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20 September 2019, Volume 17 Issue 5 Previous Issue    Next Issue

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Expert Consensus

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Chinese expert consensus on oral and maxillofacial ambulatory surgery JIANG Can-hua, JIAN Xin-chun, ZHANG Zhi-yuan, ZHENG Jia-wei, SHI Bing, LIU Yan-pu, HE Yue, PENG Xin, SHANG Zheng-jun, HAN Xin-guang, LIU Wei-dong, MO Yang, GUO Feng, CHENG Zhi-gang, CHEN Chuan-jun, GONG Zhong-cheng, JIN Wu-long, ZHANG Shi-zhou, YUAN Rong-tao, YAN Feng-guo, LI Peng-cheng, ZHANG Sheng, GAO Xing, CHEN Jie 2019, 17 (5):  385-390.  doi: 10.19438/j.cjoms.2019.05.001 Abstract ( 539 )   Ambulatory surgery is defined as an operation/procedure where the patient is discharged on the same working day. Ambulatory surgical hospitalization significantly increases the turnover rate of hospital beds and the utilization ratio of medical resources, reduces the hospital acquired infection, accelerates patients' recovery and lowers the hospitalization expenses. It has become a rising medical service for some patients who need only simple or less complicated surgical treatments. Since multiple parts including surgical operation, anesthesia and perioperative nursing are involved, ambulatory surgical hospitalization in China is still in a primary stage. Ambulatory oral and maxillofacial surgery only being carried out in some hospitals and has not been popularized so far, owing to lack of standardized processes consensus and guidelines. In order to promote the development and popularization of ambulatory oral and maxillofacial surgical hospitalization, experts from 15 medical institutions were assembled by the Chinese Ambulatory Surgery Alliance and Chinese Society of Oral and Maxillofacial Surgery to discuss and formulate this consensus, referring to successful experiences in foreign countries and based on our national situation. With a view to the adoption of this consensus, we are hoping to provide a theoretical and practical guidance and reference for ambulatory oral and maxillofacial surgical hospitalization in China. References | Related Articles | Metrics

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Treatment protocols for lip defects based on local flap reconstruction: Chinese expert consensus LIU Jian-hua, ZHANG Zhi-yuan, SHI Bing, GUO Chuan-bin, SUN Jian, WANG Hui-ming, SUN Chang-fu, ZHENG Qian 2019, 17 (5):  391-396.  doi: 10.19438/j.cjoms.2019.05.002 Abstract ( 515 )   Lip defect, in addition to cause facial appearance deficiency, often causes facial dysfunction, such as eating inconvenience, language incompetence, difficulty in chewing, slobbering, etc., which brings great pain and financial burden to the patients. Lip defect generally refers to a full-thickness composite tissue defect, which can be caused by congenital disease, inflammation, trauma, or tumor. Lip malignancy is the major cause of lip defect after tumor resection. However, the surgical level of repair technique after lip cancer resection is uneven, and lack of uniform standards to classify the different defect degree. Meanwhile, the confusion of treatment protocol results in postoperative deficiencies of lip shape and function, in other words, increases the patient's economic burden. Therefore, in order to standardize the diagnosis and treatment techniques for lip defect, to improve the therapeutic effect, as well as to reduce the waste of medical resources, it is urgent to work out expert consensus on lip restoration and reconstruction. References | Related Articles | Metrics

Original Articles

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Identification of core differentially expressed genes and pathways of salivary gland pleomorphic adenoma based on RNA-Seq WANG Yang, XIA Liang, HU Yu-hua, ZHANG Chun-ye, WANG Li-zhen, LI Jiang, TIAN Zhen 2019, 17 (5):  397-402.  doi: 10.19438/j.cjoms.2019.05.003 Abstract ( 261 )   PURPOSE: The aim of this study was to identify the core differentially expressed genes (DEGs) signatures during pleomorphic adenoma (PA) and identified the key pathways and genes in PA. METHODS: The mRNA expression of 5 cases of PA and salivary gland was detected by RNA-Seq. Then the differentially expressed genes (DEGs) were screened. Protein-protein interaction (PPI) network of the DEGs was constructed and the core modules and hub genes were screened. The activated pathways associated with the core modules was analyzed, and the possible interaction between them and PLAG1 was predicted. Furthermore, the hub genes expression was validated by RT-PCR in 20 pairs of PA and normal salivary tissues. Statistical analysis was performed using SPSS 20.0 software package. RESULTS: In total, 3810 DEGs were identified in PA, including 2021 down-regulated genes and 1789 up-regulated genes. PI3K-AKT signaling pathway, ER receptor signaling pathway, Rap1 signaling pathway and cGMP-PKG signaling pathway were activated in the core modules. PLAG1 may interact with the core modules through PHLPP1, LRRK2, and beta-catenin proteins. The expression of the hub genes in 20 pairs of PA and normal salivary tissues were validated by RT-PCR, the expression trend was in accordance with the mRNA sequencing (P<0.0001). CONCLUSIONS: Hub genes including ADCY3, ADCY5, ADORA1, APLN, APP, C5, CCL28, DRD2, FPR3, GABBR1 may play important roles in the oncogenesis and development of PA, which can provide ideas for preventing recurrence and screening prognostic markers of PA. PLAG1 may induce oncogenesis of PA by interacting with PHLPP1, LRRK2, and beta-catenin proteins,which indirectly activate the PI3K-AKT signal pathway, ER receptor signal pathway, Rap1 signal pathway, and cGMP-PKG signal pathway. References | Related Articles | Metrics

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The establishment of a bisphosphonate-related osteonecrosis of the jaw animal model in osteoporosis rats LI Lu, QIU Yu, HUANG Li, JIANG Zhi-hao, WANG Ri-hui, GAO Bing-ju, LI Jun, LIAO Yun-yang, LIN Li-song 2019, 17 (5):  403-411.  doi: 10.19438/j.cjoms.2019.05.004 Abstract ( 305 )   PURPOSE: To establish medication-related osteonecrosis of jaw-liked animal model in osteoporosis rats. METHODS: Thirty six-month-old female osteoporosis Sprague-Dawley rats were created by bilateral ovariectomy. After 12 weeks, all rats were administrated by subcutaneous injections of alendronate(1.0 mg/kg/day dosage) for 60 days then randomized into two groups: Group 1 (control group) no intervention after ALN administration; group 2 (experimental group) bilateral maxillary and mandible first molars were extracted after ALN administration. Five rats were randomly euthanized at 2 weeks, 4 weeks and 8 weeks after interventions from each group, and underwent clinical, serological, histopathologic and histomorphometric evaluations. SPSS 19.0 software package and R program were used for statistical analysis. RESULT: MRONJ lesions were observed in group 2 rats 2 weeks after operation, the occurrence rate was significantly greater than group 1 (P<0.01); Mandible had higher incidence of 56.7% than maxillar which had a probability of BRONJ of 26.7%. The time-varying serum concentration of RANKL and OPG were unrelated with the occurrence. Hematoxylin-Eosin staining demonstrated that trabecular bone structure of MRONJ lesion areas was disorganized, large number of empty bone sinkholes were generated by the nuclear of osteocyte karyolysis (P<0.05). According to the degrees of osteonecrosis lesion and soft tissue damage, the morbidity and pathological degree of group 1 were significantly lower than that of group 2(P<0.05). The degree of MRONJ lesions was escalated over time. Micro-CT revealed that the MRONJ lesion area had microcracks and osteolysis. The value of Tb.N and BMD had significant changes in Stage 2 MRONJ rats compared to other stages(P<0.05). The difference of Tb.Sp between stage 0 and non-MRONJ rats was statistically significant(P<0.05). CONCLUSIONS: The MRONJ animal model had been successful established by subcutaneous injection of high dose ALN for 60 days associated with teeth extraction in osteoporosis rats, the typical lesions had been observed 2 weeks after intervention; while the animal model stabled 8 weeks after operation. The lesion degree of BRONJ had close relation to time. With regard to local risk factors of BRONJ, this study confirmed that teeth extraction was a remarkable risk factor of BRONJ. The variation of serum RANKL/OPG ratio might be related to BRONJ, Tb.Sp might be effective bone morphogenetic marker associated with BRONJ in the early stage, and microcracks had been observed in the lesion area. References | Related Articles | Metrics

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Generation of Fgf9 conditional knockout mice in cartilage WENG Meng-jia, ZHANG Xiao-yue, CHEN Zhen-qi 2019, 17 (5):  412-417.  doi: 10.19438/j.cjoms.2019.05.005 Abstract ( 307 )   PURPOSE: To establish a conditional knockout mouse model of fibroblast growth factor 9 (FGF9) in cartilage with Cre-LoxP system. METHODS: The recombinant vector of exon 2 of mouse Fgf9 was constructed and transfected into ES cells by electroporation. The positive ES cells were screened by G418 and Ganciclovoir and identified by PCR. ES cells were microinjected into the blastocysts of C57BL/6J mice and then transferred into the uterus of pseudopregnant mice to obtain chimeric mice. Flox region in chondrocytes of flox homozygous and Cre-positive fetuse was knocked out by hybridizing the Neo-free mice with Col II-Cre mice and induced with tamoxifen. RESULTS: Fgf9 Flox heterozygous mice reproduced steadily without obvious abnormality. After mating with Col II-Cre transgenic mice, the Flox mice successfully produced a conditional knockout mouse model of Fgf9 in cartilage tissue. CONCLUSIONS: Conditional knockout mice model of FGF9 was successfully established with Cre-LoxP system, which lays a foundation for further study of the function of FGF9 in osteochondral development and bone and joint homeostasis. References | Related Articles | Metrics

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Evaluation of "five-point eight-line-segments" anatomic flap design for precise subtotal tongue reconstruction WANG Jie-qi, ZHANG Han-qing, LI Qun-xing, WANG Zhang-song, FANG Ze-zhen, LI Jin-song, FAN Song 2019, 17 (5):  418-423.  doi: 10.19438/j.cjoms.2019.05.006 Abstract ( 333 )   PURPOSE: To explore a flap design technique based on anatomy to achieve precise subtotal tongue reconstruction and evaluate the clinical efficacy. METHODS: Forty-four patients suffering from tongue squamous carcinoma received subtotal tongue reconstruction with anterolateral thigh flap, they were randomly divided into 2 groups according to flap design methods, a "five-points eight-line-segments"(FIPELS) group (23 patients) and a conventional flap design group (21 patients). All patients received nerve coaptation to the lingual or glossopharyngeal nerve. Likert scale was applied to assess the swallowing function, speech articulation, cosmetic outcomes, as well as epicritic sensation, proprioception and thermal sensitivity of the reconstructed tongue. The outcomes were analyzed by SPSS 18.0 software package. RESULTS: All flaps healed well, except 3 patients developed partial necrosis. FIPELS group attained larger area of flap than conventional group. Compared to the conventional group, the swallowing function (P=0.016) and cosmetic outcomes (P=0.001) in FIPELS group were significantly improved, but the speech articulation failed to achieve better outcome (P=0.064). Patients in both groups recovered similarly in epicritic sensation proprioception and thermal sensitivity. CONCLUSIONS: The clinical efficacy of FIPELS design based on anatomy for precise subtotal tongue reconstruction is remarkable and worthy of popularization. References | Related Articles | Metrics

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Clinical and prognostic analysis of extranodal marginal zone B cell lymphoma of mucosa-associated lymphoid tissue occurring in oromaxillofacial head and neck region ZHANG Tian, WU Yun-teng, GUO Wei 2019, 17 (5):  424-430.  doi: 10.19438/j.cjoms.2019.05.007 Abstract ( 709 )   PURPOSE: This retrospective study was performed to explore the clinical profile,staging,treatment and prognosis of extranodal marginal zone B cell lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) occurring in oromaxillofacial head and neck region, in order to provide more medical evidence for the clinical practice. METHODS: One hundred and five patients with MALT lymphoma occurring in oromaxillofacial head and neck region from the Department of Oromaxillofacial Head and Neck Oncology of Shanghai Ninth People's Hospital were included in this retrospective analysis. SPSS 22.0 software package was used for data analysis. RESULTS: The female-to-male ratio was 2.5∶1. Median age at diagnosis was 56 years (range, 18-86 years). The most common clinical manifestation was progressive swelling of local sites; 52% of patients had long-term xerostomia, confirmed autoimmune diseases or chronic parotitis. According to Ann Arbor staging, 48 patients were in stage Ⅰ, 25 in stage Ⅱ, 7 in stage Ⅲ, 25 in stage Ⅳ. Only one patient had B symptom and no patients had bone marrow involvement. The most common sites were parotid gland, palate and submandibular gland. Fifty patients received single treatment and 49 patients received combined modality treatment.The median follow-up time was 60 months and 8 patients were lost to follow-up. The complete response rate after initial treatment was 80%. Tumor progression was observed in 12 patients and 14 patients died. The 5-year overall survival(OS) and progression-free survival(PFS) were 89% and 88%, respectively. Systemic treatment(chemotherapy or rituximab) was able to significantly improve PFS in patients with disseminated disease(P<0.05). MALT-IPI was an independent prognostic factor affecting OS and Ann Arbor staging affecting PFS. CONCLUSIONS: The outcome of initial treatment is satisfactory and the disease progresses slowly. Systemic therapy may improve PFS in patients with disseminated disease. MALT-IPI and Ann Arbor staging are independent prognostic factors. References | Related Articles | Metrics

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Comparison of piezosurgery device and traditional method in extraction of horizontally impacted mandibular third molar DING Feng, WU Xian, YANG Xi-hu, ZHOU Fei-jun, DING Xiao-jun 2019, 17 (5):  431-435.  doi: 10.19438/j.cjoms.2019.05.008 Abstract ( 1449 )   PURPOSE: To compare the clinical effect of using piezosurgery device and traditional method in extraction of horizontally impacted mandibular third molar. METHODS: Two hundred and forty patients with horizontally impacted mandibular third molar were equally divided into 2 groups: using piezosurgery device and traditional method for extraction. The operation time, intraoperative and postoperative complications including deformation of extraction sockets, dry socket, limitation of mouth opening, pain and swelling, and fear were observed and compared between the two groups. The data were analyzed with SPSS 13.0 software package. RESULTS: The operation time was (18.0±6.3) min in the minimally invasive extraction group, significantly shorter than the traditional method group which was (37.0±8.2）min (P<0.05); significant difference was found in the incidence of medium or severe tooth sockets deformation and incidence of psychological fear during operation between the two groups(P<0.05); the degree of mouth opening after surgery, the incidence of moderate or severe pain after surgery was significantly lower in the group with piezosurgery device than in the group with traditional method (P<0.05). CONCLUSIONS: Minimally invasive extraction with piezosurgery device is better than traditional method in extraction of horizontally impacted mandibular third molar, with shorter operation time and fewer intraoperative and postoperative complications, which should be widely applied in clinic. References | Related Articles | Metrics

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A case-control study on the risk factors of patients with non-syndromic cleft lip and palate in Kashgar area of Xinjiang Uygur Autonomous Region ALIMUJIANG Sufuer, BILIKEZI Yusufu, RENAGUZI Abudumijiti 2019, 17 (5):  436-439.  doi: 10.19438/j.cjoms.2019.05.009 Abstract ( 285 )   PURPOSE: To investigate the risk factors of non-syndromic cleft lip with or without cleft palate (NSCL/P) in Kashgar area of Xinjiang Uygur Autonomous Region. METHODS: This case-control study involved 102 NSCL/P patients and 204 normal children from Kashgar area. A questionnaire focusing on various possible risk factors, and responses were analyzed through univariate and multivariate Logistic regression with SPSS 17.0 software package. RESULTS: Logistic regression analysis revealed that family history, consanguineous marriage, drugs, sickness and malnutrition in early pregnancy, contact with pesticides, chemicals, poor mental state increased the risk of NSCL/P(P<0.05). Folic acid supplementation decreased the risk of NSCL/P(P<0.05). CONCLUSIONS: Taking sufficient folic acid, avoiding consanguineous marriage, avoiding contact with pesticides and chemicals, improving health and nutritional status during early pregnancy may decrease the birth rate of NSCL/P in Kashgar area of Xinjiang Uygur Autonomous Region. References | Related Articles | Metrics

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Application of PDCA nursing in perioperative care for oral malignant tumor patients with anterolateral thigh flap reconstruction HUANG Jia-ni, XU Zhu-feng, YU Xi-xi, WANG Yue-ping 2019, 17 (5):  440-443.  doi: 10.19438/j.cjoms.2019.05.010 Abstract ( 258 )   PURPOSE: To analyze the effect of PDCA nursing model in perioperative care for oral malignant tumor patients with anterolateral thigh flap reconstruction. METHODS: Oral malignant tumor patients received anterolateral thigh flap reconstruction in the Department of Oromaxillofacial Head and Neck Oncology of our hospital from 2017.02 to 2018.02 were included. The patients were randomly separated into two groups: PDCA nursing group and conventional nursing group. Incidence of complications, awareness of health education and satisfaction of patients were collected from both groups. SPSS 18.0 software package was used for statistical analysis. RESULTS: Sixty patients were finally selected: thirty in each group. Patients in PDCA group had significantly lower incidence of complications and better awareness of health education and satisfaction (P<0.05) compared with conventional nursing group. CONCLUSIONS: PDCA nursing model can improve the awareness of health education and nursing satisfaction and reduce the incidence of complications. References | Related Articles | Metrics

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Phenotype study of parotid gland in 140 patients with first and second branchial arch syndrome ZHENG Ya-feng, ZHOU Xia, SHANG Fei-fei, MA Lian 2019, 17 (5):  444-447.  doi: 10.19438/j.cjoms.2019.05.011 Abstract ( 624 )   PURPOSE: To explore parotid gland phenotype of patients with first and second branchial arch syndrome on spiral CT scans. METHODS: 140 patients with first and second branchial arch syndrome were included. The form and proportion of different parotid gland phenotypes were evaluated according to CT reports from medical imaging department of Peking University School of Stomatology. RESULTS: The three phenotypes of parotid gland in patients with first and second branchial arch syndrome included bilateral symmetry of parotid gland (22.9%), parotid gland hypoplasia (15.7%) and absence of parotid gland (61.4%). CONCLUSIONS: Parotid gland absence and hypoplasia are the main manifestations in patients with first and second branchial arch syndrome. References | Related Articles | Metrics

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Application of end tidal carbon dioxide monitoring in difficult tracheal intubation during oral and maxillofacial surgery LIU Bo-yan, YAN Jia, JIANG Hong 2019, 17 (5):  448-452.  doi: 10.19438/j.cjoms.2019.05.012 Abstract ( 265 )   PURPOSE: To evaluate the efficacy of fiberoptic bronchoscopy combined with end-tidal carbon dioxide monitoring for endotracheal intubation in patients with difficult airway in oral and maxillofacial surgery. METHODS: Sixty patients with expected difficult airway under general anesthesia undergoing oral and maxillofacial surgery from November 2018 to January 2019 were selected. ASA grade I-II patients were randomly divided into two groups (n=30). Patients in the experimental group received end-tidal carbon dioxide monitoring combined with fiberoptic bronchoscopy for transnasal endotracheal intubation under the condition of preserving patients' spontaneous breathing, while patients in the control group only received fiberoptic bronchoscopy for the procedures. The success rate of the first endotracheal intubation, the duration of endotracheal intubation with fiberoptic bronchoscopy, the number of attempts, and the incidence of endotracheal complications were recorded. GraphPad Prism 6 was used for statistical analysis. RESULTS: A total of 60 patients were included and 60 were actually completed. There was no significant difference in the success rate of first endotracheal intubation between the two groups (90.0% for the control group and 93.3% for the experimental group, P=0.2196). There was no significant difference in the average number of intubation attempts between the two groups (1.2±0.2 times in the control group and 1.1±0.1 times in the experimental group, P=0.6451). The intubation time in the experimental group was significantly lower than that in the control group (29.5±2.3) s in the control group and (15.8±1.2) s in experimental group, P=0.0192:. During intubation, there was no significant difference in the incidence of tachycardia (HR>100 times/min) between the two groups (6.6% for the control group and 3.3% for the experimental group, P=0.1746). There was no significant difference in the incidence of increased blood pressure (20% higher than the essential blood pressure) during intubation between the two groups (10.0% in the control group and 6.7% in the experimental group, P=0.2541). The incidence of oxygen saturation decrease (SpO2<90%) in the experimental group was significantly lower than that in the control group (13.3% in the control group and 6.7% in the experimental group, P=0.0412). The incidence of epistaxis was significantly lower in the experimental group than in the control group (16.7% in the control group and 6.7% in the experimental group, P=0.0224). There was no significant difference in the incidence of postoperative pharyngeal pain between the two groups (6.7% in the control group and 3.3% in the experimental group, P=0.1652). Postoperative hoarseness did not occur in either group. There was no significant difference in the incidence of postoperative adverse memory between the two groups (6.7% in the control group and 3.3% in the experimental group, P=0.1652). CONCLUSIONS： End-tidal carbon dioxide monitoring combined with endotracheal intubation through nasal fiberoptic bronchoscopy can shorten the duration of endotracheal intubation, decrease oxygen saturation during intubation and reduce the incidence of epistaxis, thus improving the efficiency and safety of endotracheal intubation. References | Related Articles | Metrics

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Comparison of body mass index on body temperature in patients undergoing combined radical neck dissection and effectiveness of different heat preservation methods QU Xing-qian, FAN Zhi-dan 2019, 17 (5):  453-456.  doi: 10.19438/j.cjoms.2019.05.013 Abstract ( 182 )   PURPOSE: To evaluate the relationship between body mass index(BMI) and body temperature in patients undergoing combined radical neck dissection and evaluate the effect of different thermal preservation measures. METHODS: Sixty patients who underwent combined radical neck dissection and surgery in our hospital were enrolled in this study according to stratified sampling method. The patients were divided into 3 groups(n=20), i.e. normal weight (group N, BMI 18.5-22.9 kg/m2); over obesity (group O,BMI 23-24.9 kg/m2), and mild obesity (group L, BMI 25.0-29.9 kg/m2). Nasopharyngeal temperature of all patients was monitored immediately, 10 min (T1), 30 min (T2), 60 min (T3), 90 min (T4) and 120 min (T5) after tracheal intubation. Another 40 patients with BMI of 18.5-22.9 kg/m2 were randomly divide into warm liquid instrument group ( group NA, n=20) and warm liquid instrument combined with constant temperature blanket group (group NB, n=20). Temperature data were collected in the same way. The data were analyzed with SPSS 20.0 software package. RESULTS: Compared with the same time point between the groups with different BMI values: the temperature of group N and group O showed significant difference only at T4 and T5 (P<0.05). There was significant difference in body temperature between group N and group L at T2-T5 (P<0.05). Difference in temperature was not statistically significant at each time point between group O and group L (P>0.05). Intra-group comparison: temperature at T1 and T3, T4 and T5 was significantly different in group N (P<0.05); temperature at T2 was significantly different between T4 and T5 (P<0.05); the difference between T3 and T4 was statistically significant. In group O: there was significant difference at T1, T4 and T5. In group L: no significant difference was found at each time point. At the same time point, temperature in group NA and group NB was significantly higher at T3, T4 and T5 (P<0.05). In the group NA , there was significant difference between T1 and T4 (P<0.05); hypothermia at T2 and T5 (P<0.05); there was no significant difference in temperature change between T3 and T5 (P>0.05), there was no significant difference in temperature at each time point in group NB. CONCLUSINS: Patients with high BMI are more likely to maintain stable body temperature during combined radical neck dissection under the same condition. Warm liquid instrument has exact effect on heat preservation, but the effect of warm liquid instrument combined with thermostatic blanket is better. References | Related Articles | Metrics

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Study on the effect of nursing intervention combined with dexmedetomidine to prevent restlessness during recovery period in children with obstructive sleep apnea hypopnea syndrome FEI Juan, YAN Jia, SHI Zhen 2019, 17 (5):  457-461.  doi: 10.19438/j.cjoms.2019.05.014 Abstract ( 241 )   PURPOSE: To explore the effect of nursing intervention combined with dexmedetomidine on restlessness and recovery time of children with obstructive sleep apnea hypopnea syndrome(OSAHS) during recovery period. METHODS: One hundred and twenty OSAHS patients who underwent elective uvulopalatopharyngoplasty from Nov. 2016 to Nov. 2018 were selected as the study subjects. They were randomly divided into experiments' group and control group equally. Patients in the control group underwent general anesthesia, and patients in the experimental group were treated with dexmedetomidine and nursing on the basis of the treatment of the control group. HR and SpO2 , intubation time, wake time, awakening period and adverse reactions in the two groups were compared when they entered the operating room (T0) and extract of tracheal intubation (T1) with SPSS 22.0 software package. RESULTS: There was no significant difference in HR and SpO2 between the two groups (P>0.05) at T0. SpO2 was significantly lower than T0 at T1 in both groups(P<0.05); HR was significantly higher than T0 at T1(P<0.05) in the control group, there was no significant difference in HR between T0 and T1 in the experimental group (P>0.05). HR of the experimental group was significantly lower than that of the control group at T1 (P<0.05); there was no significant difference in SpO2 between the two groups at T1 (P>0.05), and no significant difference in extubation time and recovery time between the two groups(P>0.05). The incidence of agitation in the experimental group was significantly lower than that in the control group (P<0.05). The incidence of adverse reactions in the experimental group was significantly lower than that in the control group(P<0.05). CONCLUSIONS: Nursing intervention combined with dexmedetomidine is important for prevention and treatment of restlessness during recovery time in children with OSAHS, which can improve the safety of general anesthesia. References | Related Articles | Metrics

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Application of multifunctional aseptic storage bag in oral surgery ZHU Yong-gan, YU Shuang 2019, 17 (5):  462-464.  doi: 10.19438/j.cjoms.2019.05.015 Abstract ( 292 )   PURPOSE: To design and make a practical multifunctional aseptic storage bag for oral surgical procedures, and explore its clinical value. METHODS: According to clinical needs, a multifunctional aseptic storage bag was developed for oral surgical procedures. The contamination rate of instruments and equipments, the funds consumed due to the contamination of instruments and equipment, the numbers of needlestick injuries with electric knife during operation, and the satisfaction of surgeons to the management of intraoperative contaminated instruments during operation were compared before (2017) and after (2018) using multifunctional aseptic storage bag. The data was analyzed with SPSS 17.0 software package. RESULTS: After application of multifunctional aseptic storage bag in oral surgical procedures in our hospital, the contamination rate of instruments and equipments decreased significantly in 2018 compared with the previous year (from 16.41% to 7.04%); the total savings were 81,765 RMB; the numbers of needlestick injuries with electric knife decreased by 19 cases (from 24 cases to 5 cases); the satisfaction of surgeons with the management of intraoperative contaminated instruments increased from 78% up to 100%,and the difference was statistically significant (P<0.05). CONCLUSIONS: This multifunctional aseptic storage bag can effectively solve the problem of difficult management of articles in oral surgical procedures. It not only reduces the consumption during operation, but also reduces the occurrence of needlestick injuries and improves the satisfaction of surgeons. References | Related Articles | Metrics

Clinical Reports

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Recurrent pleomorphic adenoma of the submandibular gland: a clinical and pathologic study of 15 cases XU Wan-lin, ZHU Yun, LU Hao, LIU Li-min, SHEN Shu-kun, LIU Sheng-wen, YANG Wen-jun 2019, 17 (5):  465-468.  doi: 10.19438/j.cjoms.2019.05.016 Abstract ( 723 )   PURPOSE: To investigate the clinicopathological feature of recurrent pleomorphic adenoma of the submandibular gland, and discuss its diagnosis, treatment and prognosis. METHODS: From June 2005 to June 2017, the clinical data and pathological features of 15 cases of recurrent pleomorphic adenoma of the submandibular gland treated in Shanghai Ninth People's Hospital were reviewed and analyzed retrospectively. RESULTS: Among 15 cases, 4(26.67%) were male while 11(73.33%) were female. Their age ranged from 25 to 73 years old (mean: 39.33). Three cases (20%) recurred twice and the other 12 patients (80%) recurred once. All patients underwent excision of the mass and submandibular gland (except 2 cases who had undergone excision of the submandibular gland in previous surgery), and the pathological results were recurrent pleomorphic adenoma, with multi-nodules and incomplete capsule. The follow-up period was 1-13 years (median: 6) and only 1 patient (6.67%) suffered from suspected recurrence, who didn't receive second surgery due to his old age. CONCLUSIONS: Recurrent pleomorphic adenoma in the submandibular gland is rare. Its clinical and pathological features were similar to those of the primary pleomorphic adenoma and surgical treatment is effective. References | Related Articles | Metrics

Dental Education

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Application of virtual endoscopy simulation system in clinical teaching of trigeminal neuralgia WEI Wen-bin, CHEN Min-jie, ZHANG Wei-jie, LIU Zhi-yang, HAN Zi-xiang, CHAI Ying 2019, 17 (5):  469-472.  doi: 10.19438/j.cjoms.2019.05.017 Abstract ( 198 )   PURPOSE: To explore the application value of virtual endoscopy simulation system in clinical teaching of trigeminal neuralgia. METHODS: The clinical teaching content of trigeminal neuralgia was presented using Stlview software based on virtual endoscopy. Twenty-four interns were enrolled from Shanghai Jiao Tong University College of Stomatology, 12 interns were assigned into the virtual endoscopic teaching group and the other 12 interns into the traditional teaching group. The age and gender of the two groups were matched. The ability to understand the knowledge of the teaching was evaluated through theoretical assessment and comprehensive ability assessment, and the results were also evaluated through self-designed questionnaires survey. SPSS 23.0 software was used to analyze the data. RESULTS: Compared with the traditional teaching group, the interns of the virtual endoscopy teaching group had no significant difference in the score of theoretical knowledge assessment (P=0.289), but the score of virtual endoscopic teaching group was significantly greater than the traditional teaching group in the comprehensive ability assessment(P=0.039), and the virtual endoscopy teaching group was evaluated by questionnaire to have significant advantages in three-dimensional sense of space, learning initiative, teaching interaction and learning interest. CONCLUSIONS: Virtual endoscopy has a broad application prospect in clinical teaching of trigeminal neuralgia, which has a complex structure and strict operation, and can improve the quality of clinical teaching. References | Related Articles | Metrics

Review Articles

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Studies on symptom cluster assessment tools for patients with head and neck cancers HUANG Yao, YU Lei-lei, YANG Yue-lai, WANG Hui-fen, YUAN Wei-jun, MAO Yue-li 2019, 17 (5):  473-477.  doi: 10.19438/j.cjoms.2019.05.018 Abstract ( 239 )   Compared with single symptom assessment, symptom clusters assessment is beneficial to comprehensive analysis to find key symptom and relieve symptom burden for patients with head and neck cancers. Because of the speciality of anatomic location and extent of tumor, head and neck cancer patients usually experience serious symptoms. These symptoms have great influence on patients' outcomes. At present, there still has been a lack of domestic study on symptom clusters assessment tool for patients with head and neck cancers. This review summarized the studies on the symptom cluster assessment instrument for patients with head and neck cancers. References | Related Articles | Metrics

Case Reports

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Diagnosis and treatment of chylous cyst of the left cervical root:report of one case WU Dan-mei, HUANG Lei, LIU Fa-xin, BAI Zhi-bao 2019, 17 (5):  478-480.  doi: 10.19438/j.cjoms.2019.05.019 Abstract ( 438 )   A case of chylous cyst at the root of left neck was retrospectively analyzed. The cervical chylous cyst was treated with sclerotherapy under B-ultrasound. After treatment, the cyst was significantly reduced, the appearance of the neck was improved, and compression of adjacent tissue and organs was relieved. References | Related Articles | Metrics