Diagnostic efficacy of CBCT, MRI, and CBCT-MRI fused images in distinguishing articular disc calcification from loose body of temporomandibular joint.

OBJECTIVES: To evaluate the diagnostic efficacy of CBCT-MRI fused images for articular disc calcification of temporomandibular joint (TMJ). MATERIALS AND METHODS: Twenty patients (24 TMJs) whose image examinations showed dense bodies in the TMJ space were included in the study. The locations of dense bodies evaluated by the three experts were used as a reference standard. Three oral and maxillofacial radiology residents evaluated whether the dense bodies were disc calcification or not, with a five-point scale for four sets of images (CBCT alone, MRI alone, both CBCT and MRI observed at a time, and CBCT-MRI fused images) randomly and independently. Each set of images was observed at least 1 week apart. A second evaluation was performed after 4 weeks. Intraclass correlation coefficients were calculated to assess the intra- and inter-observer agreement. The areas under the ROC curves (AUCs) were compared between the four image sets using Z test. RESULTS: Ten cases were determined as articular disc calcifications, and fourteen cases were recognized as loose bodies in the TMJ spaces. The average AUC index for the CBCT-MRI fused images was 0.95 and significantly higher than the other sets (p < 0.01). The intra- and inter-observer agreement in the CBCT-MRI fused images (0.90-0.91, 0.93) was excellent and higher than those in the other images. CONCLUSIONS: CBCT-MRI fused images can significantly improve the observers' reliability and accuracy in determining articular disc calcification of the TMJ. CLINICAL RELEVANCE: The multimodality image fusion is feasible in detecting articular disc calcification of the TMJ which are hard to define by CBCT or MRI alone. It can be utilized especially for inexperienced residents to shorten the learning curve and improve diagnostic accuracy.

Quantitative assessment of condyle positional changes before and after orthognathic surgery based on fused 3D images from cone beam computed tomography.

OBJECTIVES: To establish one method that can be used to quantitatively evaluate the condyle positional changes with 3D images in postoperative mandibular prognathism patients. MATERIALS AND METHODS: This is a retrospective observational study. Twenty-one patients who underwent bilateral sagittal split ramus osteotomy (BSSRO) were scanned with cone beam computed tomography (CBCT) for temporomandibular joints (TMJs) at 1 week preoperatively (T0), 1 to 2 weeks (T1), 3 months (T2), 6 months (T3), and 12 months (T4) postoperatively. The data were then grouped into T0T1, T1T2, T2T3, T3T4 and T0T1, T0T2, T0T3, and T0T4. Semi-automatic registration was conducted, and the condyle positional changes were measured in segmented 3D models. Inter- and intra-observer variability and the repeatability of registration were analyzed with paired t test; the repeated measurement analysis of variance was used for analyzing the repeatability of the marked points; the consistency of segmentation was analyzed with nonparametric test of multiple paired samples (Friedman test) and the independent-sample t test was applied to comparing changes between different periods of time. Differences were considered to be statistically significant when P < 0.05. RESULTS: In T0T1 and T1T2, the condylar position was changed greatly. In T2T3, the mean condylar translations were less than 0.2 mm in all directions, the mean rotational changes of condyle were less than 0.2 mm; in the period of T3T4, the mean condylar translations in all directions were less than 0.02 mm. For series 2, the condyle translational changes in axial, coronal, and sagittal views were within 0.10 mm, and the rotation direction of condyle in all three views was the same within 1 year after operation. CONCLUSIONS: Fused three-dimensional images can be used to qualitatively and quantitatively evaluate condyle positional changes. The condylar position might be stable at 3 months postoperatively. The condyles of most of patients did not fully return to their preoperative position within 1 year after the operation. CLINICAL RELEVANCE: One method for fusing images has been established to detect the condylar positional changes. This method may be applied to estimate the bony changes of condyle, even bony changes in other part of dentomaxillofacial region. Meanwhile, the data of condyle positional changes from asymptomatic patients after the surgery within 1 year can be used as a reference for further exploration of the relationship between orthognathic surgery and the occurrence of osteoarthritis postoperatively in the future. KEY POINTS: • By fused 3D images, the change of condylar position after bilateral sagittal split ramus osteotomy can be observed intuitively. • For the patients with mandibular prognathism, the condylar position would be stable at 3 months postoperatively. • The condyles of most mandibular prognathism patients did not fully return to their preoperative position within 1 year after operation.

Diagnosis of Bilateral Calcifications of Temporomandibular Joint Disc by Image Fusion.

The calcification of the articular disc is an uncommon lesion, usually discovered in hips, elbows, and shoulders, but rarely in temporomandibular joints (TMJ). The TMJ disc calcification may be related to pain and limitation of the mandibular mobility, however, most of the patients were asymptomatic. A 61-year-old female was referred to our hospital after a maxillofacial fist injury, bilateral TMJ disc calcifications were found accidentally by radiological examination. Here the significance of image fusion of cone-beam computed tomography and magnetic resonance imaging (MRI) in the diagnosis of this lesion was emphasized.

Bifid variations of the mandibular canal: cone beam computed tomography evaluation of 1000 Northern Chinese patients.

OBJECTIVES: The aim of this study was to evaluate and quantify variations of bifid mandibular canals (BMCs) in a population of Northern China by using cone beam computed tomography (CBCT). STUDY DESIGN: CBCT images of 1000 consecutive patients were analyzed by using the NewTom proprietary software. BMCs were identified and classified on the basis of the Naitoh classification. Linear and angular measurements of BMCs were performed. Statistical analyses were conducted by using χ2 and Wilcoxon tests. RESULTS: BMCs were observed in 13.2% of 1000 patients and 8.4% of 2000 sides. The prevalence of BMCs was significantly lower in patients in the first 2 decades and in cases with a class II molar relationship. The retromolar canal (68.4%) was the most common type of BMC observed. No buccolingual canals were identified; however, 2 special canals were detected. A classification system of 3 subtypes of retromolar canals was suggested. On average, the beginning site of the branches from the opening of the main canal was at a distance of 8.1 mm. The mean diameter and length of BMCs were 2.1 mm and 12.6 mm, respectively. CONCLUSIONS: This study underlined the prevalence and characteristics of BMCs in a population of Northern China. Preoperative identification of BMCs with CBCT may help prevent postoperative complications.

Buccal mucosa cell damage in individuals following dental X-ray examinations.

The aim of the present study was to monitor genotoxic and cytotoxic effect of X-ray on exfoliated buccal mucosa cells and investigate the association between the effects and the accumulated absorbed doses of oral mucosa. 98 participants' buccal mucosa cells were collected before and 10 days after different series of dental radiographs performed. Cytological preparations were successively dyed with the methods of Feulgen and fast-green, and analyzed under a light microscope. Micronuclei (MN)and other cells were scored. Accumulated absorbed dose of buccal mucosa was estimated with the method of anthropomorphic phantom and dosimeter chips. The dose rang was 0.18-3.54 mGy. A significant difference in the rate of MN cell was found before and after X-ray examinations (P = 0.008) as well as in the rates of Pyknotic (p < 0.001) and Karyolytic cell (p = 0.0021). When only the patients whose mucosa absorbed dose is lower than 1 mGy was analyzed, significant differences were not found except for Karyolytic cells (p = 0.0313). There was a correlation between the accumulated does and the change rate (ρ = 0.25, p = 0.0118). The frequency of micronuclei cells in buccal mucosa may be increased when a series of dental radiographs including a CBCT examination was performed.

Age estimation based on pulp cavity/chamber volume of 13 types of tooth from cone beam computed tomography images.

AIM: The aims of this study are to identify which type of tooth has the strong relationship between age and pulp cavity/chamber volume among 13 types of tooth from the same dentition and to determine whether the inclusion of multiple types of tooth may improve the accuracy of age estimation. MATERIALS AND METHODS: Cone beam computed tomography (CBCT) images from 115 females and 125 males aged between 16 and 63 years were analyzed. The DICOM data of all the images were imported into ITK-SNAP 2.4 for the calculation of pulp cavity/chamber volumes. Logarithmic regression analysis and multiple linear regression analysis were applied to establish the relationship between age and pulp cavity/chamber volumes. RESULTS: Among the 13 types of tooth, maxillary second molars have the largest R (2) (0.491, 0.642, and 0.498) and the smallest SEE (8.119, 6.754, and 8.022) in male, female, and pooled gender samples, respectively. The multiple linear regression analysis for the combination of multi-types of tooth indicated that a larger R (2) (0.627, 0.701, and 0.631) and smaller SEE (7.100, 6.258, and 6.970) than the counterpart calculated from the logarithmic regression analysis of a single type of tooth in male, female, and pooled gender samples, respectively. CONCLUSION: The pulp chamber volume of the maxillary second molars has the largest correlation coefficient with age. Using multiple types of tooth may improve the accuracy of age estimation compared with only one type of tooth used.

DNA methylation profiling in different phases of temporomandibular joint osteoarthritis in rats.

OBJECTIVE: Temporomandibular joint osteoarthritis (TMJOA) is a complex disease with strong genetic and epigenetic components in its pathogenesis. The aim of this study was to evaluate DNA methylation in mandibular head cartilage in different phases of experimentally-induced TMJOA in rats. DESIGN: DNA methylation was evaluated using microarrays in the mandibular head cartilage of early, intermediate and late stage experimentally-induced TMJOA, and of the normal age-matched control groups. Genes with differentially methylated CpG sites were analyzed to reveal the over-represented gene ontologies and pathways at different stages, and were compared with published expression profiles to assess their overlappings. The DNA methylation patterns of the target genes were validated by methylated DNA immunoprecipitation qPCR in additional independent cartilage samples and mRNA levels were analyzed by real-time PCR. RESULTS: We observed 9489 differentially methylated regions between the TMJOA and controls. A total of 440 consistently altered genes were revealed in all three stages; most (80%) were hypomethylated and many were associated with cell cycle regulation. We also detected different DNA methylation changes in early and late stage TMJOA (Rearly=0.68, Rlate=0.47), while the differences between age-matched healthy cartilage were subtle. Strong inverse changes between methylation status and mRNA levels were confirmed in Adamts5, Chad, Cldn11 and Tnf. CONCLUSIONS: Our data reveals dynamic DNA methylation patterns during the progression of TMJOA, with a different host of genes and pathways. The changes of cartilage DNA methylation patterns might contribute to understand the etiologic mechanisms of TMJOA epigenetically.

Synovial TRPV1 is upregulated by 17-ß-estradiol and involved in allodynia of inflamed temporomandibular joints in female rats.

Women with reproductive capability are more likely to suffer from temporomandibular disorders (TMD), with orofacial pain as the most common complaint. In the past, we focused on the role of estradiol in TMD pain through the nervous system. In this study, we explored estradiol's influence on synoviocyte gene expressions involved in the allodynia of the inflamed TMJ. The influence of 17-ß-estradiol on NGF and TRPV1 expression in TMJ synovium was determined in vivo and in vitro and analyzed by Western blot and real-time PCR. Complete Freund's adjuvant (CFA) injection into the TMJ was used to induce TMJ arthritis. Capsazepine served as a TRPV1 antagonist. Head withdrawal threshold was examined using a von Frey Anesthesiometer. We observed that estradiol upregulated the expressions of TRPV1 and NGF in a dose-dependent manner. In the primary cultured synoviocytes, TRPV1 was upregulated by lipopolysaccharide (LPS), estradiol, and NGF, while NGF antibodies fully blocked LPS and estradiol-induced upregulation of TRPV1. Activation of TRPV1 in the primary synoviocytes with capsaicin, a TRPV1 agonist, dose-dependently enhanced COX-2 transcription. Moreover, intra-TMJ injection of TRPV1 antagonist, capsazepine, significantly attenuated allodynia of the inflamed TMJ induced by intra-TMJ injection of CFA in female rats. This article presents a possible local mechanism for estradiol that may be involved in TMJ inflammation or pain in the synovial membrane through the pain-related gene TRPV1. This finding could potentially help clinicians understand the sexual dimorphism of TMD pain.

Age estimation based on pulp chamber volume of first molars from cone-beam computed tomography images.

AIM: To establish a method that can be used for human age estimation on the basis of pulp chamber volume of first molars and to identify whether the method is good enough for age estimation in real human cases. MATERIALS AND METHODS: CBCT images of 373 maxillary first molars and 372 mandibular first molars were collected to establish the mathematical model from 190 female and 213 male patients whose age between 12 and 69 years old. The inclusion criteria of the first molars were: no caries, no excessive tooth wear, no dental restorations, no artifacts due to metal restorative materials present in adjacent teeth, and no pulpal calcification. All the CBCT images were acquired with a CBCT unit NewTom VG (Quantitative Radiology, Verona, Italy) and reconstructed with a voxel-size of 0.15mm. The images were subsequently exported as DICOM data sets and imported into an open source 3D image semi-automatic segmenting and voxel-counting software ITK-SNAP 2.4 for the calculation of pulp chamber volumes. A logarithmic regression analysis was conducted with age as dependent variable and pulp chamber volume as independent variables to establish a mathematical model for the human age estimation. To identify the precision and accuracy of the model for human age estimation, another 104 maxillary first molars and 103 mandibular first molars from 55 female and 57 male patients whose age between 12 and 67 years old were collected, too. Mean absolute error and root mean square error between the actual age and estimated age were used to determine the precision and accuracy of the mathematical model. The study was approved by the Institutional Review Board of Peking University School and Hospital of Stomatology. RESULTS: A mathematical model was suggested for: AGE=117.691-26.442×ln (pulp chamber volume). The regression was statistically significant (p=0.000<0.01). The coefficient of determination (R(2)) was 0.564. There is a mean absolute error of 8.122 and root mean square error of 5.603 between the actual age and estimated age for all the tested teeth. CONCLUSION: The pulp chamber volume of first molar is a useful index for the estimation of human age with reasonable precision and accuracy.

Cheek fistula from the ectopic salivary gland: a variant of the oculo-auriculo-vertebral spectrum.

OBJECTIVES/HYPOTHESIS: This study aimed to investigate the diagnosis and management of a distinct developmental deformity syndrome characterized by congenital cheek fistula, ectopic accessory parotid gland, and preauricular appendage. STUDY DESIGN: Retrospective study. METHODS: We analyzed the medical records, radiologic and histopathologic findings, and follow-up data for seven patients (four males) with a congenital cheek salivary fistula. Computed tomography, fistulography, and sialography had been performed for diagnosis. Surgical treatment effect was evaluated. RESULTS: The mean age of the patients was 8.1 years (range, 2-16 years). The distinctive clinical feature was a congenital skin orifice lateral to the commissure with saliva discharge during eating. The cheek fistulae were accompanied by ipsilateral preauricular appendages in all seven patients. The skin orifice connected to an ectopic gland anterior to the masseter and inferior to Stensen's duct. Parotid sialography demonstrated an intact Stensen's duct in all cases. Hypoplasia of the ipsilateral mandible could be observed in five cases. Excision of the ectopic gland, skin orifice, and fistula was performed in five cases resulting in optimal treatment outcomes with no recurrent or adverse events. CONCLUSIONS: A congenital saliva-discharging fistula with an ectopic accessory parotid gland, ipsilateral preauricular appendage, and mandibular hypoplasia constitutes a rare developmental syndrome. Surgical excision can effectively treat congenital cheek salivary fistula. LEVEL OF EVIDENCE: 4.

Ankylosis of temporomandibular joint caused by psoriatic arthritis: a report of four cases with literature review.

Psoriatic arthritis (PsA) is an inflammatory joint disease associated with psoriasis. PsA is often confused with other diseases such as osteoarthritis and rheumatoid arthritis. PsA involving temporomandibular joints (TMJs) are uncommon: only 19 articles with 43 cases have been documented in the literature. TMJ ankylosis caused by PsA is rare, with only six cases having been reported. The authors present four cases of ankylosis of the TMJ secondary to PsA and review the literature. The findings of this study suggest that more attention should be paid to psoriasis patients with TMJ symptoms and proper treatment should be taken to prevent irreversible TMJ damage.

[Diagnosis and treatment of the ganglion cysts and synovial cysts arising from the temporomandibular joints].

OBJECTIVE: To give a reference for the early diagnosis and treatment of the cysts arising from the temporomandibular joint. METHODS: Nine patients finally diagnosed as temporomandibular joint cysts at the Peking University Hospital of Stomatology from May 1998 to August 2013 were selected and reviewed. Their clinical manifestations, imaging features, diagnoses and differential diagnoses, treatments and follow-ups were summarized and discussed. RESULTS: In the 9 patients, 3 were males and 6 females. Their ages ranged from 33 to 62 years with a median age of 39 years; the course of the disease ranged from 2 weeks to 3 years with a median of 4 months. The image examinations were performed with conventional X-ray examinations in 7 cases, CT scans in 8 cases, MRI in 6 cases and ultrasound in one case. Of the 9 cases, 7 were finally diagnosed as ganglion cyst and 2 as synovial cyst. Ganglion cysts mainly presented as the mass of preauricular area or joint area, with no obvious symptoms or only local discomfort, occasionally with pain. The synovial cysts manifested as the painful swelling of preauricular area and limited mouth-opening, accompanying with occlusal disorders. The treatments included surgical resection in 8 cases, repeated arthrocenteses and lavages in one case. The follow-ups were from 3 months to 9 years, one case with recurrence, and the remaining eight cases without recurrence. CONCLUSION: MRI examinations are very helpful in the early diagnosis and treatment planning of temporomandibular joint cysts. Surgical resection can have good results. Repeated arthrocenteses and lavages also have a good result, which may be an alternative choice for synovial cyst, but more accumulation of clinical experience is further needed.

[Investigation on radiographic signs of osteoarthrosis in temporomandibular joint with cone beam computed tomography in adolescents].

OBJECTIVE: To investigate the occurrence and radiographic signs of osteoarthrosis of the temporomandibular joints (TMJOA) with cone beam computed tomography (CBCT) in adolescents. METHODS: Individuals with temporomandibular disorders (aged 10-19 years) in the patients group (n=386) and pre-orthodontic patients with malocclusion (aged 10-19 years) in the control group (n=339) were included in the present study. All the patients in both groups had been examined by CBCT. The abnormalities of the condyle were evaluated. The results of radiological findings were compared between the patients group and the controls by using chi-square tests. Inter- and intra-examiner agreements were assessed using Cohen's Kappa coefficient and all statistical analysis was performed using SPSS 13.0. RESULTS: 157 patients in the patients group and 41 subjects in the control group had radiographic signs of TMJOA. The occurrence of OA was significantly higher in the patients group (40.7%, 157/386) than in the controls (12.1%, 41/339), the difference was statistically significant (P<0.05). The occurrence of TMJOA was significantly higher in females (44.6%, 123/276) than in males (30.9%, 34/110) in the patients group (P<0.05) but showed no significant difference in the controls (females: 13.7%, 32/234, and male: 8.6%, 9/105, P>0.05). In addition, the patients group showed significantly higher occurrence of ill-defined cortical bone (31.7%, 65/205) small bony defect and extensive erosion (25.4%, 52/205) than the controls (1.7%, 1/58 and 5.2%, 3/58, respectively, P<0.05), while the subjects in the control group had significantly higher occurrence of flattening and shortening of the condyle (39.7%, 23/58) and sclerosis (39.7%, 23/58) than patients with temporomandibular disorders (6.3%,13/205 and 14.6%, 30/205, respectively, P<0.05). CONCLUSION: TMJOA is not uncommon in adolescent patients with TMD and with malocclusion. Patients in the two study groups had different radiographic signs of OA. The patients with temporomandibular disorders often demonstrate erosive changes, while the pre-orthodontic patients with malocclusion often demonstrate relatively stable radiographic signs.

Measurement accuracy of temporomandibular joint space in Promax 3-dimensional cone-beam computerized tomography images.

OBJECTIVE: The aim of this study was to evaluate and compare the measurement accuracy of the temporomandibular joint (TMJ) space in the Promax 3D cone-beam computerized tomography (CBCT) images scanned with 2 different dental protocols. STUDY DESIGN: TMJ space impression models were made according to the occlusion. Forty joints were scanned with the standard and the large view protocol of the Promax 3D CBCT scanner. Two observers measured the joint spaces 3 times on both radiographs and the photocopies of the impression models. RESULTS: A total of 120 CBCT images were measured. There were no significant differences among the actual joint spaces and the CBCT measurements performed with the 2 scanning protocols (P = .305). The inter- and intraobserver variabilities were not significant. CONCLUSIONS: The 2 scanning protocols provided by the Promax 3D CBCT scanner were reliable and similar for recording the TMJ space.

Hippocampal nerve growth factor potentiated by 17ß-estradiol and involved in allodynia of inflamed TMJ in rat.

UNLABELLED: The hippocampus is believed to play an important role in sex-based differences of pain perception. Whether estrogen potentiates allodynia in the inflamed temporomandibular joint (TMJ) through affecting the expressions of pain-related genes in the hippocampus remains largely unknown. Because the nerve growth factor (NGF) is an important gene related to inflammatory pain, we tested whether hippocampal NGF may be involved in TMJ inflammatory pain. Here we showed that the rat hippocampal NGF was upregulated by TMJ inflammation induced by complete Freund adjuvant. NGF upregulation was further potentiated by estradiol in a dose-dependent manner. In contrast, NGF transcription in the amygdala, prefrontal cortex, and thalamus was not affected by TMJ inflammation and estradiol. An intrahippocampal injection of NGF antibody or NGF receptor inhibitor K252a (inhibitor for tropomyosin receptor kinase A, TrkA) reduced the allodynia of inflamed TMJ in proestrous rats. Our data suggest that the hippocampal NGF is involved in estradiol-sensitized allodynia of inflammatory TMJ pain. PERSPECTIVE: We report that complete Freund adjuvant-induced temporomandibular joint (TMJ) inflammation upregulated hippocampal nerve growth factor (NGF) expression, and estradiol replacement potentiated this upregulation. These results propose that estradiol could modulate TMJ pain through the NGF signaling pathway in the hippocampus to exacerbate TMJ pain and offer a possible mechanism of sexual dimorphism of temporomandibular disorder pain.

[Detection accuracy of occlusal caries by cone-beam computed tomography images scanned with different parameters].

OBJECTIVE: To compare the detection accuracy of occlusal caries in cone-beam computed tomography (CBCT) images scanned with different scanning parameters. METHODS: Thirty-seven extracted human premolars and molars without restorations or obvious cavities were selected for this study. The teeth 3 or 4 as a group were mounted in 12 plaster blocks and scanned with DCT Pro (VATECH, Co., Ltd., Yongin-Si, S.Korea) at normal and high resolution settings and with ProMax 3D (Planmeca Oy, Helsinki, Finland) at low, normal and high resolution settings. In addition, the tooth blocks were imaged with the ProMax 3D at three different tube currents. Ten doctoral candidates of Peking University School and Hospital of Stomatology evaluated all the images of the tooth blocks using a five-level confident scale. Actual presence and the extent of caries were established by histological examinations. The areas under the ROC curves (Az value) were analyzed. RESULTS: Eleven (29.7%, 11/37) teeth were sound, 13 (35.1%, 13/37) had enamel caries and 13 (35.1%, 13/37) had dentine caries. There were no significant differences between normal resolution and high resolution for DCT Pro on the detection accuracy of occlusal (enamel+dentine) caries (0.698 ± 0.064 vs. 0.735 ± 0.044, P>0.05).No significant differences were found for ProMax 3D among low, normal and high resolution (0.700 ± 0.031 vs. 0.700±0.054 vs. 0.701 ± 0.041, P>0.05). For dentinal caries, there were no significant differences between CBCT images scanned with different resolutions for DCT Pro(0.776 ± 0.078 vs. 0.811 ± 0.047, P>0.05) or ProMax 3D (0.713 ± 0.039 vs. 0.685 ± 0.063 vs. 0.713 ± 0.040, P>0.05). No significant differences were found for enamel caries detection for DCT Pro (0.620 ± 0.068 vs. 0.659 ± 0.048, P>0.05)or ProMax 3D (0.686 ± 0.050 vs. 0.685 ± 0.063 vs. 0.689 ± 0.063, P>0.05). For ProMax 3D, there were no significant differences among different tube currents on the detection accuracy of occlusal caries (0.653 ± 0.065 vs. 0.700 ± 0.054 vs. 0.67 ± 0.062, P>0.05). CONCLUSION: Different resolutions did not have an impact on the detection accuracy of occlusal caries. The tube currents for ProMax 3D did not show any effect on occlusal caries detection.

[Outcomes of combined pulmonary resection and off-pump coronary artery bypass grafting for patients with lung tumor and concurrent coronary heart disease].

OBJECTIVE: To analyze the outcomes of lung resection and off-pump coronary artery bypass grafting (OPCAB) synchronously for the patients with lung tumor and concurrent coronary heart disease. METHODS: Twenty-two patients with lung tumor and concurrent coronary heart disease underwent combined surgical interventions between January 2003 and December 2011. They included 20 males and 2 females with a mean age of (65 ± 4) years. The TNM stage of lung cancer was predominantly at stages I and II. A majority of them had two and three-vessel disease. The tests of cardiothoracic functions were normal. The biopsy of lung tumor was carried out initially through sternotomy approach. Then OPCAB was performed. Finally lung resection was carried out according to the pathological results of lung tumor. RESULTS: All patients survived. The average number of anastomosed coronary vessels was 2.3. After myocardial revascularization through a sternotomy approach, the procedures included lobectomy and partial lung resections through sternotomy only (n = 11), lobectomy through a lateral thoracotomy approach (n = 9) and lobectomy and bypass to left anterior descending (LAD) through left thoracotomy only (n = 2). Neither death nor new MI occurred during the perioperative period. The mean stay in-hospital was (17 ± 7) days and mean operative duration (233 ± 1) min. The diagnoses were non-small cell lung cancer (n = 18) and benign tumor (n = 4). The most frequent complications were cardiac arrhythmias, atelectasis and pulmonary infections. All of them were followed up for 10-60 months. Within this period, 4 patients died from cancer recurrence. CONCLUSION: The combined procedure of OPCABG grafting and pulmonary resection is a safe and effective treatment option for patients with lung cancer and concurrent coronary heart disease.