-term survival rate and quality of life of oral mucosal melanoma (OMM) and make the consensus to better guide clinical work, this expert group will focus on OMM and conduct in-depth discussion, and establish expert consensus based on evidence-based medicine and empirical medicine. Considering the individual differences of patients, this consensus can be used as a reference for clinical practice of OMM.
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    Effect of MMP-9 inhibitor on invasion and migration ability of human tongue squamous cell carcinoma SCC-25 cell and its mechanism
    SHUI Wen-jun, GAO Jin-xing, REN Lei
    China Journal of Oral and Maxillofacial Surgery    2021, 19 (5): 424-428.   DOI: 10.19438/j.cjoms.2021.05.007
    Abstract107)      PDF (4217KB)(110)      
    PURPOSE: To study the effect of matrix metalloproteinase-9 (MMP-9) inhibitors on invasion and migration ability of human tongue squamous cell carcinoma (TSCC) SCC-25 cells, and explore its related mechanisms. METHODS: SCC-25 cells in the logarithmic phase were taken and treated with 0, 5, 10, and 20 μmol/L MMP-9 inhibitor BB-94 respectively, and divided into control group, experimental group A, B and C. RT-qPCR, Western blot were used to determine the expression of MMP-9. Transwell chamber experiment was used to determine invasion ability. Scratch test was used to determine migration ability. Western blot was used to determine the protein expression of intercellular adhesion molecule-1 (ICAM-1), E-cadherin (E-cad), and connexin 43 (Cx43). SPSS 22.0 software package was used for data analysis. RESULTS: Compared with the control group, the relative expression of MMP-9 mRNA and protein, migration rate, and number of penetrating cells/field of view in experimental A, B, and C group decreased significantly(P<0.05). Compared with experimental group A, the relative expression of MMP-9 mRNA and protein, migration rate, and number of penetrating cells/field of view in experimental B, and C group decreased significantly (P<0.05). Compared with experimental group B, the relative expression of MMP-9 mRNA and protein, migration rate, the number of penetrating cells/field of view in experimental group C decreased(P<0.05). Compared with the control group, the relative expression of ICAM-1 protein in experimental group A, B, and C decreased, while the relative expression of E-cad and Cx43 protein increased significantly (P<0.05). Compared with experimental group A, the relative expression of ICAM-1 protein in experimental group B and C decreased, while the relative expression of E-cad and Cx43 protein increased significantly (P<0.05). Compared with experimental group B, the relative expression of ICAM-1 protein in experimental group C decreased, while the relative expression of E-cad and Cx43 protein increased(P<0.05). CONCLUSIONS: MMP-9 inhibitor can inhibit TSCC cell invasion and migration in a dose-dependent manner. It is speculated that its mechanism of action is related to down-regulation of ICAM-1 expression and up-regulation of E-cad and Cx43 expression.
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    Application of keystone flap in the reconstruction of maxillofacial soft tissue defect:report of 8 consecutive cases
    WANG Yi, CHEN Chuan-jun, XIANG Xian-wang
    China Journal of Oral and Maxillofacial Surgery    2021, 19 (5): 460-463.   DOI: 10.19438/j.cjoms.2021.05.014
    Abstract106)      PDF (3186KB)(142)      
    PURPOSE: To evaluate the effect of keystone flap in reconstruction of maxillofacial soft tissue defects. METHODS: From January 2019 to June 2020, 8 patients with maxillofacial defects after tumor resection were selected, and keystone flap was designed to reconstruct maxillofacial soft tissue defects. The wound areas ranged from 4 cm×3 cm~15 cm×8 cm; the position and shape of the keystone flap were designed flexibly according to the different defect sites during operation, and the long axis of the keystone flap was consistent with that of the adjacent well-known arteries as far as possible. The central 1/3 of the flap was connected to the base of soft tissue, and the remaining portion of the flap could be properly separated from the base of soft tissue, so that the flap could obtain greater freeness and rotation. RESULTS: All flaps survived and healed primarily in this group.The color and shape of the skin flap recovered well during follow-up from 1 to 6 months. No infection, necrosis and obvious scar contracture were observed, which was acceptable to all patients. No significant impairment of facial function was observed. CONCLUSIONS: Keystone flap rich blood supply, decreased morbidity and effective outcomes, simple to be designed and can satisfy the reconstruction of various minor and medium soft tissue defects in maxillofacial area, which is worthy of clinical application.
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    The role of microglia in the trigeminal spinal subnucleus caudalis in regulation of orofacial cancer-induced pain in rats
    WANG Hui, SUN Jin-hu
    China Journal of Oral and Maxillofacial Surgery    2021, 19 (5): 405-410.   DOI: 10.19438/j.cjoms.2021.05.004
    Abstract102)      PDF (4932KB)(124)      
    PURPOSE: To explore the role of microglia activation in the trigeminal spinal subnucleus caudalis (Vc) in the development of orofacial cancer-induced pain. METHODS: Adult male Wistar rats(280-300 g) were injected with Walker 256 cell suspension under the tongue mucosa to establish tongue tumor pain model. In experiment 1, the rats were randomly divided into control group (Sham) and tumor group (Tumor) (n=10). Head withdrawal mechanical threshold (HWMT) was measured with Von Frey Hair, and immunofluorescence technology was used to detect the proliferation and activation of microglia in the Vc. In experiment 2, the rats were randomly divided into four groups(n=10), i.e., Sham + Veh (intraperitoneal injection with PBS in group Sham), Sham + Mino (intraperitoneal injection with minocycline in group Sham), Tumor + Veh (intraperitoneal injection with PBS in group Tumor), Tumor + Mino (intraperitoneal injection with minocycline in group Tumor). The proliferation and activation of microglia in the Vc were detected, the mRNA expression level of Iba-1, IL-6, IL-1β and TNF-α in Vc were detected by qRT-PCR, and the orofacial mechanical pain of rats was measured by HWMT. SPSS 19.0 software package was used for data analysis. RESULTS: As the tumors continued to grow, HWMT in the tumor-bearing rats were decreased initially on day 5(P<0.05) versus the sham group and continued to decline until day 10. Marked proliferated and activated microglia were observed on day 5 and day 10 compared with the sparsely ramified microglia in the sham group. Treatment with minocycline (Tumor + Mino) inhibited the proliferation and activation of microglia and the mRNA expression level of Iba-1, IL-6, IL-1β and TNF-α in the Vc. HWMT was significantly higher in tumor-bearing rats receiving minocycline (Tumor + Mino) than in tumor-bearing rats receiving vehicle (Tumor + Veh). CONCLUSIONS: Activation of microglia promoted the release of inflammatory factors, which played a role in the development of orofacial cancer pain. Inhibition of microglia activation could significantly alleviate orofacial cancer-induced pain.
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    Effect of fibrin glue on osteogenesis and mineralization during rapid maxillary expansion
    ZHAO Han-jiang, WANG Ze-ying, LIN Dan, SHEN Guo-fang
    China Journal of Oral and Maxillofacial Surgery    2021, 19 (5): 397-404.   DOI: 10.19438/j.cjoms.2021.05.003
    Abstract100)      PDF (7004KB)(99)      
    PURPOSE: To investigate the effect of accelerating osteogenesis and mineralization during rapid maxillary expansion by in situ injection of fibrin glue. METHODS: In in vitro experiments, rat bone marrow stromal cells (rBMSCs) were co-cultured with fibrin glue fabricated with different concentrations of thrombin. The effects of degradation products of fibrin glue on the proliferation and osteogenic differentiation of rBMSCs were tested by CCK-8, alkaline phosphatase (ALP) staining and ALP activity quantification as well as alizarin red staining. rBMSCs were combined with fibrin glue by co-culture, two-dimensional surface culture and three-dimensional culture, respectively. Cell morphology and adhesion were observed by FITC-phalloidine fluorescence staining. In in vivo experiments, 12 6-week male SD rats were used to establish rapid maxillary expansion (RME) model with 100 g expanding force for 7 days. After 7-day expansion, they were divided into two groups: retention for 14 days as control group (R group) while in situ injection of fibrin glue combined with retention for 14 days as experimental group (R+FG group). Micro-CT scanning for three-dimensional reconstruction and analysis were conducted to compare the difference of new bone volume and bone mineral density. The osteogenesis and angiogenesis in mid-palatal suture were observed by H-E staining, Masson's trichrome staining, TRAP staining and sequential fluorescent labeling. GraphPad Prism 8.0.1 software package was used for statistical analysis. RESULTS: The degradation products of fibrin gel had little effect on cell proliferation and osteogenic differentiation of rBMSCs(P>0.05). In addition, rBMSCs cultured in three ways had great cell tractility. Compared with R group, the relative bone volume(P<0.001) and bone mineral density of trabeculae (P<0.001) were significantly increased in R+FG group. A large number of new trabeculae with higher mineralization degree were observed and the number of osteoclasts was decreased in mid-palatal suture. Mineral apposition rate was significantly accelerated in R+FG group(P<0.001). CONCLUSIONS: The degradation products of fibrin glue had no effect on proliferation and differentiation of rBMSCs. Fibrin glue could promote new bone formation, mineralized rate and inhibit osteo-clastogenesis in mid-palatal suture after RME in SD rats, which might be related to regulation of osteogenic differentiation by the surface structure of fibrin glue.
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    Clinical application and operational practice of simultaneous repair of soft and bone tissues of oroantral fistula based on bag-like absorbable biofilm
    XIA Liang, ZHAO Zheng-yi, ZOU Duo-hong, YANG Chi, ZHANG Zhi-yuan
    China Journal of Oral and Maxillofacial Surgery    2021, 19 (6): 489-493.   DOI: 10.19438/j.cjoms.2021.06.002
    Abstract97)      PDF (888KB)(44)      
    [Summary] Oroantral fistula, defined by abnormal oral-maxillary sinus communication resulted from many factors, is a common disease in oral and maxillofacial surgery. The traditional repair method of oroantral fistula was based on various soft tissue flap grafting. Although it can repair the oroantral fistula, there is a lack of simultaneous repair of bone tissue. With the rapid development of dental implantology, patients with oroantral fistula also require implant restoration of the missing teeth when repairing soft tissue. This poses a new challenge to the treatment of oroantral fistula, which means that both soft and hard tissue need to be repaired. Based on the bag-shaped absorbable membrane invented by the authors, using biomaterials alone, simultaneous repair and regeneration of soft and hard tissues in the area of oroantral fistula can be achieved without autologous bone. This new treatment has the advantages of less invasion, moderate difficulty of operation, reliable clinical effect and easy to be promoted and popularized. Therefore, it is currently favored by more and more doctors and patients. However, due to the uneven clinical skills of dentists, in order to standardize clinical operating standards, ensure medical treatment effects, and reduce postoperative complications, the clinical application and operating specifications of simultaneous repair of soft and hard tissues of oroantral fistula have been proposed in this paper. It was aimed to provide a certain reference and basis for the majority of dentists in the application of this technology and promote its clinical application.
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    A novel EDA gene mutation identified by whole exome sequencing in one patient with HED
    YU Kang, SHEN Yi-han, JIANG Cai-ling, WANG Feng, WU Yi-qun
    China Journal of Oral and Maxillofacial Surgery    2021, 19 (5): 429-433.   DOI: 10.19438/j.cjoms.2021.05.008
    Abstract97)      PDF (3717KB)(137)      
    PURPOSE: This study aimed at revealing a novel ectodysplasin A (EDA) gene mutation in one hypohidrotic ectodermal dysplasia (HED) family. METHODS: Genomic DNA was extracted from peripheral blood of patients, and whole exome sequencing was used for gene sequencing. EDA1 (ectodysplasin A1) wild-type and mutant expression plasmids were constructed. Protein expression levels were detected by Western blotting. The effect on downstream NF-κB pathway activity was detected by dual luciferase analysis. The data was analyzed with SPSS 20.0 software. RESULTS: We identified a novel EDA c.649_666del (p.Pro217_Pro222del) mutation. Compared with wild-type EDA1, the mutant EDA1 protein can be expressed and secreted normally, but its transcriptional activation of downstream NF-κB pathway was significantly decreased(P<0.05). CONCLUSIONS: This study identified a novel deletion mutation of EDA gene, which expanded the mutation spectrum of X-linked hypohidrotic ectodermal dysplasia and can be helpful for prenatal consultation, diagnosis and correction.
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    ATIP1 and ATIP3a, two isoforms of MTUS1/ATIP, suppressed proliferation and induced apoptosis in oral malignant tumor cells
    ZHAO Ting-ting, FENG Yan-qing, HE Qian-ting, MO Yun-long, DONG En-en, WANG An-xun
    China Journal of Oral and Maxillofacial Surgery    2021, 19 (5): 417-423.   DOI: 10.19438/j.cjoms.2021.05.006
    Abstract93)      PDF (5341KB)(105)      
    PURPOSE: To investigate the role of MTUS1/ATIP in suppression of proliferation and induce apoptosis of oral malignant tumor cells. METHODS: The expression level of MTUS1/ATIP in oral malignant tumor cells (UM1, SACC-83) was detected. Oral malignant tumor cells were transfected with ATIP1 and ATIP3a vector for 48 h. Proliferation analysis was performed with MTT assay. Flow cytometry and immunofluorescence technique were employed to measure cell cycle and apoptosis of oral malignant tumor cells. The expression level of proteins ATIP1, ATIP3a, Caspase3, ERK1/2, pERK1/2 in oral malignant tumor cells transfected with ATIP1 and ATIP3a was detected by Western blotting. The data was analyzed using SPSS 19.0 software package. RESULTS: ATIP1, ATIP3a and ATIP3b were the major isoforms produced by MTUS1 gene and significantly decreased in oral malignant tumor cells [TSCC cell line UM1, parotid adenoid cystic carcinoma (ACC) tissue and cell line SACC-83]. Restoration of MTUS1 (ATIP1 and/or ATIP3a) expression induced anti-proliferative activities against oral malignant tumor cells (UM1 and SACC-83), with a cooperative effect between ATIP1 and ATIP3a. In TSCC cells, the inhibition rate of ATIP1 was approximately 38.8% (24 h) and 57.3% (48 h), the inhibition rate of ATIP3a was approximately 48.1% (24 h) and 56.5% (48 h); however, the inhibition rate increased to 93.5% (24 h) and 88.8% (48 h) with combined action of ATIP1 and ATIP3a in TSCC cell lines (P<0.05). A similar effect was observed in adenoid cystic carcinoma (ACC) cells (P<0.05). Over-expression of ATIP1 led to G1/G0 cell cycle arrest, whereas ATIP3a caused G2/M arrest (P<0.05). Both ATIP1 and ATIP3a induced apoptosis and inhibited phosphorylation of ERK1/2 (extracellular-regulated kinase). CONCLUSIONS: The results suggest that MTUS1 is a promising anticancer agent for oral malignant tumor and has apoptosis-inducing activities via ERK1/2 pathway.
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