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20 January 2022, Volume 20 Issue 1 Previous Issue    Next Issue

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Expert Consensus

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Chinese expert consensus statement on the application of of indocyanine green(ICG) fluorescence imaging in the treatment of oral squamous cell carcinoma WANG Yu-xin, WANG Zhi-yong, WANG Yong-gong, WANG Hui-ming, WANG Li-zhen, TIAN Hao, YE Jin-hai, FU Kun, RUAN Min, SUN Chang-fu, SUN Guo-wen, LIU Fa-yu, XU Bi-yun, HOU Jun, LIU Bing, LIU Liang, CHEN Yong-feng, CHEN Zhan-wei, XIAO Can, LI Si-yi, LI Zhi-yong, LI Yong, LI Nan, ZHANG Chen-ping, ZHANG Dong-sheng, ZHANG Sheng, ZHANG Kai, YANG Xi, HE Wei, SU Tong, JI Tong, LIN Li-song, LUO Rui-hua, ZHAO Zhi-li, HU Qin-gang, TANG Zhan-gui, XU Wei-jia, HUANG Zhi-quan, HUANG Xiao-feng, LIANG Yu-jie, HAN Zheng-xue, HAN Wei, JIANG Can-hua, YU Jian-jun, CAI Zhi-gang, LIAO Gui-qing, LIAO Sheng-kai, CAI Hui-ming, WEI Jian-hua 2022, 20 (1):  1-6.  doi: 10.19438/j.cjoms.2022.01.001 Abstract ( 579 )   PDF (847KB) ( 310 )   Indocyanine green (ICG) is a near-infrared fluorescent dye. Based on the enhanced permeability and retention (EPR) effect, the ICG fluorescence imaging was applied extensively in biomedical fields. The technique could sensitively detect imaging difference between the tumor and surrounding tissue, and define the tumor border to assist in tumor resection. Nevertheless, the application in the treatment of oral squamous cell carcinoma (OSCC) is still at the neonate stage. Thereby, its indication, standard operation procedure and caution required normalization. On the Evidence-based approaches including multi-center study, systemic reviews of related scientific publications,the Chinese experts reach a consensus of ICG fluorescence imaging technique to instruct the clinical practice of OSCC surgery. References | Related Articles | Metrics

Expert Editorial

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Current evidence-based treatment of infantile hemangiomas ZHENG Jia-wei, ZHAO Ze-liang, CHEN Qi-ming 2022, 20 (1):  7-14.  doi: 10.19438/j.cjoms.2022.01.002 Abstract ( 251 )   PDF (1222KB) ( 278 )   Infantile hemangioma is the most common benign tumor in childhood. Early intervention is currently advocated so as to minimize complications and negative effects on mental development. With the successful application of various β-blockers, the treatment methods have undergone revolutionary changes, and the treatment effect has also been improved. Based on literature review and evidence-based medicine, this article summarized the indications, advantages and disadvantages and selection of various treatment methods for infantile hemangioma, in order to provide guidance for clinical application. References | Related Articles | Metrics

Original Articles

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Preparation and property of digital drug-loaded chlorhexidine gluconate PLA/nHA composite scaffold ZHANG Xiu-xiu, SUN Jian, LI Ya-li, LIU Yan-shan, CHEN Li-qiang, XU Yao-xiang, XU Ze-xian, MENG Kun, SUN Ming, ZHOU Dong-yang, XU Dian, GAO Xiao-han, CHENG Li-di 2022, 20 (1):  15-21.  doi: 10.19438/j.cjoms.2022.01.003 Abstract ( 304 )   PDF (1539KB) ( 167 )   PURPOSE: To investigate the physical and chemical properties, cytocompatibility and antibacterial activity of 3D printed porous polylactic acid/nano-hydroxyapatite(PLA/nHA) scaffolds loaded with chlorhexidine gluconate chitosan nanoparticles (CSn-CG). METHODS: By means of ion crosslinking, CSn (blank chitosan nanospheres) and CSn-CG were prepared. The morphology of the nanospheres was observed under transmission electron microscopy(TEM). PLA/nHA scaffolds were prepared using PLA and nHA as raw materials by digital design and 3D printing technology, and the scaffolds were loaded with CSn and CSn-CG by immersion method. The experiment was divided into PLA/nHA group, PLA/nHA/CSn group and PLA/nHA/CSn-CG group. The scaffolds were characterized by scanning electron microscopy (SEM), X-ray photoelectron spectroscopy (XPS), Fourier transform infrared spectroscopy (FTIR) and X-ray diffraction(XRD). In vitro release test was used to evaluate the sustained-release performance of the scaffolds. CCK-8 method was used to evaluate the biocompatibility of scaffolds. The antibacterial effect of the stent was detected by AGAR diffusion method. SPSS 25.0 software package was used for data analysis. RESULTS: CSn-CG was homogeneous nanospheres. SEM showed that the scaffolds in each group were all three-dimensional network structure with regular pore size. The results of in vitro release showed that CG could be released slowly from the stent at low speed, and the time lasted for 30 days. CCK-8 results showed that PLA/nHA/CSn-CG promoted proliferation of MC3T3-E1. In vitro antibacterial experiment results showed that the experimental group had obvious antibacterial circle, which indicated that the scaffold had good antibacterial effect. CONCLUSIONS: The 3D-printed PLA/nHA/CSn-CG scaffold has good physical and chemical property, biocompatibility and antibacterial effect in vitro, which provides basis for further application of tissue engineered bone. References | Related Articles | Metrics

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Effect of exogenous bFGF on osseointegration of titanium implants in type 2 diabetic rats and its possible mechanism WANG Hui-li, XIE Bing, WEI Yu-hong 2022, 20 (1):  22-27.  doi: 10.19438/j.cjoms.2022.01.004 Abstract ( 195 )   PDF (1113KB) ( 118 )   PURPOSE: To investigate the effect and mechanism of exogenous basic fibroblast growth factor (bFGF) on osseointegration of titanium implants in type 2 diabetes mellitus (T2DM) rats. METHODS: Forty SPF male SD rats were randomly divided into control group, T2DM group, bFGF-T2DM group, and lithium chloride (LiCl)-T2DM group. The control group was fed with normal diet, and the remaining rats were fed with high-fat and high-sugar + intraperitoneal injection of streptozotocin (STZ) 30 mg/kg to establish a T2DM model. After modeling, pure titanium implants were implanted in the proximal epiphysis of the right tibia. The bFGF-T2DM group was treated with recombinant rat basic fibroblast growth factor (rrbFGF)-poly lactic-co-glycolic acid (PLGA) microspheres before implantation, and the remaining rats were treated with placebo- PLGA microsphere processing. After implantation of LiCl-T2DM group, LiCl 60 mg·kg-1·d-1 was injected subcutaneously for 8 weeks, and the remaining rats were injected with equal volume of normal saline. The general conditions of the rats after surgery were observed and random blood glucose was recorded. Eight weeks after operation, ponceau red staining was used to observe bone histological morphology and bone histological parameters were calculated. Western blotting was used to detect the expression of osteocalcin (OCN), type I collagen (collagen type I, Col-1), core binding factor 2 (runt-related transcription factor 2, Runx2), β-catenin and cell-myc(c-myc) in the bone tissue around the implants. SPSS 20.0 software package was used for data analysis. RESULTS: The random blood glucose of T2DM group, bFGF-T2DM group and LiCl-T2DM group was significantly higher than that of the control group (P<0.05). Eight weeks after implantation, no bone implant contact was found in T2DM group. bFGF-T2DM group had a wide range of bone implant contact, which was close to the control group. In LiCl-T2DM group, there was no bone tissue contact in some areas. Compared with the control group, the relative expression of β-catenin and c-myc protein in T2DM group, the relative expression of OCN, Col-1, Runx2 and bone-implant contact(BIC), trabecular bone volume(TBV) of LiCl-T2DM group and T2DM group decreased, and the relative expression of β-catenin and c-myc protein increased significantly in LiCl-T2DM group(P<0.05). There was no significant difference in BIC, TBV, relative expression of OCN, Col-1, Runx2, β-catenin and c-myc between the control group and bFGF-T2DM group(P>0.05). Compared with T2DM group, BIC, TBV, relative expressions of OCN, Col-1, Runx2, β-catenin and c-myc in bFGF-T2DM group and LiCl-T2DM group were increased significantly(P<0.05). Compared with bFGF-T2DM group, BIC, TBV and relative expressions of OCN, Col-1, Runx2 in LiCl-T2DM group were significantly decreased, while the relative expression levels of β-catenin and c-myc protein were significantly decreased (P<0.05). CONCLUSIONS: Exogenous bFGF can promote the healing of titanium implant bone tissue in T2DM rats and promote bone formation. The mechanism may be related to the activation of Wnt/β-catenin signaling pathway. References | Related Articles | Metrics

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Clinicopathological characteristics and prognostic analysis of oral squamous cell carcinoma with parotid lymph node metastasis LI Xing, XU Fei-hu, YANG Yun-bo, HAN Nan-nan, RUAN Min 2022, 20 (1):  28-31.  doi: 10.19438/j.cjoms.2022.01.005 Abstract ( 1045 )   PDF (717KB) ( 152 )   PURPOSE: To investigate the clinical regularity of oral squamous cell carcinoma(OSCC) with parotid lymph node metastasis and its influence on prognosis. METHODS: A retrospective analysis of the clinicopathological data of 60 oral squamous cell carcinoma patients with or without parotid lymph node metastasis admitted to Shanghai Ninth People's Hospital of Shanghai Jiao Tong University School of Medicine from January 2003 to December 2017 was conducted. SPSS 23.0 software package was used for data analysis. RESULTS: Primary tumor T stage(P=0.022) and cervical lymph node status(N stage, P=0.008) were closely related to parotid lymph node metastasis. Parotid metastatic lymph nodes were mostly located in the lower pole of the superficial parotid gland and prone to extracellular invasion(P<0.05). Parotid gland lymph node metastasis is closely related to the prognosis of oral squamous cell carcinoma(P=0.0004), and the 5-year survival rate of gingival squamous cell carcinoma with parotid lymph node metastasis was significantly higher than that of tongue squamous cell carcinoma(P=0.0427). CONCLUSIONS: Parotid lymph node metastasis is a poor prognostic factor for oral squamous cell carcinoma. Higher T and N stages are two important factors that promote LN metastasis to parotid gland in OSCC patients. References | Related Articles | Metrics

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Measurement of distal stump pressure of branches of the external carotid artery and the feasibility of the distal stumps in retrograde blood supply fashion to nourish the free flap CHEN Chuan-jun, WANG Yi, XIANG Xian-wang, LI Tao, HU Li-guo 2022, 20 (1):  32-36.  doi: 10.19438/j.cjoms.2022.01.006 Abstract ( 240 )   PDF (1214KB) ( 134 )   PURPOSE: To measure the stump pressure of branches of the external carotid artery and investigate the feasibility of the distal stumps in reversed blood flow to perfuse the free flap. METHODS: The superior thyroid artery, lingual artery, facial artery and superficial temporal artery were respectively cannulated with a 22 gauge cannula connected to a transducer, which in turn was connected to a Philips monitor, the initial mean arterial pressure (MAP) and distal stump MAP after occlusion were determined. The ratio between initial MAP and the stump MAP was defined as the stump pressure ratio. The stump pressure ratio of the external carotid artery branches in this study and that of the documented lower limb vessel were compared and analyzed. RESULTS: The stump pressure ratio of the branch vessels of the external carotid artery reached more than 70%, greater than the recorded stump pressure ratios of the lower limb vessel. CONCLUSIONS: It is feasible to perfuse the free flap with reversed recipient artery in head and neck region based on the sufficient stump pressure after occlusion of the branch vessels of the external carotid artery. References | Related Articles | Metrics

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Effect of stretching devices on mouth opening limitation in patients after temporomandibular joint disc anchoring FAN Shuai, CAI Bin, HE Dong-mei, XU Li-li, LU Shen-ji, FANG Zhong-yi 2022, 20 (1):  37-41.  doi: 10.19438/j.cjoms.2022.01.007 Abstract ( 355 )   PDF (1226KB) ( 134 )   PURPOSE: To observe the effects of jaw stretching devices in the treatment of limited mouth opening in patients with temporomandibular joint(TMJ) disc displacement without reduction after disc anchoring. METHODS: Sixty-seven patients with limited mouth opening after TMJ disc anchorage were followed up, including 32 patients in the stretching device group and 35 patients in the control group. Patients in the control group were given home rehabilitation training, while patients in the stretching devices group were given jaw stretching device training combined with home rehabilitation training. The maximum active mouth opening, pain evaluated with visual analog scale (VAS), jaw functional limitation scale-8(JFLS-8) were evaluated before and 6 weeks after treatment. Statistical analysis of the data was performed with SPSS 17.0 software package. RESULTS: The follow-up results showed that the maximum mouth opening and JFLS-8 of the two groups were significantly improved. The maximum active mouth opening of the stretching device group (36.7 mm) was significantly better than that of the control group (29.1 mm, P<0.05), JFLS-8 of the stretching device group (7.3) was significantly lower than that of the control group (11.2, P<0.05). CONCLUSIONS: The use of jaw stretching devices has a good effect on the increase of mouth opening and improvement of function in patients with TMJ after disc anchoring, which is worthy of clinical application. References | Related Articles | Metrics

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Multivariate analysis of the position of condyle with cone-bean CT in adolescent malocclusion patients GAI Yun, JIANG Zhi-yue, LIU Shu, ZHENG Zhi-jun 2022, 20 (1):  42-47.  doi: 10.19438/j.cjoms.2022.01.008 Abstract ( 286 )   PDF (912KB) ( 96 )   PURPOSE: To analyze the relationship among condylar position and gender and craniofacial bone morphology in adolescent patients with skeletal malocclusion. METHODS: Odontic simulation software (Dolphin imaging11.8) was used to reconstruct cone-beam CT(CBCT) images of 391 patients with different skeletal malformations aged 15-16 years.The anterior, superior, and posterior spaces of temporomandibular joint(TMJ) were measured on the sagittal plane of the condyle to calculate the relative position of the condyle. The difference of condylar position between different genders, sagittal, and vertical skeletal types were analyzed, and the correlation was evaluated by a multivariate logistic regression model with SPSS 23.0 software package. RESULTS: Univariate analysis showed that the condylar position was different between different sagittal facial types and gender(P<0.05). Compared with men, the OR value of anterior condylar displacement in female was 1.942(95%CI: 1.166-3.236, P=0.011). The greater of the right articular eminence angle, the easier the condyle moved backward, and the OR value was 1.032(95%CI: 1.000-1.066, P=0.048). CONCLUSIONS: The articular eminence angle may be related to the posterior displacement of the condyle, and female condyle is more likely to move forward than male. References | Related Articles | Metrics

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Timing of rapid transfusion of single large-dose platelet before operation in children with Kasabach-Merritt phenomenon HU Guang-zhen, WANG Xin-ying, GONG Yu-bin, DONG Chang-xian 2022, 20 (1):  48-51.  doi: 10.19438/j.cjoms.2022.01.009 Abstract ( 281 )   PDF (506KB) ( 110 )   PURPOSE: To investigate the timing of rapid transfusion of single large-dose platelet in children with Kasabach-Merritt syndrome (KMP) before surgery. METHODS: A retrospective analysis was performed on 66 children with KMP in our center from June 2011 to December 2019. The effects of rapid transfusion of single large-dose platelet at different time periods before surgery was determined. Among them, 30 children received platelet transfusion 12+-24 h before surgery and 36 children received platelet transfusion 6-12 h before surgery. All patients received transfusion of high-dose rapid platelet with 1/2-2/3 of the treatment volume, and the transfusion was completed within 2-3 h. The effect on platelet correction at 1 h before operation was compared between two groups. Statistical analysis was performed using SPSS 21.0 software package. RESULTS: The 1 h platelet count (PLTC) before operation in 6-12 h group was in the normal range, even higher than the normal range; 4 cases in 12+-24 h group had a 1 h PLTC lower than the normal range; the platelet and 4 coagulation indices at 1 h before operation was compared between the two groups, the difference in platelet count was statistically significant(P<0.05). The platelet count between the two groups after operation had no significant difference(P>0.05). During the whole platelet transfusion process, no complications occurred, and the difference in heart rate before and after transfusion was not statistically significant. CONCLUSIONS: Six to twelve hours before surgery is a safer and more effective period of rapid transfusion of single large-dose platelet in children with KMP. References | Related Articles | Metrics

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Clinical application of 3D printed positioning guides in assisted preparation of anterolateral thigh perforator flap SHI Wei-hong, LIU Yan, AMANNISAHAN·Jiapaer, AYIDANA·Wulaerbieke, HE Qi, LING Bin 2022, 20 (1):  52-57.  doi: 10.19438/j.cjoms.2022.01.010 Abstract ( 249 )   PDF (1292KB) ( 227 )   PURPOSE: To investigate the accuracy and feasibility of using 3D-printed fixed positioning guides to locate the perforating vessels in anterolateral thigh perforator flaps. METHODS: Twenty patients who attended the Department of Oral and Maxillofacial Surgery of the First Affiliated Hospital/Affiliated Stomatological Hospital of Xinjiang Medical University from January 2019 to December 2020 and required anterolateral thigh perforator flap transplantation and reconstruction for oral and maxillofacial soft tissue defects were collected. Patients in the experimental group used a 3D-printed positioning guide to intraoperatively locate the perforator vessels and assist in the preparation of the anterolateral thigh perforator flap (n=8), while in patients of the control group, conventional Doppler ultrasound was used to locate the perforator vessels and assist in the preparation of an anterolateral thigh perforator flap (n=12). The two groups were compared in terms of flap preparation time, bleeding volume, postoperative donor site shape satisfaction, LEFS score, penetrating vessel localization, and the presence of postoperative flap complications. SPSS 24.0 software package was used for statistical analysis. RESULTS: The differences in flap preparation time, bleeding volume, postoperative donor site shape satisfaction, and positioning of the penetrating vessels were statistically significant (P<0.01); the differences in postoperative flap complications and LEFS scores were not statistically significant (P>0.05). CONCLUSIONS: 3D-printed fixed positioning guide provides a new method for positioning the perforating vessels of the anterolateral thigh flap, which is more accurately locates the vessels intraoperatively, improves the surgical efficiency, and increases the patient's satisfaction with postoperative recovery of the donor site. References | Related Articles | Metrics

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Comparison of two different decompression procedures for treating large mandibular odontogenic cysts WANG Lei, WANG Zhou-yang, MA Chun-yue, WANG Liang, GUO Bing, QIN Xing-jun 2022, 20 (1):  58-62.  doi: 10.19438/j.cjoms.2022.01.011 Abstract ( 493 )   PDF (1250KB) ( 229 )   PURPOSE: To explore the differences in the prognosis of two different types of decompression procedures for treating large mandibular odontogenic cysts. METHODS: This retrospective cohort study included 93 patients with large mandibular odontogenic cysts, and divided into wall removal group(51 cases) and wall retaining group (42 cases) according to different methods of decompression. Cyst area, volume, HU values and cyst density were compared. The results were analyzed using Prism 7.0 software. RESULTS: After 1 year, the wall removal group was not inferior to the wall retaining group in terms of cyst area, cyst volume, and the difference between the HU values of the original cyst region and the normal mandible. In subgroup analysis, there was no significant difference between the two groups in percentage of patients in whom the cystic area was reduced by 90% after 1 year. However, changes in HU values in the wall removal group were significantly better than those in the wall retaining group. More importantly, patients underwent only one operation in wall removal group if there was no recurrence, which improved the quality of life and reduced the financial burden. CONCLUSIONS: The results suggest that cyst wall removal group showed better results than cyst wall retaining group in large mandibular odontogenic cysts. References | Related Articles | Metrics

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The effect of film retainer to improve loss of adjacent contact between implant restorations in 58 consecutive cases YU Jiao, ZHU Xiao-mi, ZHAO Ya-jun 2022, 20 (1):  63-67.  doi: 10.19438/j.cjoms.2022.01.012 Abstract ( 291 )   PDF (653KB) ( 123 )   PURPOSE: To explore the clinical application effect of vacuum-formed compression film retainer (VFR) to improve the contact loss of implant restoration. METHODS: Fifty-eight patients with single crown restorations (all using Straumann implants) were selected from our hospital from June 2019 to October 2020. According to the clinical randomized case-control study, they were divided into 2 groups, each with 29 cases, with a total of 116 implanted single crown adjacent surfaces. The experimental group wore film retainer during the night, while the control group did not wear film retainer during day and night. The periodontal probing depth(PD), looseness (M), and gingival bleeding index (BI) of implants and natural teeth were checked immediately, 1, 3, 6 and 12 months after crown restoration. The surface contact tightness and the number of metal paper layers, and the mesial/distant/neighbor contact loss rate were calculated. The data was statistically analyzed by SPSS 19.0 software package. RESULTS: As time went by, the loss rate of the mesial and distant neighbors of the two groups of implanted single crowns gradually increased, and the loss rate of the mesial neighbors of the control group during the 12-month follow-up was 62.06%, which was significantly higher than that of the experimental group of 31.03% (P<0.05). The loss rates of single crown mesial contact loss in the experimental group at 1, 3 and 6 months of follow-up were 17.24%, 20.68% and 27.58%, respectively, while those in the control group were 20.68%, 37.93%, and 48.27% (P>0.05). There was no significant difference of the loss rate of single-crown distal neighbor contact between the two groups at 1, 3, 6 and 12 months of follow-up(P>0.05). At 12-month follow-up, the experimental group had 9 cases with loss of near neighbor contact, which was less than 18 cases of the control group(P<0.05). There was no significantly difference in the number of distant neighbor contact loss between the two groups(P>0.05). In the experimental group, the increase in metal paper wearing the film retainer was not more than 2 cases (an increase of 2 pieces was the standard), which was less than 19 cases in the control group (P<0.05). At 12-month follow-up, the tension value of the mesial adjacent surface was reduced. There was no contact loss on the mesial adjacent surface, but its tightness decreased. Time extension of the adjacent surface contact loss cannot be ruled out. There was no obvious change rule of tension value of the distance between the two groups of adjacent surfaces. During the entire follow-up period, the implants and natural teeth of the two groups had no obvious changes in PD, BI, and M. The experimental group had no significant food impaction complaints, but 8 cases had significant food impaction in the control group, however they could be cleaned by flossing. CONCLUSIONS: VFR can effectively reduce the contact loss rate of the near neighbors of the implanted single crown, it has no obvious impact on oral hygiene of implanted single crowns. References | Related Articles | Metrics

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Construction and evaluation of sleep promotion protocol for patients with head and neck tumor during intensive care unit LI Yan, HUANG Yao, NI Ying, YANG Yue-lai, YIN Qi 2022, 20 (1):  68-71.  doi: 10.19438/j.cjoms.2022.01.013 Abstract ( 243 )   PDF (538KB) ( 113 )   PURPOSE: To build an evidence-based sleep promotion protocol for head and neck tumor patients in intensive care unit(ICU). METHODS: According to the clinical situation and Omaha system, evidence-based method was used to screen the best evidence to build the sleep promotion protocol for head and neck tumor patients in ICU. Delphi's method was used to consult 10 medical care experts in the field of head and neck tumor and ICU for 2 rounds. SPSS 23.0 software package was used for data analysis. RESULTS: Twenty-nine high-quality evidences were included to build the sleep promotion protocol for head and neck tumor patients in ICU, including health education, guidance and consultation, treatment and procedure, case management and monitoring. CONCLUSIONS: The sleep promotion protocol for head and neck tumor patients in ICU is based on evidence-based medicine rigorously and the result is reliable, which is of great significance to promote sleep of head and neck tumor patients in ICU. References | Related Articles | Metrics

Clinical Reports

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Retrospective analysis of 127 cases of medication related osteonecrosis of the jaw: a summary of 10 years' experience in a single center HU Long-wei, YAN Ran, WEN Jin, ZHANG Chen-ping, ZHAO Xiao-mei, LI Si-yi 2022, 20 (1):  72-76.  doi: 10.19438/j.cjoms.2022.01.014 Abstract ( 318 )   PDF (555KB) ( 137 )   PURPOSE: This study aimed to provide better diagnosis and treatment of medication related osteonecrosis of the jaw (MRONJ) by analyzing the clinical data retrospectively. METHODS: A total of 127 MRONJ cases surgically treated from January 2008 to June 2018 at Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine were enrolled. According to the diagnostic criteria and classification proposed by American Association of Oral and Maxillofacial Surgeons in 2014, the cause, risk factors and predilection site of MRONJ were analyzed and the treatment methods, therapeutic effects and prognosis were evaluated. RESULTS: Ninety-three cases(73.23%) occurred in mandible, thirty cases (23.62%) occurred in maxilla, four cases (3.15%) occurred in both maxilla and mandible. Trauma was the main cause of MRONJ, ninety-eight cases (77.17%) of MRONJ occurred due to trauma including tooth extraction, dental implantation and tooth exfoliation. Six cases (4.72%) were classified as stage 0,thirteen cases (10.24%) as stage Ⅰ, eighty cases (62.99%) as stage Ⅱ, twenty-eight cases (22.05%) as stage Ⅲ. In both stage 0 and stage Ⅰ, all the cases received conservative surgical methods including curettage of osteomyelitis, partial mandibulectomy and debridement. In stage Ⅱ, seventy-one cases received conservative surgical methods, eight cases received segmental mandibulectomy, one case received simultaneously free flap reconstruction after mandibulectomy. In stage Ⅲ, seventeen cases received conservative surgical methods, nine cases received segmental mandibulectomy, two cases received simultaneously free flap reconstruction after mandibulectomy. Three cases had relapse in both stage 0 and stage Ⅰ. Twenty-four cases had relapse in stage Ⅱ. Eleven cases relapsed in stage Ⅲ. CONCLUSIONS: MRONJ has a predilection to occur in mandible. Jaw trauma is the main cause. MRONJ is complicated and prone to relapse after partial resection. References | Related Articles | Metrics

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Application of ultrasound assisted parotid flap sialolithotomy for deep parotid stones: report of 5 cases JIN Zhi-lei, LIU Wei-jun, WU Guo-rong, ZHOU Qin, SHI Huan 2022, 20 (1):  77-80.  doi: 10.19438/j.cjoms.2022.01.015 Abstract ( 708 )   PDF (724KB) ( 110 )   PURPOSE: To explore the clinical value of ultrasound-assisted parotid flap sialolithotomy in the treatment of deep parotid duct stones. METHODS: From January 2019 to June 2020, five patients with deep parotid duct stones in the Department of Oral Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, were collected. Preoperative CT scan showed that the stones were located in the intraparenchymal duct, which was at the anterior edge of the masseter muscle. The patient underwent parotid flap stone extraction under general anesthesia. During operation, a small S-shaped incision was designed behind the ear with the aid of B-ultrasound. The marginal mandibular branch of the facial nerve was dissected to expose the duct in the gland where the stone was located. Then, the wall of the duct wall was cut to remove the stone, and the duct was sutured tightly. Follow-up data were collected at 1 week, 3 months, and 12 months after operation. RESULTS: All stones were successfully removed. One patient developed symptoms of parotid duct obstruction after operation, which improved after washing and dilatation treatment. No facial nerve injury, salivary fistula, infection and other complications occurred. The clinical symptoms before surgery were completely relieved at 12-month follow-up, and the curative effect was satisfactory. CONCLUSIONS: Ultrasound-assisted parotid flap sialolithotomy for deep parotid duct stones has a high success rate, good curative effect, and is worth of wide application. References | Related Articles | Metrics

Dental Education

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Influence of COVID-19 on oral and maxillofacial surgery teaching mode YANG Xi, FANG Xiao, HE Jie 2022, 20 (1):  81-87.  doi: 10.19438/j.cjoms.2022.01.016 Abstract ( 251 )   PDF (904KB) ( 114 )   PURPOSE: To understand and compare online learning situation of students during the epidemic prevention and control period of COVID-19, and provide reference for the change of teaching mode of dental education. METHODS: Seventy-nine college students of the third and fourth grade from College of Stomatology Shanghai Jiao Tong University were selected as the research subjects, and online learning questionnaire survey was carried out. SPSS 21.0 software package was used to analyze the data. RESULTS: 86.08% of students received online education for the first time because of the epidemic prevention and control. Recording and broadcasting, recording and broadcasting plus Q & A group of Wechat platform were the online teaching forms adopted by most teachers, accounting for 51.9% and 35.44%, respectively. More than 70% of the students agreed that online education achieved the expected effect and can cope with the final exam. 84.28% of the students believed that increasing online teaching can effectively improve the connection between theoretical teaching and clinical hospital practice, eight-year program students' acceptance of online teaching is better than students of five-year program and international students. CONCLUSIONS: Online teaching is an important way to maintain the teaching work during the prevention and control of COVID-19. Correct and rational use of information technology, combination of recording and broadcasting, live broadcast and Q & A group from Wechat platform, can give full play to their advantages, and is a feasible direction of teaching reform in the future. References | Related Articles | Metrics

Review Articles

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Research progress of exosomal miRNA in oral diseases ZHANG Rui-peng, CHEN Yun-fang, YAN Hong-hai 2022, 20 (1):  88-92.  doi: 10.19438/j.cjoms.2022.01.017 Abstract ( 291 )   PDF (574KB) ( 203 )   Exosomes are nano-scale vesicles secreted by living cells into the extracellular matrix, and they play an important role in material exchange and signal transduction between cells. It can transfer the lipids, proteins, and nucleic acids to the recipient cells through ligand binding, phagocytosisand plasma membrane fusion, and regulate the physiological and pathological processes of the recipient cells. As an important "cargo" in exosomes, microRNAs are transported to recipient cells and participate in gene transcription and regulatory signaling pathways, thereby regulating the development of diseases. In recent years, research on exosomal miRNAs in periodontal diseases, mucosal-related diseases, oral cancer and other diseases has been increasing. This article reviewed the regulatory mechanisms of exosomal miRNAs in oral diseases, and discussed the potential prospects of exosomal miRNAs as biomarkers in the diagnosis of oral diseases. References | Related Articles | Metrics

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Research progress of the anatomy of maxillary sinus and the complications of external maxillary sinus lifting surgery WU Jiong-rui, GAO Yi-ming 2022, 20 (1):  93-97.  doi: 10.19438/j.cjoms.2022.01.018 Abstract ( 496 )   PDF (535KB) ( 186 )   When performing implantation in the posterior maxillary region, the clinical condition of insufficient residual alveolar bone often occurs. External maxillary sinus lifting surgery can achieve the purpose of vertical bone reconstruction, which has become a common clinical means. Because of the influence of anatomical structure variation of maxillary sinus, such as thickening of mucosa, existence of septum, and deviation of maxillary sinus artery , intraoperative and postoperative complications are not rare, such as perforation of the Schneiderian membrane, intraoperative hemorrhage, maxillary sinusitis, and etc. In this paper, the anatomical structure and research progress related to surgical complications were summarized. References | Related Articles | Metrics

Case Reports

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Sialadenoma papilliferum：a clinicopathologic study of one case HAN Lin-zi, FANG Yi-kang, YU Wen-yi, WANG Qi-min, TONG Lei, QIU Jian-zhong, YUAN Rong-tao 2022, 20 (1):  98-100.  doi: 10.19438/j.cjoms.2022.01.019 Abstract ( 553 )   PDF (819KB) ( 183 )   Sialadenoma papilliferum（SP） is a kind of rare benign tumor of salivary glands without pain and showing a characteristic papillary growth, it was classified as a ductal papilloma in the WHO's latest tumor classification. The lesions mainly affect the minor salivary glands and the most common site was the palate. The purpose of this paper was to describe a case of sialadenoma papilliferum occurring in mandibular retromolar region and discuss its clinical features and histopathology. References | Related Articles | Metrics

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A case report of alveolar bone distraction osteogenesis in congenital bilateral severe alveolar cleft deformity CHEN Jia-yi, SUN Yi-ting, LIU Jia-qiang 2022, 20 (1):  101-104.  doi: 10.19438/j.cjoms.2022.01.020 Abstract ( 319 )   PDF (875KB) ( 112 )   The conventional treatment for alveolar cleft is cancellous iliac bone grafting. However it is difficult to transfer and suture mucosal flaps and reconstruct blood supply in patients with wide alveolar cleft, and the success rate of bone grafts is lower. Alveolar bone distraction osteogenesis can effectively close or narrow the wide alveolar cleft, which is beneficial to improve the effect of bone grafting. This article reported a case of alveolar bone distraction osteogenesis for the treatment of congenital bilateral severe alveolar cleft. The osteotomy line we placed in the mesial aspect of the cleft and micro-implants and posterior teeth were used as anchorage, and power chains were applied to pull the bone back, narrowing the alveolar cleft and ameliorating the maxillary protrusion at the same time. References | Related Articles | Metrics