Analysis of clinical changes and magnetic resonance imaging features of 37 patients with temporomandibular joint disc condylar complex with anterior disc displacement without reduction.

OBJECTIVES: This study aims to investigate clinical outcomes, imaging changes, and age differences with regard to temporomandibular joint disc condylar complex with anterior disc displacement without reduction (ADDWoR). METHODS: A total of 37 patients (45 lateral joints) with ADDWoR who were admitted to The First Affiliated Hospital of Zheng Zhou University from January 2016 to June 2023 were selected. The patients were composed of 4 males and 33 females and had an average age of 23.5 years. The average course of the disease was 14.4 months. Clinical and magnetic resonance imaging (MRI) data were collected at the end of initial diagnosis and follow-up, and the length and thickness of the articular disc, the angle of the disc condyle, and the height of the condyle were measured. The statistical significance of the changes was assessed using SPSS 25.0 software package. RESULTS: At the end of follow-up, disc displacement in three patients (three lateral joints) was healed. Approximately 48.4% of the patients felt that limitation of mandibular movement was not alleviated; 58.3% of patients reported that pain during mouth opening was not reduced; 54.5% reported pain while chewing; 33.3% of the patients showed facial deviation, and only one showed remission. The mean disk-condyle angle increased from 61.63° to 67.81°. The average length of articular disc shortened from 8.20 mm to 7.27 mm, and the height of the condyle significantly decreased from 23.17 mm to 22.76 mm (P<0.05). The absorption ratio of the condyle increased, and no significant differences in the changes of joint soft and hard tissues between the adolescent and adult groups (P>0.05). CONCLUSIONS: In different age groups of patients with ADDWoR, clinical symptoms cannot be completely relieved. The disc is anteriorly displaced and shortens, condylar height decreases, and secondary facial asymmetry and mandibular retraction occur.

Induction chemotherapy combined with immunotherapy in locally advanced head and neck squamous cell carcinoma.

BACKGROUND: This study aimed to explore the efficacy and safety of sintilimab combined with induction chemotherapy (IC) in locally advanced head and neck squamous cell carcinoma (HNSCC) patients. METHODS: A total of 163 patients were prospectively enrolled; 98 patients received IC only, and 65 patients received IC with sintilimab. Following neoadjuvant therapy, patients either underwent surgery (31.9%) or chemoradiotherapy (68.1%). Objective response rate (ORR), progression free survival (PFS), overall survival (OS), and toxicities between the two groups were compared. RESULTS: The ORR in the IC group was significantly lower than that in the IC with sintilimab group (68.4% vs 84.6%, P = 0.019). Grade 3 or higher acute toxicity occurred in 15 (15.3%) and 12 (18.5%) patients in the IC and IC with sintilimab groups, respectively. However, this difference was not significant (P = 0.596). After follow-up with a median time of 28.0 months, the IC group had a 2-year PFS rate of 27% (95%CI: 18-36%), whereas the IC with sintilimab group had a 2-year PFS rate of 44% (95%CI: 32-56%), and this difference was significant (P = 0.041). The 2-year OS rates in the IC and IC with sintilimab groups were 61% (95%CI: 52-70%) and 70% (95%CI: 60-80%), respectively, the difference was not significant (P = 0.681). CONCLUSIONS: Addition of sintilimab to IC could provide longer PFS time than traditional chemotherapy regimen, without increasing the toxicity events.

[Clinical analysis of arthroscopy used in the diagnosis and treatment of synovial chondromatosis of the temporomandibular joint].

OBJECTIVES: To evaluate the value of arthroscopy in the diagnosis and treatment of synovial chondromatosis of the temporomandibular joint (TMJSC). METHODS: The cases of 16 patients preliminarily diagnosed with TMJSC by magnetic resonance imaging (MRI) from July 2011 to December 2018 were analyzed retrospectively. If the diagnosis was confirmed by arthroscopy, the opening operation was performed. The preoperative MRI, arthroscopy and opening operation, postoperative pathology and postoperative MRI of confirmed cases were analyzed, and clinical follow-up was performed to evaluate the curative effect of open surgery. The degree of mouth opening and visual analogue scale (VAS) scores for pain pre-operation and during follow-up of the confirmed cases were analyzed by t-test. RESULTS: Fourteen cases of TMJSC were diagnosed by arthroscopy, consistent with the postoperative pathological diagnosis. Postoperative MRI examination showed that articular cavity lesions basically disappeared. Ten patients with synovial chondromatosis were followed-up (follow-up rate, 71.4%) from 6 months to 7 years and 8 months (average follow-up time, 17.6 months); no recurrence was found, and clinical symptoms improved by varying degrees. Before operation and at follow-up, t-test results of opening degree difference were t=7.757, P<0.05; t-test results of VAS were t=-3.274, P<0.05. CONCLUSIONS: Arthroscopy is essential in the diagnosis and treatment of TMJ synovial chondromatosis.

The assessment of the accuracy of clinical preoperative lymph node.

PURPOSE: The aim of the present study is to assess the accuracy of clinical preoperative lymph node and to define the degree of relation between the clinical preoperative assessment and histopathological examination in patients with head and neck cancer and cN+. METHODS: This retrospective study was performed on 125 patients (85 males and 40 females) at the Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Zhengzhou University, between December 2012 and December 2014. RESULT: Of all the patients who underwent neck dissection, 37 were found with no neck metastasis. Positive or suspected lymph nodes were detected at computed tomography (CT) in 44 and detected at ultrasonogram diagnosis (USG) in 38 of 125 patients, and the necks were assessed as normal in 55 (44%) by both USG and CT. CONCLUSION: Further investigation is needed to evaluate the rates of overall survival and disease-free survival of these N0 patients with neck dissection.

[Retrospective study of temporomandibular joint dislocation by surgical treatment].

OBJECTIVE: This study aimed to retrospectively analyze temporomandibular joint dislocation by surgical treatment and evaluate the treatment effect. METHODS: From May 2012 to April 2016, a total of 17 cases of temporomandibular joint dislocation were surgically treated, including 8 cases of irreducible dislocation (ID) and 9 cases of recurrent dislocation (RD). Synovial injection of sclerosing agent by arthroscope was performed in 5 cases, 9 sides; augmentation of the articular eminence by titanium plate implantation was performed in 7 cases, 12 sides; iliac bone transplantation was performed in 1 case, 1 side; Medpore implantation was performed in 3 cases, 6 sides; and eminectomy and capsular tightening were performed in 1 case, 2 sides. Follow-up was conducted 1-5 years after the operation, and the success rate statistics was obtained. RESULTS: The cure rate of synovial injection of sclerosing agent by arthroscope was 77.8% (7/9), and the effective rate was 100%. The cure rate of titanium plate implantation was 75% (9/12), and the effective rate was 100%. The cure rates of augmentation of the articular eminence by Medpore implantation (6/6), iliac bone graft (1/1), and eminectomy (2/2) were 100%. CONCLUSIONS: The surgical method of temporomandibular joint dislocation was selected according to the state of the patients. The postoperative recurrent patients were advised to undergo augmentation of the articular eminence by Medpore implantation, which offered a reduced chance of recurrence and relatively less injury, as well as a simple operative method.

The Use of Venous Coupler Device in Free Tissue Transfers for Oral and Maxillofacial Reconstruction.

PURPOSE: Microvascular anastomosis remains the most challenging and important technique affecting the success of free tissue transfers. A microvascular anastomotic coupling device is often used. This study is a retrospective review of the use of a venous coupler for head and neck reconstruction during a 2-year period at the Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Zhengzhou University (Zhengzhou, China). MATERIALS AND METHODS: Sixty-nine consecutive cases of microvascular free flaps from December 2012 through December 2014 were retrospectively reviewed. Patients' demographic information (age and gender), defect location, flap type, recipient vein, anastomotic time, coupler size, microvascular complications, and flap survival rate were collected and analyzed. RESULTS: Sixty-nine anastomotic coupler devices were used for 69 flaps. Of the 69 flaps performed, there were 26 anterior lateral thigh flaps (37.68%), 25 radial forearm flaps (36.23%), 17 fibula flaps (24.64%), and 1 deep inferior epigastric perforator flap (1.45%). The branch of the internal jugular vein was the most common recipient vein (n = 29; 40.03%), followed by the facial vein (n = 25; 36.23%) and the external jugular vein (n = 15; 21.74%). Coupler sizes ranged from 1.5 to 3.5 mm, with most being 2.5 mm (n = 41; 59.42%), followed by 3.0 mm (n = 19; 27.54%), 2.0 mm (n = 7; 10.14%), 1.5 mm (n = 1; 1.45%), and 3.5 mm (n = 1; 1.45%). The average operation time was 3 to 11 minutes for venous anastomosis (∼6 minutes on average). Postoperative complications were seen in 7 of 69 flaps (10.14%), and no complications led to complete flap loss. The overall flap success rate was 100%. Total coupler venous thrombosis rate was 4.35% (3 of 69). CONCLUSION: The microvascular coupler shows reliability for venous anatomosis in head and neck reconstruction free tissue transfers. Use of a microvascular anastomotic coupler could simplify vascular anatomosis, considerably shorten operative time, and achieve excellent vessel patency and flap success rate.

[Cervical ectopic thymus in an infant].

Cervical ectopic thymus rarely occur. We reported a case of cervical thymus presenting as a unilateral neck mass in an infant. Ultrasonography showed a low echo-level mass with clear border and abundant blood flow signal in the left neck. Preoperative chest CT revealed normal structures in the superior mediastinum including the thymus. Surgical resection was performed and the histological diagnosis was ectopic cervical thymus.

[Diagnosis and choice of surgical methods on traumatic temporomandibular joint ankylosis].

PURPOSE: The purpose of this study was to explore the diagnosis and operative methods for traumatic temporomandibular joint ankylosis. METHODS: Fourteen patients (8 females, 6 males; aged from 7 to 23 years, median age 17.5 years) with traumatic TMJ ankylosis of 1 to 15 years' duration, with a maximal mouth opening(MMO) from 0 to 1.0cm(average:0.46cm) preoperatively were included in this study. They were further divided into two types(I and II) based on false articulation medial to the analysis as shown by coronal computed tomography (CT) coronoid scan. 7 TMJs were treated with medial arthroplasty(MA), in which the lateral fusional bone was removed and the medial false articulation was retained for type I, 6 TMJs were treated with natural positional arthroplasty(NPA) in which the bony fusion between the condyle and glenoid fossa was separated and shaved, the disc was retained and repositioned for type II. Follow-up was carried out and the surgical effect was assessed based on clinical and imaging findings. Student's t test was conducted for comparison with SPSS15.0 software package. RESULTS: There was 9 TMJs from 7 patients for type I and 5 TMJs from 5 patients for type II as shown by CT. The mean postoperative MMO was 3.12cm, and the condylar shape was smooth on CT scan. There was significant difference between preoperative and postoperative MMO, P<0.01. There was no significant difference between MA and NPA, P>0.05. CONCLUSIONS: It is concluded that type I is more common in traumatic TMJ ankylosis than type II. The surgical effect of MA and NPA is good, with less injury, and is worthy of wide application.

[Culture of rabbit parotid acinar cells and evaluation of its excretion function in vitro].

PURPOSE: To obtain a large number of rabbit parotid acinar cells with excretion function in vitro. METHODS: Rabbit parotid acinar cells were cultured in the reformed DMEM; The shape and structure of cultured cells were observed with phase contrast microscope; Pan cytokeratin(PCK), alpha-amylase and actin of the cultured parotid acinar cells were examined with immunocytochemical SP technique; the secretion of different generations was evaluated with positive expression status of alpha-amylase. SPSS10.0 software package for windows was used for Student's t test. RESULTS: The acinar cells had the ability of proliferation, they could pass 4 generations and survive for 4 weeks. The specific immunocytochemical staining for PCK and alpha-amylase could be seen in the plasm and (or) membrane of parotid acinar cells, but not for actin. The positive expression of alpha-amylase in the primary generation, generation 1, 2 and 3 was 79.6%, 76%, 47.7% and 2.4%, respectively, which decreased gradually. There was a significant difference between the second generation and two earlier generations(P<0.05). CONCLUSION: The primary and first generations of parotid acinar cells maintain their characteristics and proliferation in vitro,which is very useful for further experiment.