Improving masticatory and swallowing ability of postoperative oral and maxillofacial tumor patients by telerehabilitation-A randomized controlled trial.

OBJECTIVE: To evaluate the effect of telerehabilitation on oral function of oral and maxillofacial tumor patients. DESIGN: Unicentral, single-blind, randomized controlled trial. SETTING: Community. SUBJECTS: Patients with primary oral and maxillofacial tumor receiving surgical treatment. INTERVENTIONS: Telerehabilitation guidance from therapists. MAIN MEASURES: At the beginning of training (T0) and 1 month (T1), 3 months (T2) and 6 months (T3) after training, patients' masticatory ability (mastication efficiency-masticatory performance evaluating gum, maximum bite force and mouth opening) and swallowing ability (water swallowing test) was measured. Modified Sato questionnaire and MD Anderson dysphagia inventory (MDADI) were used for self-evaluation of masticatory and swallowing ability. RESULTS: A total of 64 participants (intervention: 33; control: 31) were included. The masticatory efficiency scores of the intervention group were significantly better than those of the control group at T2 (intervention: 3.67 (0.48); control: 3.03 (0.85)) and T3 (intervention: 4.20 (0.30); control: 3.50 (0.79)); and maximum mouth opening was better at T2 (intervention: 3.18 (0.59); control: 2.77 (0.54)) and T3 (intervention: 3.54 (0.58); control: 3.09 (0.41)). In water swallowing test, the intervention group had better scores at T2 and T3. The scores of MDADI scale in intervention group were better than those in the control group after 3 months of training. In subgroup analysis, the intervention group of oral cancer patients had better swallowing function at T2 and T3, but no significant difference was found in the subgroup of oropharyngeal cancer. CONCLUSIONS: Telerehabilitation could greatly improve the long-term (3-6 months) training effect under the condition of greatly saving medical resources and reducing personnel contact.

Influence of inflammation on bleeding and wound healing following surgical extraction of impacted lower third molars.

OBJECTIVE: This study aimed to investigate the effect of inflammatory states following impacted lower third molar (ILTM) surgery regarding postoperative bleeding and wound healing. METHODS: The study included patients who underwent extraction of ILTMs associated with or without inflammatory conditions. Post-extraction bleeding and wound healing were assessed. In addition, mean grey values (MGVs) of alveolar bone and bone height using an orthopantomography radiograph were analyzed. RESULTS: A total of 376 patients were enrolled; 171 pericoronitis, 51 pulpitis, 44 chronic periapical periodontitis, 36 chronic periodontitis, and 74 control. The bleeding score in the control group was significantly lower than in the periapical periodontitis and periodontitis groups. Excellent wound healing for control, pericoronitis, pulpitis, periapical periodontitis, and periodontitis groups was (78.38%, 35.67%, 70.59%, 70.45%, and 33.33%, respectively). Patients with pericoronitis and periodontitis had significantly poorer wound healing (P < 0.01). The MGV in periapical periodontitis and periodontitis was considerably lower than in the control group. CONCLUSIONS: The inflammatory conditions associated with ILTMs increase the risk of bleeding. So suturing with the placement of local hemostatic agents over a pressure pack alone is recommended. The poorest wound healing was in localized gingival inflammation. Furthermore, MGV was affected by age and was lower with periapical periodontitis.

The prevalence of extra-salivary gland complications in immunoglobulin G4-related sialadenitis.

OBJECTIVES: To estimate the prevalence of extra-glandular lesions in patients with immunoglobulin G4-related sialadenitis (IgG4-RS). METHODS: Six electronic databases (PubMed, EMBASE, Science Direct, Scopus, Web of Science, and China National Knowledge Infrastructure) were systematically searched from the date of inception of each database to March 2021. The Strengthening the Reporting of Observational Studies in Epidemiology statement was used to conduct methodological quality assessment, and a random-effect meta-analysis model was applied to estimate the prevalence. Publication bias was visually assessed using a funnel plot and calculated via Begg's and Egger's tests. The Stata 15 software was used to perform data analysis. RESULTS: A total of 43 articles comprising 1,864 patients with IgG4-RS were considered to be eligible for this study. The pooled prevalence of extra-salivary gland lesions in IgG4-RS was 76.53% with a confidence interval (CI) of (69.39%, 83.04%). A higher prevalence was associated with studies published before or during 2015 (84.38%, CI [74.23%, 92.58%]) than those published after 2015 (68.55%, CI [58.44%, 77.88%]). Lacrimal gland involvement (54.68%, CI [45.61%, 63.60%]) and lymph node swelling (56.96%, CI [48.16%, 65.56%]) were the most frequent lesions. CONCLUSIONS: Extra-glandular lesions were common in patients with IgG4-RS. More high-quality prospective studies with less heterogeneity are required to determine the accurate prevalence.

DOCK8 Serves as a Prognostic Biomarker and Is Related to Immune Infiltration in Patients With HPV Positive Head and Neck Squamous Cell Carcinoma.

PURPOSE: Dedicator of cytokinesis 8 (DOCK8) was reported to have a vital link to immunoregulation. However, the mechanisms by which it drives immune infiltration in cancer remain uncertain. We tried to assess the role of DOCK8 in patients with cancer, especially human papillomavirus (HPV)-positive head and neck squamous cell carcinoma (HNSCC). METHODS: Data on the expression and survival of DOCK8 in patients with various cancers were analyzed using the Oncomine and TIMER databases. The TIMER database assessed the relationship of DOCK8 with immune infiltration levels and various markers of multiple immune cells. Gene set enrichment analysis revealed tumor-associated biological processes related to DOCK8. ENCODE database was used to explore relevant transcription factors of DOCK8, and a PPI network was constructed using GENEMINIA. The expression and survival role of DOCK8 was confirmed in patients from independent GEO datasets. RESULTS: We determined that DOCK8 expression was upregulated or downregulated in various cancers unlike in healthy tissues. A high expression of DOCK8 was significantly correlated with a favorable prognosis in HPV-positive HNSCC and lung adenocarcinoma (LUAD). Furthermore, multivariate Cox regression analysis revealed that DOCK8 was an independent prognostic factor of HPV-positive HNSCC. Additionally, elevated DOCK8 expression was positively correlated with multiple immune cell infiltration levels and immune marker expression associated with particular immune cell subsets. Also, 14 pathways involved in immune activities and carcinogenesis, 22 potential TFs, and co-expression proteins of DOCK8 indicated DOCK8 to be related to tumor-associated biological processes. Ultimately, we verified that DOCK8 is upregulated and confers a favorable overall survival and progression-free survival status in patients with HPV-positive HNSCC. CONCLUSION: These results elucidate that high expression of DOCK8 indicates a favorable prognosis in patients with HPV-positive HNSCC as well as increased microenvironmental immune infiltration levels. It would provide new insights into the prognosis predicting and clinical regimen decision making in patients with HPV-positive HNSCC.

Acellular dermal matrix for prevention of Frey's syndrome after superficial parotidectomy of benign tumors.

PURPOSE: To evaluate: 1) the efficacy of acellular dermal matrix (ADM) to prevent Frey's syndrome (FS) after superficial parotidectomy of benign tumors. 2) the effect of different follow-up intervals on the incidence of FS. METHODS: Fifty-five patients with benign parotid gland tumors underwent superficial parotidectomy were divided into two groups: Non-ADM group (n = 31, 56.3%) and ADM group (n = 24, 43.6%). The primary outcomes measure was the incidence of FS. The secondary outcomes were surgical site depression, infection, salivary sialocele, and salivary fistula. Subjective FS was evaluated using a clinical questionnaire submitted via WeChat at 3, 6, 12, 18, 24, and 32 months postoperatively. Objective FS was evaluated using Minor starch-iodine test at 6 and 12 months postoperatively. RESULTS: There was a statistically significant difference in the incidence of subjective and objective FS when ADM compared with Non-ADM groups (P<0.05). The respective incidence of subjective FS at 3, 6, 12, 18, 24, and 32 months was 4.2%, 8.3%,20.8%, 20.8%, 20.8%, 20.8% in ADM group and 3.2%, 9.7%, 29%, 38.7%, 45.2% in Non-ADM group. The incidence of objective FS after 6 and 12 months was 4.2%, 8.3% in ADM group and 8.3% (2/24), 38.7% (12/31) in Non-ADM group respectively. Five patients in ADM group and 1 patient in Non-ADM group developed sialocele, and all patients resolved with conservative management. Surgical site depression was significantly higher in the Non-ADM group (15/31) compared with (5/24) in ADM (P=0.049). No cases of immune rejection, infection, hematoma, or salivary fistula were observed in ADM group. CONCLUSIONS: The current study demonstrated that 1) ADM could reduce the incidence of FS in the patients undergoing superficial parotidectomy. 2) the peak onset of about 18 months appear to be acceptable follow-up for the development of FS.

Comparison of Internal Jugular Vein System Anastomosis and External Jugular Vein System Anastomosis in Free Flaps for Head and Neck Reconstruction: A Meta-Analysis.

PURPOSE: The purpose of the present study was to investigate the differences in postoperative thrombosis and flap failure between internal jugular vein (IJV) system anastomosis and external jugular vein (EJV) system anastomosis in free flaps for the reconstruction of head and neck defects. MATERIALS AND METHODS: We searched PubMed, Web of Science, EMBASE, Chinese BioMedical Literature Database, and other databases until March 2019 for studies that had reported data for anastomosis for the 2 different venous systems in the microvascular free-flap reconstruction of head and neck defects. We assessed thrombosis and flap failure in patients undergoing anastomosis of the IJV system and patients undergoing anastomosis of the EJV system. RESULTS: Nine studies with a total of 2051 patients with venous anastomosis were included in the present meta-analysis. IJV system anastomosis showed a significantly lower incidence of venous thrombosis than did the EJV system (relative risk [RR], 0.55; 95% confidence interval [CI], 0.37 to 0.82). Eight studies were included in the analysis of the flap failure rate, which showed a lower failure rate for the IJV system anastomosis than for the EJV system (RR, 0.59; 95% CI, 0.35 to 1.00). CONCLUSIONS: The incidence of thrombosis and flap failure after venous anastomosis in the IJV system was lower than that in the EJV system. The results from the present study have shown that the IJV system should be the first choice for venous anastomosis in the reconstruction of free flaps.

Planning Minimal Access Incisions in Resectioning Benign Parotid Tumors.

BACKGROUND: Traditional parotid surgery leaves visible submaxillary cicatrices, unaesthetic results from incisions, and a high incidence of postoperative complications. This study aimed to examine the feasibility of newly designed incisions for the removal of benign parotid lesions. METHODS: The authors randomly assigned patients (n = 48) with benign parotid lesions admitted to our department from November 2016 to April 2019. In the study group, an aesthetic incision was designed through a preoperative examination combined with a medical history and physical examination. Half of the patients (n = 24) underwent surgery with the new incision design, while the patients in the control group (n = 24) received conventional surgery. The therapeutic effects and outcomes of the two groups were compared. RESULTS: The postoperative complication rate of the study group (n = 6) was significantly lower than that of the control group (n = 15). Compared to conventional surgery, patients who received the hidden incisions had less total drainage volume, decreased length of incision, and fewer days of postoperative hospitalization (P < 0.05). On an average follow-up of 20 months, no recurrence was found in any patient. CONCLUSIONS: Minimal access incisions, aided with loupe magnification, greatly improve the surgical safety, patient outcomes, and final scar appearance. The described technique is worth further study and utilization.

Impact of wound closure on fibular donor-site morbidity: a meta-analysis.

BACKGROUND: Vascularized free fibular flaps have been the "workhorses" for reconstruction of many kinds of bone defects. Nevertheless, there is no consensus regarding the optimal wound closure method for fibular donor sites. This study aimed to compare prognostic outcomes of primarily closures (PC) and skin grafts (SG) for fibular donor sites. METHODS: Studies regarding donor-site outcomes of PC versus SG in patients undergoing free fibular flap procedures were included. Two authors individually searched PubMed, Web of Science, EMBASE, Cochrane Library and clinicaltrials.gov up to February 2019, extracted the data and assessed quality of each selected article. Ultimately, The incidences of donor-site morbidities were evaluated. RESULTS: Five studies with a total of 119 patients were included in our analysis. No significant differences were found with respect to the rates of donor-site problems between the PC and SG groups. CONCLUSIONS: Fibular flap patients undergoing PC and SG wound closures may have similar donor-site outcomes. Additional large-scale studies are necessary to draw a solid conclusion.

Miniplates Versus Reconstruction Plates in Vascularized Osteocutaneous Flap Reconstruction of the Mandible.

PURPOSE: The main aim of this article is to compare the complication rate associated with the use of miniplates versus reconstruction plates in vascularized osteocutaneous flap reconstruction of the mandible. PATIENTS AND METHODS: The authors searched PubMed, Web of Science, EMBASE, Chinese BioMedical Literature Database (CBM), Cochrane Library, and clinicaltrials.gov up to September 2017 to identify studies that compared the complication rate of miniplates versus reconstruction plates in patients undergoing mandibular reconstruction. Two reviewers individually extracted the data and performed a quality assessment. Plate exposure, plate fracture/removal, infection, and overall complications were evaluated. RESULTS: Five studies with 511 cases were included in our analysis. No significant difference was found between the groups. However, the reconstruction plate led to fewer overall complications and plate exposure postoperatively than did the miniplate. CONCLUSION: Our meta-analysis suggests that miniplates and reconstruction plates are suitable for mandibular reconstruction with a vascularized osteocutaneous flap.

Congenital Loss of Permanent Teeth in a Patient With Congenital Insensitivity to Pain With Anhidrosis due to 2 Novel Mutations in the NTRK1 Gene.

Congenital insensitivity to pain with anhidrosis (CIPA), also known as hereditary sensory and autonomic neuropathy type IV, is an extremely rare autosomal recessive disorder. This study investigated the oral and craniofacial manifestations of a 7-year-old Chinese boy affected by CIPA and identified 2 novel mutations in the NTRK1 gene, and a new feature of the disorder was identified. The patient had typical features, including insensitivity to pain, anhidrosis, and mental retardation; recurrent fractures and osteoporosis also were noted. His oral and craniofacial manifestations included congenital blepharoptosis, a large number of missing teeth, serious tooth abrasion, severe soft tissue injuries, and dental caries. Radiographic examination showed congenital loss of the permanent tooth germs, thin and weak alveolar bone of the mandible, and a fracture of the right mandible. This study extends the spectrum of NTRK1 mutations observed in patients with a diagnosis of CIPA and is the first to propose that congenital loss of permanent teeth may occur in CIPA patients. Furthermore, it highlights the importance of including an oral and maxillofacial surgeon and a pediatric dentist on the multidisciplinary team.

Discontinuous Versus In-Continuity Neck Dissection in Squamous Cell Carcinoma of the Tongue and Floor of the Mouth: Comparing the Rates of Locoregional Recurrence.

PURPOSE: To date, consensus has not been reached on which treatment modality, that is, in-continuity neck dissection or discontinuous neck dissection, is more appropriate for managing patients with squamous cell carcinoma (SCC) of the tongue and floor of the mouth. This study aimed to perform a meta-analysis to compare discontinuous neck dissection with in-continuity neck dissection as a treatment modality for SCC of the tongue and floor of the mouth. MATERIALS AND METHODS: The PubMed, Web of Science, China National Knowledge Infrastructure, and Wanfang databases were searched for articles that compared discontinuous neck dissection with in-continuity neck dissection in SCC of the tongue and floor of the mouth until March 1, 2017. The predictor variable was whether discontinuous neck dissection or in-continuity neck dissection was performed in each group. The primary outcome variable was the incidence of locoregional recurrence. Two authors individually extracted the data and assessed the study quality. The meta-analysis was performed using Stata (version 13.0; StataCorp, College Station, TX). RESULTS: We included 8 studies with 796 patients in our meta-analysis. The results showed that in-continuity neck dissection had a statistically significantly lower incidence of locoregional recurrence than discontinuous neck dissection (random-effects model: relative risk, 0.459; 95% confidence interval, 0.240 to 0.877; P = .019). Because significant heterogeneity among studies (I2 = 74.5%, P < .001) was found in the heterogeneity evaluation, a separate analysis was performed. However, the results still showed that in-continuity neck dissection had a statistically significantly lower rate of locoregional recurrence than discontinuous neck dissection in patients with T2 and T3 SCC of the tongue and floor of the mouth (fixed-effects model: relative risk, 0.281; 95% confidence interval, 0.183 to 0.433; P < .001). CONCLUSIONS: Compared with discontinuous neck dissection, in-continuity neck dissection can significantly reduce the rate of locoregional recurrence in patients with SCC of the tongue and floor of the mouth.

The application of fibular free flap with flexor hallucis longus in maxilla or mandible extensive defect: a comparison study with conventional flap.

BACKGROUND: The repair and reconstruction of maxillary and mandibular extensive defects have put huge challenges to surgeons. The fibular free flap (FFF) is one of the standard treatment choices for reconstruction. The conventional FFF has deficiencies, such as forming poor oral mucosa, limited flap tissue, and perforator vessel variation. To improve the use of FFF, we add the flexor hallucis longus (FHL) in the flap (FHL-FFF). In this paper, we described the advantage and indication of FHL-FFF and conducted a retrospective study to compare FHL-FFF and FFF without FHL. METHODS: Fifty-four patients who underwent FFF were enrolled and divided into two groups: nFHL group (using FFF without FHL, 38 patients) and FHL group (using FHL-FFF, 16 patients). The perioperative clinical data of patients was collected and analyzed. RESULTS: The flaps all survived in two groups. We mainly used FHL to fill dead space, and the donor-site morbidity was slight. In FHL group, flap harvesting time was shorter (118.63 ± 11.76 vs 125.74 ± 11.33 min, P = 0.042), the size of flap's skin paddle was smaller (16.5 (0-96) vs 21.0(10-104) cm2, P = 0.027) than nFHL group. There were no significant differences (P > 0.05) in hospital days, hospitalization expense, rate of perioperative complications, etc. between the two groups. Compared with FFF without FHL, FHL-FFF will neither affect the use of flap nor bring more problems. CONCLUSION: The FHL-FFF simplifies the flap harvesting operation. The FHL can form good mucosa and make FFF rely less on skin paddle. It can be used for adding flap tissue and dealing with perforator vessel variation in reconstruction of maxillary and mandibular extensive defects.

Risk Factors for Early and Late Donor-Site Morbidity After Free Fibula Flap Harvest.

PURPOSE: This article reports on the incidence of donor-site complications and identifies predictive factors for early and late donor-site complications. MATERIALS AND METHODS: From January 2007 through December 2012, 45 patients underwent free fibula flap reconstruction and their medical records were reviewed. They were asked to complete a questionnaire on the operated leg and they were evaluated for ankle stability and ambulatory status. RESULTS: One patient (2.2%) developed a complication owing to a hematoma, but no other patients had any complications. During the risk factor analysis, no domain was found to be statistically associated with early morbidity; late dysfunction was noted in 20 patients (57.1%), and of these cases, at least 2 symptoms were found in 10 patients (50%). The most common complication was numbness followed by toe contracture and abnormal ambulatory movement. During the risk analysis, the following domains affected late donor-site morbidity: harvested fibula length, operation time, and follow-up time. Furthermore, in cases with complications, patients with the osteocutaneous fibula flap complained more than patients with the osseous flap (P = .07). CONCLUSION: Early donor-site morbidity was uncommon, but late morbidity occurred frequently. Harvested fibula length, operation time, and follow-up time were statistically linked to postoperative function.

Reconstruction of Complex Total Parotidectomy Defect With a Chimeric Anterolateral Thigh Perforator Flap and Vascularized Motor Branch of Femoral Nerve Grafting.

Reconstruction of complex total parotidectomy defects after ablation is always a challenge for surgeons. The surgical technique in reconstructing total parotidectomy defects using an anterolateral thigh (ALT) flap has not been described in detail. This report describes the treatment of a difficult case with a complex total parotidectomy defect. An ALT flap composed of a vascularized motor branch of the femoral nerve and a narrow portion of the vastus lateralis muscle was harvested. An 8-cm-long vascularized nerve was transplanted into the gap, which can be considered a cable transplant graft, and a myocutaneous paddle was used to cover and fill in the soft tissue defect. There were no complications after surgery, and the patient was satisfied with the reconstructed facial contours. This case shows that using a chimeric ALT flap for reconstruction is possible in a complex total parotidectomy defect.

Transverse cervical vessels as recipient vessels in oral and maxillofacial microsurgical reconstruction after former operations with or without radiotherapy.

BACKGROUND: The purpose of this study was to investigate the reliability and outcome of using the transverse cervical vessel (TCV) as a recipient vessel for microvascular reconstruction in patients whose vessels in the neck region are unavailable because of previous surgery or radiotherapy. METHODS: Between January 2012 and August 2014, secondary head and neck reconstruction was performed using the TCV as a recipient vessel in eight patients who had undergone previous neck dissection and radiation therapy (n = 5). Five patients had a recurrent carcinoma, one had undergone an operation for scar release and two had been treated surgically for a second primary cancer. The anterolateral thigh flap (ALT), anteromedial thigh flap (AMT), and fibular flap were used for the reconstruction. Clinical data were recorded for each patient. RESULTS: All of the ipsilateral transverse cervical arteries were found to be free of disease. The second free flap was revascularized using the TCVs (n = 6) or the external (n = 1) or internal (n = 1) jugular vein. The free flaps used for the reconstruction included the ALT flap (n = 6), AMT flap (n = 2), and fibular flap (n = 1). All of the flaps survived without vascular events, and the patients healed without major complications. The mean follow-up time was 11 months. One patient died of distant metastases during follow-up. CONCLUSIONS: In patients who have previously undergone neck surgery with or without radiotherapy, the TCVs are reliable and easily accessible recipient vessels for microsurgical reconstruction in the oral and maxillofacial region. If the transverse cervical vein is unavailable, the internal or external jugular vein should be dissected carefully to serve as an alternative for microvascular anastomoses.

Pituitary tumor-transforming gene 1 (PTTG1) is overexpressed in oral squamous cell carcinoma (OSCC) and promotes migration, invasion and epithelial-mesenchymal transition (EMT) in SCC15 cells.

Pituitary tumor-transforming gene 1 (PTTG1) is an important oncogenic transcription factor implicated in various malignancies, including oral squamous cell carcinoma (OSCC), a common malignancy of head and neck. Although PTTG1 is reportedly overexpressed in OSCC tissues, its role in human OSCC remains elusive. Thus, this study was conducted to explore the correlation between PTTG1 expression and tumorigenesis of OSCC. We first examined PTTG1 mRNA and protein expression in 28 pairs of OSCC tissues and adjacent non-tumor tissues. PTTG1 protein levels in 98 OSCC specimens were also evaluated by using immunohistochemistry. Our data showed that both mRNA and protein expression levels of PTTG1 in OSCC tissue specimens were markedly higher than that in the corresponding non-tumor tissue samples. A high level of PTTG1 protein expression was found in 74 out of 98 cases (75.51 %) and it was correlated with lymph node metastasis (P = 0.002) and tumor-node-metastasis (TNM) stage (P = 0.007) of patients with OSCC. Moreover, forced overexpression of PTTG1 enhanced SCC15 cell migration and invasion, whereas knockdown of PTTG1 resulted in reverse phenomena. In addition, elevated PTTG1 also increased the activities and expressions of matrix metalloproteinase (MMP)-2, and enhanced epithelial-mesenchymal-transition (EMT) process in SCC15 cells. The EMT changes were accompanied by downregulation of epithelial cadherin (E-cadherin) protein expression and upregulation of snail and vimentin. In summary, our results illustrate that PTTG1 may contribute to the development and progression of human OSCC.

Modified visor approach applied to total or subtotal glossectomy and reconstruction: avoidance of lip splitting and mandibulotomy and cutting off mental nerve.

A lower lip-splitting incision has traditionally been performed with different types of mandibulotomy approaches for obtaining wide access to total or subtotal glossectomy. However, lip splitting can be associated with unfavorable aesthetic and function results. We describe our new modification of a traditional visor approach without lip splitting, mandibulotomy, and reserve mental nerve to avoid these morbidities and to compare aesthetic, functional, and patient subjective outcomes between the two access procedures.Of the patients undergoing total or subtotal glossectomy and reconstruction with flaps, 99 were grouped according to a surgical access procedure performed (lip split and mandibulotomy [LSM] or modified visor approach [MVA]). Data on surgical morbidity and outcomes were compared. All the tumors were safely removed by means of our modified visor approach through the combined intraoral and transcervical routes with adequate resection margins. There were no troublesome difficulties in reconstruction of the surgical defects with various flaps. Recurrence rates, swallowing, chewing, and speech were similar for both groups. Rates of postoperative fistulae were 9.3 % (LSM) vs 0 % (MVA). There were significant differences between the two groups in the temporomandibular joint (TMJ) signs (p = 0.000) and for appearance domains (p = 0.01). Avoiding lip splitting and mandibulotomy reduces patient morbidity and hospital stay and gets excellent aesthetic consequences; reserve mental nerve can avoid lower lip numbness after surgery. In our experience, the lower lip-splitting and mandibulotomy procedure for surgical exposure is unnecessary for both oncologic resection and reconstruction of tongue cancers.

Cetuximab inhibits oral squamous cell carcinoma invasion and metastasis via degradation of epidermal growth factor receptor.

Cetuximab (Erbitux, C225) is a chimeric monoclonal antibody that binds to the extracellular domain of epidermal growth factor receptor (EGFR), inhibiting tumor growth, invasion, angiogenesis and metastasis. However, the mechanisms underlying the effect of Cetuximab in human oral squamous cell carcinoma (OSCC) remain unclear. Here, we report that Cetuximab modulates EGFR protein stability through the ubiquitin/proteasome pathway, resulting in the inhibition of human OSCC growth. Cetuximab significantly inhibited the migration and invasion of human OSCC cells by blocking epithelial/mesenchymal transition (EMT) and the AKT and ERK pathways. Furthermore, Cetuximab-inhibited cell growth by modulating the expression of integrin ß5. Taken together, these results provide novel insights into the mechanism of Cetuximab action and suggest potential therapeutic strategies for OSCC.

Tuberculous osteomyelitis of the mandible with diffuse swelling of the floor of the mouth: a case report.

Primary orofacial tuberculosis (TB) is uncommon, especially with regard to the jaw. We report an unusual case for which the final diagnosis was tuberculous osteomyelitis of the mandible with cervical tuberculous lymphadenitis. The follow-up examinations for our patient showed complete regression of the swelling and healing of the mandibular lesion after 4 months of TB antibiotic therapy. The purpose of the present study was to alert clinicians to our findings and encourage them to consider oral TB in the differential diagnosis for jaw lesions with multiple enlarged cervical lymph nodes.