Current status and prospect of supermicrosurgery in maxillofacial reconstruction / 中华显微外科杂志

Supermicrosurgery is a hot topic in the field of microsurgery and reconstruction. The core concept of supermicrosurgery is precision and minimally invasive, which coincides with the concept of maxillofacial reconstruction. Oral and maxillofacial regions play an important role in aesthetics and function, and the structure of oral and maxillofacial tissues is complex. Various types of flaps, especially vascularised free flaps, are required for the repair of various complex maxillofacial defects. However, at present, conventional microsurgery does meet the requirement of mandibular reconstruction in special cases. Super microsurgical technique can further supplement the deficiency of conventional methods of repair and reconstruction in maxillofacial reconstruction. Under the guidance, many new methods of maxillofacial surgery have inevitably emerged. The application of supermicrosurgery in maxillofacial head and neck is still in its early stage, and there are still many difficulties to overcome and many technical issues to be furtherresolved. Supermicrosurgery is not only an advanced technique, but also an advanced concept in surgery. Supermicrosurgery is expected to show its clinical value in oral and maxillofacial reconstruction. In this paper, the application of supermicrosurgery in maxillofacial reconstruction is reviewed and its application prospect is prospected.

Accuracy of Computer-Aided Design/Computer-Aided Manufacturing Surgical Template for Guidance of Dental Implant Distraction in Mandibular Reconstruction With Free Fibula Flaps.

PURPOSE: The direction and orientation of the osteotomized upper segments in dental implant distractor (DID) can be compromised due to an unpredicted vector of distraction. The present study aimed to evaluate the accuracy of computer-aided design/computer-aided manufacturing (CAD/CAM) surgical templates to precisely guide the distraction process in lengthening of the alveolar height for functional mandibular reconstruction. PATIENTS AND METHODS: This retrospective study included all consecutive patients who underwent digitally designed mandibular reconstruction using the fibular flap and DID with the help of CAD/CAM designed surgical templates in a single-stage procedure from 2011 to 2014. First, the preoperative digital planning was performed on 3-dimensional models. Afterward, simulation of the distraction process was made on the virtual model and the resulting new height of the fibula was evaluated. The preoperative simulation was applied to accurately define the exact location and path of the DID device to achieve the suitable vertical height. The preoperative digital planning was used to help the design of the CAD/CAM surgical template, which was then fabricated by means of the 3-dimensional printing technology. The manufactured surgical template-assisted both horizontal and vertical osteotomies of the fibular segments and defining the DID path to lead the distractor into the accurate position. The outcome evaluation was achieved through comparing both preoperative virtual planning with postoperative actual outcomes. RESULTS: This study included 14 subjects, 8 were males and 6 were females. The mean age at time of surgery was 31.07 years (range 18-47). All fibular flaps showed 100% success rate. The mean vertical bone height attained with the DID device was 11.35 mm. The vertical and horizontal osteotomies of the fibular segments were completed, then the DID devices were successfully positioned guided by the template. The mean values of the linear and angular deviations for the distractor position and upper segments were calculated and recorded. The maximum linear deviation between the virtual and the postoperative actual distractors was 0.93 mm in the anteroposterior direction, and the greatest in the horizontal plane was 4.64°. CONCLUSIONS: CAD/CAM surgical templates can accurately guide the direction and orientation of the DID device for functional mandibular reconstruction; therefore, helping to improve the outcomes by accurately transferring the preoperative virtual plan to real surgical procedure.

Incidence and Mortality of Sarcomas in Shanghai, China, During 2002-2014.

Background: Sarcomas are a heterogeneous group of rare but deadly malignant tumors. The aim of this study was to comprehensively describe the incidence and mortality of sarcomas in Shanghai during 2002-2014. Method: Data were from Shanghai Cancer Registry. All new cases diagnosed with sarcomas and all death records where the cause of death listed as sarcomas were included. The characteristics of sarcomas incidence and mortality were analyzed. Age-standardized rates (ASRs) were adjusted by the world standard population. The trends were assessed by Joinpoint analysis. Results: A total of 9,440 incident cases were identified. The ASR was 3.4/105 for all sarcomas combined. Incidence of sarcomas overall was similar in females (3.5/105) as in males (3.4/105). Except for sarcomas "Not Otherwise Specified" (NOS), the most common histological subtype was gastrointestinal stromal sarcoma (GISS) (14.8%), which was followed by fibrosarcoma (7.2%), lipoblastoma (6.7%), leiomyosarcomas (6.5%), and osteosarcoma (5.3%). Among those incident cases, 87.9% were located in soft tissue sarcomas (STS) and 12.1% in bone and joint (bone sarcomas). The ASRs for STS and bone sarcomas were 2.8/105 and 0.6/105, respectively. Incidence rates for all STS combined rose exponentially with age, while bone sarcomas had the highest incidence at age 0-19. There were 4,279 deaths during 2002-2014 with the ASR of 1.3/105. Age-adjusted mortality due to sarcomas was slightly higher in males (1.5/105) than females (1.2/105). Except for sarcomas NOS, leiomyosarcomas was the most common subtype, comprising 9.9% of deaths due to sarcomas, followed by lipoblastoma (6.4%) and osteosarcoma (6.3%). The ASRs of mortality for STS and bone sarcomas were 1.0/105 and 0.2/105, respectively. For both males and females, the age-standardized incidence for STS and bone sarcomas did not change meaningfully over the study period. In contrast, age-standardized STS mortality in females increased by 2.3% per year (95% CI: 0.3, 4.4%), but was unchanged in males. No meaningful trends in bone sarcomas mortality were observed for either males or females. Conclusion: This population-based study was the first report of epidemiology of sarcomas in Shanghai according to anatomic site and histologic type. The diversity and rarity of sarcomas suggested more detailed data are warranted.

Oral maxillofacial-head and neck tumor and holistic integrative medicine / 中华口腔医学杂志

The advance of clinical diagnosis and treatment in oral and maxillofacial-head and neck tumors has been through the process of specialization and multidisciplinary cooperation. In most cases, a single discipline cannot meet the requirements of diagnosis and treatment, which needs the cooperation of oral and maxillofacial surgery, otolaryngology and oncology approach and therapeutic method such as surgery, radiotherapy and chemotherapy. Holistic integrative medicine aims at integrating the most effective clinical practice experience and patients' individual situation and prognosis, establishing new medical mode conforming to the modern concept and fulfilling the medical system adapting to the specific characteristics of the diseases.

A clinical study of the characteristics of the cervical lymph node metastasis in patients with salivary gland adenoid cystic carcinoma / 中国肿瘤临床

Objective:Adenoid cystic carcinoma (ACC) is an uncommon malignant neoplasm, which mostly originates from the major and minor salivary glands of the head and neck region. This study aims to provide new information on head and neck ACC with cervical lymph node metastasis. Methods:Out of the 616 patients who underwent primary tumor resection from 1995 to 2008 in the authors' hospital, 62 cases with cervical lymph node metastasis were analyzed. Results:The general incidence rate of cervical lymph node me-tastasis in ACC was approximately 10%. The base of the tongue, mobile tongue, and mouth floor were the most frequent sites of lymph node metastasis with incidence rates of 19.2%, 17.6%, and 15.3%, respectively. Most cases exhibited the classictunnel-stylemetastatic pattern of occurrence, and the levelⅠb andⅡregions were the most frequently involved areas. Primary site and lympho-vascular invasions were significantly associated with lymph node metastasis. High patient mortality rate was also significantly correlat-ed with a high number of lymph node positive cases. Conclusion:Cervical lymph node metastasis has a high tendency of occurrence in the tongue-mouth floor complex, following the classictunnel-stylemetastatic pattern. Peritumoral lymphovascular invasion could be taken as a strong predictor for the occurrence of lymph node metastasis, which ultimately leads to poor prognosis of ACC patients. A selective neck dissection should be considered as a management in such patients.

Survival analysis of 256 patients with oral cancer / 中国肿瘤临床

Objective:To analyze survival in patients with advanced oral cancer from prospective clinical trials. Methods:From 2008 to 2010, 256 patients with oral cancer at clinical stage III/IVA were randomly categorized into two groups. Patients in the experi-mental group received neo-adjuvant chemotherapy, surgery, and post-operative radiation, and patients in the control group underwent surgery and post-operative radiation. All patients were routinely followed-up after treatments. Survival was analyzed using Kaplan–Meier method and log-rank test, and differences were considered statistically significant at P value lower than 0.05. Results: Each group was composed of 128 patients. With the median follow-up period of 60 months, the 5-year overall survival rate was 61.7%and the disease-free survival rate was 53.9%. The overall survival rate (P=0.350) and the disease-free survival rate (P=0.160) were not sig-nificantly different between the experimental and control groups. Patients with positive pathological response to neo-adjuvant chemo-therapy exhibited significantly improved overall survival (P＜0.05). Conclusion:Radical surgery should be emphasized to improve the prognosis of oral cancer. Functional reconstruction could also improve the quality of life and survival of patients. Despite that neo-adju-vant chemotherapy could not improve the survival of patients with advanced oral cancer in entirety, it could benefit patients exhibiting positive treatment responses.

Cranio-maxillofacial resection for the treatment of oral, maxillofa-cial, head and neck tumors involving the skull base:a 10-year ret-rospective study at a single center / 中国肿瘤临床

Objective:To review our patients who underwent cranio-maxillofacial resection in the recent 10 years and explore the indication of the operation. Methods:From 2003 to 2013, 116 patients underwent cranio-maxillofacial resection in our department for the treatment of tumors involving the skull base. Tumors that involved the skull base were divided into 3 types according to skull base invasions shown in the coronal planes of CT and MRI scans. Type 1 tumor was adjacent to the skull base with free bone (n=45), type 2 tumor involved the skull base with intact dura (n=30), and type 3 tumor involved dura with free brain (n=41). All patients underwent cranio-maxillofacial resection by oral and maxillofacial surgeons and neurosurgeons. The defects after cranio-maxillofacial resection were reconstructed immediately with adjacent local or regional flaps (n=62) and free vascularized flap (n=54) according to different de-fects, respectively. Results:Cranio-maxillofacial resection was successfully performed in all patients. No intraoperative complication was found. The overall success rate of soft tissue flaps and free flaps was 98.3%and 96.4%, respectively. Three patients with intracrani-al infection (n=2) and bleeding in the internal carotid artery were dead postoperatively even though they underwent salvage surgery. The overall rate of complications was 14.7%, and the dead rate was 2.6%. Recurrence or distant metastasis was found in 36 patients dur-ing the follow-up period. Conclusion: For the indication of cranio-maxillofacial resection, the balance between tumor resection and postoperative function, survival rate, and quality of life should always be considered. This technique includes the balance between func-tion and form, survival and quality of life, donor and recipient sites, and primary and secondary functions.

Anatomy of superficial circumflex iliac artery perforator flap and its clinical application in tongue reconstruction / 中国肿瘤临床

Objective:To assess the anatomy of superficial circumflex iliac artery perforator (SCIP) and its feasibility for tongue re-construction after tumor resection. Methods:From January 2014 to January 2015, a total of 15 patients with oral maxillofacial defects underwent SCIP flap surgery. Perforator identification and SCIA course were performed intra-operatively. The relationships among the SCIA, deep circumflex iliac artery (DCIA), and superficial inferior epigastric artery (SIEA) were determined intra-operatively. Surgical procedures, measurement of vessel's caliber and pedicle's length, SCIP flap anatomy, and their outcomes were described. Results:Flap mean thickness was approximately 1.2±0.3 cm. The mean diameter of the SCIA was 0.7±0.2 cm, and that of the superficial circumflex iliac vein was 1.2±0.2 cm. The relationships among SCIA, DCIA, and SIEA were described and subdivided into typeⅠ(8/15), typeⅡ(2/15), typeⅢ(2/15), typeⅣ(2/15), and typeⅤ(1/15) in intra-operative dissection. The flap sizes were in the range from 6 cm × 4.5 cm to 11 cm × 10 cm. A total of 14 SCIP flaps survived, and 1 SCIP flap underwent necrosis. Conclusion:The SCIP flap is a reliable, thin, and pliable flap with long vascular pedicles and hidden donor site morbidity. Its texture is a perfect match for tongue defect reconstruc-tion.

Clinical application of free vascularized bone flaps for reconstruction for osteoradionecrosis of the mandible / 中国肿瘤临床

Objective:To assess the effectiveness of free vascularized bone flap transfer for treatment of advanced osteoradionecrosis of the mandible (ORNM). Methods:We reviewed 53 patients who were treated for ORNM by radical resection and reconstruction with free vascularized bone flaps in our institute between January 2003 and January 2015. Results:Among the 53 vascularized bone flap patients, 48 (90.57%) had fibula osteocutaneous and 5 (9.43%) had deep circumflex iliac artery (DCIA). Postoperative complications occurred in 5 (10.42%) of the 48 fibula osteocutaneous patients (4 cases of vein thrombosis and 1 case of arterial crisis). In three of these patients, flap was salvaged back to normal in a timely manner by vascular exploratory surgery. However, pectoralis major myocutaneous flap was conducted as a second procedure for the other two patients. Meanwhile, complications occurred in 2 (40%) of the 5 DCIA transfer patients (1 case of vein thrombosis and 1 case of arterial crisis). None of these two flaps was salvaged back. Necrosis transfer bone was finally removed. No obvious donor site complications were noted. The mean follow-up time was 28 months. Our results showed that 88.57%of the patients with ORNM were stable, 85.71%of the patients can open their mouth at 2-3 figures, 85.72%of the patients can eat soft or semi-liquid food, and 80%patients can speak clearly and can be understood by others around them. No significant difference was found in mouth opening and face type of the patients with or without the intact condyle. However, the temporomandibular joint area discomfort of the patients with intact condyle was obviously less than that of patients with removed condyle. Conclusion:Radical resection, followed by vascularized bone flaps, especially fibula osteocutaneous, is still the best way to treat ORNM, as long as the indications are chosen appropriately, intraoperative work is conducted properly, and postoperative complications are controlled.

Fifteen cases of juvenile ossifying fibroma of the jaw / 中国肿瘤临床

Objective:To analyze the clinical manifestations, radiographic features, and pathological classification of the juvenile ossifying fibroma (JOF) of the jaws and discuss its clinical management and prognosis. Methods: From January 2005 to December 2014, 15 patients with JOF who underwent surgery were retrospectively investigated with regard to clinical and radiologic data. On the basis of the standards of the World Health Organization in 2005, JOF was divided into juvenile psammomatoid ossifying fibroma (JPOF) and juvenile trabecular ossifying fibroma (JTOF). Results:Among the 15 patients, 10 were female and 5 were male. Patient age ranged from 7 years old to 18 years old with a mean of 10.93 years old. Nine cases were located in the mandible and 6 in the maxilla. The clinical manifestation was painless swelling of the jaw, but 20%of the cases showed jaw swelling with pain. Various JOF radiolog-ic appearances, such as radiolucent, mixed radiopaque-radiolucent, or ground-glass pattern, were observed. Ten of the 15 patients were JTOF and 5 were JPOF With regard to treatment, 4 patients underwent conservative surgery, 3 patients lived with tumors, and 11 pa-tients underwent radical surgery during the follow-up period; no lesion recurrence occurred. Nine patients underwent reconstruction, that is, 5 cases with fibula flap graft, 3 cases with free iliac graft, and 1 case with costal cartilage graft. Conclusion:JOF is a rare form of benign fibro-osseous lesions and occurs in adolescents. Mandible and maxilla are two of the most common locations. Early diagnosis and treatment and strict clinical and radiological follow-up is important in the clinic because of the aggressiveness and high recurrence rate of JOF. Operation time and treatment options should be selected according to the patients' specific situation.

Multidisciplinary team diagnosis and treatment of oral cancer / 中国肿瘤临床

Oral cancer is the most common form of malignant tumor in the head and neck. However, traditional systematized and individualized treatments cannot provide a full range of treatment strategies for patients. As such, multidisciplinary team (MDT) diagno-sis plays an important role in improving the survival and prognosis of patients. Compared with a traditional single disciplinary model, the MDT diagnosis model provides a high-quality comprehensive individualized treatment. The MDT diagnosis and treatment model al-so contributes to medical education and clinical research. Although this model has been established overseas, it is in the initial develop-mental stage in China;thus, appropriate guidelines have yet to be designed. Therefore, MDT diagnosis and treatment model focusing on oral should be promoted and standardized.

Cyclin D1 as a potential predictive biomarker for TPF induction chemotherapy in cN2 patients with oral squamous cell carcinoma / 中国肿瘤临床

Objective:To investigate the potential prognostic value of cyclin D1 expression in patients with locally advanced oral squamous cell carcinoma (OSCC) and its relationship with taxol (Docetaxel)/cisplatin plus 5-fluorouracil (TPF) induction chemothera-py. Methods:A total of 256 patients with locally advanced OSCC were selected from Shanghai Ninth People's Hospital of Shanghai Ji-ao Tong University School of Medicine between March 2008 and December 2010 as the objects of study in this prospective randomized clinical trial. The effect of TPF induction chemotherapy was investigated. Immunohistochemical staining against cyclin D1 was per-formed in the pretreatment biopsy specimen of the patients. The relationship between cyclin D1 expression and prognostic data of the TPF induction arm and control arm was analyzed. Results:Cyclin D1 expression was detected in 232 out of the 256 patients. Patients with low cyclin D1 expression showed significantly better overall survival (OS) (P=0.001), disease-free survival (DFS) (P=0.003), lo-coregional recurrence-free survival (LRFS) (P=0.004), and distant metastasis-free survival (DMFS) (P=0.001) than those with high cy-clin D1 expression. No significant differences existed in OS, DFS, LRFS, or DMFS between the patients with TPF induction chemother-apy and the control. Cyclin D1 expression levels were not predictive of the benefit from TPF induction chemotherapy in the overall pop-ulation. However, patients with nodal stage cN2 and high cyclin D1 expression, who were undergoing TPF chemotherapeutic regimen, showed significantly higher OS (P=0.024) and DMFS (P=0.024) than cN2 patients with high cyclin D1 expression but undergoing stan-dard surgical treatment. Conclusion:Cyclin D1 can be used as a prognostic biomarker for patients with locally advanced OSCC. Fur-thermore, cN2 OSCC patients with high cyclin D1 expression can receive long-term benefit from the addition of TPF induction chemo-therapy to standard surgical treatment.

Increased expression of MUC-1 has close relation with patient survivor in high-grade salivary gland mucoepidermoid carcinoma.

PURPOSE: High-grade mucoepidermoid carcinoma (MEC) is an infrequent malignant neoplasm originates most commonly in the salivary glands with poor prognosis. Thus far, there is little knowledge on MUC-1 expression in high-grade MEC or how it may relate to patient survival. The aim of this study was to determine the extent of MUC-1 expression in high-grade MEC and correlate expression with clinic outcome. METHODS: Surgical specimens from 62 cases of primary high-grade MEC and 10 cases of normal salivary gland tissue were examined by immunohistochemistry. The relationship between MUC-1 expression and the clinicopathological data and patient survival was analyzed. RESULTS: The disease-free survival rates were 54.6% (3 years) and 37.7% (5 years) for high-grade MEC patients. Patient who with primary location at submandibular gland have the worst prognosis (P = 0.042) in comparing with other sites. High expression of MUC-1 in high-grade MEC was significantly correlated with lymphatic/regional metastasis (P = 0.003) and clinic stage (P = 0.02), and high expression of MUC-1 (>75%) was confirmed to be significant independent prognostic factors in high-grade MEC patients [HR 2.929 (95% CI 1.246-6.881); P < 0.0137]. CONCLUSIONS: The findings suggest that high levels of MUC-1 expression may be a potential marker for worse outcome in high-grade MEC and could be used as a new molecule target to improve outcomes for these patients in the future.

Classification and reconstruction of the defects after combined cranio-maxillo-facial resection / 中华显微外科杂志

Objective To review our patients who underwent reconstruction of the defect after combined cranio-maxillo-facial resection in recent years.Methods From January,2005 to January,2011,88 patients underwent reconstruction of the defect after combined cranio-maxillo-facial resection.Different reconstructive techniques were used according to the defect classifications in dura,skull base bone,and facial tissues.For dural defects,no repair (37 cases),primary closure (25 cases),and dural repair (26 cases) were performed,respectively.Dural repair materials included thigh fascia lata (2 cases),temporalis fascia (2 cases),pericranium (1 case) and artificial dural patch (21 cases).Bone reconstruction of the skull base were performed in 61 patients with titanium mesh (57 cases),free iliac bone graft (1 case),free cranial bone graft (2 cases) and Medpor (1 case),respectively.Limited facial soft and hard tissue defects in 44 patients were reconstructed with temporalis system of flaps (36 cases),sternocleidomastoid myocutaneous flap (6 cases),and pterygoid muscle flap (2 cases),respectively.Extensive facial soft and hard tissue defects in 44 patients were reconstructed with free latissimus dorsi myocutaneous flap (26 cases),free pectoralis major myocutaneous flap (12 cases),free anterolateral thigh perforator flap (5 cases cases) and free anteromedial thigh perforator flap (1 case),respectively.Results The overall success rate of 88 flaps was 100％.Cerebrospinal fluid leak was found in 4 patients,wound infection was found in 2 patients,intracranial infection was found in 2 patients,respectively.Six patients with cerebrospinal fluid leak or wound infection were cured by conservative treatment.Two patients with intracranial infection were dead although they underwent salvage surgery.Overall rate of complications was 9.1％,dead rate was 2.3％.Conclusion Successful reconstruction of the defect after combined cranio-maxillo-facial resection can be achieved by watertight dural repair,bone reconstruction of the skull base and well-vascularized tissue covered.Regional flap and free tissue transfer are both preferred reconstructive technique depending on the anatomic site and the extent of the defect.

Gland-preserving surgery can effectively preserve gland function without increased recurrence in treatment of benign submandibular gland tumour.

The most widely accepted treatment for neoplasms of the submandibular gland usually involves excision of the entire gland. Our aim was to establish a gland-preserving operation for benign tumours of the submandibular gland and evaluate its efficacy. We treated 40 patients from January 2007 to December 2008 with benign submandibular gland tumours who were listed to have an operation that either preserved the gland or sacrificed it. Duration of operation, extent of injury to the nerve, postoperative function of the gland, aesthetic appearance, and recurrence were assessed. We found no significant difference in baseline characteristics among the 20 patients in each group (19 men; 21 women, mean (SD) age of 34 (33.8 ± 5.72) years. The extent of injury to the lingual nerve and submandibular branch, together with deformities of the facial contour, were significantly less in the group in which the gland was preserved. Postoperative salivary production and overall patients' satisfaction were also better in that group. There was no recurrence in either group during the follow up period of 38 months-5 years. The gland-preserving procedure has advantages over the typical approach in which the gland is sacrificed. There is less risk of injury to the nerve, less deformity of the facial contour, better preservation of function, and patients are more satisfied. The gland-preserving technique should therefore be the first choice for management of benign submandibular tumours.

Compartmental tongue surgery / 中国癌症杂志

Despite the evolution in cancer management and the introduction of multidisciplinary treatment modalities, 5-year overall survival rate of oral cancer remained to be 45-50%. Retrospectively, one patient's prognosis, relapse pattern and survival were determined by clinicopathological parameters. Nevertheless, radical resection with adequate safe margins is crucial for local control in treatment strategy for oral cancer. However, orthogonally muscle orientation of tongue with enriched neurovascular bundles and lymphatic network make it disadvantaged for progressive deep tumor invasion and regional metastasis. Tumor spread along the muscle fibers following the path of least resistance, this thereby reflected the shortcomings of conventional 1-2cm circumferential wide excision. Compartment resection is removal of entire primary lesion along with its entire potential spreading path with an advantage in removing the potential spreading path. Contrary, lymphatic drainage of tongue cancer is outstanding, there is overtly existence of lymphatic vessels and lingual lymph node which occult lymph node metastasis might easily being overshadowed. Routine neck dissection is disadvantaged for unable to reach. Nevertheless, compartmental surgery can overcome it by bringing lingual lymphatic system into surgical ifeld. Compartment resection is more appreciable than conventional 1-2cm wide resection in fuliflling oncological radicality criteria. In summary, we need to explore the characteristic pattern of tumor invasion and metastasis for other subtypes of oral cancer, thereby establishing a location orientated compartment resection, subsequently enhance the radicality of surgical management and strive to improve the survival rate.

Toll-like receptor-9 agonists increase cyclin D1 expression partly through activation of activator protein-1 in human oral squamous cell carcinoma cells.

Increasing evidence suggests that malignant transformation can result from chronic infection, and Toll-like receptors (TLRs) may play an important role in this process. We have previously reported that the increased expression of TLR-9 is associated with tumor cell proliferation in oral cancer. However, the mechanisms involved have not been elucidated. The aim of this study was to investigate whether CpG-oligodeoxynucleotides (CpG-ODN), a special TLR-9 agonist, is able to exert the proliferation-promoting effect in human oral squamous cell carcinoma (OSCC), and to explore the possible underlying molecular mechanism. Flow cytometry, MTT, and colony formation assay were used to evaluate cell proliferation and cell cycle distribution. The mRNA and protein levels were analyzed by quantitative RT-PCR and Western blot assay. Luciferase reporter gene, EMSA, and ChIP assays were used to detect the activity of activator protein-1 (AP-1) and nuclear factor-κB (NF-κB) in HB cells. Results showed that CpG-ODN could stimulate proliferation of HB cells in a dose- and time-dependent manner with a promoted G(1) /S cell cycle progression. Increased cyclin D1 expression was detected in the nuclear region after CpG-ODN treatment. Moreover, CpG-ODN promoted nuclear translocation and activation of AP-1, which appeared to be required for TLR-9-mediated cyclin D1 expression and subsequently cell proliferation, but seemed to have little impact on NF-κB activity. Our results indicate that CpG-ODN stimulates tumor cell proliferation through TLR-9-mediated AP-1-activated cyclin D1 expression in OSCC HB cells. Pharmacologic inhibition of the TLR-9/AP-1/cyclin D1 pathway may be a new therapeutic approach for prevention as well as treatment of OSCC.

Dental implant distractor combined with free fibular flap: a new design for simultaneous functional mandibular reconstruction.

PURPOSE: The purpose of the present study was to present a new method that combines the use of the fibular flap and a custom-made vertical distractor/dental implant device into 1 surgical procedure for simultaneous functional mandibular reconstruction. PATIENTS AND METHODS: The present retrospective case series included 10 patients who were treated using the fibular flap and dental implant distractor (DID) in a single-stage procedure. These 10 patients were treated within a 3-year period (from 2005 to 2007). RESULTS: Of the 10 patients included in the study, 5 were males and 5 were females. The mean age of the sample was 33.8 years (range 17 to 48). The cumulative survival rate of the fibular flaps was 100%. The mean vertical bone height attained with the DID device was 11.4 mm. The mean period from the first operation to the start of dental implant loading was 6.3 months. The cumulative survival rate of the dental implants was 93.75%. CONCLUSIONS: The use of the DID in the fibular flap for mandibular reconstruction is advantageous because it combines vertical distraction osteogenesis of the fibular flap and dental implantation into a single procedure. Implants placed in the reconstructed areas were found to integrate normally, with survival rates comparable to those with 2-stage operations. As such, this novel DID technique can be used for single-stage reconstruction and rehabilitation of segmental mandibular defects in selected patients.

Increased expression of Toll-like receptor-9 has close relation with tumour cell proliferation in oral squamous cell carcinoma.

OBJECTIVE: Toll-like receptor-9 (TLR-9), a new member of the interleukin-1 receptor superfamily, was recently found to have a high level of expression in many carcinoma specimens. The objective of this study was to examine the TLR-9 expression and its role in tumour cell proliferation in oral squamous cell carcinoma. MATERIALS AND METHODS: Western blot and immunohistochemistry were used to detect TLR-9 protein in oral squamous cell carcinoma (OSCC) Tca-8113 cell lines and clinical specimens (n=60). The relationship between TLR-9 expression and clinicopathologic features was analysed. Cell proliferation and inflammatory chemokines secretion were tested by MTT and ELISA methods respectively. RESULTS: Results showed that TLR-9 expression level was higher in OSCC tissues than in paired adjacent normal tissues (P<0.01), and the expression level of TLR-9 was significantly associated with tumour size (P=0.001), tumour clinical stage (P=0.003) and Ki-67 expression (P<0.01). In vitro results also suggested that stimulation of Tca-8113 cells with TLR-9 agonist CpG-ODN could significantly increase tumour cell proliferation as well as subsequent IL-1α and IL-6 secretions (P<0.01), which could be partially inhibited by usage of anti-TLR-9 protein. CONCLUSIONS: It was therefore hypothesized that increased expression of TLR-9 may be of great value in assessing the development of OSCC, and could be used as a new target for OSCC prevention and therapy in future.

Oral and maxillofacial desmoid-type fibromatoses in an eastern Chinese population: a report of 20 cases.

OBJECTIVE: Primary desmoid-type fibromatoses arising from the oral and maxillofacial region are uncommon and hold the character of local invasion and regional recurrence. The purpose of this study was to analyze the clinicoepidemiologic characteristics of this rare disease in an eastern Chinese population. STUDY DESIGN: Epidemiological and clinicopathological data on 20 patients were reviewed from the hospital records and analyzed accordingly. RESULTS: Twelve males and 8 females with a ratio of 3:2 were involved. The mandible was the most common site of presentation. Suspected malignant change was found in 6 cases and an extremely high recurrence rate was also found in up to 53%. Abnormally high blood levels of alkaline phosphatase were found in 65% of patients, which had a close relation with tumor malignant change. CONCLUSION: Chinese people are more susceptible to desmoid-type fibromatoses and are at an extremely high risk of regional malignant change. Elevated serum alkaline phosphatase levels may be taken as an indicator for malignant transformation.