[Application of reversed pedicled submental island flap].

OBJECTIVE: To explore the clinical applications of reversed pedicled submental island flap in the face and oropharynx. METHODS: The clinical data of ten cases of reconstruction of defect in the area of face or oropharynx following resection of tumors with reversed pedicled submental island flaps between January of 2004 to December of 2006 were retrospectively studied. The cases included six males and four females, aged from 24 to 76 (median 55 years). One of the cases suffered from upper lid melanoma, two hard palate myoepithelioma, one maxillary ameloblastoma, four tonsil cancer and two lingual carcinoma. The submental island flaps were dissected according to the area of the defection, the distal facial vessel was used as the pedicle of the flaps, and the flaps were transferred through under the skin of the face or the mandible to the area of the defection. Radical neck dissection was performed in the four tonsil cancers and two lingual carcinomas simultaneously. RESULTS: All the flaps showed pale, edema and/or congestion after the surgical treatment, but swelling and congestion disappeared gradually 5 days later. One of the cases suffered from severe congestion of the flap, but the flap survived by stabbing with needle and draining. The flap of another case separated from the hard palate was sutured again, and healed. Lower lip palsy occurred in another case, and recovered 3 months later by conservative therapy. None of the flaps necrosed. CONCLUSIONS: Because of the upper pedicle, reversed pedicled submental island flap can be transferred to a long distance to reconstruct the defect in the upper face or around the orbit, and radical neck dissection can be performed simultaneously, it is a reasonable candidate in repairing the defect of the face and oropharynx.

[Apoptosis in nasopharyngeal carcinoma cell line NCE induced by curcumin and its molecular mechanism].

OBJECTIVE: To investigate the mechanism underlying the curcumin-induced apoptosis of nasopharyngeal carcinoma (NPC) cell line NCE cells. METHODS: The characteristics of apoptosis were identified by observation acridine orange and ethidium bromide stains, ultrastructure assay, DNA fragmentation assay and TdT-mediated dUTP nick end labeling method (TUNEL). Mitochondrial membrane potential (delta psi m), activity of caspase-3, cytosol cytochrome C and expression of gene Fas were determined by flow cytometry (FCM), Western Blot and reverse transcription-polymerase chain reaction (RT-PCR). RESULTS: Several evidences of apoptosis were obtained from curcumin-treated NCE cells by acridine orange and ethidium bromide stains, ultrastructure identification, DNA fragmentation assay and TUNEL staining. And the mean TUNEL-positive rates increased significantly at the 3 different time points (12 h, 24 h and 48 h; 25.6%, 40.3% and 54.5%, respectively). In the curcumin-treated-groups, delta psi m altered significantly and the positive rates increased in a time-dependent manner. At the 3 different time points, the mean positive rates were 26.8%, 42.3% and 68.2%, respectively. When caspase-3 activity was detected, 80.5% cells presented proteases activities after 12 h incubation with curcumin. Western Blot analysis showed that cytoplasmic cytochrome C increased significantly after incubation with curcumin. Flow cytometry and RT-PCR analysis showed that curcumin could up-regulate the Fas expression in time-depended manner , the positive rates of Fas protein increased from 33.6% to 89.9%. CONCLUSIONS: Curcumin induced apoptosis of NCE cells both through mitochondria-dependent pathway and death receptor pathway.

[Resection of malignant tumors of the anterior skull base and the fronto-orbito-ethmoidal region by overturn of frontonasal flap].

OBJECTIVE: To introduce a better surgical approach for the resection of malignant tumors in the anterior skull base and in the fronto-orbito-ethmoidal region. METHODS: A "U" form incision on the bilateral superciliary arch was made and connected with the unhealthy nasal side incision. Then the frontal musculocutaneous flap was over-turned upward. The nasal pyramid was over-turned to the healthy side. The malignant tumors in the anterior skull base and the fronto-orbito-ethmoidal region were fully exposed and resected. RESULTS: From december 1986 to december 1996, 50 patients received tumour resection through this approach. Postoperatively, the one-year survival rate was 86.0% (43/50), the three-year survival rate was 62.0% (31/50), and the five-year survival rate was 44.0% (22/50). CONCLUSION: The frontonasal flap overturn approach provided good exposure of surgical field, avoided the coronal incision, and the reaction of brain was mild. We believe this surgical approach is superior to traditional combined craniofacial approach.

[Surgical treatment of transcranial middle cranial fossa-lateral skull base malignant tumor].

OBJECTIVE: To evaluate the surgical method of transcranial middle cranial fossa-lateral skull base malignant tumor. METHODS: Sixteen patients with transcranial middle cranial fossa-lateral skull base malignant tumors were treated by three surgical methods. (1) Postauricular "C" form incision, combined with subtotal resection of temporal bone and high lateral neck approach to resect tumors located in middle cranial fossa, lateral skull base, and parotid region. (2) Temporal side "tungue" form incision, middle cranial fossa approach to resect tumors inside and outside the skull. (3) Temporal-auricular-mandible swing approach to resect tumors in parapharyngeal-infratemporal fossa-middle cranial fossa. Thirteen of the 16 cases received radiotherapy postoperatively. RESULTS: After operation, 11 of the 16 cases survived more than three years, five cases died within three years. Three-year-survival rate was 69%. CONCLUSIONS: Our results showed that the three surgical methods adopted could fully expose the internal and external skull lesion to remove the extensive malignant tumors. For late stage malignant tumors of the skull base, it should be treated aggressively by combination of surgical therapy and postoperative radiotherapy.