China Journal of Oral and Maxillofacial Surgery

Research and treatment of cleft lip and palate in China: review of 30 years

SHI Bing, LI Cheng-hao, LI Jing-tao, YANG Chao, YI Heng, JIA Zhong-lin, LI Yang, HA Pin

2016, 14 (5): 385-397.

Abstract ( 649 )

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Team approach for cleft treatment began in China since first introduced in 1990s. Multidisciplinary teams were established in several cleft centers. Based on the experience from developed countries, the Chinese teams are focusing on the development of indigenized and individualized intervention protocol for Chinese cleft patients; meanwhile, genetic and molecular mechanisms involved in normal and abnormal cleft lip/palate development were intensively investigated. Boosted by modern biological technology and evidence-based medicine, Chinese teams are making progressive exploration on innovative treatment technique. After generations of endeavor, we are able to offer world-class care to cleft patients.This review highlighted current team approach and treatment methods involved in clefts with special respect to recent advances derived from 1990s in China.

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Osseointegration study of SLM porous multi-rooted implants in rabbits

ZHANG Qing, OU Yue-jian, YOU Jia, XU Hai-yan, SUN Qi-jun

2016, 14 (5): 397-403.

Abstract ( 317 )

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PURPOSE: The aim of this study was to develop a multi-rooted dental implant (MRI) with a connected porous surface structure to facilitate osseointegration. METHODS: MRIs manufactured by selective laser melting (SLM) and commercial implants with resorbable blasting media (RBM)-treated surfaces were inserted into the hind limbs of New Zealand white rabbits. Osseointegration was evaluated periodically over 12 weeks by micro-computerized tomography (CT) scanning, histological analysis, mechanical push-out tests, and torsion tests. The results were analyzed by using SPSS19.0 software package for ANOVA intra-group and un-paired t test. RESULTS: Bone volume densities were consistently higher in MRI group than in RBM group throughout the study period, ultimately resulting in a peak value of 48.41% for MRI. Histological analysis revealed denser surrounding bone growth in MRIs; after 4 and 8 weeks, bone tissue had grown into the pore structures and root bifurcation areas, respectively. Biomechanics tests indicated binding of the porous MRIs to the neobone tissues, as push-out forces strengthened from 294.7 N to 446.5 N and maximum mean torsion forces improved from 81.2 N to 289.6 N(MRI), versus 34.8 N to 87.8 N in the RBM group. CONCLUSIONS: MRIs manufactured by SLM possess a connected porous surface structure that improves the osteogenic characteristics of the implant surface and may promote implant survival.

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Methods for recording vibrissal motor recovery in rats

CHENG Jia, WU Shu, FEI Yi-fan, LIU Yuan, HUANG Jian-tao, ZHAO Yun-fu

2016, 14 (5): 404-408.

Abstract ( 351 )

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PURPOSE: To introduce a simple, objective and quantifiable videographic method for tracking the process and extent of vibrissal motor recovery following facial nerve injury. METHODS: Thirty two adult female Sprague-Dawley rats were subject to adaptive training for 3 weeks and then they were randomized into 4 groups (n=8 in each group): main trunk experimental crush injury (group A), main trunk transection and end to end suture (group B), main trunk sham surgery control (group C) and main trunk transection denervation control (group D). Whisking recovery was measured on a scheduled basis for 2, 4, 8 and 12 weeks. The rats underwent a 5-min videographic recording session during which tagged vibrissae were continuously monitored. The video sequences were slowly reviewed and 5 s sequence fragments containing the most vigorous whisking were analyzed offline using Proanalyst motion analysis software. The selection criteria used were stable position of the head, frequency of whisking, and amplitude of vibrissal protraction. The data were analyzed using SPSS 21.0 software package. RESULTS: There was no significant difference in any preoperative whisking parameters between the manipulated side and intact side. In group A, 2 weeks after surgery, the mean whisking amplitude was approximately 77% of its value on the intact sides, and recovered approximately 96% within 12 weeks. In group B, at 10-14 days, the vibrissae "rose" again to the level of the mouth and acquired a posterior orientation with only slight tremor-like movements; by the 4 week, the rats had approximately 40% of recovery of whisking amplitude compared to the intact sides; 12 weeks postoperatively, the whisking amplitude reached 77%. Since the 4 week, group A and B had similar whisking frequency in both sides. Fourteen days postoperatively, all animals in group C exhibited normal whisking function compared with the preoperative vigorous whisking. Animals in group D had no recovery of whisking function during the study. CONCLUSIONS: Observations on body restrained rats showed that majority of free whisking on both sides is synchronous and symmetric, which allows us to compare vibrissal motor data between intact and manipulated side after facial nerve injury. The videographic technique, when used in conjunction with body restrained procedures and motion analysis software, may be an objective tool to evaluate motor recovery from facial nerve manipulation in the rat model.

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Three-dimensional finite element analysis of 3 different treatment methods for mandibular symphyseal fracture combined with bilateral intracapsular condylar fractures

XU Xiao-feng, SU Jia-nan, DAI Jie-wen, SHI Jun, XU Bing

2016, 14 (5): 409-412.

Abstract ( 459 )

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PURPOSE: To evaluate the width stability of mandibular symphyseal fracture combined with bilateral intracapsular condylar fractures treated with 3 different methods. METHODS: A heterogeneous mandible model was established by using empirical express, and the three different treatment methods were simulated. RESULTS: Compared with other conditions, the model had little displacement when the condylar fractures were treated surgically with preservation of lateral pterygoid muscle attachment, just like using the lag screw for fixation. CONCLUSIONS: For the treatment of mandibular symphyseal fracture combined with bilateral intracapsular condylar fractures, 2 mini plates can provide enough stability when the bilateral intracapsular condylar fractures are fixed with preservation of the lateral pterygoid muscle attachment.

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MicroRNA-582-5p regulates invasion and migration of salivary gland adenoid cystic carcinoma

ZENG Wei, LU Wen-hui, ZHANG Zhi-li, ZHAO Xiao-peng

2016, 14 (5): 413-418.

Abstract ( 281 )

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PURPOSE: To investigate the function of miR-582-5p in cell invasion and migration in salivary gland adenoid cystic carcinoma(ACC). METHODS: The expression levels of miR-582-5p were detected by real-time PCR in parotid ACC cancers and normal tissues. Cell invasion and migration were detected by Transwell assays. Western blotting and IHC were performed to detect the expression of FOXC1, which was predicted as target gene of miR-582-5p. Student's t test or one-way ANOVA were performed to analyze the data using SPSS 16.0 software package. RESULTS: After transfection with miR-582-5p mimics, the expression of miR-582-5p was significantly up-regulated（P<0.001）. The invasion and migration ability of SACC-83 was substantially inhibited by miR-582-5p.The target gene of miRNA was identified by luciferase reporter assay. Western blotting showed that FOXC1 was positive in SACC-83. With the elevated expression of miR-582-5p, the expression of FOXC1 was down regulated substantially in SACC-83. FOXC1 was found with higher expression in SACC compared with adjacent normal tissues. CONCLUSIONS: Lower expression of miR-582-5p played an important role in the process of invasion and migration of SACC-83. Overexpression of miR-582-5p in SACC-83 could substantially suppress the ability of cell invasion and migration. MiR-582-5p may exert its action by regulating the expression of target gene FOXC1.

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Accuracy of 3D printing individual titanium plates for maxillary repositioning in orthognathic surgery

LI Biao, JIANG Teng-fei, CAI Ming, SHEN Shun-yao, JIANG WEN-bo, SHEN Guo-fang, WANG Xu-dong

2016, 14 (5): 419-424.

Abstract ( 516 )

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PURPOSE: To develop and validate the technique of using individual titanium plates for maxilla in orthognathic surgery. The individual titanium plates were designed in the computer and fabricated using 3D printing technique. METHODS: Eight patients with dental maxillofacial deformities were enrolled. Surgeries were planned with computer-aided surgical simulation planning method. Osteotomy guides and individual titanium plates were used in this technique to separately guide the osteotomy and repositioning for the maxilla during operation without surgical splints. The outcome evaluation was completed by comparing planned outcomes with postoperative results of all patients enrolled. The outcome measurements were the linear and angular differences for the maxilla when the planned and postoperative computed tomography models were registered at the cranium. Statistical analysis was performed, and the accuracy was reported using root mean square deviation (RMSD) with SPSS 13.0 software package. RESULTS: All surgeries were successfully completed using the technique of individual titanium plate. The preliminary results showed no significant difference for maxilla reposition. The largest RMSDs were 0.64 mm and 1.65° for the maxilla, and 0.32 mm for upper dental midline in mediolateral direction. CONCLUSIONS: The results showed that individual titanium plates could provide a reliable method for transfer of orthognathic surgery planning.

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Diagnosis and treatment of acute traumatic temporomandibular joint disc displacement in 42 consecutive patients

HE Dong-mei, YANG Xiu-juan, YANG Chi

2016, 14 (5): 425-429.

Abstract ( 564 )

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PURPOSE: To explore the diagnosis, treatment results and sequela of traumatic temporomandibular joint disc displacement (ATDD) in 42 consecutive patients. METHODS: Patients diagnosed of ATDD and treated from 2010 to 2015 were recruited. Their clinical and radiologic characters were analyzed based on 3 stages: acute phase, subacute phase and chronic phase. Conservative and surgical treatment results were evaluated and compared with SPSS software package. RESULTS: Forty-two patients with 59 joints were included in the study. Among the acute and sub-acute phases patients (18 cases with 27 joints), 18.5% of the joints had condylar surface bone destruction, whereas 75% in the chronic phase (24 cases with 32 joints). Twenty-two cases with 30 joints accepted conservative treatment; among them, 90% developed osteoarthritis after a mean follow-up period of 8.8 months. Thirty-one cases with 47 joints accepted surgical treatment after injury or conservative treatment. Among them, 23 cases with 34 joints had disc reposition, 95.5% were effective (15 cases with 22 joints, mean follow-up period of 22 months). Eight cases with 13 end-stage joints accepted condylar resection and joint replacement. Their maximal incisor opening after surgery was significantly increased compared with that before surgery and conservative treatment (P<0.01). CONCLUSIONS: ATDD is easy to lead to osteoarthritis and ankylosis, disc reposition in the acute and sub-acute phases can significantly reduce the occurrence of above sequel; however, in the chronic phase, joint replacement may be necessary in selected patients.

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Two-subunit-osteotomy approach of vascularized iliac-internal oblique muscle composite flap in total maxillary reconstruction

YU Miao, WANG Hui-shan, HAN Jing, HU Long-wei, LIU Jian-nan, WANG Yang, ZHANG Chen-ping, XU Li-qun

2016, 14 (5): 430-434.

Abstract ( 393 )

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PURPOSE: Through three dimensional measurement and analysis of normal adult maxilla, to delineate maxillary morphological features and regularities which can be applied to conduct osteotomy of iliac bone and reconstruction of total maxillary defect. METHODS: A total of 40 normal maxillary CT data (Dicom format) were collected and delivered to Proplan CMF 2.0. The real-size maxillary model was established on which 6 anatomic bony marks were set up and 7 maxillary contour variables (including 6 linear and 1 angular items) were measured. The data were analyzed using SPSS 19.0 software package. A female patient with total maxillary defect underwent maxillary reconstruction with vascularized iliac composite flap in two-subunit-osteotomy approach was presented. RESULTS: The coefficience variation of maxillary linear variables was greater than that of angular variable. The contour of maxilla could be divided into two subunits of paranasal region and infraorbital region though a line segment from nasion to distal alveolar crest of maxillary second premolar. The anterior intersection angle (δ) between the two subunits was 150° with no significant sex and individual differences (P=0.1527, CV=2.74%). Two-subunit-osteotomy approach was clinically applied to shape the iliac bone into paranasal triangular segment and infraorbital quadrangular segment to reconstruct total maxillary defect, which achieved excellent cosmetic subunit. CONCLUSION: Two-subunit-osteotomy approach of vascularized iliac composite flap can rapidly and accurately reconstruct total maxillary defect and achieve excellent cosmetic and functional results.

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Exercise therapy maintains the disc-condyle relationship after mandibular manipulation to correct anterior temporomandibular joint displacement

JIANG Xin, LIU Li-kun, CAI Bin, FANG Zhong-yi, XU Li-li, FAN Shuai

2016, 14 (5): 435-439.

Abstract ( 532 )

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PURPOSE: To evaluate the clinical possibility and results of maintaining disc-condyle relationship by exercise therapy after successful manual reposition of temporomandibular joint (TMJ) disc. METHODS: Nineteen patients of acute TMJ disc displacement without reduction with limited opening underwent successful manual reposition of TMJ disc from Oct. 2013 to Jan. 2016 in the Department of Rehabilitation Medicine, Shanghai Ninth People'S Hospital, Shanghai Jiao Tong University School of Medicine, were included in the study. The patients were treated by mandibular manipulation aided by occlusal splint technique and exercises, including disc reposition exercise,jaw movement exercise, stabilization exercise and cervical posture exercise. The treatment was continued for 2 weeks, 5 times a week. Before and after treatment, and at 1, 6, 12-month of follow-up, maximum active mouth opening (mm) and visual analogue scale (VAS) of pain were evaluated. MRI was performed 1,6 and 12 months after treatment. The data were compared between pre- and post-therapy with paired t test and χ² test using SPSS 19.0 software package. RESULTS: Two weeks after treatment, the maximum active mouth opening was increased from (21.5±5.9)mm to (40.2±1.8)mm(P<0.05), VAS score dropped from 0.9±1.6 to 0(P<0.05). One, 6 and 12 months after treatment, the maximum active mouth opening was≥40 mm, and VAS score was 0. Six months after treatment, 18 patients (95%) were normal, 1 patients (5%) displayed displacement with reduction on MRI. Twelve months after treatment, 15 patients (79%) were normal, 3 patients（16%） displayed displacement with reduction, 1 patients (5%) had displacement without reduction on MRI. No significant relationship was found on MRI after treatment (P>0.05). CONCLUSIONS: The results indicate that exercise therapy can help to maintain disc-condyle relationship after successful reposition of acute TMJ anterior disc displacement without reduction via mandibular manipulation aided by occlusal splint.

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Expression and clinical significance of SALL4 in oral squamous cell carcinoma

LIU Si-qiang, SUN Na, ZHANG Feng-he

2016, 14 (5): 440-444.

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PURPOSE: To investigate the expression and clinical significance of Sal-like protein 4 (SALL4) in oral squamous cell carcinomas (OSCC). METHODS: Real-time PCR, Western blotting and immunohistochemistry were used to analyze the expressions levels of SALL4 mRNA and protein in 50 OSCC tissue specimens in comparison with their adjacent normal tissue specimens. SPSS17.0 software package was used to identify correlations between SALL4 expression and the clinicopathological features in OSCC. RESULTS: Expression of SALL4 was upregulated in OSCC tissue at both mRNA and protein levels compared with the adjacent normal tissue (P<0.05). Immunohistochemistry detected positive nucleus staining of SALL4 protein. Expression of SALL4 was significantly correlated with OSCC staging and lymph node metastasis (both P<0.05). CONCLUSIONS: SALL4 may be an extremely useful diagnostic marker for OSCC. Furthermore, SALL4 may play an important role in metastasis of OSCC; however, the underlying molecular mechanism needs to be further investigated.

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Treatment of venular malformations with LED-IB compound narrow spectrum photodynamic therapy: short-term outcome in 280 consecutive patients

ZHOU Tian-yuan, ZHAO Hai-guang, WANG Xiao-yong, ZHENG Jia-wei, GE Jing

2016, 14 (5): 445-448.

Abstract ( 326 )

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PURPOSE: To investigate the short-term clinical effect and safety of hematoporphyrine injection combined with LED-IB compound narrow spectrum photodynamic therapy in the treatment of venular malformation. METHODS: A consecutive 280 patients with venular malformation were treated from December 2011 to November 2015.Among them, 116 cases were male and 164 cases were female. Lesions of 162 patients were located at head and face, 63 cases at neck, 30 cases at limbs and 25 cases at the trunk. The size of the lesion was from 6.3 cm² to 92.0 cm², with an average size of 30.7 cm². Slow intravenous injection of hematoporphyrin (3-5 mg/kg) was performed. Immediately after the injection, LED-IB compound narrow spectrum photodynamic therapy was given for 20-35 min. The irradiation dose for children was 80 mW/cm² and 100 mW/cm² for adults. The extinctive degree of erythema and adverse reactions after treatment were recorded and analyzed. RESULTS: Two-hundred and eighty patients were treated for 504 times totally, with an average of 1.8 times. Follow-up time was 1-4 years with an average of 2.1 years. The efficacy was excellent in 204 cases, good in 62 cases and poor in 14 cases. The overall effective rate was 95%. No recurrence was found during the follow-up period. Most of the patients developed edema for 3-5 days and scab for 5-7 days. The edema in 2 cases continued for 20 days. Five cases had pigmentation, one case suffered from temporary skin photosensitivity reaction and the time of avoiding light rays exposure was for 3 months. Scars were left in 2 patients because of the thick scab and improper care. CONCLUSIONS: LED-IB compound narrow spectral photodynamic therapy for venular malformation is simple and effective. The use of photosensitizer is safe and the adverse reactions after treatment and during follow-up are rare.

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Bisphosphonate-related osteonecrosis of the jaw: report of 9 cases

ZHANG Xue-wei, LIU Hao, CHEN Rui-yang, ZHANG Ping, YANG Li, WU Wei, YAN Ying-bin

2016, 14 (5): 449-454.

Abstract ( 484 )

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PURPOSE: To summarize the clinical features and outcomes of bisphosphonate-related osteonecrosis of the jaw (BRONJ). METHODS: A total of 9 patients diagnosed and treated as BRONJ in our hospital from January 2013 to April 2015 were included. Their clinical data and imaging findings were analyzed. RESULTS: All patients received intravenous infusion of bisphosphonates with the average treatment duration of 42.7 months. During bisphosphonate treatment, seven patients had a history of tooth extraction, and the other 2 patients used removable dentures. Three patients were diagnosed as BRONJ at the first clinical visit; however, the other 6 patients got the confirmed diagnosis after visiting more than 2 medical institutions. The average time from the occurrence of oral symptoms to diagnosis was 6.9 months. The clinical manifestations of BRONJ included local pain, facial space infection, non-healing of extraction sockets, and exposure of sequestrum. The imaging findings of BRONJ included increased bone mineral density, periosteal reaction, sequestrum formation and diffused bone destruction. Of the 9 patients, one patient was classified into stage 0, 4 patients stage Ⅱ, and 4 patients stage Ⅲ. Five patients underwent surgery, four cases received conservative treatment. The average follow-up time was 10.3 months. Three patients in stage Ⅲ had long-standing chronic inflammation of soft tissue with acute attack of infection, while the remaining 6 patients were cured or in stable condition during the follow-up period. CONCLUSIONS: Due to lack of characteristic clinical manifestations and imaging findings, medical history of bisphosphonate treatment is the key to making a diagnosis of BRONJ. The outcome of BRONJ is generally poor, and patients in stage Ⅲ tend to be difficult to cure and easy to relapse.

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Open versus closed treatment of unilateral mandibular condyle fractures: a meta analysis of randomized controlled trials

HAN Xiao-dong, LIN Xiao-zhen, SHAO Xiao-jun, WANG Yan-yi, ZHANG Ming

2016, 14 (5): 455-460.

Abstract ( 336 )

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PURPOSE: To evaluate the effect of open and closed treatment of unilateral mandibular condyle fractures using meta-analysis. METHODS: Databases as the Cochrane Library, PubMed, Embase, CNKI, CBM, VIP, and Wanfang Data were searched from inception to September 25, 2015. All randomized clinical trials (RCTs) on treatment of unilateral mandibular condyle fractures were collected, and then selected on the basis of the inclusion and exclusion criteria. The data were extracted from the included articles and meta analysis was performed using RevMan5.3. RESULTS: A total of 5 RCTs involving 197 patients were included and analyzed. The results of meta analysis showed that the maximal mouth opening (WMD: 5.60, 95% CI:4.42-6.77, P<0.01), protrusion (WMD:1.30, 95% CI:0.35-2.25, P<0.01) and sum of bilateral laterotrusions (WMD: 2.50, 95% CI:1.77-3.22, P<0.01) of open surgery were significantly higher than conservative treatment. The incidence of temporomandibular joint pain was significantly lower than conservative treatment (OR:0.14, 95% CI:0.04-0.43, P<0.01). There was no significant difference in incidence of malocclusion between the 2 groups (OR:0.33, 95% CI:0.07-1.46,P>0.05). CONCLUSIONS: Compared with conservative treatment, open surgery has significant advantages in improving mouth opening and mandibular movement, and reducing the incidence of joint pain.

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Research advances in PHACES syndrome

ZHANG Ling, ZHENG Jia-wei

2016, 14 (5): 467-470.

Abstract ( 390 )

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Hemangiomas are the most common benign tumors in infancy, and in rare cases, they can be associated with dysmorphic malformation. The acronym, PHACES syndrome is a cutaneous condition characterized by multiple congenital abnormalities, including: posterior fossa brain malformations, hemangiomas of the face, arterial cerebrovascular anomalies, cardiovascular anomalies, eye anomalies and sternal defects/supraumbilical raphe. Its prevalence is unknown, but has a striking female preponderance. Among the systemic abnormalities, neurological and cardiac malformations predominate. PHACES syndrome had been recognized as a new and independent entity. This review highlighted the recent findings in clinical feature, diagnosis and management of PHACES syndrome.

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Radionuclide therapy for infantile hemangioma: an overview

WANG Fei-nan, FAN Xin-dong

2016, 14 (5): 471-474.

Abstract ( 375 )

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Radionuclide radiation for infantile hemangioma has been one of the modalities in many medical institutes of China, but less and less used abroad. This review was focused on the advantages and side effects of this treatment, with the aim to provide guide to make treatment plan.

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Radiological features of renal osteodystrophy in oral and maxillofacial region: A case report

YOU Meng, TANG Bei, WANG Yang, WANG Zi-jiang, WANG Kai-li, WANG Hu

2016, 14 (5): 475-477.

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A case of chronic renal failure accompanied with maxillofacial osteodystrophy was reported. The radiological features on panoramic, skull PA-LAT, and CT radiography were described and summarized based on literatures. On the plain radiographs, jaw bones presented diffuse or localized demineralization, thinning of cortical bone, and loss of dental lamina. CT images showed unique features of coarsened trabecular pattern and serpiginous tunneling or channeling within the jaw bone.

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A case of Castleman's disease in the neck and review of the literature

PANG Chao-yuan, WU Jing, SHI Min, YANG Lin

2016, 14 (5): 478-480.

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Castleman's disease is a lymphoproliferative disease which is rare and hard to diagnose, it can involve any lymph nodes of the body, and lacks characteristic clinical diagnostic criteria. This paper reported a patient with Castleman`s disease in the neck, its classification was multicentric and hyaline vascular type. PET-CT, ultrasound examination and histological findings were discussed in order to improve in depth understanding of the disease.

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