Lack of association between PAX6/SOSTDC1/FAM20B gene polymorphisms and mesiodens.

BACKGROUND: The purpose of this study was to analyze the association between the genetic polymorphism of genes (PAX6, SOSTDC1and FAM20B) and the susceptibility to mesiodens. METHODS: This study was carried out on 50 patients with mesiodens and 50 controls. The family history of each patient with mesiodens were recorded. Genomic DNA was extracted from saliva samples, and single nucleotide polymorphisms were detected in all exons and exon/intron boundaries of PAX6, SOSTDC1 and FAM20B using Sanger sequencing. The data were analyzed using pearson chi-square test with theoretical frequency ≥ 5. For theoretical frequency less than 5 but at least 1 (≤20% cell), the data were analyzed by continuity correction. For the rest, Fisher's Exact test was used. A P-value< 0.05 was considered statistically significant. The Odds ratio (OR) and confidence intervals (CI) were recorded. RESULTS: Three polymorphisms were detected in PAX6. Two polymorphisms were detected in SOSTDC1. Twenty-nine polymorphisms were detected in FAM20B. Although, the T allele of FAM20B (rs3766626) appears to be associated with mesiodens (P = 0.051), there were no significant differences of PAX6/SOSTDC1/FAM20B gene polymorphisms between the two groups. The T allele of FAM20B (rs3766626) was associated with susceptibility to two mesiodens (P < 0.001; OR = 8.333; CI = 2.516-27.600). CONCLUSIONS: Lack of association between PAX6/SOSTDC1/FAM20B gene polymorphisms and mesiodens in the population studied was detected. Further studies with large samples on T allele of FAM20B (rs3766626) are needed.

[Clinical application of free peroneal artery leaflet perforator flap in postoperative complex defect of oral cancer].

Objective:To investigate the clinical effect of a segmented perforator flap of free peroneal artery to repair a complex defect after oral cancer. Methods:Forty-eight patients with oral cancer admitted to the Department of Oral and Maxillofacial Surgery of the First Affiliated Hospital of Bengbu Medical College from January 2018 to January 2022, including 8 of buccal cancer, 7 of floor cancer, 14 of tongue cancer, 5 of retromolar cancet, 9 of maxillary gingival cancer and 5 of mandibular gingival cancer. After lesion resection, 24 patients in the experimental group used the partial perforator flap to repair the defect, and 24 patients in the control group used the single flap to repair the defect. Compared with the general data of the two groups, the difference was not statistically significant（P>0.05）, which was comparable. The flap cutting range of the experimental group was 38.5-74.5 cm², and tension-reduced suture for the donor area. In the control group, the myocutaneous flap incision range was 61.0-76.5 cm², and skin graft suture for the donor area. Flap survival and patient survival were recorded and compared. The patients were followed up at 6 and 12 months after surgery, and their swallowing function and speech function, including the drinking water test, functional oral food intake scale and the Chinese language clarity test word table, were evaluated respectively, and their subjective satisfaction with the repair appearance was recorded. Patients in both groups were followed up for 12 to 60 months. Kaplan-Meier method was used to calculate the cumulative survival rate of patients, and survival curves were plotted. log-rank test was used to compare the survival curves between groups. Results:The survival rate of the two groups was 100%. The 5-year survival rate was 62.5% in the experimental group and 54.2% in the control group. There was no significant difference between the two groups （P>0.05）. According to the results of the functional recovery evaluation, the groups in swallowing and speech function and subjective satisfaction（P>0.05）, and at 12 months after surgery（P<0.05）. Conclusion:The segmented perforator flap of free peroneal artery is flexible and can repair different anatomical structures of postoperative composite defect of oral cancer, which can effectively improve postoperative functional recovery and patient satisfaction. Therefore, the peroneal artery segmented perforator flap is the ideal flap for reconstructing postoperative composite defect of oral cancer.

[Application of infrared thermography technique to assist peroneal artery perforator flap in the repair of oral and maxillofacial defects].

Objective: To explore the application value of infrared thermography (IRT) technique assisted peroneal artery perforator flap in repairing oral and maxillofacial defects. Methods: The clinical data of 20 patients with oral and maxillofacial malignant tumors treated with peroneal artery perforator flap between October 2020 and December 2021 were retrospectively analysed. There were 13 males and 7 females, with an average age of 56.5 years (range, 32-76 years). There were 8 cases of tongue cancer, 5 cases of parotid gland cancer, 4 cases of buccal cancer, and 3 cases of mandibular gingival cancer; and 12 cases of squamous cell carcinoma, 3 cases of adenoid cystic carcinoma, and 5 cases of mucoepidermoid carcinoma. Color Doppler ultrasound (CDU) and IRT technique were performed before operation to locate the peroneal artery perforator and assist in the design of the flap. The sensitivity, specificity, positive predictive value, and negative predictive value of CDU and IRT technique were compared with the actual exploration during operation. The accuracy of CDU and IRT technique in detecting the number of peroneal artery perforator and the most viable perforating points was compared. The patients were followed up regularly to observe the recovery of donor and recipient sites, the occurrence of complications, and the recurrence and metastasis of tumors. Results: The sensitivity, specificity, positive predictive value, and negative predictive value of peroneal artery perforators detected by IRT technique before operation were 72.22%, 50.00%, 92.86%, and 16.67% respectively, which were higher than those by CDU (64.17%, 33.33%, 84.62%, and 14.29% respectively). Forty-five peroneal artery perforators were found by CDU before operation, and 35 were confirmed during operation, with an accuracy rate of 77.8%; 43 "hot spots" were found by IRT technique, and 32 peroneal artery perforators were confirmed within the "hot spots" range during operation, with an accuracy rate of 74.4%; there was no significant difference between the two methods ( χ²=0.096, P=0.757). The accuracy rates of the most viable perforating points found by CDU and IRT technique were 80.95% (17/21) and 94.74% (18/19), respectively, and there was no significant difference between them ( χ²=0.115, P=0.734). The localization errors of CDU and IRT technique were (5.12±2.10) and (4.23±1.87) mm, respectively, and there was no significant difference between them ( t=1.416, P=0.165). All the perforator flaps survived, and the incisions of donor and recipient sites healed by first intention. All patients were followed up 5-18 months, with an average of 11 months. The skin flap was soft and had good blood supply, and the lower limb scar was concealed and the lower limb had good function. No lower limb swelling, pain, numbness, ankle instability, or other complications occurred, and no tumor recurrence and metastasis were found during the follow-up. Conclusion: Compared with the CDU, using the IRT technique to assist the preoperative peroneal artery perforator flap design to repair the oral and maxillofacial defects has a high clinical application value.

[The clinical application of free skin flap transplantation in the one-stage repair and reconstruction after total glossectomy].

Objective:To investigate the clinical application of free skin flap in the one-stage repair and reconstruction after total glossectomy in patients with advanced tongue cancer. Method:Twenty-eight patients who underwent total glossectomy for advanced tongue cancer and treated with the one-stage repair and reconstruction with free skin flap ranged from January 2008 to July 2018 were recruited in this study. Among them, there were 12 cases of squamous cell carcinoma, 8 cases of adenocarcinoma, and 8 cases of adenoid cystic carcinoma. The free radical forearm flap and perforator flap of posterolateral peroneal calf peroneal artery were used in 16 and 12 cases, respectively. All patients were treated with outpatient functional rehabilitation sequence and postoperative radiotherapy within 6 months, and were followed up regularly for 1, 3 and 5 years to understand their living conditions, and Washington University students' quality questionnaire 4 was used to investigate the functional factors of the healthy patients in different periods of time after surgery. Result:The survival rate of the free skin flap was 94%. The radical forearm flap was immediately changed to perforator flap posterolateral peroneal calf peroneal artery in 2 cases due to the necrosis of the artery. The hospitalization time of the patients was 10-14 days, with an average of 12.5 days. The wounds inside and outside of the mouth were healed by first intention at the time of discharge. All nasogastric tube and tracheal tube were removed safely within 45 days after the surgery and the functions of swallowing, breathing, language and chewing were gradually restored. According to the questionnaire survey, patients' attention to quality of life gradually shifted from function to feeling. With the direct calculation method, the 1-,3-, and 5-year survival rate was 96.40%, 64.71%, 55.60%, respectively, while tumor-free survival rate was 85.70%, 58.82%, 55.60%, respectively. Conclusion:The comprehensive treatment based on free tissue flap repair and reconstruction of tissue defects can significantly improve the radical cure rate of patients with advanced tongue cancer, and can effectively restore the functions of swallowing, breathing, language, chewing and so on. It is a kind of treatment method worthy of promotion.

[Effect of double-leaf perforator free flap posterolateral calf peroneal artery on reconstruction of oropharyngeal anatomy after ablation of advanced oropharyngeal carcinoma].

OBJECTIVE: To evaluate the effect of using free double- leaf perforator flap posterolateral calf peroneal artery in anatomical reconstruction of the oropharyngeal structure after ablation of advanced oropharyngeal carcinoma. METHODS: Twenty-six patients with oropharyngeal defects after ablation of oropharyngeal malignancies were recruited, including 12 with carcinoma in the tongue base, 5 in the latenral pharyngeal wall and 9 in the soft palate. Between July, 2016 and July, 2018, the patients underwent surgeries for reconstruction of the oropharyngeal defects using flaps. The areas of tissue defects repaired by double-leaf perforator flaps ranged from 40.5 to 72.5 cm2. Reconstruction was performed for oropharyngeal defects in the soft palate, pterygopalate, parapharyngeal, pterygo- mandibular, and tongue base tissues. The patients' outcomes including mouth opening, functions of deglutition, linguistic function, restoration of palatopharyngeal anatomical structure and postoperative survival were evaluated, and their quality of life was assessed using FACT-H&N scale (Chinese Edition). RESULTS: All the 26 patients with transplantation of the free flaps survived. Six months after the operation, the oropharyngeal function and anatomical structure of the patients were basically restored. The questionnaire survey showed that the patients' physical, social/family, emotional and functional conditions, the total score of the core scale, items scores for the head and neck, and the total score of the scale all improved significantly after the operation compared with those before the operation (P < 0.05). CONCLUSIONS: The free peroneal artery bilobate perforator flap in the posterolateral crus, which seldom has anatomical variations of the blood vessels, allows flexible design and contains rich tissue volume to facilitate defect repair with different approaches and ranges. The application of this flap, which is an ideal perforator flap for reconstruction of the oropharyngeal structure and function, can improve the quality of life of patients following operations for advanced oropharyngeal cancer.

[Clinical application of mandibular osteomuscular flap pedicled with temporalis to repair maxillary bone defect].

OBJECTIVE: To evaluate the clinical effect of mandibular osteomuscular flap pedicled with temporalis to repair maxillary defect. METHODS: From March 2008 to May 2010, ten cases of maxillary defects resulted from malignant tumor resection were treated with mandibular osteomuscular flap pedicled with temporalis. Ten cases of malignant tumor included six cases of Squamous cell carcinoma,one case of duct carcinoma, osteosarcoma, chondrosarcoma and malignant melanoma. One case was repaired by mandibular osteomuscular flap only, nine cases were repaired by mandibular osteomuscular flaps combined with other soft tissue flaps. RESULTS: All the 10 mandibular osteomuscular flaps survived completely with no complication. The patients were followed up for 12 to 36 months, with an average of 18 months. Satisfactory appearance and complete functional restoration were achieved except for one case of chondrosarcoma recurrence. CONCLUSIONS: The mandibular osteomuscular flap pedicled with temporalis is safe and easily performed with less complication. It is an ideal method for repairing the maxillary defect.

[Early effectiveness of combining radial forearm free flap and adjacent tissue flap in reconstruction of palatomaxillary defects].

OBJECTIVE: To investigate the method of combining radial forearm free flap and adjacent tissue flap in reconstruction of palatomaxillary defects and its effectiveness. METHODS: Between March 2005 and May 2010, 17 patients with palatomaxillary defects were treated. There were 11 males and 6 females with an age range of 45-74 years (mean, 62.5 years), including 1 case of benign tumor and 16 cases of malignant tumors (7 cases of squamous cell carcinoma of palate, 1 case of recurring squamous cell carcinoma of palate, 1 case of malignant melanoma of palate, 1 case of adenoid cystic carcinoma of palate, 1 case of malignant melanoma of maxilla, 1 case of ductal carcinoma of maxilla, and 4 cases of squamous cell carcinoma of maxilla). The maxillectomy defect ranged from 7.0 cm x 5.5 cm to 10.0 cm x 7.5 cm. According to Brown's classification for the maxillectomy defect, there were type II in 15 cases, type III in 2 cases. Palatomaxillary defects were repaired with radial forearm free flap and buccal fat pad in 11 cases, and with radial forearm free flap, buccal fat pad, and mandibular osteomuscular flap pedicled with temporal muscle in 6 cases. The effectiveness was evaluated after operation by observing the vitality of the flap, the functions of speech, swallowing, breath, and the facial appearance. RESULTS: All cases were followed up 6-12 months without tumor recurrence. All flaps and skin grafts at donor sites survived. The functions of speech, swallowing, and breath were normal without obvious opening limitation. The facial appearance was satisfactory without obvious maxillofacial deformity. No enophthalmos occurred in patients with orbital floor and infraorbital rim defects. The patients had no oronasal fistula with satisfactory oral and nasal functions. CONCLUSION: According to the type of palatomaxillary defects, it can have good early effectiveness to select combining radial forearm free flap and buccal fat pad or combining radial forearm free flap, buccal fat pad, and mandibular osteomuscular flap for repairing defects.