Extirpation of primary malignancies in the pterygopalatine and infratemporal fossa via modified maxillary swing approach / 中华口腔医学杂志

Five patients with primary malignancies in the pterygopalatine fossa (PPF) and infra temporal fossa (ITF) were enrolled in this retrospective study between January 2012 and January 2018. After malignancies proven by biopsy and evaluation with CT and MRI scan, all patients received modified maxillary swing (MMS) approach for extirpation of malignant tumors in the PPF and ITF under general anesthesia. En bloc resection with wide surgical margins was successfully performed in all cases. Negative margins were observed in 4 cases and positive margins were found in one patient with adenoid cystic carcinoma who received postoperative radiotherapy. The most common complication was facial numbness. During the follow-up period (range 12 to 57 months), one patient suffered from recurrence while others did not. The advantages of MMS include wide surgical field, full exposure and easy manipulation. The MMS approach is expected to become an standard method for monobloc resection of malignancies in the PPF and ITF.

"Cause Analysis and Countermeasure Research on Public Remedy ""Silence"" in Medical Disputes" / 中国医学伦理学

Firstly, this article introduced the definition of medical dispute and public remedy. Thereafter, it analyzed the causes of public remedysilence in medical disputes from four perspectives including the self-defect of public remedy, inadequacy of legal construction, lack of trust in public remedy, and the popularity of private remedy. Finally, it pointed out the countermeasures of enhanced legal construction, unimpeded public remedy and striking private remedy to solve the problem of public remedy silence in medical disputes.

[Clinical application of the combined radical operation without breaking lower lip and mandible for tongue and lingual root carcinoma].

OBJECTIVE: To investigate the clinical applicability and outcomes of the combined radical operation without breaking the lower lip and mandible with one-stage reconstruction using free anterolateral thigh flap for tongue and lingual root carcinoma. METHODS: The operation with or without breaking lower lip and mandible was performed respectively in 245 patients (experimental group) and 120 patients (control group). RESULTS: Removal of tumor and neck dissection were conducted successfully in all patients of two groups with no serious postoperative complication. With the follows-up of 6 to 36 months, in the patients of experimental group there was no recurrence for primary sites but 3 cases with neck lymphnode recurrence, the functions of chewing, swallowing and speaking were good, there was no damage to appearance, and no osteoradionecrosis occurred in the lymphnode positive cases after radiotherapy; in the patients of experimental group there was no recurrence for primary sites but 4 cases with neck lymphnode recurrence, the functions of chewing, swallowing and speaking were good, but there was apparent scar in neck and face, and osteoradionecrosis occurred in 11 of lymphnode positive cases. CONCLUSIONS: The combined radical operation without breaking the lower lip and mandible with one-stage reconstruction using free anterolateral thigh flap is feasible for tongue and lingual root carcinoma (T2-T3), which reduces the risk for osteoradionecrosis in lymphnode positive cases after radiotherapy and keeps good appearance for patients.

Analysis of the causes of flap necrosis after head and neck reconstruction / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To analyze the causes of the vascular crisis and necrosis of free flaps used for reconstruction of defects following head and neck cancer resection and the managements of these issues.</p><p><b>METHODS</b>A total of 850 cases with head and neck tumors who underwent free flap reconstruction from October 2010 to April 2014 were studied retrospectively. The risks for vascular crisis and necrosis were analyzed with one-factor analysis and multivariate analysis.</p><p><b>RESULTS</b>The total success rate of 95.1% (808/850) for the free flap reconstruction was obtained. Twelve flaps due to poor blood supply indicated during operation were replaced by other free flaps. Among 73 flaps with vascular crisis, 31 flaps were salvaged by surgical exploration and subcutaneous injection of low molecular heparin calcium. Obesity, smoking, preoperative radiotherapy and surgeon's experience, rather than age, hypertension and diabetes, were the risk factors of skin flap necrosis. Two-vein anastomosis had a higher success rate than one-vein anastomosis.</p><p><b>CONCLUSIONS</b>The necrosis rate of free flaps can be reduced by the choice of suitable flaps, subtly preparation of flaps, carefully vascular anastomosis, and prompt perioperative managements. The two-vein anastomosis is recommended. Diabetes, hypertension and elderly patients are not the contraindications for free flap reconstruction.</p>

Application of improved submental island flap in hypopharyngeal cancer reserved laryngeal function surgery / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#This study aimd to evaluate the application and clinical effect of improved submental island flap in hypopharyngeal cancer reserved laryngeal function surgery.@*METHOD@#A retrospective review of clinical data was performed on 38 patients of hypopharyngeal cancer reserved laryngeal function using sumental island flaps, by the way of improving in design of vascular pedicle, reconstructive mode of laryngeal and hypopharyngeal function and closing of wound of neck following hypopharyngeal cancer resection. Meanwhile, the effect and prognosis was comprehensively assessed on patients with hypopharyngeal cancer reserved laryngeal function using improved submental island flaps.@*RESULT@#The submental flaps kept alive in all 38 cases. During the follow-up period, 18 cases were dead, and of them, 7 cases died of the second primary carcinoma, included 4 cases of esophagus cancer, 1 case of cancer of soft palate, 2 cases of nasopharyngeal carcinoma; and 5 cases died of cervical or parapharyngeal lymph nodes recurrence; 2 cases died of hepatic metastasis; and 4 cases died of pulmonary metastasis. The overall 5-years survival rate was 52.6%.@*CONCLUSION@#Improved submental island flap repairing postoperative defect of hypopharyngeal cancer reserved laryngeal function has many advantages including higher success rate, more security, easy and simple to operate as well as good clinical effects, and is worth to widespread using.

Observation on clinical effect of ECF regimen and DOF regimen in treating advanced gastric cancer / 重庆医学

Objective To observe the efficacy and adverse reactions of ECF regimen (epirubicin combined with cisplatinum and fluorouracil) and DOF regimen (docetaxel combined with oxaliplation and fluorouracil ) in the treatment of advanced gastric cancer .Methods 68 cases of advanced gastric cancer were randomly divided into the ECF group (30 cases) and the DOF group (38 cases) .The ECF group was treated with epirubicin 50 mg/m2 on 1 d ,cisplatin 20 mg/m2 on 1-3 d and fluorouracil 500 mg/m2 on 1-5 d .The DOF group was treated with docetaxel 75 mg/m2 on 1 d ,oxaliplatin 130 mg/m2 and fluorouracil 500 mg/m2 on 1-5 d . 21 d were as a cycle of treatment .All cases received two cycles of chemotherapy at least .The efficacy and toxicity were evaluated according to the WHO standard .Results All cases were evaluable for the objective response .The overall response rate was 46 .67% in the ECF group and 42 .11% in the DOF group .The major adverse reactions in the two groups were marrow depression , gastrointestinal reaction ,alopecia and neurotoxicity ,etc .The occurrence rate of neurotoxicity in the DOX group was 39 .47% (26/38) ,which was higher than 13 .33(4/30) in the ECF group ,the occurrence rate of nausea and vomiting in the ECF group was 93 .33% (28/30) ,which was higher than 68 .24(26/38) in the DOF group ,the difference between the two groups was statistically significant (P<0 .05) .Conclusion Both of the two regimens have the similar effect for treating advanced gastric cancer and the ad‐verse reactions are tolerable .

Effects of cancer associated fibroblasts on biological function of tongue cancer cell / 中国免疫学杂志

Objective:To elucidate the effects of CAFs on the proliferation,migration and invasion of oral cancer cells and those on tumor growth.Potential mechanism was discussed.Methods:CAFs and SCC-9 or CAL-27 were cocultured.The proliferation of oral cancer cells were detected by measuring the level of RFP.A interaction model between CAFs and SCC-9 or CAL-27 were established with Transwell chambers to abserve the effects of CAFs on the migration and invasion of OCCs.The conditioned medium collected from mono-cultured CAFs or SSC-9 cell,and co-culture were subjected to a cytokine antibody array.Volumes of xenografts were obtained and presented.Results:At day 5,significant difference was found in OCC proliferation between OCC-CAFs group and OCC group.The SCC-9 cell number was up to 4.41±0.38 times as many as the initial number in co-culture group and 3.21±0.35 times in SCC-9 group(P<0.05).The proliferation of CAL-27 was similar to that of SCC-9.SCC-9 cells migrated to the bottom in group SCC-9+CAFs were 2.6± 0.42 times as many as group SCC-9(P<0.05).CAL-27 cells migrated to the bottom in group CAL-27+CAFs were 3.11±0.46 times as many as group CAL-27 ( P<0.05 ) .The similar results were found in invasion analysis.OCCs invaded more quickly towards medium derived from co-cultured cells than that from OCCs alone.Three human cytokines(CCL2,CCL5 and IL-8)were significantly upregulated in conditioned medium from co-cultured cells compared with those from CAFs or SSC-9 alone.Six weeks after injection,we observed that SCC-9 mixed with CAFs generated tumors of greater volume than those generated from SCC-9 cells alone.Conclusion:CAFs Promote the Proliferation,Migration,Invasion of oral cancer cells and tumor growth.Cytokines(CCL2,CCL5 and IL-8)may responsible for the bi-ological function change of cancer cells.

Surgical treatment of tremendous neurogenic tumors in the root of neck / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To evaluate surgical treatment outcomes in 6 cases with tremendous neurogenic tumors in the root of neck.</p><p><b>METHODS</b>Neck-chest-axil-arm "T" incision was used to remove huge tumor in the root of neck.</p><p><b>RESULTS</b>The tumors in the root of neck in 6 patients were removed successfully and no serious complication occurred. With postoperative follows-up for 2-6 years(median 4.5 years), only 1 case died due to the recurrence of lesion in vertebral canal in 11 months after surgery and the other cases survived with satisfying therapeutic outcomes.</p><p><b>CONCLUSION</b>Surgery is an effective method to remove advanced tumor in the root of neck and to improve the quality of life for the patients.</p>