China Journal of Oral and Maxillofacial Surgery

Hospital infection control strategies of oral surgery outpatient operating room during the period of work resumption from COVID-19

YUAN Dan, CHEN Xue-feng, ZHANG Shan-yong, ZHU Qiu-li, YUN Bai, ZHANG Qin, GU Yu-juan, CAI Yong, YANG Chi

2020, 18 (6): 481-485. doi: 10.19438/j.cjoms.2020.06.002

Abstract ( 462 )

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Currently, the prevention and control of COVID-19 situation shows a positive trend in China. However, with the resumption of work and input of a large number of overseas personnels, the epidemic risk of infection is still existing. Proper implementation of hospital infection control measures to reduce the risk of spread and infection, as well as open oral surgery to ensure the needs of patients are important problems of oral surgery outpatient operating room. This article summarized the difficulties and problems of COVID-19 prevention and control during the period of resumption and foreign input, formulated and adjusted the corresponding hospital infection prevention and control strategy according to different levels of public health emergency response, raised new strategies for hospital infection control of oral surgery outpatient operating room.

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Salivary glands: reservoir and victim of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)

ZHANG Zhuo-yu, SA Guo-liang, WEI Ze-quan, YANG Xue-wen

2020, 18 (6): 486-489. doi: 10.19438/j.cjoms.2020.06.003

Abstract ( 651 )

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Coronavirus disease 2019(COVID-19) has spread globally and is progressing rapidly, which has a huge impact on human health, economic activities and life styles. Oral and dental care, which produces a lot of aerosols due to the usage of dental turbine, is a high-risk medical field. Whether salivary glands can be infected by SARS-CoV-2 is positively linked with the risks that the dentists confront, as salivary glands are the resources of saliva. This review summarized the literature on SARS-CoV-2 infection and impact of salivary glands, as well as their replication in salivary glands, so as to protect dentists during COVID-19 outbreak.

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Inhibitory effect of α-eleostearic acid on tongue squamous cell carcinoma CAL-27

WANG Zi-yu, DING Yu-jie, CHEN Bing, SHEN Hao-chong, MENG Jian, TONG Wei-feng

2020, 18 (6): 490-494. doi: 10.19438/j.cjoms.2020.06.004

Abstract ( 243 )

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PURPOSE: To investigate the effect of α-eleostearic acid (α-ESA) in bitter melon seed oil on the proliferation, migration and apoptosis of tongue squamous cell carcinoma CAL-27 cells. METHODS: CAL-27 cells were cultivated in vitro and α-ESA was added at the concentrations of 0, 70, 80, 90, 100, 110 and 120 μmol/L. CCK-8 assay and flow cytometry were used to detect the cell proliferation inhibition rate at 24, 48, and 72 h and apoptosis rate at 48 h respectively. CAL-27 cells were treated with α-ESA at concentrations of 0, 80 and 100 μmol/L. The cell migration capacity after 24 hours of α-ESA administration was measured by cell scratching assay. The morphology of apoptotic cells after 48 h of α-ESA administration was observed by Hoechst 33258 staining. SPSS 21.0 software package was used for statistical analysis. RESULTS: The proliferation of CAL-27 cells was inhibited by α-ESA in a time and concentration-dependent manner (P<0.05). After 24, 48, and 72 h of α-ESA administration, the half inhibitory concentration(IC₅₀) was (123.48±1.00) μmol/L, (80.22±0.03) μmol/L, and (69.27±80.34) μmol/L, respectively, which was gradually decreased. The results of flow cytometry showed that the apoptosis rate increased significantly with the increase of α-ESA concentration (P<0.05). After 24 h of incubation, the wound healing rate of CAL-27 cells was (40.08±2.19)% and (22.06±2.04)% after administration of 80 and 100 μmol/L α-ESA, which was significantly lower than the control group (74.74±2.17)%(P<0.01). Densely stained or fragmented bright blue fluorescence was observed under fluorescence microscope which represented cell apoptosis. CONCLUSIONS: α-ESA can inhibit the proliferation and migration of CAL-27 cells in vitro, and therefore has certain anti-tumor effects.

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Effect of long noncoding RNA FOXD2-AS1 on migration and invasion of tongue squamous cell carcinoma: an in vitro study

ZHOU Guang-ming, LIANG Yan-can, HUANG Zi-xian, ZHANG Bin

2020, 18 (6): 495-500. doi: 10.19438/j.cjoms.2020.06.005

Abstract ( 203 )

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PURPOSE: To investigate the effects of long noncoding RNA FOXD2-AS1 on migration and invasion of tongue squamous cell carcinoma (TSCC). METHODS: RT-qPCR was carried out to validate the expression of lncRNA FOXD2-AS1 in 35 paired clinical TSCC tissues, the relationship between FOXD2-AS1 expression and clinicopathological characteristics was analyzed with the 8th version of UICC TNM staging criteria. Receiver operating characteristic curve (ROC) was made according to RT-qPCR data. Transwell migration and invasion, colony formation assays were performed to detect migration, invasion and proliferative ability of TSCC cells after FOXD2-AS1 being downregulated in SCC-9 and CAL-27 cell lines. Western blot was conducted to detect the influence that FOXD2-AS1 downregulation might have on downstream molecules. SPSS 23.0 software package was used to analyze the data. RESULTS: Compared to para-carcinoma tongue tissues, lncRNA FOXD2-AS1 was highly expressed in TSCC tissues and its high expression was associated with cervical lymph node metastasis and poor TNM stages. In ROC, area under curve (AUC) was 0.8122,95% CI was 0.7141-0.9103,sensitivity and specificity were 0.6 and 0.8857, respectively, and the value of cutoff was 4.122. After FOXD2-AS1 being downregulated in SCC-9 and CAL-27 cell lines,Transwell migration and invasion assays revealed that migration and invasion of TSCC cells were inhibited, but the proliferative ability remained unchanged. Western blot indicated that the expression of β-catenin in Wnt/β-catenin signal pathway downregulated after lncRNA FOXD2-AS1 knockdown. CONCLUSIONS: lncRNA FOXD2-AS1 is highly expressed in TSCC, which promotes migration and invasion of TSCC and is associated with cervical lymph node metastasis and poor TNM stages, probably through modulating Wnt/β-catenin signal pathway.

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A novel staging system and corresponding therapeutic strategies for medication-related osteonecrosis of the jaw

LIU Zhong-long, JIANG Jun-jian, LI Xiao-guang, ZHU Feng-shuo, TANG Xiao, ZHU Ling, HE Yue

2020, 18 (6): 501-507. doi: 10.19438/j.cjoms.2020.06.006

Abstract ( 501 )

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PURPOSE: To propose a new clinical staging method that can be performed to guide the diagnosis and treatment of MRONJ through a retrospective study of patients with medication-related osteonecrosis of the jaw (MRONJ). METHODS: The clinical data of 74 MRONJ patients admitted to Shanghai Ninth People's Hospital between 2008 and 2018 were enrolled. A novel staging method and corresponding treatments were proposed on the basis of anatomic structures (inferior alveolar canal and floor of maxillary sinus) and boundary of bone lesions. RESULTS: A new staging system with four different stages (stage 0: 7 cases; stageⅠa: 18 cases; stageⅠb: 14 cases; stage Ⅱa: 12 cases; stage Ⅱb: 15 cases; and stage Ⅲ: 8 cases) was proposed. Outcome of these samples demonstrated that only 12 cases hold progressed state. CONCLUSIONS: This new staging system is suitable for clinical diagnosis and therapeutic selection for MRONJ.

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Correlation among pain, anxiety and personality traits of patients undergoing impacted mandibular third molar extraction

HU Hui-jun, CHANG Zhi-ming, LI Xiao-lei, MIAO Qian-dai, HAN Yan

2020, 18 (6): 508-511. doi: 10.19438/j.cjoms.2020.06.007

Abstract ( 559 )

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PURPOSE: To study the occurrence of pain and anxiety of patients undergoing impacted mandibular third molar extraction, and analyze their correlation with personality traits. METHODS: Eighty-five patients undergoing impacted mandibular third molar extraction were selected as the subjects. Pain visual analogue scale (VAS) scores, modified dental anxiety scale (MDAS) scores and Eysenck personality questionnaire (EPQ-RSC) scores were measured and recorded. The correlation between VAS score, MDAS score and personality traits was analyzed using SPSS 19.0 software package. RESULTS: Among 85 patients, mild and moderate pain accounted for 52.94% and 47.06% respectively. Patients with mild, moderate and severe anxiety accounted for 61.18%, 28.23% and 10.59%, respectively. There were no significant differences in L, P or E scores between patients with mild and moderate pain (P>0.05). N scores of patients with mild pain were significantly lower than those with moderate pain (P<0.05). There was no significant difference in L or P scores between patients with different levels of anxiety (P>0.05). The order of N scores of patients with different levels of anxiety from low to high was as follows: mild, moderate, severe (P<0.05). The order of E score from high to low was as follows: mild, moderate, severe (P<0.05). Correlation analysis showed that pain was positively correlated with neuroticism (r=0.198, P=0.001). Anxiety was positively correlated with neuroticism (r=0.205, P<0.001), but negatively correlated with introversion and extroversion (r=-0.312, P<0.001). CONCLUSIONS: Patients undergoing impacted mandibular third molar extraction all have anxiety and postoperative pain, and there is an obvious correlation between anxiety and neuroticism, introversion and extroversion.

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The Application of mixed reality and 3D printing in the treatment of long-standing zygomatic orbital complex fracture

LYU Ji-lian, ZHAO Yuan, CAI Xiao-qing, ZHANG Rui

2020, 18 (6): 512-515. doi: 10.19438/j.cjoms.2020.06.008

Abstract ( 301 )

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PURPOSE: To investigate the effect of mixed reality (MR) and 3D printing in the treatment of long-standing zygomatic orbital complex fracture. METHODS: Eight cases with long-standing zygomatic fracture were operated based on MR and 3D printing technology. CT data were imported into the computer medical image processing software for fracture segmentation, virtual reduction, 3D printing of fracture reduction model. During operation, titanium plate rigid internal fixation, MR accurate verification and positioning were performed. Facial shape and symmetry were compared and observed on the healthy side after operation. The difference of protrusion and height of bilateral zygoma before and after operation was compared by t test with SPSS 22.0 software package. RESULTS: Mouth opening and masticatory function of the patients returned to normal after operation. The wounds healed at one stage without bleeding and infection. The two sides of the face, the protrusion and height of the bilateral zygoma were the same. The difference of protrusion and height of the zygoma before and after operation were (9.82±1.11) mm, (1.12±0.48) mm and (10.19±1.01) mm, (1.13±0.42) mm, respectively. The difference was statistically significant compared with that before operation (t=24.77, P<0.05; t=24.68, P<0.05). CONCLUSIONS: MR and 3D printing technology can effectively restore the shape of the middle face and masticatory function, achieve accurate and personalized treatment, and provide a new way for clinical diagnosis and treatment.

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Nutritional status and quality of life in 28 patients with advanced oral squamous cell carcinoma during neoadjuvant chemotherapy

ZHANG Xin-rui, JIANG Yi-ting, ZHANG Han-zhi, ZHANG Mei-fang, ZHANG Hai-feng, SUN Juan, REN Guo-xin

2020, 18 (6): 516-520. doi: 10.19438/j.cjoms.2020.06.009

Abstract ( 324 )

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PURPOSE: To explore the changes of nutritional status and quality of life in patients with advanced oral squamous cell carcinoma(OSCC) during neoadjuvant chemotherapy and their correlation, and evaluate the effect of chemotherapy on nutritional status and quality of life. METHODS: During June 2019 to December 2019, 28 patients with advanced OSCC who received neoadjuvant chemotherapy in the Department of Oromaxillofacial Head and Neck Oncology of Shanghai Ninth People's Hospital were enrolled in the cohort study. TPF regimen (docetaxel+cisplatin+5-fluorouracil) was used in the whole group. During chemotherapy, individual regimen was used for nutritional support. The changes of PG-SGA, QLQ-H&N35 scores and their correlation before and after the chemotherapy were analyzed. The patients were divided into the response group (CR+PR) and the non-response group (PD+SD) for stratified analysis according to the tumor regression using SPSS 23.0 software package. RESULTS: The PG-SGA score and QLQ-H&N35 score of patients after chemotherapy were significantly lower than those before chemotherapy(P=0.0301; P=0.0015), and there was significant correlation between them(r=0.5953, P<0.0001). Stratified analysis showed that there was no significant difference in PG-SGA score and QLQ-H&N35 score between response group and non-response group(P>0.05). There was no significant difference in body weight, muscle mass and fat mass between the two groups (P>0.05). There was no significant difference in body weight and fat between the two groups(P>0.05), but there was significant increase in muscle mass in response group and significant decrease in muscle mass in the non-response group(P=0.0358). CONCLUSIONS: Neoadjuvant chemotherapy can improve the nutritional status and quality of life of patients with advanced OSCC.

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Effect of chemohyperthermia on nitric oxide and T lymphocyte in patients with oral and maxillofacial cancers

LIU Ying, LI Chen-xi, WANG Bing, GONG Zhong-cheng

2020, 18 (6): 521-525. doi: 10.19438/j.cjoms.2020.06.010

Abstract ( 340 )

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PURPOSE: To study the effects of chemohyperthermia on nitric oxide (NO) and T lymphocyte in patients with oral and maxillofacial cancers. METHODS: Sixty patients with oral and maxillofacial cancers admitted to University Cancer Center Hamburg (UCCH) from December 2017 to December 2019 were randomly divided into thermochemotherapy group(n=30) and conventional chemotherapy group(n=30) according to a random number table method. Patients in the conventional chemotherapy group were given intravenous chemotherapy alone, while patients in the thermochemotherapy group were given thermochemotherapy on the basis of intravenous chemotherapy. The therapeutic effect, NO, T lymphocyte, quality of life along with toxic and side effects of the two groups were compared. Statistical analysis of all data was performed using SPSS 22.0 software package. RESULTS: The effective rate of treatment and disease control rate in the thermochemotherapy group were significantly higher than those in the conventional chemotherapy group. After treatment, the content of NO in the conventional chemotherapy group was significantly lower than that in the thermochemotherapy group. CD4⁺,CD4⁺/CD8⁺ in the thermochemotherapy group were significantly higher than those in the conventional chemotherapy group. The functional indexes such as physical function, emotional function, social function and comprehensive quality of life scores in the thermochemotherapy group were significantly higher than those in the conventional chemotherapy group. The symptom indexes such as fatigue, pain and constipation in the thermochemotherapy group were significantly lower than those in the conventional chemotherapy group (P<0.05). There was no significant difference in toxic and side effects between the two groups (P>0.05). CONCLUSIONS: Chemohyperthermia can improve the therapeutic effect and NO content of patients with oral and maxillofacial cancer, improve the immune function of patients, enhance the quality of life of patients, and has higher safety.

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Prognostic value of plasma level of miR-136-5p in patients with oral squamous cell carcinoma

CHEN Xiu-min, LIU Zu-zhi, LIN Jian-neng

2020, 18 (6): 526-530. doi: 10.19438/j.cjoms.2020.06.011

Abstract ( 184 )

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PURPOSE: To investigate the prognostic value of plasma level of miR-136-5p in patients with oral squamous cell carcinoma (OSCC). METHODS: From January 2015 to October 2018, 86 OSCC patients and 50 normal controls were selected from Danzhou People's Hospital. The expression of miR-136-5p in plasma of the two groups were detected by real-time fluorescence quantitative PCR. The optimal cut-off value of plasma miR-136-5p expression level was determined by ROC curve, and OSCC patients were divided into high miR-136-5p group(n=36) and low miR-136-5p group (n=50). The clinicopathological features of the two groups were compared. Survival curves were drawn by Kaplan-Meier method. Single factor and multi factor Cox regression models in SPSS 20.0 software package were used to analyze the risk factors of poor prognosis in OSCC patients. RESULTS: The expression level of plasma miR-136-5p in OSCC group(1.27±0.51) was significantly lower than that in the control group (4.38±1.26, P<0.01). Low expression of plasma miR-136-5p was related to the clinical stage, differentiation degree, tumor diameter and cervical neck lymph node metastasis of OSCC (P<0.05). Survival analysis showed that the overall survival rate of low miR-136-5p group(48.0%) was significantly lower than that of high miR-136-5p group (68.4%,P<0.01), and the progression-free survival rate of low miR-136-5p group(28.6%) was significantly lower than that of high miR-136-5p group (57.8%,P<0.01). Multivariate Cox regression model analysis showed that clinical stage [HR(95%CI) =2.462(1.805-4.193)], cervical neck lymph node metastasis [HR (95%CI)= 2.913 (2.142-5.827)and plasma miR-136-5p expression<2.82 [HR (95%CI)=3.856 (3.114-8.205)were independent risk factors for poor prognosis of patients with OSCC(P<0.05). CONCLUSIONS: Low expression of plasma miR-136-5p is related to short survival time of OSCC patients, which is expected to be a biomarker for predicting poor prognosis of OSCC.

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Full-time rehabilitation nursing in arthroscopic discopexy for anterior disc displacement with perforation of temporomandibular joint

YUN Bai, YU Lei-lei, LUO Yi

2020, 18 (6): 531-534. doi: 10.19438/j.cjoms.2020.06.012

Abstract ( 651 )

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PURPOSE: To introduce and evaluate the effect of full-time rehabilitation nursing in arthroscopic discopexy for patients of anterior disc displacement with perforation in temporomandibular joint(TMJ). METHODS: A retrospective study from January 2017 to December 2018 was made on patients (anterior disc displacement with perforation) who were treated by arthroscopic discopexy combined with full-time rehabilitation nursing intervention. The values of clinical parameters including visual analogue scale (VAS) for pain and maximum inter-incisal opening (MIO) were compared pre- and post- operatively. The results were analyzed by paired t test with SPSS 24.0 software package. RESULTS: A total of 54 patients met the inclusion criteria in this study. With the intervention of whole course rehabilitation nursing intervention, all patients presented with good cooperation and high compliance, and no patient was lost to follow-up. Meanwhile, all patients finished the postoperative mouth opening training and jaw pad treatment. During the follow-up of 6 months, the mean value of MIO increased from (31.76± 7.40) mm (before treatment) to (35.24± 6.22) mm (P=0.001) and the mean score of VAS decreased from 3.13± 2.76 to 0.96± 1.26(P=0.04). CONCLUSIONS: Full-time rehabilitation nursing provides a more comprehensive and individualized intervention, which effectively enhances the treatment of arthroscopic discopexy for patients of anterior disc displacement with perforation in TMJ by improving mouth opening, and relieving pain.

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Review and analysis of misdiagnosis of Sjögren's syndrome with salivary gland mass

HUANG Jian-hu, YIN Xue-lai, SHI Huan, HU Yong-jie

2020, 18 (6): 535-538. doi: 10.19438/j.cjoms.2020.06.013

Abstract ( 393 )

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PURPOSE: The characteristics of Sjögren's syndrome (SS) with misdiagnosis of salivary gland masses were analyzed to provide reference for clinical diagnosis. METHODS: This study retrospectively analyzed the clinical data of 45 patients who underwent parotid / submandibular gland tumor resection and had a final pathological diagnosis of benign lymphoepithelial disease, and compared with salivary gland tumor diseases. Microsoft excel was used to build a database and perform statistical analysis. RESULTS: All involvement 45 patients were female, 24.4% of the patients had bilateral salivary glands, a small number of patients complained dry mouth (11.1%), dry eyes (4.4%), easy fatigue (6.7%), joint pain (22.2%) and other clinical symptoms, nearly half of the patients had moderate mass texture (55.6%) and low mobility (53.3%). Among 35 patients who received CT examination, 13 (37.1%) reported the possibility of autoimmune diseases; 15 (53.3%) received B ultrasound examination, and 13 (76.9%) received MRI examination. The reports of 8 (53.3%) and 10 (76.9%) patients respectively suggested the possibility of autoimmune diseases. CONCLUSIONS: For middle-aged women with salivary gland tumor as the chief complaint, especially those with bilateral involvement of the tumor, SS should be excluded before surgery. B-ultrasound and MRI can be used as additional clinical routine examinations in addition to CT for the initial diagnosis of salivary gland tumor.

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Retrospective analysis of 5 cases with oral-facial-digital syndrome type I

TANG Xiao-yu, GU Dong-kun, LI Dong, NIU Qian-yun, WU Dan-dan

2020, 18 (6): 539-543. doi: 10.19438/j.cjoms.2020.06.014

Abstract ( 662 )

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PURPOSE: To analyze the clinical features in 5 individuals with oral-facial-digital syndrome type I, and investigate the diagnosis and therapy of oral-facial-digital syndrome typeⅠ. METHODS: A retrospective study was conducted in 5 patients with oral-facial-digital syndrome typeⅠ from November 2015 to September 2019. The experience in diagnosis and treatment was summarized and analyzed. RESULTS: Five patients with oral-facial-digital syndrome type Ⅰwere all females and were examined clinically and radiographically, associated oral and facial malformations were observed in 5 patients, digital malformations were observed in 2 patients, polycystic kidney disease was observed in 2 mothers with abortion history. All the patients had satisfied functional and esthetic results. The pathology of tongue nodules was hamartoma. CONCLUSIONS: Oral-facial-digital syndrome typeⅠhad complex phenotype and always complicated with other systemic malformations. Multidisciplinary comprehensive sequence therapy was necessary, surgical treatment was used to correct the malformation and dysfunction. Other systemic malformations must be examined, which will guide health surveillance and medical management of these patients.

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Clinical application of seminal vesicle speculum in diagnosis and treatment of 11 patients with obstructive salivary gland disease

WANG Shao-ru, GAO Jian-gang, XU Zhu-qing, CHEN Zheng-gang, ZHENG Jian-jin, QIU Jian-zhong, YUAN Rong-tao, ZHOU Jian-hua

2020, 18 (6): 544-547. doi: 10.19438/j.cjoms.2020.06.015

Abstract ( 372 )

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PURPOSE: To investigate the feasibility and curative effect of use of seminal vesicle speculum for diagnosis and treatment of obstructive salivary gland diseases. METHODS: Eleven patients diagnosed with obstructive salivary gland diseases from October 2018 to July 2019 in the Department of Oral and Maxillofacial Surgery of Qingdao Municipal Hospital Affiliated to Qingdao University were collected. All patients underwent preoperative CT examinations to quire detailed information of the number, location and size of stones. The intraductal features in salivary gland were directly observed by seminal vesicle endoscopy under general anesthesia and simultaneous removal of the obstructive objects. Postoperative efficacy was observed and evaluated. RESULTS: Preoperative CT examinations showed no calculi in 3 cases of parotid gland and 1 cases of submandibular gland, single or multiple intramedullary dense stone shadows were found in 7 cases of submandibular gland. In 10 patients, obstruction disappeared after removing the calculi or catheter dilation and lavage with seminal vesicle. In one case with obvious stenosis of the catheter orifice, a small incision was added at the floor of mouth to take the calculi. No symptom recurred during the follow-up of 6 to 12 months after operation. CONCLUSIONS: Seminal vesicle speculum can be used for diagnosis and treatment of obstructive salivary gland diseases, which can partially replace the function of sialoendoscopy as an innovative minimally invasive treatment.

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Oral propranolol in the treatment of proliferating infantile haemangiomas: British Society for Paediatric Dermatology consensus guidelines (translation version)

WANG Qi-zhang, ZHENG Jia-wei

2020, 18 (6): 548-552. doi: 10.19438/j.cjoms.2020.06.016

Abstract ( 427 )

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Infantile hemangiomas IH are the most common vascular tumors of infancy. However, there are still some controversies over indications, pretreatment investigations, its use in PHACES syndrome as well as cessation of treatment. The present study applied a modified Delphi technique involving an international treatment survey, a systematic evidence review of the literature, a face-to-face multidisciplinary panel meeting and anonymous voting. The expert panel achieved consensus on 47 statements in eight categories eventually. This clinical guideline will contribute to standardize and simplify the treatment of IH with oral propranolol and assist in clinical decision-making.

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