Vascularized Combined with Nonvascularized Fibula Flap for Mandibular Reconstruction: Preliminary Results of a Novel Technique.

BACKGROUND: Repair of long-span mandibular defects with vascularized free fibular grafts is now a routine procedure. Vertical discrepancy between a graft segment and the occlusal plane can be resolved through several options, including delayed onlay bone graft, iliac bone reconstruction, fibula distraction, and double-barrel fibula flap grafts. The present study (level of evidence: level IV, case series) introduces a new method for mandibular augmentation, wherein a vascularized fibular segment was used to simulate the superior alveolar ridge of the neomandible, whereas a nonvascularized fibular segment was used to reconstruct the inferior border. METHODS: Patients who underwent mandibular reconstruction with this technique between January 2014 and May 2017 were retrospectively reviewed for complications, vertical height, bone resorption rates, and crown to implant (C/I) ratios. RESULTS: The study included 10 patients. Flap loss occurred in 1 patient. A sufficiently long vascular pedicle could be maintained when the average fibular length was up to 15.3 cm to reconstruct long-span mandibular defects. Mean height of the neomandible at 2 weeks and 1 year after surgery was 34.1 and 29.4 mm, respectively. Mean resorption rates of vascularized and nonvascularized fibulas were 10.3% and 3.4%, respectively, at 1 year after surgery. Dental implants were placed in 4 patients with a mean C/I ratio of 1:1.15. CONCLUSION: The present method to reconstruct the alveolar ridge and basal portion of the mandible with vascularized and nonvascularized fibular flaps was safe and effective. It provided sufficient vertical height for lip support and implantation as well as adequate length for long-span mandibular reconstruction.

Angle-to-Angle Mandibular Defect Reconstruction With Fibula Flap by Using a Mandibular Fixation Device and Surgical Navigation.

PURPOSE: Although free fibula flaps are widely used for mandibular reconstruction, 3-dimensional (3D) position is difficult to control in angle-to-angle mandibular defects. The present study describes a revised approach for angle-to-angle mandibular reconstruction with fibula flaps by using mandibular fixation device and surgical navigation. METHODS: Preoperative maxillofacial and fibular computed tomography (CT) scans were acquired, and CT data were imported into ProPlan CMF software. Virtual mandibulectomy was performed, and 3D fibula image was superimposed on the mandibular defect. The fibula flap was shaped according to virtual parameters and the stereo model. Surgical navigation was used to check and correct shaped segments. Position of the osteotomy lines and relevant parameters regarding the shape of the fibula flap were provided to the surgeon. A mandibular fixation device (Cibei, China) was fixed to bilateral mandibular ramus before mandibulectomy, which maintained normal mandibular width. Under computer navigation guidance, the fibula flap was accurately positioned in 3D direction, and the defect could be precisely reconstructed despite the lack of stable occlusal relationship after osteotomy. RESULTS: Postoperative CT and 3D error analysis revealed that osteotomy lines and reconstruction contour matched well with preoperative planning. Using our method, we precisely recovered the original configuration of the mandible. Bilateral condyles were located in the temporomandibular joint fossae, and normal mandibular width was maintained. Compared with preoperative positions, the average shift on the remaining mandible was 0.803 ±â€Š0.502 mm (largest, 1.886 mm). Average shift in the reconstructed mandible was 0.281 ±â€Š0.300 mm, largest being 2.441 mm. CONCLUSIONS: We describe a novel method for angle-to-angle mandibular reconstruction with free fibula flap. A mandibular fixation device combined with computer-assisted techniques involving surgical navigation improved clinical outcomes of this procedure.

Long non-coding RNA UCA1 contributes to the progression of oral squamous cell carcinoma by regulating the WNT/ß-catenin signaling pathway.

With the development of functional genomics studies, a mass of long non-coding RNAs (LncRNA) were discovered from the human genome. Long non-coding RNAs serve as pivotal regulators of genes that are able to generate LncRNA-binding protein complexes to modulate a great number of genes. Recently, the LncRNA urothelial carcinoma-associated 1 (UCA1) has been revealed to be dysregulated, which plays a critical role in the development of a few cancers. However, the role of the biology and clinical significance of UCA1 in the tumorigenesis of oral squamous cell carcinoma (OSCC) remain unknown. We found that UCA1 expression levels were upregulated aberrantly in tongue squamous cell carcinoma tissues and associated with lymph node metastasis and TNM stage. We explored the expression, function, and molecular mechanism of LncRNA UCA1 in OSCC. In the present work, we revealed that UCA1 silencing suppressed proliferation and metastasis and induced apoptosis of OSCC cell lines in vitro and in vivo, which might be related to the activation level of the WNT/ß-catenin signaling pathway. Our research results emphasize the pivotal role of UCA1 in the oncogenesis of OSCC and reveal a novel LncRNA UCA1-ß-catenin-WNT signaling pathway regulatory network that could contribute to our understanding in the pathogenesis of OSCC and assist in the discovery of a viable LncRNA-directed diagnostic and therapeutic strategy for this fatal disease.

Long non-coding RNA MALAT-1 modulates metastatic potential of tongue squamous cell carcinomas partially through the regulation of small proline rich proteins.

BACKGROUND: We previously described several abnormally expressed long non-coding RNA (lncRNA) in tong squamous cell carcinomas (TSCCs) that might be associated with tumor progression. In the present study, we aimed to investigate the role of abnormally expressed metastasis-associated lung adenocarcinoma transcript 1 (MALAT-1) lncRNA in the metastatic potential of TSCC cells and its molecular mechanisms. METHODS: Expression levels of MALAT-1 lncRNA were examined via quantitative reverse transcriptase polymerase chain reaction (qRT-PCR) in 127 TSCC samples as well as paired adjacent normal tissues and lymph node metastases (if exist). Lentiviral vectors expressing short hairpin RNA (shRNA) were used to knock down the expression of MALAT1 gene in two TSCC cell lines (CAL27 and SCC-25) with relatively higher MALAT-1 expression. Proliferational ability of the TSCC cells was analyzed using water soluble tetrazolium-1 (WST-1) assay. Metastatic abilities of TSCC cells were estimated in-vitro and in-vivo. We also performed a microarray-based screen to identify the genes influenced by MALAT-1 alteration, which were validated by real-time PCR analysis. RESULTS: Expression of MALAT-1 lncRNA was enhanced in TSCCs, especially in those with lymph node metastasis (LNM). Knockdown (KD) of MALAT-1 lncRNA in TSCC cells led to impaired migration and proliferation ability in-vitro and fewer metastases in-vivo. DNA microarray analysis showed that several members of small proline rich proteins (SPRR) were up-regulated by KD of MALAT-1 lncRNA in TSCC cells. SPRR2A over-expression could impair distant metastasis of TSCC cells in-vivo. CONCLUSION: Enhanced expression of MALAT-1 is associated with the growth and metastatic potential of TSCCs. Knock down of MALAT-1 in TSCCs leads to the up-regulation of certain SPRR proteins, which influenced the distant metastasis of TSCC cells.

Factors associated with follow-up attendance of patients with oral squamous cell carcinoma: A retrospective cohort study.

BACKGROUND: This study examined the postoperative follow-up attendance of oral squamous cell carcinoma (OSCC) patients, evaluated some of the factors associated with it, and assessed its relationship with early detection of postoperative disease progression. METHODS: An exploratory retrospective cohort study of 430 OSCC patients was conducted. We examined associations of follow-up attendance within the first year after surgery with selected demographic and clinical factors, and with early detection of disease progression. RESULTS: The mean number of follow-up visits within the first year after surgery was 3.9 out of the 12 recommended at our center; few patients were fully adherent. Age ≥70 years, unmarried status, high education level, and negative history of surgery for premalignant or malignant lesions from oral cavity or other sites were significantly associated with lower follow-up attendance. Greater follow-up attendance was significantly associated with early detection of disease progression during the first year after surgery (p = 0.025). CONCLUSIONS: Adherence to follow-up visits was poor. Several sociodemographic and clinical factors were related to follow-up attendance, greater follow-up attendance was significantly associated with early detection of disease progression, and these should be further explored in future research.

Computed tomography-defined sarcopenia as a risk factor for short-term postoperative complications in oral cancer patients with free flap reconstruction: A retrospective population-based cohort study.

BACKGROUND: Postoperative complications after free flap reconstruction for oral cancer can increase cost and prolong hospitalization. This study explored risk factors for complications, focusing on sarcopenia. METHODS: The study explored the associations between computed tomography-defined sarcopenia and the occurrence of postoperative complications, adjusted for age, gender, smoking, alcohol, ASA scoring, clinical stage of tumor, tumor site, type of free flap used, presence of tracheotomy, and blood test parameters. RESULTS: Of 253 patients, 17.39% (44/253) of oral cancer patients had comorbid sarcopenia. Univariate analysis showed an overall postoperative complication rate of 65.90% in the sarcopenia group and 51.67% in the non-sarcopenia group. Multivariate modeling showed sarcopenia and smoking were major risk factors for total and respiratory complications, increasing the risks by over two-fold. No factors significantly impacted surgery-specific complications. CONCLUSIONS: This study identified sarcopenia as a risk factor for postoperative complications in oral cancer patients undergoing flap reconstruction.

Factors affecting postoperative sleep quality of patients undergoing flap transfer for head and neck reconstruction.

OBJECTIVES: This study aimed to examine the postoperative sleep quality of patients undergoing flap transfer for head and neck reconstruction and to identify the associated factors. MATERIALS AND METHODS: We carried out a prospective cohort study of patients who underwent flap transfer for head and neck reconstruction at our institute between August 2020 and December 2021. The insomnia severity index (ISI) was used to examine the patients' sleep quality at postoperative week 1. Patients with an ISI score ≥ 15 were recognized as suffering from significant clinical insomnia. Descriptive statistics was used to expound the postoperative sleep quality. Associations between postoperative sleep quality and clinical variables were examined using the Chi-squared test and a Binary logistics regression model to identify the associated risk factors. RESULTS: Among the 101 patients included, their average ISI score was 15.6 (range 2-25), and 62 patients (61.4%) experienced significant clinical insomnia. Anxiety (odds ratio = 8.361; 95% confidence interval: 1.001-69.837; P = 0.049) and postoperative complications (odds ratio = 6.285; 95% confidence interval: 1.941-20.351; P = 0.002) were significantly associated with postoperative insomnia of the included patients. CONCLUSION: Postoperative sleep disturbances are highly prevalent among patients undergoing flap transfer for head and neck reconstruction, for which anxiety and postoperative complications are independent risk factors. Psychotherapy is necessary for patients with anxiety symptoms and measures should be taken to minimize the postoperative complications. Moreover, pain treatment is necessary to improve postoperative sleep quality and quality of life.

Tobacco Smoke Plays an Important Role in Initiation and Development of Lung Cancer by Promoting the Characteristics of Cancer Stem Cells.

Lung cancer is one of the most common causes of cancer-related deaths worldwide. Tobacco smoke is the single greatest risk factor of lung cancer. Although enormous progress in understanding the molecular mechanisms by which tobacco smoke leading to lung cancer has been made, the molecular pathogenesis remains largely unclear. Cancer stem cells have been implicated in cancer initiation, development, and drug resistance. In this review, we reviewed the relationship between tobacco smoke and lung cancer, the key role of cancer stem cells in lung cancer and other tumors. More importantly, we elucidate the mechanism of tobacco smoke promoting lung cancer from the perspective of the characteristics of cancer stem cells induced by tobacco smoke.

A Rare Case of Bilateral Malignant Paragangliomas.

BACKGROUND: Paragangliomas are neuroendocrine neoplasms that arise from the extra-adrenal paraganglia of the autonomic nervous system. Approximately 3% of all paragangliomas occur in the head and neck region. Most reported cases are benign and unilateral. We present a rare case of bilateral malignant paragangliomas. CASE DESCRIPTION: A 28-year-old woman presented with a 10-year history of bilateral neck swelling. Physical examination showed bilateral neck masses with obvious pulsation. Enhanced computed tomography revealed 2 irregular solid nodules, located in the left and right carotid artery bifurcation, respectively. Carotid artery angiography showed compression of the internal and external carotid arteries by the tumors on both sides. On diagnosis of the bilateral carotid body tumors, preoperative embolization was performed. The left-side lesion and lymph nodes were resected and a diagnosis of malignant paraganglioma with lymph node metastasis was made. She was treated with 50-Gy radiotherapy, and computed tomography performed 2 years later showed that the right-side lesion was unchanged. She was symptom-free as of the last follow-up. CONCLUSIONS: The rarity of bilateral malignant paragangliomas makes their management clinically challenging. The primary management of a recognized malignancy should be directed toward complete surgical removal of the primary tumor and regional lymph nodes. Postoperative radiation is beneficial in slowing the progression of residual disease. Genetic studies have shown that familial paragangliomas are associated with germline mutation of SDHD on 11q23.

Concomitant paraganglioma and thyroid carcinoma: A case report.

BACKGROUND: Paraganglioma/pheochromocytoma and medullary thyroid carcinoma can coexist and are often found in multiple endocrine neoplasia (MEN). However, very few cases highlight papillary thyroid carcinoma. We present herein a rare case of head and neck paraganglioma associated with papillary thyroid carcinoma. CASE SUMMARY: A 51-year-old man presented to our department with right-sided neck swelling and hypertension. Physical examination showed neck masses with obvious pulsation. Concentrations of serum calcium, phosphorus, parathormone, thyroid stimulating hormone, free thyroxine, and calcitonin were within normal limits. Enhanced computed tomography revealed an irregular solid nodule, located in the carotid artery bifurcation. A low-density nodule of the thyroid isthmus with a spot-like dense shadow was also detected. The diagnosis of carotid body tumor was raised and an ultrasound-guided fine needle aspiration biopsy of the thyroid nodule revealed papillary thyroid carcinoma. The patient underwent surgery for lesion excision, total thyroidectomy, and neck dissection, and the pathology was reported as paraganglioma and papillary carcinoma. Genetic studies showed negative results for germline mutation of succinate dehydrogenase subunit D on 11q23. He was treated with 131I after surgery and remained disease-free so far. CONCLUSION: The presence of concomitant paraganglioma and thyroid papillary carcinoma could be either coincidental or a result of an unknown mutation.

Surgical management and follow-up of lateral skull base tumors: An 8-year review.

The purpose of the present article was to describe the diagnostic evaluation of, and surgical approaches to, lateral skull base tumors (LSBTs). The study is a retrospective review of 21 patients diagnosed with tumors that involve lateral skull base (8 with malignant diseases and 13 with benign lesions) who were surgically treated during a 8-year period. The transparotid-transmandibular (38%) was the most commonly performed surgical procedure, followed by the transmandibular (24%), the transmaxillary (24%), the transcervical approach (10%) and the combined approach (4%). The surgical procedures were uneventful and there were no postoperative mortalities. Complications were encountered in 12 cases, and morbidity was not remarkable during the perioperative stages. After an average follow-up of 46 months, only 1 of 14 patients with benign diseases had a recurrence following the resection of a pleomorphic adenoma. Of 7 patients with malignant tumors, 5 are alive with no evidence of disease. The majority of the benign lateral skull base tumors can be removed surgically with a low rate of complications and recurrence. However, malignant neoplasms carry a poor prognosis and a low rate of disease-free survival.

Salivary duct carcinoma of the parotid gland: A case report and review of the literature.

Salivary duct carcinoma (SDC) is a rare and aggressive parotid malignancy that most commonly affects males in the fifth and sixth decades of life. Histopathology specimens obtained from SDC patients demonstrate a resemblance to ductal carcinoma of the breast. Therefore, to distinguish SDC from breast ductal carcinoma, several immunohistochemical markers exist that may enable surgeons to make an accurate diagnosis. In this study, the case of a 54-year-old male with salivary duct carcinoma of the right parotid gland is presented. The results of the present case study revealed that the SDC sample was positive for the expression of human epidermal growth factor 2 (Her-2), cytokeratin (CK) 8/CK 18, p63, high molecular weight CK and calponin, and negative for expression of the estrogen receptor and progesterone receptor. Based on the result, an ipsilateral selective neck dissection followed by adjuvant post-operative radiation therapy was suitable at the primary treatment stage. At one year of follow-up, the patient was alive and free of recurrence. In advanced cases of SDC, treatment with anti-HER-2 monoclonal antibodies, such as trastuzumab, is recommended.

Basaloid squamous cell carcinoma of the maxillary gingiva: A case report and review of the literature.

Basaloid squamous cell carcinoma (BSCC) is a rare, but distinct histologic variant of squamous cell carcinoma in the head and neck region. It is considered to have a poor prognosis due to its aggressive behavior and tendency to metastasize. The usual sites of BSCC are the floor of the mouth, hypopharynx and base of the tongue, and according to the English-language literature its presentation in the gingiva is somewhat uncommon. In the current report, the unusual case of a 40-year-old male is presented; the patient exhibited a painless irregular mass in the maxillary gingiva, which infiltrated the maxillary sinus, as observed by computed tomography. Hematoxylin and eosin-stained sections revealed a diagnosis of BSCC with typical central necrosis in the cancer nests, which contained basaloid and squamous cells. Immunohistochemistry revealed that p63 was weakly positive, high molecular weight cytokeratin (CK) was focally positive, and S-100, CK7, CK14 and vimentin were negative. It must be noted that histopathology results may be incorrectly interpreted as adenoid cystic carcinoma, undifferentiated carcinoma and basal cell adenocarcinoma.

[Expression and significance profile of human beta-defensin-2 in salivary gland tumors and inflammation].

OBJECTIVE: To investigate the expression characteristics of human beta-defensin-2 (HBD-2) mRNA and protein in salivary gland benign and malignant tumor tissues, as well as in salivary gland inflammation. METHODS: The expression of HBD-2 in salivary gland benign tumor, salivary gland cancer, inflammation tissues and normal salivary gland tissues were detected by polymerase chain reaction (PCR), real-time polymerase chain reaction (Real-Time PCR) and immunohistochemical. The differences expression of HBD-2 mRNA and protein were analyzed. RESULTS: RT-PCR results showed that HBD-2 mRNA expression in salivary gland benign tumors, salivary gland cancer, and inflammation tissues was 6.468-, 0.334-, and 10.563-fold higher than that in normal tissues, respectively (P < 0.05). HBD-2 was expressed in the nuclei of these organs and malignant tissues. CONCLUSION: HBD-2 mRNA and protein expressions are significantly increased in salivary gland benign tumor tissues and inflammation tissues compared with those in normal salivary gland tissues, but are significantly decreased in salivary gland cancer. The protein nuclear transfer in salivary gland cancer tissues is also significantly increased.