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Table of Content

    20 May 2022, Volume 20 Issue 3 Previous Issue    Next Issue
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    Expert Consensus
    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
    2022, 20 (3):  209-218.  doi: 10.19438/j.cjoms.2022.03.001
    Abstract ( 662 )   PDF (1176KB) ( 344 )  
    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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    Original Articles
    Mechanism of EGFR-targeted drugs for pain relief in oral cancer
    WEI Dong-liang, LI Zhi, JU Hou-yu, WU Yun-teng, GUO Wei, REN Guo-xin
    2022, 20 (3):  219-224.  doi: 10.19438/j.cjoms.2022.03.002
    Abstract ( 104 )   PDF (907KB) ( 44 )  
    PURPOSE: The purpose of this study was to investigate whether drugs targeting EGFR (erlotinib, Nimotuzumab) could affect the pain threshold of experimental animals and to preliminarily explore the mechanism. METHODS: Naive mice were divided into two groups(physiological saline, n=6; erlotinib, n=6), the difference of pain threshold between the two groups was compared by Von Frey fiber test, hot plate test and 5% formalin test 1 h after administration. Nude mice were selected and divided into 3 groups (Sham + NS group, n=10; Plantar neoplasia + NS group, n=10; Plantar neoplasia + Nimotuzumab group, n=10). The mechanical pain threshold and thermal pain threshold of the mice were detected 1d before modeling and 1, 5, 7, 10 and 14 d after modeling. The mouse feet were dissected 14 days later, and the concentrations of IL-1β and IL-6 were detected by ELISA after tissue homogenization. The data were processed by Graphpad Prism statistical software. RESULTS: After erlotinib injection, the mechanical pain threshold and thermal pain threshold of mice had no obvious changes. After injection of 5% formalin in mice, the duration of licking in the anterior phase (0-10 min, P<0.01) and posterior phase (10-60 min, P<0.01) decreased significantly. Heat and mechanical pain sensitivity could be induced after plantar tumor formation in nude mice. Nimotuzumab slowed down tumor growth rate and increased thermal pain threshold (P<0.05) and mechanical pain threshold (P<0.05) in plantar tumorigenic mice. ELISA showed that the concentration of IL-1β (P<0.05) and IL-6 (P<0.05) in the plantar tissue of mice in the Nimotuzumab treatment group was significantly lower than that of the PBS treatment group. CONCLUSIONS: Erlotinib can alleviate pain induced by formalin in mice. Nimotuzumab can reduce mechanical and thermal pain sensitivity induced by plantar tumor formation, and the mechanism may be related to the decrease of inflammatory cytokines in local tissues. EGFR-targeted drugs may be one of the good analgesics for patients with advanced cancer pain.
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    Long-term effectiveness of periodontal micro-osteotomy assisted orthodontic treatment in adult patients with primary alveolar defect
    WANG Bo, YU Hong-bo, XIA Yun-yui, FANG Bing, GUO Qiu-man
    2022, 20 (3):  225-229.  doi: 10.19438/j.cjoms.2022.03.003
    Abstract ( 106 )   PDF (967KB) ( 75 )  
    PURPOSE: To quantitively investigate the long-term effectiveness of periodontal micro-osteotomy assisted orthodontic treatment of adult patients with primary alveolar defect. METHODS: The sample consisted of 30 adult cases with primary alveolar defect in the lower anterior region who accepted periodontal micro-osteotomy assisted orthodontic treatment with over 2 years of follow-up, selected from consecutive patients at the Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital since Jan.2014. Alveolar bone morphology of lower anterior teeth with primary alveolar defect was appraised with the help of cone-beam CT (CBCT) in the surgical sites at different time points. The data were processed using SAS 9.1 software package. RESULTS: Periodontal micro-osteotomy assisted orthodontic treatment in adult patients with primary alveolar defect showed stable long-term effect of bone augmentation and minimal root resorption. However, the effect of bone augmentation was less when approaching the alveolar bone crest, and vertical alveolar bone loss was observed on both labial and lingual side in the surgical sites. CONCLUSIONS: Periodontal micro-osteotomy assisted orthodontic treatment is a promising approach for the treatment of adult patients with primary and inflammatory alveolar defect; however, vertical alveolar bone loss could be observed in the surgical sites.
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    Efficacy of I.lanceolatum injection on postoperative reaction following dental implant surgery
    ZHU Qing-qing, SUN Qiang, WANG Dong-ling, ZHOU Hong
    2022, 20 (3):  230-234.  doi: 10.19438/j.cjoms.2022.03.004
    Abstract ( 73 )   PDF (607KB) ( 30 )  
    PURPOSE: The aim of this study was to explore the effects of i.lanceolatum injection on postoperative reaction , following the placement of dental implants with guided bone regeneration(GBR). METHODS: Ninety patients requiring dental implants with GBR were included in this randomized controlled clinical trial. The patients were evenly divided into 3 groups. I.lanceolatum injection was adopted in the experimental group after surgery, dexamethasone injection was adopted in the control group, and patients didn't receive any injection in the blank group. Postoperative pain, swelling, early wound healing, and satisfaction were analyzed and evaluated after follow-up appointments at day 1, day 3, and day 7. SPSS 25.0 software package was used for data analysis. RESULTS: The experiment group had significantly lower pain and swelling indices than the blank group at day 1 and 3(P<0.05); it also had higher wound healing indices than the blank group at day 1 and 3(P<0.05). Operative satisfaction indices of the experimental and control group were significantly higher than the blank group(P<0.05). CONCLUSIONS: Postoperative adverse reactions can be improved by using i.lanceolatum injection following dental implant surgery with GBR.
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    Comparison of the effect of two kinds of biopsy on prognosis of oral mucosal malignant melanoma - a retrospective analysis of156cases
    HAN Ru-xue, MA Xu-hui, LI Zhi, REN Guo-xin, GUO-Wei, WU Yun-teng, LIANG Xiang
    2022, 20 (3):  235-238.  doi: 10.19438/j.cjoms.2022.03.005
    Abstract ( 109 )   PDF (682KB) ( 45 )  
    PURPOSE: To compare the effect of two kinds of biopsy on prognosis of oral mucosal malignant melanoma (OMM), in order to find an optional biopsy method for OMM. METHODS: Patients with OMM treated at Shanghai Ninth Hospital, Shanghai Jiao Tong University School of Medicine from Jan.2010 to Jan.2018 were retrospectively analyzed. Correlation between biopsy methods and prognosis were explored. Overall survival (OS) was the primary outcome, and OS was the time from pathological diagnosis to the date of death or follow-up (September 1, 2021). SAS 9.3 software was used for statistical analysis. RESULTS: Univariate analysis showed that T stage, cervical lymph node(CLN) status, biopsy type and OS were statistically correlated. All the three variables were included in Cox regression model for multivariate analysis. The results showed that T stage, CLN and biopsy type were independent prognostic factors of OS(P<0.05). CLN and biopsy methods were identified as prognostic factors. Incidences of CLN and distant metastasis were both significantly less in cryogenic biopsy group than in incisional biopsy group (53% vs. 74% and 22% vs. 42%, Log-rank=12.955, P<0.01 respectively). The 3- and 5-year OS was significantly longer in cryogenic biopsy group than in incisional biopsy group (65% vs. 42%,Log-rank=12.570, P<0.01 and 54% vs. 20%, Log-rank=7.203, P<0.01, respectively). CONCLUSIONS: The 3- and 5- year OS in cryogenic biopsy group was significantly better than that in the incisional biopsy group. Cryogenic biopsy could significantly reduce CLN and distant metastasis of OMM. Therefore, Use of cryogenic biopsy instead of incisional biopsy to clarify the diagnosis of OMM is recommended.
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    Prognostic factors of primary intraosseous squamous cell carcinoma: a retrospective review of98consecutive cases
    YANG Jin-gang, XIA Rong-hui, ZHU Yun, WU Si-cheng, DONG Ya-bing, YANG Gong-xin, SHI Jun-long, CUI Ying-hui, ZHU Ling, ZHOU Shang-hui
    2022, 20 (3):  239-243.  doi: 10.19438/j.cjoms.2022.03.006
    Abstract ( 67 )   PDF (529KB) ( 35 )  
    PURPOSE: To delineate the clinical and pathological features and determine the prognostic factors of primary intraosseous squamous cell carcinoma (PIOSCC). METHODS: The clinical, radiological, histopathological and postoperative follow-up data of patients diagnosed with PIOSCC in Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from 2013 to 2017 were collected, and the prognostic factors of PIOSCC were analyzed by descriptive statistical methods. Baseline data were analyzed by univariate and multivariate survival analysis with SPSS 23.0 software package. RESULTS: A total of 98 patients with PIOSCC were enrolled, with a mean age of 56.6 years. Among them, there were 71 males and 27 females, and 33 in the maxilla, 65 in the mandible. Of the 95 patients followed up, 24 patients developed local recurrences and 10 patients developed distant metastases; furthermore, most local recurrences and distant metastasis occurred within 2 years after operation. The estimated 2-year and 5-year overall survival were 74.7% and 61.8%, respectively. Univariate analysis showed that tumor site, tumor size, positive margin, and cervical lymph node metastasis were significant prognostic factors for overall survival; facial numbness, positive margin were significant prognostic factors for local recurrences; and tumor site, cervical lymph node metastasis were significant prognostic factors for distant metastasis. Multivariate analysis showed that only positive margin and cervical lymph node metastasis remained as significant prognostic factors for overall survival. CONCLUSIONS: Recurrence, metastasis, and death occurred most frequently within 2 years after operation of PIOSCC. Positive margin and cervical lymph node metastasis were negative prognostic factors for PIOSCC.
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    Perioperative thromboelastography evaluation in70free flap transplantations for oral, maxillofacial reconstruction
    LIU Di, ZHANG Si-min, ADILIJIANG Saimaiti, ZULIHUMA Kadi, MUHESEN Yashengjiang, NIJIATI Nuermuhanmode, MAIMAITITUXUN Tuerdi
    2022, 20 (3):  244-250.  doi: 10.19438/j.cjoms.2022.03.007
    Abstract ( 69 )   PDF (834KB) ( 32 )  
    PURPOSE: To investigate the clinical value of thromboelastography (TEG) in prevention of thrombosis of free flap anastomosis during perioperative period of oral and maxillofacial defects reconstructed with free flap. METHODS: The clinical data of 70 patients with oral and maxillofacial defects repaired with free flap were analyzed retrospectively. According to different coagulation test methods and anticoagulation guidelines, the patients were divided into control group (routine coagulation test, anticoagulation treatment according to routine coagulation indexes) and experimental group (TEG test and routine coagulation test, anticoagulation treatment according to TEG indexes), with 35 cases in each group, their coagulation status and complications such as flap thrombosis and hematoma, etc. were compared. SPSS24.0 software package was used for statistical analysis. RESULTS: The levels of activated partial thromboplastin time(APTT) and plasma thrombin time(TT) of routine coagulation test in the two groups decreased successively at three time points, and the level of fibrinogen (FIB) increased at three time points. There was no significant difference between the two groups (P>0.05); the difference of international normalized ratio (INR) at three time points was not statistically significant (P>0.05). There was no significant difference in Angle, MA, LY30% and EPL at three time points in TEG of the experimental group (P>0.05). The values of R and K decreased successively at three time points, and the difference was statistically significant (P<0.05); before operation and 24h after operation, the number of positive cases of hypercoagulable patients in TEG test was greater than that in routine coagulation test, and the difference was statistically significant(P<0.05). There was no significant difference in flap complications between the two groups (P>0.05). CONCLUSIONS: The detection rate of TEG in hypercoagulable patients was higher than that in routine coagulation test; the results of TEG and routine coagulation test have clinical reference value for the use of anticoagulants.
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    Expression, clinical significance of cathepsin B, Beclin-1in the gingival tissues of patients with peri-implantitis
    XUE Qiu-bo, XUE Lu-feng, MA Cheng, DING Hao-yue
    2022, 20 (3):  251-256.  doi: 10.19438/j.cjoms.2022.03.008
    Abstract ( 63 )   PDF (745KB) ( 44 )  
    PURPOSE: To explore the changes and clinical significance of cathepsin B (Cat B) and Beclin-1 expression in the gingival tissues of patients with peri-implantitis. METHODS: One hundred and twenty-four cases with peri-implantitis were collected as the experimental group, and 124 cases of healthy gingival tissues (due to impacted tooth extraction) as the control group. The expression of Cat B and Beclin-1 mRNA and protein in the gingival tissues of the two groups were detected by RT-PCR and Western blot, respectively. One year after operation, the patients with peri-implantitis were classified into loosing/dropping group and non-loosing/dropping group. The clinical data of patients in the two groups were analyzed. Logistic multivariate regression analysis was conducted to evaluate related factors affecting implant loosing/dropping in patients with peri-implantitis. A receiver operating characteristic curve (ROC) was made to analyze the predictive value of Cat B and Beclin-1 mRNA expression in gingival tissue for the occurrence of implant loosing/dropping in patients with peri-implantitis. SPSS21.0 software package was used for data analysis. RESULTS: Cat B and Beclin-1 mRNA and protein expression in the gingival tissues of the experimental group was significantly higher than those of the control group(P<0.05). The incidence of implant loosing/dropping in patients with peri-implantitis was 16.94% one year after operation. The prevalence of diabetes, smoking history, implant loading time, procalcitonin(PCT), and the expression of Cat B and Beclin-1 mRNA in gingival tissue in the loosing/dropping group were significantly higher than those in the non-loosing/dropping group (P<0.05). Logistic multivariate analysis showed that PCT, Cat B and Beclin-1 mRNA were risk factors affecting the occurrence of implant loosing/dropping in patients with peri-implantitis (OR=2.751, 3.414, 3.196, P<0.05). ROC analysis showed that the best cut-off points for the expression of Cat B and Beclin-1 mRNA in gingival tissue to predict the occurrence of implant loosing/dropping in patients with peri-implantitis were 1.42 and 2.51, respectively, and the sensitivities were 61.90% and 76.19%, respectively; specificity was 76.70%, 60.19%, and AUC was 0.728 and 0.771, respectively. CONCLUSIONS: Compared with healthy gingiva, Cat B and Beclin-1 mRNA in the gingival tissues of patients with peri-implantitis are both highly expressed, and the expression of Cat B and Beclin-1 mRNA in the gingival tissues has an effect on peri-implant inflammation. The predictive value of the occurrence of implant loosening/dropping in patients is high, and it can be used as an important reference index for clinical evaluation of the occurrence of implant loosing/dropping.
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    Analysis of clinical characteristics, secondary effects of234supernumerary teeth based on cone-beam CT
    FAN Yong-jing, JIN Wu-long, WANG Shu-min, WANG Shu
    2022, 20 (3):  257-262.  doi: 10.19438/j.cjoms.2022.03.009
    Abstract ( 70 )   PDF (588KB) ( 46 )  
    PURPOSE: Cone-beam CT(CBCT)was used to analyze the related characteristics of supernumerary teeth and provide more reference for clinical diagnosis and treatment. METHODS: A total of 234 multiple teeth diagnosed by CBCT from the Department of Stomatology, Affiliated Hospital of Inner Mongolia Medical University from January 2019 to December 2020 were selected as the research subjects. The growth and development characteristics and secondary effects of supernumerary teeth were analyzed with SPSS 25.0 software package. RESULTS: The average age of patients was 11.16±7.61 years old, with the largest number of patients in the age group of 7-12 years old. The male to female ratio was 1.6∶1. Han nationality accounted for 85.0%. The supernumerary teeth were mainly unilateral. The quantity was mostly one. Maxillary supernumerary teeth mainly occurred in the incisor area, while mandibular supernumerary mainly occurred in the premolar area. Maxillary supernumerary teeth in the incisor area was more common in the age group of 7-12 years old, while those in the canine and premolar area were more common in the age group of 13-18 years old, those in the molar area were more common in the age group over 19 years old. Supernumerary teeth in the incisor area was more likely to occur in males, and mainly conical; the remaining of the growth areas were more likely to occur in females and mainly nodular. The differences were statistically significant(P<0.05). Development status in the age group over 19 years old was better than the other three groups; the molar area was better than other areas; the maxilla was better than the mandible; the differences were statistically significant (P<0.05). The supernumerary teeth located between the roots of the two permanent teeth were better than the other three groups, the difference was not statistically significant(P>0.05). The eruption situation was that partial root formation and fully formed supernumerary teeth were higher than crown formation, positive growth was higher than other directions, supernumerary teeth located between the roots of two permanent teeth were higher than the other groups. The differences were statistically significant(P<0.05). The secondary effects were that supernumerary teeth located in each growth area and located on the labial side, the apex of the permanent teeth and between the roots of the two permanent teeth mainly affect the adjacent permanent teeth, and most of the supernumerary teeth located on the palatal side of the permanent teeth have no secondary effects. The differences were statistically significant(P<0.05). CONCLUSIONS: CBCT can accurately analyze the clinical characteristics of supernumerary teeth, which is beneficial to formulate and improve the diagnosis and treatment plan and improve the treatment effect.
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    Effect of mineral trioxide aggregate, autologous platelet-rich fibrin on alveolar bone regeneration in patients with maxillary anterior tooth extraction
    TANG Tian; , CHENG Qun; , DING Zi-qing; , ZHU Xin-ling; , HU Ying-ying;
    2022, 20 (3):  263-267.  doi: 10.19438/j.cjoms.2022.03.010
    Abstract ( 59 )   PDF (923KB) ( 44 )  
    PURPOSE: To investigate the effect of mineral trioxide aggregate (MTA) and autologous platelet-rich fibrin (PRF) on alveolar bone regeneration in patients with maxillary anterior tooth extraction. METHODS: Sixty-six patients receiving maxillary anterior tooth extraction in Hangzhou Stomatological Hospital from January 2017 to December 2019 were enrolled, and divided into 3 groups according to different filling materials: MTA group, PRF group and combined group, with 22 cases in each group. Cone-beam CT(CBCT) was performed before operation, 1, 3, 6 and 12 months after operation. Healing of injured tissue, alveolar bone density and alveolar bone volume were compared among 3 groups. The data were processed using SPSS 21.0 software package. RESULTS: A total of 61 patients completed the follow up(92.42%, 61/66), including 20 cases in MTA group, 20 cases in PRF group and 21 cases in combined group. Compared with the baseline data, MTA group, PRF group and combined group showed an increment in alveolar bone density 3, 6 and 12 months postoperatively (P<0.05). The alveolar bone density 6 and 12 months postoperatively in combined group were significantly higher than that in MTA group and PRF group(P<0.05), and the alveolar bone density 6 months and 12 months postoperatively in MTA group were significantly higher than that in PRF group. Alveolar bone volume showed a decrease in all 3 groups at postoperative 3, 6 and 12 months(P<0.05), alveolar bone volume of combined group at postoperative 6 and 12 months were significantly lower than that of PRF group(P<0.05). CONCLUSIONS: In single application, MTA has a better effect on restoration and regeneration of alveolar bone in patients with maxillary extraction than PRF, while combined application of the two has the best long-term effect in alveolar bone regeneration.
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    Comparison of two methods of intralesional injection of pingyangmycin for the treatment of microcystic lymphatic malformations in children's lip, face
    TAI Mao-zhong, CHEN Tao, LI Ke-lei, GE Chun-xiao, XU Zhen-guo, QIN Zhong-ping
    2022, 20 (3):  268-272.  doi: 10.19438/j.cjoms.2022.03.011
    Abstract ( 78 )   PDF (1919KB) ( 33 )  
    PURPOSE: To summarize the long-term clinical experience of two methods of intralesional injection of pingyangmycin for the treatment of microcystic lymphatic malformation (LM) in children's lip and face. METHODS: From January 1990 to January 2013, a total of 68 children with diffuse microcystic LM were admitted and treated. All patients received intralesional injection of pingyangmycin, and a total of 68 cases were followed up to the age of 18 years. Among 68 patients, 37 were male and 31 were female. The age at consultation ranged from 10 months to 11 years, and the median age was 3.5 years. From January 1990 to December 1998, 32 children (group A) were treated with full-layer intralesional injection of pingyangmycin at one time. From January 1999 to January 2013, 36 children (group B) were treated with in-layers intralesional injection of pingyangmycin at different times, first mucosal, and submucosa injection followed by percutaneous injection of face and lip after mucosal lesions disappeared. The therapeutic effect was evaluated according to a 4-grade system. The course of treatment, total dose of pingyangmycin were recorded, and long-term local complications were observed. SPSS 18.0 software package was used for statistical analysis. RESULTS: The patients were followed up for 5 to 25 years, there were 4 cases of grade Ⅲ and 28 cases of grade Ⅳ in group A, and 5 cases of grade Ⅲ and 31 cases of grade Ⅳ in group B. By Fisher's exact test, there was no significant difference in the efficacy rate of grade Ⅳ between group A and group B (P>0.05). The treatment course of group A was(5.9±1.4) times, and that of group B was (6.4±1.3) times. The total dose of pingyangmycin was (44.1±8.5) mg in group A and (48.2±10.6) mg in group B, respectively. In group A, 20 cases (62.5%) showed local atrophy and depression, and in group B, 1 case (2.8%) showed atrophy and depression. CONCLUSIONS: Compared with full-layer intralesional injection of pingyangmycin at one time in the treatment of microcystic lymphatic malformation, the incidence of complications of local atrophy and depression in the long term was significantly reduced when using in-layer injection at different times. After treatment, the facial appearance was good and the patients’ satisfaction was high.
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    Imaging features of temporomandibular joint disorder: comparison of the efficacy of cone-beam CT, MRI
    CHEN Jian-rong, DING Shui-qing, CHEN Liang, HE Jia-jia, QI Rong-xing
    2022, 20 (3):  273-276.  doi: 10.19438/j.cjoms.2022.03.012
    Abstract ( 97 )   PDF (460KB) ( 60 )  
    PURPOSE: To analyze the features on cone-beam CT (CBCT) and MRI of temporomandibular joint disorder (TMD). METHODS: The data of 45 patients with TMD treated in Nantong Hospital of Stomatology from August 2018 to May 2020 were collected. All patients completed CBCT and MRI within 2 weeks, and the characteristics of TMJ and masticatory muscle lesions on CBCT and MRI were evaluated, including joint space stenosis, bone destruction, bone hyperplasia and sclerosis, condyle deformation, bone cystoid degeneration, articular disc displacement, joint capsule effusion and masticatory muscle lesions. SPSS 25.0 software package was used for data analysis. RESULTS: According to TMD clinical classification, 31 cases (68.9%) were classified as type I painful diseases, and 14 cases (31.1%) were classified as type II joint diseases. Among the 90 joints of 45 patients, the number of TMJ and masticatory muscle lesions detected by MRI (71/90) was significantly higher than the number of lesions detected by CBCT (58/90) (P=0.032). Among them, the number of articular disc displacement (19/90), joint capsule effusion (28/90) and masticatory muscle edema (22/90) were significantly higher than the number of cases detected by CBCT which was 3/90, 8/90 and 5/90 (P<0.001). The number of cases of hyperosteosis (18/90) and condyle mutation (15/90) detected by CBCT was significantly higher than the number of cases detected by MRI which was 8/90 and 6/90 (P<0.05). CBCT and MRI had no significant differences in detecting joint space stenosis, bone destruction and cystoid degeneration(P>0.05). CONCLUSIONS: Both CBCT and MRI have high clinical value in evaluating TMD. CBCT has advantages in evaluating bone quality, while MRI has a good effect in evaluating joint discs and soft tissues.
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    Comparison of laryngeal mask, endotracheal intubation under sevoflurane induced anesthesia in interventional surgery of maxillofacial vascular malformation in infants
    ZHANG Ying, ZHOU Jia-qian, KANG Hua
    2022, 20 (3):  277-281.  doi: 10.19438/j.cjoms.2022.03.013
    Abstract ( 58 )   PDF (596KB) ( 48 )  
    PURPOSE: By observing and comparing the use of endotracheal intubation or laryngeal mask after sevoflurane inhalation induced anesthesia in infants with maxillofacial vascular malformation, to evaluate what kind of safe and reasonable ventilation methods should be used in these children undergoing general anesthesia. METHODS: From January 2020 to June 2020, 80 children with maxillofacial vascular malformation undergoing interventional surgery at Shanghai Ninth People's Hospital Shanghai Jiao Tong University School of Medicine were selected and divided into laryngeal mask group (group A, n=40) and endotracheal intubation group (group B, n=40). Heart rate (HR) and mean artery pressure (MAP) were measured pre-induction of anesthesia(T0), after induction of anesthesia(T1), immediately after intubation (T2), at the beginning of operation (T3), at the end of operation (T4) and 1 min after extubation (T5). The operation time, recovery time (time from stopping anesthesia to extubation) and the time out of the operating room of the two groups were counted. The occurrence of restlessness, cough, aspiration, nausea and vomiting, hoarseness and sore throat were observed. Statistical analysis was performed using SPSS 26.0 software package. RESULTS: There was no significant difference in HR and MAP at each time point in group A. The HR and MAP after intubation and extubation in group B were significantly higher than those before induction, and higher than those at corresponding time points in group A(P<0.05). There was no significant difference in operation time, recovery time and the time out of the operating room between the two groups(P>0.05). The incidence of restlessness and cough in group B was significantly higher than that in group A (P<0.05). CONCLUSIUNS: Laryngeal mask or endotracheal intubation after sevoflurane inhalation induced anesthesia can successfully complete interventional operation of maxillofacial vascular malformation in infants. Laryngeal mask anesthesia has the advantages of stable hemodynamics and fewer postoperative complications, which is a safe, effective and rapid anesthesia method.
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    Retrospective study on perioperative management of19children with cleft palate, coagulation disorders
    CHU Jun, HU Ming, WANG Guo-min, LYU Ting-zheng
    2022, 20 (3):  282-286.  doi: 10.19438/j.cjoms.2022.03.014
    Abstract ( 70 )   PDF (585KB) ( 32 )  
    PURPOSE: To discuss the perioperative prophylaxis for children with cleft palate and coagulation disorders in order to improve surgical safety. METHODS: A retrospective study was conducted between November, 2011 and November, 2019 from the Department of Pediatric Surgery, Shanghai Children's Medical Center, identified 38 patients with cleft palate, among whom 19 were complicated with coagulation disorders (abnormal group) and 19 were included as control. Six of 19 patients in the abnormal group were previously diagnosed hemophilia (3 were hemophilia A, 2 were hemophilia B, 1 was hemophilia C),and the remaining 13 patients were first diagnosed with abnormal coagulation by routine preoperative examinations. All patients in the abnormal group underwent prophylactic blood substitution with blood coagulation factors, prothrombin complex concentrate or fresh frozen plasma before surgery. The average surgery time, intraoperative blood loss and average hospitalization days were statistically analyzed with SPSS 22.0 software package. RESULTS: In the abnormal group, 18 of 19 patients' APTT improved obviously before surgery,and underwent surgical treatment successfully and recovered without any surgical complications after prophylactic blood substitution. One patient suffered from hemorrhage of about 250 mL and had fully recovery after intraoperative PPSB, plasma and red blood cell treatment. The intraoperative blood loss and average hospitalization days between the two groups had no significant difference(P>0.05). CONCLUSIONS: Appropriate application of perioperative blood substitution can effectively reduce intra- and post-operative bleeding for patients with cleft palate and coagulation disorders and improve surgical safety.
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    Clinical Reports
    Juvenile psammomatoid ossifying fibroma: clinical analysis of8consecutive cases
    TONG Chun-shi, MA Xin, FAN Ming-liang, WANG Yong-gong, PENG Li-wei, LUO Shu-wen
    2022, 20 (3):  287-291.  doi: 10.19438/j.cjoms.2022.03.015
    Abstract ( 59 )   PDF (1234KB) ( 40 )  
    PURPOSE: To analyze the clinical and imaging features, treatment options, and prognosis of juvenile psammomatoid ossifying fibroma (JPOF). METHODS: Clinical and imaging data of 8 JPOF patients (male, n=4; female, n=4) who were admitted during February 2016 and October 2020 were collected and follow-ups were made to summarize the clinical manifestations, imaging features, treatment options and prognosis. RESULTS: Eight JPOF cases were included into this study with an average age of 14.1±7.9 years. Among these JPOF cases, the lesions were found to originate in the jaw(n=3), ethmoid sinus (n=2), maxilla/maxillary sinus (n=1), nasal cavity (n=1), and frontal sinuses (n=1), averaging (37.0±9.7) mm in diameter. The clinical manifestations were predominantly nasal congestion and discharge, as well as local swelling and pain. Of the 8 JPOF patients, four received CT, three received MRI, and the remaining one was examined through CT and MRI. CT scans exhibited space-occupying lesions with a circular or oval inner core circumscribed by a sclerotic shell of bone, while MRI findings demonstrated mixed-signal of cystic-solid tumors. JPOF patients all received surgical treatments. To be specific, transnasal endoscopic procedures were adopted for radical curettage of JPOF in the ethmoid sinus, maxilla/maxillary sinus, and nasal cavity. JPOFs arising in the frontal sinuses were removed via open surgery; of the three patients with JPOFs in their jaws, two underwent curettage of the lesion involving the jaw and partial removal of the surrounding bone containing the lesional tissues, in which cases a relapse was identified 6 months later. Segmental resection of the jaw was performed on the third patient in combination with a vascularized iliac crest bone graft for jaw reconstruction, and no recurrent JPOF was detected up to the last follow-up date. CONCLUSIONS: JPOF is a rare benign bone tumor that most frequently occurs among teenagers. As the clinical and imaging features are inconspicuous, pathology remains to be the mainstay in diagnosing JPOF. Considering its invasive growth, it is recommended that radical curettage be carried out to reduce the risk of recurrence.
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    Clinical, pathological analysis of 33 cases of embryonal rhabdomyosarcoma of head, neck
    XU Wei-jing, GAO Zhen-jie, FU Kun, GAO Ning, CHENG Long, HE Wei
    2022, 20 (3):  292-297.  doi: 10.19438/j.cjoms.2022.03.016
    Abstract ( 81 )   PDF (1510KB) ( 57 )  
    PURPOSE: To summarize the clinical manifestations, imaging characteristics, treatment and pathological types of embryonal rhabdomyosarcoma (ERMS) in the head and neck, in order to provide reference for the diagnosis and treatment of the disease. METHODS: Thirty-three cases with ERMS diagnosed by pathology in the First Affiliated Hospital of Zhengzhou University from February 2012 to September 2021 were analyzed retrospectively, and their clinicopathological data were analyzed. SPSS 19.0 software package was used for statistical analysis. RESULTS: The age of the patients ranged from 9 months to 59 years old, with an average age of(12.1±13.9) years. The main symptoms were swelling, pain and numbness. It showed low density on CT, medium signal on MRI on T1WI and medium to high signal on T2WI. Immunohistochemical results showed that 22 cases were Desmin positive, 23 were myogenin positive, 22 were MyoD1 positive, and Ki-67 proliferation index was 57%±19%. The Ki-67 index in cases with cervical lymph node metastasis was significantly higher than that in cases without cervical lymph node metastasis [(63.5±10.96)%:(53.4±21.5)%, P=0.022]. ROC curve was used to analyze the power of Ki-67 index in predicting cervical lymph node spread. The area under ROC curve of end-stage patients was 0.75 (P=0.024). A cut-off value of >55% resulted in sensitivity of 100% and specificity of 65%. CONCLUSIONS: Head and neck ERMS is common in children and adolescents. CT, MRI combined with PET-CT and other imaging examinations can guide the diagnosis, treatment and monitoring of recurrence and metastasis. Pathological examination is the gold standard for ERMS diagnosis. Cervical lymph node metastasis is associated with Ki-67 values.
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    An analysis of phenotype, genotype in selected tooth agenesis: report of two cases
    JIANG Cai-ling, YU Kang, WU Yi-qun
    2022, 20 (3):  298-302.  doi: 10.19438/j.cjoms.2022.03.017
    Abstract ( 61 )   PDF (1068KB) ( 44 )  
    PURPOSE: To explore the pathology of selective tooth agenesis. METHODS: The clinical manifestations of 2 patients were collected based on complete oral examinations, panoramic radiographs and pedigree information. Peripheral venous blood was taken from probands and their patients and DNA were extracted. Whole-exome sequencing (WES) and Sanger sequencing were performed to identify the causal gene variants. Aligned multi sequencing was conducted to predict the structure of LRP6 and LRP6 mutation. RESULTS: We discovered two probands with sporadic or heredity diagnosed selective tooth agenesis, proband 1 had a nonsense mutation (c.C1573T, p.R525X) of LRP6 and proband 2 had a frameshift mutation (c.4611delT, p.C1537fs) of LRP6. The predicting structure of LRP6 and LRP6 mutation illustrated that the mutation altered protein structure and created a premature stop codon. Aligned multi sequencing showed the LRP6 protein sequence highly conservative, suggesting that the mutation was hazardous. CONCLUSIONS: The results revealed two novel mutations of LRP6 of selective tooth agenesis which is helpful in prenatal diagnosis and genetic counseling.
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    Dental Education
    Application of virtual, simulation technology in experimental teaching of mandibular impacted tooth extraction
    WU Ye, LIU Huan-huan, CHEN Jia-min, NIU Gang, WANG Tao, XIE Fu-ping, LIN Li-song
    2022, 20 (3):  303-306.  doi: 10.19438/j.cjoms.2022.03.018
    Abstract ( 68 )   PDF (831KB) ( 47 )  
    PURPOSE: To construct the experimental teaching mode of mandibular impacted tooth extraction by virtual simulation technology, and discuss the difference between the novel teaching mode and traditional impacted tooth extraction method. METHODS: Eighty students were randomly divided into experimental group and control group, with 40 students in each group. The control group received traditional experimental teaching method for impacted tooth extraction, while the experimental group received experimental teaching method for minimally invasive impacted tooth extraction constructed by virtual simulation technology. The students' mastery of impacted tooth extraction and understanding of complications after impacted tooth extraction were measured through various indexes. SPSS 11.0 software package was used for data analysis. RESULTS: The didactic test score of experimental group was significantly higher than that of the control group(P<0.05). Students in the experimental group had a more comprehensive grasp of the extraction of impacted teeth than the control group, and the surrounding tissues were better protected in the experiment group, especially the postoperative complications were more thoroughly understood. CONCLUSIONS: The laboratory teaching method of surgically guided minimally invasive impacted teeth extraction using virtual model can enhance the understanding of dental students on impacted teeth extraction, which is beneficial to improve the quality of teaching.
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    Case Reports
    Case report of parotid, submandibular lymph node metastasis of ocular sebaceous gland carcinoma
    FU Hong-hai, QIU Na-na, SUN Le-gang, WANG Fang
    2022, 20 (3):  307-309.  doi: 10.19438/j.cjoms.2022.03.019
    Abstract ( 72 )   PDF (894KB) ( 40 )  
    Ocular sebaceous gland carcinoma usually occurs in the upper eyelid, and metastasis to the parotid gland and submandibular lymph node is rare. Therefore, it is necessary to differentiate it from the primary parotid gland tumor in clinical practice. In this paper, we reported a case of ocular sebaceous gland carcinoma of the upper eyelid with metastasis to the parotid and submandibular lymph nodes, providing clinical guidance for the diagnosis and treatment of this disease.
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    Parotid gland atrophy caused by residual butter after orbital trauma: a case report, literature review
    FANG Yi-kang, HAN Lin-zi, SHENG Shan-gui, YAN Ting-ting, WANG He-jing, YUAN Rong-tao
    2022, 20 (3):  310-312.  doi: 10.19438/j.cjoms.2022.03.020
    Abstract ( 78 )   PDF (985KB) ( 35 )  
    Through the analysis of the incidence and treatment of a patient with parotid gland atrophy caused by residual butter secondary infection after orbital trauma caused by mechanical butter, this paper summarized the cause, clinical diagnosis, treatment options, and prognosis of such cases. For this kind of fat-soluble amorphous foreign body trauma, a clear diagnosis, thorough debridement, multidisciplinary consultation, and a complete treatment plan are mandatory.
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