Primary maxillary sinus carcinosarcoma with multidisciplinary management: a case report with 4 years follow-up and literature review.

BACKGROUND: Primary maxillary sinus carcinosarcoma (CS) is an extremely rare malignant tumor characterized by biphasic histologic components, lack of standardized treatment, high recurrence rate, and poor prognosis. This paper presents a case of primary maxillary sinus CS and its treatment. CASE PRESENTATION: A 39-year-old female patient complained of right facial pain and maxillary teeth numbness on March 21, 2018. Computed tomography examination revealed a malignant mass with osteolytic destruction. Preoperative biopsy suggested sarcomatoid carcinoma or CS. A total right maxillectomy under general anesthesia was performed on April 12, 2018. The final staging was T3N0M0 (ACJJ 2019). Postoperative radiotherapy and chemotherapy were performed. On May 26, 2018, the patient received the first cycle of doxorubicin plus ifosfamide. Two days before radiotherapy, the patient received an intra-oral prosthesis. From June 20, 2018, to August 22, 2018, the patient received concurrent chemoradiotherapy: radiotherapy (60 Gy in 30 fractions) and the second cycle of doxorubicin. Then, the patient received four cycles of doxorubicin plus ifosfamide. The patient was followed for 39 months with no evidence of disease. CONCLUSION: Using multidisciplinary therapy, clinical-stage T3N0M0 (ACJJ 2019) maxillary sinus CS may achieve a good prognosis.

A Hypothesis and Pilot Study of Age-Related Sensory Innervation of the Hard Palate: Sensory Disorder After Nasopalatine Nerve Division.

BACKGROUND The nasopalatine nerve may be injured during extraction of teeth embedded in the anterior hard palate. The neural recovery process and its impact on sensation in the anterior hard palatal region are controversial. In our clinical practice, we noticed a distinct recovery process in children compared with adolescents or adults after surgery. We hypothesized that the sensory innervations of the anterior palate might shift during later childhood and pre-adolescence, which is due to the development of the nasopalatine nerve along with the maxillary growth and permanent teeth eruption. MATERIAL AND METHODS Forty patients (20 females and 20 males, mean age 11.8±2.2) with impacted supernumerary teeth in anterior palatine area were included into our study, and were divided into 3 groups according to their age. A 24-week follow-up was conducted and the sensation in the anterior hard palate region was examined at every check point. All the data were collected and analyzed by Kaplan-Meier analysis. RESULTS Fourteen children did not complain of any numbness immediately after anesthetization, and other children with sensory disorders had shorter healing periods compared to adolescent/adult patients. CONCLUSIONS The results indicated that the dominant nerve of the anterior hard palate region was dramatically changed from the greater palatine nerve to the nasopalatine nerve, which is important in deciding when to operate and in selection of anesthesia method.

Smad7 attenuates TGF-ß-mediated aging-related hypofunction of submandibular glands.

Submandibular glands have essential functions in taste, mastication, swallowing, and digestion. Submandibular gland hypofunction is prevalent in the elderly, impairing the patients' quality of life. Current clinical treatment strategies have not decelerated or reversed the pathological process of submandibular gland hypofunction. Therefore, novel restoration strategies should be explored. However, studies on the mechanism of aging-related submandibular gland hypofunction remain very limited. The role of the TGF-ß/Smad pathway in fibrosis has been studied in other organs. Therefore, this study aimed to elucidate the role of TGF-ß/Smad signaling in the aging-related submandibular gland hypofunction. The results showed that Smad7 knockout in mice decreased the salivary flow rate. H&E, Masson trichrome, and immunohistochemistry staining of MCP-1 and α-SMA showed that Smad7 knockout in mice resulted in lymphocytic infiltration, acinar cell atrophy, and interstitial fibrosis. The Western blotting of collagen I and III also confirmed extensive fibrosis. We then found that Smad7 depletion resulted in the TGF-ß-mediated fibrosis via mir-21, mir-29, and np_5318, and NFκB-driven inflammation activation. This study confirmed the inhibitory role of Smad7 in the aging-related submandibular gland hypofunction. Therefore, it provided a promising treatment target for aging-related dysfunction and sialadenitis of submandibular gland.

Maxillofacial injuries caused by the 2008 Wenchuan earthquake in China.

PURPOSE: To describe the pattern of maxillofacial injuries sustained by survivors of the 2008 Wenchuan earthquake in the West China Hospital of Stomatology from May 12 to June 23, 2008. PATIENTS AND METHODS: Cross-sectional data were analyzed using hospital-based records of earthquake survivors admitted to the West China Hospital of Stomatology. A self-designed form to record information about variables such as the gender and age of the survivors and type of location of soft and hard tissue injuries was used. RESULTS: The age of earthquake survivors of maxillofacial injuries ranged from 4 to 84 years. Fractures and soft tissue injuries were the most common of all injuries in the maxillofacial region, constituting 40.7% and 38.9%, respectively. Thirteen patients (11.5%) had dental injuries and 9 (8.0%) also had other organ injuries. CONCLUSION: During the Wenchuan earthquake, the incidence of maxillofacial injuries in survivors was relatively low compared with injury in other organs. However, because most injuries were maxillofacial fractures and facial soft tissue damage, special attention was paid to maxillofacial injury when planning and providing emergency treatment. The effective management of earthquake injuries and those caused by other types of disaster requires a multidisciplinary approach, and maxillofacial surgeons should form an integral part of this multidisciplinary team.

Piezosurgery vs conventional rotary instrument in the third molar surgery: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND/PURPOSE: The surgical removal of mandibular third molars is frequently accompanied by significant postsurgical sequelae. Different instruments such as piezosurgery and conventional rotary handpiece have been used to decrease such adverse events. There are controversial results from randomized controlled trials evaluating the effects of Piezosurgery in the mandibular third molar extraction, compared with conventional rotary instrument. This study was performed to determine the impact of piezosurgery versus conventional rotary instrument on postoperative reactions after extraction. MATERIALS AND METHODS: A systematic review and meta-analysis was performed to combine relevant RCTs results. RESULTS: Five RCTs were eligible for this study, enrolling a total of 402 patients. Compared with conventional rotary instrument, pain score at 6 or 7 days and mouth opening at 1 day after surgery was significantly lower in Piezosurgery group (SMD -0.33, 95% CI: -0.56 to -0.10, P = 0.005), as well as swelling score at 7 days after surgery (SMD -1.95, 95% CI: -3.22 to -0.67, P = 0.003). Furthermore, mouth opening at 1 day after surgery was significantly better in patients treated with Piezosurgery (SMD 0.84, 95% CI: 0.19 to 1.49, P = 0.01). However, more operation time will be required for Piezosurgery (MD 6.23, 95% CI: 3.32 to 9.14, P < 0.0001). With regard to analgesic dosage, pooled results from two RCTs suggested there were no significant differences between Piezosurgery and conventional rotary instrument (SMD -1.45, 95% CI: -4.39 to 1.49, P = 0.33). CONCLUSION: There might be some advantages on third mandibular molar extraction with piezosurgery compared to conventional rotary instrument. More multi-centre trials are required to get more conclusive results.

Primary tumor prevalence has an impact on the constituent ratio of metastases to the jaw but not on metastatic sites.

This article provides an overview of metastases to jaws (MJ), mainly concerning the differences between American and Chinese patients, and exploring the relationship between the primary tumors' prevalence (PTP) and constituent ratio of MJ. Information concerning of 399 MJ cases in 215 papers, including one new case in our hospital, was subjected to statistic analysis. The main clinical features of MJ, such as constituent ratio of PTP and that of MJ, metastatic sites, treatments, and prognosis were summarized. Breast, lung, kidney, prostate and thyroid (in descending order) were the leading primary sites of MJ. Furthermore, the constituent ratio of MJ was found to be correlated with that of PTP in all subjects including American and Chinese subjects in our study. As to metastatic sites in the mandible, a specific "M" shaped pattern appeared regardless of the tumor type or constituent ratios of MJ were in all subjects. Almost all subjects received traditionally palliative treatments, and the prognosis was quite poor. The PTP had a significant impact on the constituent ratio of MJ. However, it was the properties of the microenvironment rather than characteristics or constituent ratios of tumor cells, that decided the metastatic sites in various tumor subjects.

Analysis of 46 maxillofacial fracture victims in the 2008 Wenchuan, China earthquake.

PURPOSE: At 14:28 hours on May 12, 2008, a massive earthquake wracked most areas of Sichuan, China, causing catastrophic human loss. The aim of this study was to delineate the characteristics of victims with maxillofacial fractures in this disaster. PATIENTS AND METHODS: A descriptive analysis was conducted based on the medical records of earthquake maxillofacial injuries casualties transferred to West China Hospital of Stomatology, Sichuan University, after the earthquake. Data regarding demographic details, psychological status, patterns, anatomic sites, etiology, concomitant injuries, and management of earthquake maxillofacial fractures were evaluated. RESULTS: A total of 46 maxillofacial fracture patients' records of 28 (60.9%) males and 18 (39.1%) females were included in this study, with peak incidence (32.6%) in the elderly age group (older than 50 years). The most common etiology of earthquake maxillofacial fractures was building collapse (71.7%). The mandible (65.2%) was the most frequent site of the maxillofacial fracture, followed by the zygomatic complex (21.7%) and maxilla (13.0%). The most prevalent of maxillofacial fracture pattern was multiple and/or comminuted fractures (56.5%), which accounted for 72.7% (24/33) in building collapse injury group. There were 9 (19.6%) patients with significant concomitant injuries and the most common site of concomitant injuries was the head (4 cases) and extremity (4 cases). Four (8.7%) patients' maxillofacial fractures were treated conservatively, 16 (34.8%) underwent closed reduction and fixation, and 26 (56.5%) underwent open reduction and rigid internal fixation (RIF). Apart from 3 patients (6.5%) who showed infection, all patients with facial fractures achieved successful bony union with an acceptable occlusion and facial form. Additionally, it is noteworthy that all patients in our study presented the symptoms of posttraumatic stress disorder (PTSD). CONCLUSION: There is a variation of mechanism of injuries, age group, severity, patterns, concomitant injuries, and management of earthquake maxillofacial fractures. Knowledge of these characteristics provides useful strategies for patient care and prevention of further complications. A multidisciplinary and coordinated approach is important for optimum stabilization and ongoing treatment of victims of building collapse injury. The high percentage of PTSD confirms that psychologists should form an integral part of this multidisciplinary team.

[Application of platelet-rich plasma in non-vascularized bone graft of maxillofacial surgery].

OBJECTIVE: To introduce the application of platelet-rich plasma (PRP) in non-vascularised bone grafts (NVBG) of maxillofacial surgery and its potential mechanism in recent years. METHODS: The latest articles were extensively retrieved, and the potential mechanism for PRP promotes the osteogenesis was discussed. RESULTS: PRP promotes osteogenesis when applied to NVBG, and the cytokine included in platelet is thought to be the ingredient for PRP's effect. Some scholar has already applied PRP in the restoration of maxillofacial bone defect and got good results. CONCLUSION: PRP has the potential to promotes osteogenesis, and more studies are needed for further understanding of its mechanism.

[Reconstruction of oral muco-defects with buccal fat pad flap].

OBJECTIVE: To evaluate the clinical outcome of the buccal fat pad flap in reconstruction of defects of the oral mucosa. METHODS: From May 1998 to July 2004, 42 patients with oral muco-defects were treated with buccal fat pad flap. Of them, there were 26 males and 16 females, aging 25-76 years. The defect was caused by buccal squamous carcinoma in 7 cases, by buccal leukoplakia in 5 cases, by squamous carcinoma of soft palate in 7 cases, by adenoid cystic carcinoma of palate in 8 cases, by carcinoma of maxillary sinus in 6 cases, by maxillo-alveolar angioma in 5 cases and by keratocyst of maxilla in 4 cases. The locations were buccal mucosa, maxillary sinus and soft palate. The size of defect ranged from 3.0 cm x 3.0 cm to 6.5 cm x 4.0 cm. RESULTS: Forty-one cases achieved healing by first intention, except one case because of large defect. Edema faded and epithelization occurred after 4 weeks of operation. Complete epithelization was observed after 6 weeks of operation. Thirty-five cases were followed up 3 months to 5 years. There were no obvious differences in layers, color, elasticity, and texture between repaired region and adjacent mucosa. CONCLUSION: The buccal fat pad flap is useful in reconstructing the muco-defects (less than 6.5 cm in diameter) of the posterior maxilla and buccal region without considerable complication. The multiplex blood supply, facility in accessing and minimal donor site morbidity make it a reliable soft tissue graft. The main shortcoming is its limited size.