[Influence of mandibulotomy approaches on oral function following radical resection of tongue carcinoma].

OBJECTIVE: This study aimed to compare the influences of postoperative oral function in patients with median or paramedian mandibulotomy during the radical resection of tongue carcinoma and to provide evidence for the choice of osteotomy location for mandibulotomy. METHODS: The clinical data of 126 patients who underwent combined radical neck dissection with mandibulectomy and glossectomy followed by simultaneous reconstruction were analyzed retrospectively. The patients were divided into two groups according to the position of mandibulotomy: median mandibulotomy group (median group, n=60) and paramedian mandibulotomy group (paramedian group, n=66). The fourth edition of the University of Washington Quality of Life Questionnaire (UW-QOL) was used to compare the differences in oral functions, such as swallowing, mastication, and speech, between the two groups during regular follow-up. SPSS 24.0 software package was used for statistical analysis, and P<0.05 was considered statistically significant. RESULTS: Six months after the operation, no significant differences in swallowing, mastication, and speech functions were found between the median and paramedian groups. However, the swallowing and speech functions in the paramedian group were better than those in the median group 1 year after the operation (P<0.05), whereas no statistical difference in mastication function was observed between the two groups. CONCLUSIONS: Evaluation of the postoperative oral function results showed that paramedian mandibulotomy was a better surgical approach than median mandibulotomy. Paramedian mandibulotomy is worth prioritizing in the radical resection of tongue carcinoma.

[Application of the nasolabial fold "smile" incision approach in posterior buccal cancer ablation].

OBJECTIVE: This study investigated the feasibility and clinical result of radical resection of posterior buccal carcinoma by using the facial nasolabial fold "smile" incision approach. METHODS: From August 2016 to March 2017, 23 patients with posterior buccal carcinoma were included in this study and underwent radical surgery. Upon finishing the cervical lymph node dissection, an arc-shaped incision was made at 1 cm lateral to the ipsilateral angulus oris, extending along the nasolabial fold upward to the inferolateral margin of the nasal alar while downward in direct continuity with the neck dissection incision. RESULTS: Satisfactory exposure and easy resection of the primary tumor with negative surgical margin were achieved in all 23 patients. After 12-22 months of follow-up (16.5 months on average), all patients recovered favorably, and no local recurrence or distant metastasis was observed. Mouth opening was restored to normal in all cases. The scars were hidden in the nasolabial fold, thus named "smile" incision. CONCLUSIONS: For posterior buccal cancer patients, the facial "smile" incision approach can satisfy the need of surgical exposure, facilitate operative performance, and preserve the annular integrity of the lips without affecting the radical tumor ablation, thereby maintaining a favorable mouth opening. With these advantages, the "smile" incision approach is considered worthy of being popularized in clinical application.

A comparative study between submandibular-facial artery island flaps (including perforator flap) and submental artery perforator flap: A novel flap in oral cavity reconstruction.

OBJECTIVE: The purpose of this study was to introduce submandibular-facial artery island flaps (S-FAIF), including the perforator flap, and to evaluate their application for intraoral reconstruction in comparison with submental artery perforator flaps (SMAPF). METHODS: Ninety-six patients who underwent intraoral reconstruction using an S-FAIF (n = 34) or SMAPF (n = 62) after cancer resection were recruited in this study. The flap characteristics (viz., pedicle length, flap size, venous drainage pattern, and harvest time), short-term outcomes (viz., flap partial loss, intraoral wound dehiscence, fistula, and wound infection), and long-term morbidity (viz., facial nerve palsy, neck motion restriction, and hair growth) were compared. RESULTS: Nine S-FAIFs were authentic perforator flaps pedicled by level Ⅰ facial artery perforators, while the rest were island flaps based on level Ⅱ facial artery perforators. The survival rates of S-FAIF and SMAPF were both 100 percent. Flap partial loss occurred in two patients in each group. The pedicle length of S-FAIF was shorter than that of SMAPF (p < 0.001). Statistics analysis revealed no significant difference regarding flap size, venous drainage pattern, short-term outcomes, neck motion restriction, or facial nerve palsy between the groups. S-FAIF required less harvest time (p < 0.001) and experienced less hair growth when compared to SMAPF (p = 0.011). CONCLUSIONS: The S-FAIF is a robust and reliable novel flap and on par with SMAPF for reconstruction of small and medium-sized intraoral defects. It is preferred to SMAPF when technical requirements for flap harvest and hair problems are considered. It should be supplemented to the armamentarium for intraoral reconstruction.

[The influence of different modes of delivering postoperative instructions on the side effects of wisdom tooth extraction].

PURPOSE: To study the difference between the distinct ways of delivering postoperative instructions to reduce the side effects of wisdom tooth extraction, including pain, bleeding and swelling, and improve the degree of satisfaction of the patients. METHODS: A group of 150 patients who underwent wisdom tooth extraction in the Department of Oral and Maxillofacial Surgery of Xiangya Hospital, Central South University between Jan. 2018 to Oct. 2018 were selected in this research randomly. They were divided into 3 groups randomly and 50 patients in each group. Patients in group 1 received verbal postoperative instructions, patients in group 2 received written postoperative instructions, and patients in group 3 received verbal plus written postoperative instructions. The information of age, sex and education level was collected for each patient. The side effects of pain, bleeding and swelling, and the satisfactory degree of the patients were recorded 7 days after surgery. SPSS 22.0 software package was used for statistical analysis. RESULTS: There were 81 women and 69 men among 150 patients. The mean age was 24.6±2.6 years. The results showed that the degree of pain of group 1 was significantly higher than group 2 (P=0.001) and group 3 (P=0.000). The satisfactory degree of group 1 was the lowest, and group 3 was the highest. CONCLUSIONS: The way of delivering postoperative instructions affects pain and satisfactory degree after wisdom tooth extraction.

[Methods and effects of injection of salvianolic acid B combined with triamcinolone acetonide in the treatment of oral submucous fibrosis].

PURPOSE: To introduce the methods of triamcinolone acetonide (TA) and salvianolic acid B(SA-B) intralesional injection in the treatment of oral submucous fibrosis and evaluate the treatment effects. METHODS: TA combined with SA-B were consecutively applied intralesionally 1 time weekly for 30 times. The technique of intralesional injection was that syringe needle be emptied into submucous tissues 1 cm posterior to the corner of oral cavity running from the front to retromolar area by pushing the injection, then the syringe needle retained to the original point and upward from the front to retromolar area by pushing the injection, finally the syringe needle returned to the starting point and downward from the front to retromolar area by pushing the injection. Mouth opening, the color change of the buccal mucosa and the increase of capillary vessels as determined by degree I-IV visual analog scale were evaluated at 12, 24, and 36 month. The data were analyzed with SPSS 21.0 software package. RESULTS: One hundred and fourteen subjects fulfilled the study without obvious adverse reactions. After treatment for 36 months , the net gain in mouth opening of the early stage group，middle stage group and advanced stage group was (12.0±1.2) mm, (14.5±2.4) mm and (15.5±1.5) mm, respectively. The response rate of color change of the buccal mucosa and the increase of capillary vessels in early stage group, middle stage group and advanced stage group after treatment for 36 months was 100%, 94.7% and 90.7%, respectively. CONCLUSIONS: Triamcinolone acetonide and salvianolic acid B intralesional injection is effective in the treatment of oral submucous fibrosis.

[Expression of PTPRZ1 in oral squamous cell carcinoma originated from oral submucous fibrosis and its clinical significance].

PURPOSE: This study was aimed to detect the expression of PTPRZ1 in oral squamous cell carcinoma (OSCC) originated from oral submucous fibrosis (OSF), and discuss its role in the development and progression of OSCC originating from OSF as well as its clinical significance. METHODS: Immunohistochemisty (IHC) and Western blot (WB) for the expression and distribution of PTPRZ1 were carried out in 36 cases of OSF transforming into OSCC, 23 cases of OSCC and 21 cases of healthy controls. The data were analyzed by Chi-square test using SPSS 21.0 software package. RESULTS: IHC results demonstrated that the expression of PTPRZ1 in OSCC originated from the OSF was strongly positive and the rate of positive expression was 72.22%; expression of PTPRZ1 in OSCC was weakly positive, the positive rate was 43.47%; and the expression of PTPRZ1 in healthy controls was negative. The rate of PTPRZ1 positive expression was significantly higher in OSCC originated from OSF and OSCC with non-OSF than that of the healthy controls (P<0.01). The positive expression rate of OSCC originated from OSF was significantly higher than that of OSCC with non-OSF (P<0.05).WB results showed the expression of PTPRZ1 was weak in the healthy controls and in OSCC with non-OSF, but strong in OSCC originated from OSF. Correlation analysis between PTPRZ1 and clinical data showed PTPRZ1 was correlated with recurrence and metastasis positively (rk=0.642, P<0.05; rk=0.656, P<0.05). CONCLUSIONS: Differential expression of PTPRZ1 in OSCC originating from OSF and OSCC with non-OSF was significant. PTPRZ1, which plays an important role in the processes of development, invasion and metastasis of OSCC originated from OSF, can be used as a molecular marker for early diagnosis and targeted gene for treatment of OSCC originating from OSF.

Trend Analysis of Betel Nut-associated Oral Cancer and Health Burden in China.

OBJECTIVE: To forecast the future trend of betel nut-associated oral cancer and the resulting burden on health based on historical oral cancer patient data in Hunan province, China. METHODS: Oral cancer patient data in five hospitals in Changsha (the capital city of Hunan province) were collected for the past 12 years. Three methods were used to analyse the data; Microsoft Excel Forecast Sheet, Excel Trendline, and the Logistic growth model. A combination of these three methods was used to forecast the future trend of betel nut-associated oral cancer and the resulting burden on health. RESULTS: Betel nut-associated oral cancer cases have been increasing rapidly in the past 12 years in Changsha. As of 2016, betel nuts had caused 8,222 cases of oral cancer in Changsha and close to 25,000 cases in Hunan, resulting in about ¥5 billion in accumulated financial loss. The combined trend analysis predicts that by 2030, betel nuts will cause more than 100,000 cases of oral cancer in Changsha and more than 300,000 cases in Hunan, and more than ¥64 billion in accumulated financial loss in medical expenses. CONCLUSION: The trend analysis of oral cancer patient data predicts that the growing betel nut industry in Hunan province will cause a humanitarian catastrophe with massive loss of human life and national resources. To prevent this catastrophe, China should ban betel nuts and provide early oral cancer screening for betel nut consumers as soon as possible.

Expert Consensus on the Detection and Screening of Oral Cancer and Precancer.

Oral cancer is an aggressive disease with a high incidence in both males and females in Asia and ranks as the first of all malignancies in India. The relatively high prevalence rate of oral cancer in Asia is mainly due to the fact that a high percentage of the population are smokers or chew betel nut. They comprised the so called 'high risk population' of oral cancer. Meanwhile, epidemiological surveys showed a much lower 5-year survival rate in patients with advanced TNM stage III and IV oral cancer than those in the earlier stage I and II disease after treatment. Therefore, it is important to identify and treat precancerous lesions and oral cancer at early stages. In this article, we describe the expert consensus contributed by outstanding clinicians and scientists at the 11th Asian Congress of Oral & Maxillofacial Surgery (ACOMS) and we highlight the importance of oral cancer screening by various conventional and novel methods based on scientific research.

Twist-related protein 1 enhances oral tongue squamous cell carcinoma cell invasion through ß-catenin signaling.

Accumulating evidence suggests that ß­catenin signaling may be involved in oral tongue squamous cell carcinoma (OTSCC) cell invasion. Abnormal activation of twist­related protein 1 (TWIST1 or TWIST) has been identified in several types of human cancer. A recent study showed that overexpression of TWIST is associated with a poor prognosis in patients with OTSCC and may enhance OTSCC cell invasion. This study investigated the effect of TWIST on ß­catenin signaling in OTSCC cells and its impact on OSTCC cell invasion. Stable overexpression of TWIST, with or without knockdown of ß­catenin, and stable knockdown of TWIST were performed in SCC­4 and TCA8113 human OTSCC cells. Overexpression of TWIST in SCC­4 and TCA8113 cells increased ß­catenin signaling luciferase reporter activity, mRNA levels of the ß­catenin signaling target genes, c­Myc and c­Jun levels, soluble ß­catenin level, the phosphorylation status of glycogen synthase kinase­3ß (GSK­3ß) at serine 9, matrix metalloproteinase­2 (MMP­2) expression and cell invasion. Knockdown of TWIST had the opposite effect. All of these changes, with the exception of phosphorylation of GSK­3ß, were eliminated by stable knockdown of ß­catenin. In addition, the phosphatidylinositol 3­kinase (PI3K) inhibitor, LY294002 abrogated the enhancing effects of TWIST on mRNA levels of c­Myc and c­Jun, soluble ß­catenin levels, MMP­2 expression, cell invasion and GSK­3ß phosphorylation. In conclusion, the present study demonstrated that TWIST enhances cell invasion and MMP­2 expression in OTSCC cells through ß­catenin signaling, probably via a PI3K­dependent mechanism. This study provides novel insights into the molecular mechanisms underlying OTSCC progression.

Median cleft of the upper lip associated with a mass: a rare case.

Median cleft lip is a midline vertical cleft through the upper lip. This is a very rare anomaly described in the literature. Median cleft lip is caused by the failure of fusion of the medial nasal prominences. In this case report, a 4-month-old boy with a median cleft associated with a mass of the upper lip is presented. The patient has no other anomalies of the nose or alveolus. The patient has normotelorism. A Z-plasty technique was used on the skin of the base of the columella. A vertical excision of the cleft with muscle approximation was performed on the white roll and the wet-dry border of either side of the defect of the upper lip. Postoperatively, the patient had a satisfactory result. The incisive scars were not visible. Cupid's bow was appropriately aligned, and the height of the upper lip was equal on both sides.

Osteoblastic cell response on biphasic fluorhydroxyapatite/strontium-substituted hydroxyapatite coatings.

Fluorhydroxyapatite/strontium-substituted hydroxyapatite (FHA/SrHA) biphasic coatings with F and Sr elements incorporated simultaneously into one coating layer were prepared on titanium substrate via colloidal sol-gel method. The bioactivity of the as-prepared FHA/SrHA biphasic coatings was evaluated in vitro by immersion in simulated body fluid (SBF). All the biphasic coatings exhibited great ability to induce apatite precipitation on their surfaces. In vitro cell responses were evaluated using osteoblast-like MG63 cells in terms of cell proliferation and differentiation (alkaline phosphatase activity and osteocalcin level). The biphasic coatings show significantly positive effects on the viability and functional activity of osteoblastic cells with clear evidence that an optimum SrHA amount dose exists, indicating that the coexistence of FHA and SrHA had a synergistic stimulatory effect. This finding suggests the potential use of this colloidal sol-gel derived FHA/SrHA biphasic coatings for hard tissue applications.

[Expression of the activating receptor NKG2D on peripheral blood mononuclear cells in patient with oral squamous cell carcinoma and its clinical significance].

PURPOSE: To investigate the expression of activating receptor NKG2D(natural killer group 2,member D) on peripheral blood mononuclear cells(PBMCs) in patients with oral squamous cell carcinoma(OSCC) and its clinicopathological significance. METHODS: The expression of NKG2D on PBMCs in 54 OSCC patients and 20 healthy controls were assessed by flow cytometry. The data was analyzed with SPSS16.0 software package for independent-sample t test and one-way ANOVA test. RESULTS: The positive rate of assay for NKG2D on PBMCs in OSCC patients (12.49±5.26)% was lower than that of the controls (22.93±8.14)% (P<0.05). And which was significantly different among different clinicopathological parameters such as tumor size and disease stage(P<0.05), but no significant difference was found among different gender, age, tumor location, tumor differentiation and cervical lymph node status (P>0.05). CONCLUSIONS: The NKG2D expression on PBMCs in OSCC patients was lower than that of healthy controls and was correlated with tumor size and disease stage.

Clinico-pathological significance of MHC-I type chain-associated protein A expression in oral squamous cell carcinoma.

The current research concerns the clinicopathological significance of MHC class I chain-related protein A (MICA) expression in oral squamous cell carcinomas (OSCCs). The expression and location of MICA protein in 14 normal oral mucous and 45 cancerous and para-cancerous tissues were assessed by immunohistochemistry and levels of MICA mRNA expression in 29 cancerous and para-cancerous tissues were determined by the real-time polymerase chain reaction. Data were analyzed with the SPSS16.0 software package. MICA was found to be located in the cytoplasm and plasma membrane. Expression was higher in para-cancerous than in cancerous tissues (P<0.05). However, no statistical difference was found between the following: 1) para-cancerous tissue with normal mucosa; 2) normal mucosa with cancerous tissue;and 3) among different clinicopathological parameters in OSCC (P>0.05). The level of MICA mRNA was higher in OSCCs than in para-cancerous tissues, and was correlated with the regional lymph node status and disease stage (P<0.05). The levels of MICA protein and mRNA expression differ among normal oral mucosa, para-cancerous tissue, and cancerous tissue. MICA may contribute to the tumorigenesis and progression of OSCC.

[Antitumor immune response of MHC class I chain-related gene A modified oral squamous cell carcinoma vaccine: an experimental study in mice].

PURPOSE: To investigate the vaccine potency of MHC class I chain-related gene A (MICA) modified oral squamous cell carcinoma cells. METHODS: Oral squamous cell carcinoma Tb cells transfected with eukaryotic expression vector pEGFP-N1-MICA and overexpressing MICA protein were inactivated by 120Gy irradiation and vaccinated human peripheral blood leucocytes reconstituted SCID (Hu-PBL/SCID)mice via intra-peritoneal injection, and the non-transfected or blank vector transfected Tb cells were used as the controls. The inhibition effect on tumorigenicity of subcutaneously challenged Tb cells in vaccinated Hu-PBL/SCID mice was detected.The expression of NKG2D and the cytotoxicity in vitro to Tb cells of peripheral blood mononuclear cells (PBMCs) and spleen cells were measured by flow cytometry and lactate dehydrogenase (LDH) release assay. SPSS16.0 software package was used for statistical analysis. RESULTS: MICA gene modified Tb tumor vaccine resulted in remarkable loss of tumor size and tumor weight in vaccinated Hu-PBL/SCID mice. Flow cytometry and lactate dehydrogenase (LDH) release assay showed MICA gene modified Tb tumor vaccine up-regulated the expression of NKG2D on PBMC and spleen cells and enhanced the cytotoxicity to tumor cells. Significant difference was found between MICA-transfected vaccine and non-transfected and blank vector-transfected vaccine (P<0.05). CONCLUSIONS: MICA gene modified oral squamous cell carcinoma vaccine can enhance the ability of antitumor immune response,and MICA may be considered as a promising immunotherapy target of oral squamous cell carcinoma.

[A retrospective study of oral squamous cell carcinomas originated from oral submucous fibrosis].

OBJECTIVE: To investigate the clinical characteristics, pathological and biological behaviors of oral squamous cell carcinomas (OSCC) originated from oral submucous fibrosis (OSF). METHODS: A total of 528 patients with OSCC treated at Department of Oral and Maxillofacial Surgery, Xiangya Hospital, Central South University from 2002 to 2010 were divided into two groups, OSCC originated from OSF and OSCC not originated from OSF. The clinical data regarding age, gender, location, pathological type, metastasis and recurrence rate of these patients were analyzed retrospectively. RESULTS: The mean age of the group of OSCC originated from OSF (45.8 years) was younger than that of the group of OSCC not originated from OSF (55.9 years). The male female ratio of the group of OSCC originated from OSF (32.3:1) was higher than that of the group of OSCC not originated from OSF (2.3:1). The metastasis and recurrence rate of the group of OSCC originated from OSF (13.5%, 39.1%) was higher than that of the group of OSCC not originated from OSF (7.6%, 27.8%.). CONCLUSIONS: OSCC originated from OSF occurs at younger age and more in male, and is clinically more invasive and metastatic.

[Expressions of RANK, RANKL, and osteoprotegerin in male rats at different ages].

OBJECTIVE: To investigate the expression of receptor activator of nuclear factor-κB (RANK), its ligand RANKL, and osteoprotegerin, and observe the effects of αD3 on their expressions in male rats at different ages. METHODS: Wistar rats at 6 weeks, 6 months, and 24 months (n=15) were examined for mRNA expressions of RANK/RANKL and osteoprotegerin in the left proximal femur using RT-PCR and for their protein expressions in the right femur using immunohistochemistry. RANK/RANKL and osteoprotegerin expressions were also detected in another 15 rats aged 24 months following intragastric administration of 0.05 µg/kg αD3 (3 times a week for 10 weeks). RESULTS: Compared with 6-week-old rats, 6-month- and 24-month-old rats showed a 6.2-fold and 7.3-fold increase of RANKL mRNA expression, respectively (P<0.05), and osteoprotegerin mRNA levels increased slightly with age. αD3 treatment resulted in significantly increased expression of RANK in 24-month-old rats with a lowered RANKL/osteoprotegerin ratio. RANKL and osteoprotegerin were co-localized in the osteoblasts and chondrocytes. αD3 treatment also caused an increased expression of osteoprotegerin mRNA in 24-month-old rats. CONCLUSION: The age-related increase of the ratio of RANKL/osteoprotegerin mRNA promotes osteoclast activity and bone turnover. αD3 has favorable effect on osteogenesis and suppress bone absorption in the femur possibly by reducing RANK expression and lowering RANKL/osteoprotegerin ratio.

[Clinical application of heterogeneous acellular dermal matrix in the surgical treatment of oral submucous fibrosis].

PURPOSE: The aim of this study was to evaluate the clinical effect of heterogeneous acellular dermal matrix in the surgical treatment of advanced oral submucous fibrosis (OSF). METHODS: There were eight patients who had undergone surgical treatment of trismus caused by OSF. Surgery was performed under general anaesthesia given through a nasoendotracheal tube using a fibreoptic bronchoscope. All the fibrous bands on the buccal mucosa were incised and bluntly dissected to stretch the mouth opening. Based on the defect, heterogeneous acellular dermal matrix graft was applied directly on the bilateral wounds. A tie-over dressing technique was used to hold the graft firmly to its bed.The sutures and dressing material were removed on the tenth to fourteenth day after the operation. All the patients were asked to stretch the mouth opening 3 times daily and were followed up for at least 6 months. A modality of medical treatment including multiple micronutrient supplements and steroid injection therapy were carried out if necessary. The changes in the interincisal distances (IDs) were analyzed in the preoperative, intraoperative, and postoperative stages. The data was analyzed with SPSS16.0 software package for one-way ANOVA. RESULTS: The overall success rate was 100% without any or only partial graft loss. There were no immunologic reactions or significant complications.The mean preoperative, intraoperative, and final follow-up interincisal distances were 12.04, 35.46, and 29.33 mm, respectively. Evaluation of the changes in the IDs revealed statistically significant differences between the values recorded at the different stages.(P<0.05). CONCLUSIONS: Heterogeneous acellular dermal matrix may be a valuable biomaterial for repairing oral mucosal defects after surgery on the fibrous bands in patients with advanced OSF through covering and protecting wound surface early,which shortens the healing time of wound, decreases relapse of fibrosis and improve the restricted mouth opening.

[Expression of RANKL/OPG in male mandible of different ages].

PURPOSE: To investigate the relationship between male osteoporosis and the expression of receptor activator of NF-κB ligand(RANKL) and osteoprotegerin(OPG)-mRNA in male mandible at different ages. METHODS: Between May 2008 and January 2009, bone tissues of the mandible were collected as the experimental material from 46 patients suffering from jaw facial deformity and extraction. The patients with periodontist, systemic disorder and smoking as well as drinking were excluded.They were divided into three groups: young group, whose age was 10-29 years old ;middle age group, whose age was 30-59 years old; aged group, whose age was 60-89 years old. The expression of RANKL mRNA and OPG mRNA was examined by real-time PCR. The data was analyzed using ANOVA followed by least significant difference (LSD) test with SPSS16.0 software package. RESULTS: (1)Compared with the young group, RANKL mRNA level in mandible was 2.1-fold and 5.3-fold higher in the middle age and aged groups, respectively, whereas OPG mRNA level was 3.3-fold and 4.8-fold higher in middle age and aged groups, respectively. RANKL and OPG were positively correlated with age.(2)The ratio of RANKL/OPG in middle age group was lower than that of young group and old group,respectively. CONCLUSIONS: (1)The expression of RANKL and OPG increases with age remarkably.(2)Bone formation of the mandible is activated in middle aged group. The formation is over absorption.(3)Bone formation of the mandible in aged group is at low level. Bone absorption exceeds bone formation.

[Dumbbell-shaped cervical spinal neurilemmoma presenting as neck mass: diagnosis and treatment].

PURPOSE: Cervical neurilemmoma originating from cervical spine could extend through foramen intervertebrale and displayed a radiographic features as a cervical intra- and extra-spinal dumbbell-shaped mass.Because of its early compressive spine cord, patients usually visited neurosurgery at first. In this paper, two patients of cervical intra- and extra-spinal dumbbell-shaped neurilemmoma visiting oral and maxillofacial surgery complained of upper cervical mass were reported, aiming to improve the diagnostic and therapeutic skill for oral and maxillofacial surgeons. METHODS: Two case of cervical dumbbell tumors who complained of a neck mass underwent surgery and were followed up by oral and maxillofacial surgeons .The pathogenesis,operative approach and prognosis were discussed by reviewing relevant literatures retrospectively. RESULTS: Both of the two patients' presenting symptoms were upper-cervical masses. Preoperative imaging suggested trans-cervical vertebra dumbbell masses.The tumors were removed through combining the posterior midline and lateral cervical approach, and a gross total resection was achieved.No evidence of recurrence was noted after one-year of follow-up. CONCLUSIONS: The initial symptom of cervical intra- and extra-spinal dumbbell-shaped neurilemmoma may be a cervical mass and inconspicuous compressive spine cord. Analysis is essentially devoted to the radicality of tumor resection, nerve root preservation, relation to the vertebral artery, and compromise of spinal stability.The surgical resection of dumbbell-shaped cervical spinal neurilemmoma can pose a formidable challenge.

[Reconstruction of oral and maxillofacial defects using free anterolateral thigh flaps in patients with malignant tumors].

PURPOSE: To explore the value of free anterolateral thigh flaps in the reconstruction of oral and maxillofacial defects following radical resection of malignant tumors. METHODS: Seventy-six cases of oral and maxillofacial malignant tumor from December 2007 to June 2009, including 32 tongue carcinomas, 16 buccal carcinomas, 10 carcinomas of floor of mouth, 9 gingival carcinomas, 8 oropharyngeal carcinomas and 1 skin carcinoma, underwent radical resection. Free anterolateral thigh flaps were used to reconstruct the defects. The postoperative effect and flap success rate were evaluated. RESULTS: Among 76 cases, 74 flaps survived completely with satisfied configuration, only 2 flaps had complete necrosis. The survival rate was 97.3%. No complications were observed in the donor site. CONCLUSIONS: The free anterolateral thigh flap is an ideal choice for reconstruction of oral and maxillofacial defects, as it has many advantages such as reliable blood supply, large size available, and little donor site morbidity.