Clinical analysis and surgical treatment evaluation of 23 cases with primary parapharyngeal space tumors / 中华口腔医学杂志

Objective@#To analyze the clinical characters and surgical treatment of primary parapharyngeal space (PPS) tumors.@*Methods@#A total of 23 cases of primary PPS tumors which were treated from November 2011 to December 2017 were included for the retrospective analysis in this study.@*Results@#Twenty-three cases of patients with primary PPS tumors were analyzed in this study. Surgical approach was as follows: transcervial approach applied in 7 cases, transparotid approach in 4 cases, transoral approach in 2 cases, transmandibular approach in 4 cases, and the combined approaches on 6 cases. Besides, among 7 cases with upper PPS tumor, we applied the surgical navigation system in the surgery of 3 cases. The mean surgery duration of these cases, 3.5 h, was shorter than unused ones, while the mean maximum size (MMS) of tumors, 5.7 cm, was also larger. So far, 23 cases had no recurrence and metastasis. The most frequent histopathological type of all the cases was pleomorphic adenoma (8 cases), followed by Schwannoma (5 cases). With an 8-to-72-months follow up, 23 cases had no recurrence, metastasis or death.@*Conclusions@#Surgical resection is preferred in the treatment of PPS tumors. In the upper PPS tumor cases, the surgical navigation system could reduce the operative duration significantly and is more suitable for larger tumors.

Evaluation and influencing factors of surgical margin status of oral squamous cell carcinoma / 中华口腔医学杂志

Surgical resection with adequate margins is an essential component of the treatment for patients with oral squamous cell carcinoma (OSCC). A distance of 5 mm or more between healthy tissue to the tumor front is generally accepted as a safe margin. It is very important for surgeons to precisely evaluate the resection area of tumor both pre- and intra-operatively and try to achieve a safe margin, which will result in a decreased risk of local recurrence. The relationship of surgical margin status to patients' prognosis, and factors which will affect surgical margin distance demand are discussed in this paper. We recommend that adequate margins evaluation should take consideration of many factors such as anatomical location, depth of tumor invasion, pattern of tumor invasion, mucosal dysplasia grade and so on. With the development of molecular biology, surgical margin study at molecular level can give us a new strategy to evaluate its adequacy.

Prognostic Factors of Primary Intraosseous Squamous Cell Carcinoma (PIOSCC): A Retrospective Review.

OBJECTIVES: To delineate clinical and pathological features and determine the prognostic factors of primary intraosseous squamous cell carcinoma (PIOSCC). MATERIALS AND METHODS: Patients diagnosed with PIOSCC, attending the department of oral and maxillofacial surgery, Nanjing stomatological hospital between 2005 and 2015, were identified and retrospectively reviewed for clinical and pathological characteristics. Therapeutic modalities were measured and related follow-up data recorded, in order to determine prognostic factors of PIOSSC. RESULTS: A total of 77 patients with PIOSCC were included in the study. Mean age at diagnosis was 58.8 years, (range, 37-81 years). Of the 77 patients, there were 58 men and 19 women. The most common location of disease was the mandible (71.42%), particularly the posterior mandible. The common presenting symptoms included jaw swelling (79.2%) and ulceration (42.65%). The estimated 2-year and 5-year overall survival were 68.9% and 38.8%, respectively. Univariate analysis identified the following as negative prognostic factors: histological grade, N classification, nodal status and treatment modalities. However, multivariate analysis determined positive nodal status, high histological grade and advanced N classification as the independent significant prognostic factors. CONCLUSION: Our results demonstrate several clinical and pathological features of PIOSCC and identify important prognostic factors associated with overall survival in PIOSCC. These prognostic factors include nodal status, histological grade, N classification, and treatment modalities, all of which are important for patient counseling and may be useful for the development of new treatment approaches.

Functional assessment: Free thin anterolateral thigh flap versus free radial forearm reconstruction for hemiglossectomy defects

BACKGROUND: To compare free thin anterolateral thigh (ALT) flap with free radial forearm (FRF) flap in the reconstruction of hemiglossectomy defects, and to introduce our methods and experience in the tongue reconstruction with free thin ALT flap. MATERIAL AND METHODS: The clinicopathologic data of 46 tongue carcinoma cases hospitalized from December 2009 to April 2014 were obtained from Nangjing Stomatological Hospital, Medical School of Nanjing University. All the subjects were evaluated for the articulation and the swallowing function 3 months after the surgery. RESULTS: Among these 46 patients, 12 patients underwent tongue reconstruction after hemiglossectomy with ALT flap; 34 patients underwent tongue reconstruction with FRF flap. The differences in the incidence of vascular crisis, the speech and the swallowing function between two groups were not significant (P﹥0.05). CONCLUSIONS: Thin ALT flap could be one of the ideal flaps for hemiglossectomy defect reconstruction with its versatility in design, long pedicle with a suitable vessel diameter, and the neglectable donor site morbidity

The management of pediatric neck masses.

Neck masses are a common clinical concern both in adults and children. The differential diagnosis is quite broad, from congenital lesions to malignant tumors. Based on the different pathologic diagnosis, the treatments are varied. To the best of our knowledge, limited reports, which specifically discuss the incidence and distribution of neck diseases in early childhood, have been published. Because of the great population in China, a thorough review of the previous clinical data for pediatric neck masses might be potentially valuable for oral and maxillofacial surgeons, which might provide a deeper understanding and better the accuracy of our clinical diagnosis and management. In this article, a 10-year retrospective review was completed; the whole cases were diagnosed and treated in the same major clinical institute in east China, which might represent as a typical cohort for the patient population and serve as a reference for future clinical management.

Establishment of CoCl2 induced hypoxic cell model of oral squamous cell carcinoma and a preliminary study on the biological behaviour change / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To mimic oral squamous cell carcinoma (OSCC) cell hypoxia by using chemical agent CoCl2 and to investigate its biological behaviour.</p><p><b>METHODS</b>Oral squamous cell carcinoma cell lines HSC-3 and SCC-4 were exposed to different concentration of CoCl2. HSC-3 and SCC-4 cells were treated with 50, 100, 150, 200 µmol/L CoCl2. Expression of hypoxia inducible factor-1α (HIF-1α), vascular endothelial growth factor (VEGF) and B-cell lymphoma-2 (BCL-2) were measured by real time polymerase chain reaction (PCR) and Western blotting in both mRNA and protein level. Cell proliferation, cell apoptosis and cell cycle were detected to analyze its biological behaviour. Both wound healing and Transwell assay were applied to test the ability of cell igration.</p><p><b>RESULTS</b>The result showed that after treatment of 150 µmol/L CoCl2 for 24 h, mRNA level of HIF-1α, VEGF and Bcl-2 was increased by 6.00 ± 0.20, 5.40 ± 0.40, 5.40 ± 0.30 (SCC-4); 5.60 ± 0.30, 5.20 ± 0.60, 5.80 ± 0.40(HSC-3). OSCC cells treated with 150 µmol/L CoCl2 for 24 h were collected. Compared with control group, the growth rate of cells was significantly decreased, P value was less than 0.05 (when HSC-3, SCC-4 cultured for 2 and 3 days). The apoptosis of OSCC cells was increased when treated with 150 µmol/L CoCl2 for 24 h:HSC-3 2.25% (control group) and 5.82% (treatment group); SCC-4 2.58% (control group) and 10.27% (treatment group). The migration ablility of OSCC cells was decreased when using 150 µmol/L CoCl2 for 24 h. The migration area ratio was (31.5 ± 2.3) % (HSC-3), (29.1 ± 1.5) % (SCC-4) in control group and (18.3 ± 1.9) % (HSC-3), (13.2 ± 0.8)% (SCC-4) in treatment group (P < 0.05).</p><p><b>CONCLUSIONS</b>The hypoxic cell model of OSCC could be induced by CoCl2. The expression level of hypoxic markers was up regulated significantly and the cells biological behaviour changed including decreased cell proliferation, increased apoptosis and decreased migration.</p>

Surgical management of temporomandibular joint ankylosis under the guidance of navigation / 中华整形外科杂志

<p><b>OBJECTIVE</b>To assess the safety and the accuracy of surgical navigation technology in the resection of severe ankylosis of the mandibular condyle with the middle cranial fossa.</p><p><b>METHODS</b>The CT scan data was transferred to a Windows-based computer workstation, and the patient' s individual anatomy was assessed in multiplanar views at the workstation. In the operation, the patient and the virtual image were matched by individual registration with the reference points which were set on the skull bone surface and the teeth. Then the real time navigation can be performed.</p><p><b>RESULTS</b>The acquisition of the data sets was uncomplicated, and image quality was sufficient to assess the operative result in three cases. The operations were performed successfully with the guidance of real-time navigation. The application of surgical navigation have enhanced the safety and the accuracy of the surgery for bony ankylosis of temporomandibular joint.</p><p><b>CONCLUSIONS</b>The application of surgical navigation can improve the accuracy and safety of surgical excision of the ankylosed skull base tissue.</p>

Combined use of an anterolateral thigh flap and rapid prototype modeling to reconstruct maxillary oncologic resections and midface defects.

The most complex area for reconstruction of the head and the neck is the maxilla and the midface because of the difficult anatomy of this region. This article aimed to describe our design for the reconstruction of the zygomaticomaxillary complex using an anterolateral thigh (ALT) flap combined with a rapid prototyping technology. Seven patients were involved in this study. All free ALT flaps survived, and the patients were satisfied with the results both esthetically and functionally 8 months after surgery. The free ALT flap with a titanium mesh made by rapid prototyping technology is a reliable option for the treatment of oncologic resections of the maxilla and other midface defects. This technique has a significantly shorter surgical time than conventional procedures, with good and predictable postoperative outcomes.

Comparative study in reconstruction of tongue defect with thin anterolateral flap and forearm flap / 中华整形外科杂志

<p><b>OBJECTIVE</b>To compare the thin anterolateral flap with forearm flap in tongue defect repairing, and to introduce our methods and experiences in the tongue reconstruction with the thin anterolateral flap.</p><p><b>METHODS</b>The clinicopathologic data of 46 cases with tongue carcinoma were obtained from School of Stomatology, Nanjing University Medical Center, Nanjing University from December 2009 to December 2011. To compare two methods of incidence of vascular crisis, tongue shape, language and swallowing functional recovery.</p><p><b>RESULTS</b>46 patients with tongue carcinoma were performed the tongue reconstruction in 12 month, which 12 cases were used the thin anterolateral flap and 34 cases were used the forearm flap. In the thin anterolateral flap group, All cases were succeeded. 1 case occurs vascular crisis. In the forearm flap group, 33 cases were succeeded, and 1 case occurs necrosis. 3 cases occurs vascular crisis. The results of comparing two methods showed that: no obvious differences in the tongue shape, and no obvious differences in the function of language and swallowing.</p><p><b>CONCLUSIONS</b>There no obvious differences in the reconstruction of tongue defect between the thin anterolateral flap and the forearm flap. The thin anterolateral flap have some advantages: little influence is on the donor site, the flap extent is abundant, the donor site is not spectacular. The thin anterolateral flap should be piror method for the tongue defect repairing.</p>

IFN-γ enhances the anti-tumour immune response of dendritic cells against oral squamous cell carcinoma.

OBJECTIVE: To investigate the expression of antigen processing-1 (Tap-1) and Tapasin in oral squamous cell carcinoma (OSCC), and observe the immune response against OSCC by use of IFN-γ-antigen induced dendritic cells (DCs) in vitro and in vivo. DESIGN: Expression of Tap-1 and Tapasin in different cell lines was analysed. CAL27 cells were treated with IFN-γ. Antigen from the treated cells was presented by DCs. Pulsed DC was then co-cultivated with CD8+ T lymphocyte to induce antigen specific cytotoxic lymphocytes (CTLs). The immune response elicited by CTLs against OSCC was observed. RESULTS: A significant lower expression of Tap-1 and Tapasin was observed in OSCC cell lines. IFN-γ exerted time-dependent effect for increasing the expression of these genes. Antigen from the treated CAL27 cells was presented by DCs. CTLs were induced and generated a strong immune response in vitro and in vivo. CONCLUSIONS: Tap-1 and Tapasin were downregulated in OSCC. IFN-γ increased the expression of these genes. Use of IFN-γ-antigen induced DCs could induce stronger immune response in vitro and in vivo.

A primary study of the different protein expression profiles between human oral squamous cell carcinoma and normal oral mucosa tissues / 实用口腔医学杂志

Objective: To identify the different protein expression profiles between human oral squamous cell carcinoma (OSCC) and normal oral mucosa tissues, and provide experimental data for further study of the development mechanism of OSCC. Methods: 10 cases of OSCC and paired normal oral mucosa tissues were collected and analyzed through two-dimensional gel electrophoresis (2-DE) and matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF-MS). Results: (1) The average protein spots of OSCC were 2 325±390, while that of normal oral mucosa tissues were 2 487±281. (2) 29 differential protein spots were found between OSCC and normal oral mucosa. Moreover, these protein spots were all down- regulated in OSCC compared with normal oral mucosa. Among these spots, 3 were identified as fibrin beta, triosephosphate isomerase (TIM) and unknown protein through mass spectrometry and bioinformation. Conclusion: Down-regulation of fibrin beta, Triosephosphate isomerase(TIM) and unknown protein are found in the development of OSCC and the mechanism needs further study.

Research and application of computer-aided technology in restoration of maxillary defect / 生物医学工程学杂志

This paper presents a new method of designing restoration model of maxillectomy defect through Computer aided technology. Firstly, 3D maxillectomy triangle mesh model is constructed from Helical CT data. Secondly, the triangle mesh model is transformed into initial computer-aided design (CAD) model of maxillectomy through reverse engineering software. Thirdly, the 3D virtual restoration model of maxillary defect is obtained after designing and adjusting the initial CAD model through CAD software according to the patient's practical condition. Therefore, the 3D virtual restoration can be fitted very well with the broken part of maxilla. The exported design data can be manufactured using rapid prototyping technology and foundry technology. Finally, the result proved that this method is effective and feasible.

Effect of local immunotherapy of interleukin 2(IL-2) in combination with chemotherapy upon intratumoral lymphocytes in oral squamous cell carcinomas / 华西口腔医学杂志

<p><b>OBJECTIVE</b>To evaluate the effect of locoregional immunotherapy of interleukin 2 (IL-2) in combination with chemotherapy upon intratumoral lymphocytes in oral squamous cell carcinomas.</p><p><b>METHODS</b>Thirty-four patients with stage T3 or T4 oral squamous cell carcinoma were randomly divided into two groups, and treated with two therapies. 23 cases of them received immunochemotherapy and 11 cases received PVP chemotherapy. Changes of T lymphocyte subsets and B cells at tumor site in the two groups were compared before and after therapy.</p><p><b>RESULTS</b>The relative numbers of CD4+, CD8+, CD20+ before and after treatment in immunochemotherapy were respectively 36.96, 35.65, 28.65 and 56.61, 38.52, 38.70. The numbers of CD4+, CD20+ increased significantly after immunochemotherapy. However, in chemotherapy group, there was no significant difference in numbers of CD4+, CD8+ and CD20+ cells between pre and post treatment.</p><p><b>CONCLUSION</b>Immunochemotherapy for oral squamous cell carcinomas may play an important role in increasing local immunity.</p>

Screening of differential expression proteins from human oral lichen planus and normal oral mucosa by two-dimensional difference gel electrophoresis and mass spectrometry / 实用口腔医学杂志

Objective:To find biomarkers for oral lichen planus by comparing differential expressing proteins. Methods:10 cases of oral lichen planus and normal oral mucosa tissues were collected.Total protein was extracted; differential proteome profiles were established and analyzed by two-dimensional polyacrylamide gel electrophoresis(2D-PAGE) and matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF-MS). Results:(1)The well-resolved,reproducible 2-DE patterns of oral lichen planus and normal oral mucosa were obtained. The results showed that average protein spots were 1 576?67 and 1 608?73 in oral lichen planus and normal oral mucosa respectively, (2) The 13 differential protein spots were identified by Imaging Master 2D image analysis software between oral lichen planus and normal oral mucosa. There were 7 protein spots in oral lichen planus were higher than those in normal oral mucosa, 6 protein spots in oral lichen planus were lower than those in normal oral mucosa. 10 differential expressing proteins were analyzed by mass spectrometry and bioinformation. 4 of them were well characterized including manganese superoxide dismutase (Mn-SOD), Annexin I, vimentin and unknown proteins. Conclusion:Differential expression proteins might be candidate biomarkers for diagnosis of oral lichen planus;and proteomic technique is valuable for screening the diagnostic biomarkers.

Dendritic cells from human peripheral monocyte induces lymphocytic respo nes against Tca8113 cells: an in vitroexperiment / 实用口腔医学杂志

Objective: To investigate the anti-tumor effect of lymph oc yte-mediated immunity induced by Tca8113 cell lysate-pulsed dendritic cells(DC s). Methods: Human peripheral blood monocytes were cultured in R PMI 1640 medium countaning ?=10% FBS with GM-CSF + IL-4 + either TNF-? or n ot. Control cells were cultured without any cytokine. Nonadherent cells were har vested, and continuously incubated with Tca8113 cell lysate made by freez-thaw method, and then the cells were cultured together with autologous lymphocytes. T he activated lymphocytes were co-cultured with Tca8113 cells at E∶T ratio of 1 00∶1. The cells were observed morphologically and assessed by immunocytochemis try before and after the pulse, while the survival rate of Tca8113 cells was stu died by MTT method. All results were analyzed statistically. Results: (1) Typical DCs were generated with higher expression of CD83 in the group s with TNF-? treatment, or with tumor antigen stimulation. (2) The effective l ymphocytes induced by DCs inhibited the proliferation of Tca8113 cells. Conclusion: DCs generated from monocytes in the presence of GM-CSF an d IL-4 can develop to be mature after tumor antigen pulse. DCs induce the lymph ocyte-mediated suppression effect on Tca8113 cells; TNF-? can accelerate DC m ature.

A clinical study on regional occult metastases for patients with squamous cell carcinoma of buccal mucosa / 实用口腔医学杂志

Objective:To assess regional occult metastases on clinical negative neck node [cN0] in patients with buccal mucosal squamous cell carcinoma. Methods:69 patients (31males and 38 females ) with cN0 buccal mucosa squamous cell carcinoma who underwent a lymph node dissection (at the Department of Oral and Maxillofacial Surgery, Affiliated Stomatological Hospital, Nanjing University Medical School) between 1992 and 2004, were retrospectively reviewed. The patients ranged in age from 31 to 79 years with a mean age of 58.2 years. All patients received radical neck dissection(RND), functional neck dissection (FND) or supraomohyoid neck dissection (SOND). Results:The incidence of occult metastases for patients with cN0 buccal mucosa squamous cell carcinoma was 14.49% (10/69).The distribution of the positive nodes was as follows: Level I,10.14%(7/69); Level II, 5.80% (4/69); Level III, 2.90%(2/69). The occult metastasis rate for patients with T1, T2, T3 and T4 was 9.52% (2/21), 15.38%(6/39), 25.00%(1/4), and 20.00%(1/5), respectively. In patients with well differentiated carcinoma,the occult metastasis rate was 14.89%(7/47); moderate differentiated,10.00%(2/20); and poorly differentiated,50.00%(1/2). Conclusion:The assessment of regional occult metastases for patients with cN0 buccal mucosa squamous cell carcinoma may play an important role in deciding treatment approaches of neck.