[Research advances on the role of microRNA engineered exosomes in diabetic wounds].

Diabetic wounds are a common complication in patients with diabetes, which is difficult to treat. Current treatment methods for diabetic wounds include debridement, functional dressing coverage, negative pressure therapy, bone cement filling, and skin grafting, etc. MicroRNA (miRNA) engineered exosomes have shown promising potential in diabetic wound repair due to the ability to alleviate inflammation, stimulate angiogenesis, and promote collagen deposition and re-epithelialization. Related researches are being actively carred out. This paper reviews the pathophysiological characteristics of diabetic wounds, the characteristics of miRNA and exosomes, the engineering methods for exosomes loaded with miRNA, and the mechanism of miRNA engineered exosomes in promoting healing of diabetic wounds, aiming to provide a reference basis for the future clinical application of miRNA engineered exosomes in diabetic wounds.

[Clinical application of submental artery perforator flap in oral and maxillofacial defect restoration after tumor resection].

Objective: To summarize the clinical anatomical features and surgical technique of the submental artery perforator flap (SMAPF), and to evaluate the outcome and value of the flap for oral cavity reconstruction after cancer ablation. Methods: A total of 56 patients with oral cancer were included in this study. The modified SMAPF excluded the anterior belly of the digastric muscle and submental fatty tissue. The primary sites of malignancy were buccal mucosa (n=24), tongue (n=21), mandibular gingiva (n=6), mouth floor (n=3), soft palate (n=2). Results: The flap size varied from 3 cm×5 cm to 5 cm×12 cm. Four flaps presented mild venous congestion, which was salvaged with conservative measures such as acupuncture and blood letting. Overall flap survival rate was 100%. The SMAPF with septocutaneous perforator was used in 49 cases and with musculocutaneous perforator in seven cases. External jugular vein and internal jugular vein provides venous drainage were applied in half cases respectively. All the patients showed a good recovery of tongue mobility and mouth opening with a follow-up of 3-41 months. Local recurrence was detected in one patient 4 months after operation. Conclusions: The SMAPF is a reliable flap for oral cavity reconstruction with outstanding functional and aesthetic outcomes.

Use of a microvascular coupler device for end-to-side venous anastomosis in oral and maxillofacial reconstruction.

The aim of this study was to compare the use of a microvascular coupler device (MCD) for end-to-side venous anastomosis (ETS group) and phleboplasties combined with MCD for end-to-end venous anastomosis (ETE group) in free tissue transfer for oral and maxillofacial reconstruction, with regard to the anastomosis time and occurrence of postoperative vascular crisis. The ETS group included 22 patients and the ETE group included 40 patients. Patient demographic data, anastomotic time, coupler size, microvascular complications, and flap survival rates were collected and analyzed. In the ETS group, the most suitable donor vessel size was greater than 2mm, varying from 2mm to 4mm. The average anastomosis time was 3.35±0.89min in the ETS group and 7.80±2.93min in the ETE group; the difference between the groups was statistically significant (p<0.0001). There were no statistically significant differences in complications or outcomes between the two groups. The ETS venous anastomosis with MCD technique is a better choice for anastomosis when the donor vessel size is greater than 2mm. In those cases with mismatched veins, ETS venous anastomosis with MCD could significantly reduce the anastomosis time compared to ETE venous anastomosis with MCD after phleboplasties.

Reconstruction of intraoral defects after resection of cancer with two types of submental artery perforator flaps.

The submental island flap is a common choice for reconstruction of intraoral defects. To obtain a thinner, more pliable flap and get a better oncological result, the submental artery perforator flap has been proposed, and to assess its feasibility for closure of defects after resection of cancers of the oral cavity we studied 20 patients, each of whom was treated in this way. All the flaps were classified into those with septocutaneous perforators (n=16) and those with musculocutaneous perforators (n=4), and the main veins that drained the flaps were two submental veins (n=17). There were two patterns of venous drainage: in pattern 1 (n=9) the external jugular vein provided the primary venous drainage, and in pattern 2, the submental veins drained mainly into the facial vein, the common facial vein, and the internal jugular (n=10). In one patient the submental veins bypassed the facial vein to drain into the internal jugular. Eighteen of the 20 patients had no postoperative complications. The remaining two developed mild venous congestion of the flaps, which was resolved with conservative management and no skin loss. No local or regional recurrence was detected after a mean (range) follow-up of 21 (4-35) months. This is a simple, reliable flap that can be used for the reconstruction of intraoral defects after resections for cancer, but its oncological outcome still requires proof in long-term, large-scale, clinical trials.

Vertical platysma myocutaneous flap reconstruction for oral defects using three different incision designs: experience with 68 cases.

This study evaluated the effects of three different incision designs for the vertical platysma myocutaneous flap (VPMF): apron, MacFee, and T-shaped. This flap was used for the reconstruction of intraoral defects following cancer ablation in selected patients. Sixty-eight cases of VPMF reconstruction were assessed: the apron incision was used in 28, MacFee incision in 22, and T-shaped incision in 18. With regard to postoperative outcomes, there were 26 cases of flap survival and two of partial necrosis with the apron incision; 20 of survival and two of partial necrosis with the MacFee incision; 15 of survival and three of partial necrosis with the T-shaped incision. Success rates were 92.9%, 90.9% and 83.3%, respectively, for VPMF with the apron, MacFee, and T-shaped incisions. A wound healing disturbance in the neck was seen in three cases of VPMF with the apron incision and one case with the MacFee incision. The MacFee incision had the best aesthetic effect, and the postoperative neck scar was more obvious for the T-shaped incision. It is recommended that VPMF with the MacFee or apron incision be used for the reconstruction of larger buccal mucosa and floor of the mouth defects, while VPMF with the T-shaped incision should be used for smaller intraoral defects, especially tongue defects of the lateral surface.

[Clinical effectiveness of salvianolic acid B and triamcinolone acetonide in treatment of oral submucous fibrosis].

Objective: To evaluate the clinical effectiveness of salvianolic acid B (SA-B) and triamcinolone acetonide (TA) by means of combined intralesional injection in the treatment of oral submucous fibrosis (OSF). Methods: According to clinical findings and symptoms, TA combined with SA-B were consecutively applied intralesionally 1 time weekly for 30 times. Mouth opening degree, color change of the buccal mucosae and numeral increase of the capillary vessels were determined by degree Ⅰ-Ⅳ visual analog scale were evaluated at 12, 24, and 36 months, respectively. Results: One hundred and fourteen subjects fulfilled the study without obvious adverse reactions. After treatment for 1 year, the net gain in mouth opening of the early stage group was (5.5 ± 1.5) mm at 12 months, (8.8 ± 1.6) mm at 24 months and (12.0±1.2) mm at 36 months. The net gain in mouth opening of the middle stage group were (5.3±1.7) mm at 12 months, (10.5±1.5) mm at 24 months and (14.5±2.4) mm at 36 months. The net gain in mouth opening of the advanced stage group were (5.7±1.3) mm at 12 months, (13.7±1.3) mm at 24 months and (15.5±1.5) mm at 36 months. The effective rates of color change of the buccal mucosae and numeral increase of the capillary vessels after treatment for 36 months were 100% in early stage group, 93% (51/55) in middle stage group and 90% (36/40) in advanced stage group. Conclusions: TA and SA-B combined intralesional injection in the treatment of oral submucous fibrosis is effective.

[Comparetive study of CBCT and MSCT in the diagnosis of styloid process syndrome].

Objective:To investigate the diagnostic value between CBCT and MSCT in the styloid process syndrome. Method:One case with styloid process syndrome is selected examination of CBCT and MSCT in the patient's position of styloid process. The length and the angle of the styloid process in the picture of CBCT and MSCT were measured and had a construct with each other. Result:MSCT is slightly clearer than CBCT in the imaging of styloid process, but there is no obvious difference in the length and angle measurement of styloid process between them. Conclusion:Except for MSCT, CBCT is another important means in the diagnosis of styloid process syndrome, CBCT has a great clinical application value.

[Construction of three-dimensional finite element model of rat molar].

OBJECTIVE: This paper was to construct three-dimensional finite element model of rat molar, and to access mechanical stress distribution in the tooth and periodontia. METHODS: The first maxillary molar of adult rat was moved for 2 weeks with initial force of 40 g and 100 g. The histological specimen of tooth and surrounding structures were sectioned serially at 4 microns-thick slices in the coronary direction. The section's microscopic photographic images were made every 140 microns. The structural information of images was traced and fed into computer for three-dimensional reconstruction of the structure and finite element model. RESULTS: The stress distribution in periodontia which lies between tooth and alveolar bone was very complicated. CONCLUSION: The three-dimensional finite element model of rat molar is simple, precise, and effective for analyzing stress in tooth and periodontia.

A surgical approach to extensive tumors in the pterygopalatine fossa extending into the maxillary sinus.

PURPOSE: This article describes a surgical approach to extensive tumors in the pterygopalatine fossa extending into the maxillary sinus. TECHNIQUE: The Barbosa approach was modified by adding a lateral incision in the mandibular gingivobuccal fold from the canine tooth to the retromolar area. RESULTS: This technique allowed a large, inferiorly based flap to be raised, which includes the parotid gland. The masseter and temporalis muscles was divided horizontally, and the ascending ramus of the mandible was osteotomized between the mandibular angle and the sigmoid notch and reflected to expose the tumor in the pterygopalatine fossa and maxillary sinus. CONCLUSION: This technique is especially useful to tumors in the pterygopalatine fossa extending into the maxillary sinus.

The effect of L-dopa on the healing of a rat mandibular defect.

PURPOSE: This study was designed to evaluate the effect of L-dopa on healing of a surgically created bony defect in the adult male rat. MATERIALS AND METHODS: Thirty-six animals underwent surgery to create a 4-mm circular defect in the left mandibular angle. They were then randomly divided into two equal groups, one receiving 0.2 g/kg/day of L-dopa for 10 days by orogastric gavage, the other group acting as a control. Six experimental and six control animals were killed at 2 weeks, and five experimental and six control animals were killed at 4 and 6 weeks postoperation. Healing was classified as complete, partial, or incomplete based on gross and radiographic observations. RESULTS: Gross observation of the experimental mandibles showed five completely healed defects (31.25%), five partially healed defects (31.25%), and six defects with no healing (37.5%). Control mandibles showed three defects with partial healing (16.67%) and 15 with no healing (83.33%). Radiographs were taken of randomly chosen mandibles in each control and experimental group. Of the six experimental mandibles, one showed no healing, three showed partial healing, and two showed complete healing of the defect. The six control mandibles showed three defects with no bone formation and three with partial healing. CONCLUSIONS: The data from this study indicate that L-dopa had a promoting effect on the bony healing of defects in the rat mandible.

Neurocristopathy that manifests right facial cleft and right maxillary duplication.

A case of 17-year-old girl with a right facial cleft and maxillary duplication is presented. A vascularized outer-table calvarial bone flap is used for the reconstruction of the bony defects as a result of an oblique facial cleft. The classifications of oblique facial clefts and treatment techniques are also discussed.

[Correction of naso-labial disfigurement subsequent to bilateral cleft lip repair with combined upper lip flap and Abbe flap].

Anomalies of the nose and lip after repair of bilateral cleft lip and palate is a psychological injury to the patients affecting their social intercourse. The author has designed an operative method using a flap of the fore-lip combined with Abbe flap of the lower lip to repair the anomaly with successful result. In two patients, free Abbe lip flap was used, with one complete success and partial necrosis of the other.

[Clinical investigation of oral submucous fibrosis].

In the Xiang Tan city of the Hunan Province 3015 adult of betel were examined intra-orally. Twenty-nine cases of oral submucous fibrosis were found. Other five cases were collected from out-patient department of the hospital. There were thirty-four cases altogether. In the control group, no case was found. The patients of submucous fibrosis were not chewers of tobacco. Four cases of leukoplakia has been found in them. There was not, however, a single case of oral cancer. The clinical investigation supports that chewing of betel is an important etiological factor of oral submucous fibrosis.

Synovial chondromatosis of the temporomandibular joint.

Synovial chondromatosis is a benign, chronic, progressive synovial metaplasia that will not resolve spontaneously. Although it is non-neoplastic, the condition can easily be mistaken histologically as malignant. One Chinese male patient with synovial chondromatosis of the temporomandibular joint is described. Awareness of this rare lesion is important to prevent overdiagnosis and radical treatment. Treatment consists of synovectomy and removal of loose bodies within the joint space.