PURPOSE: To explore the expression and biological function of miR-125b-5p in oral squamous cell carcinoma. METHODS: The expression of miR-125b-5p in OSCC and its correlation with prognosis was analyzed by TCGA database. The expression of miR-125b-5p in OSCC tissue samples and cell lines was analyzed by miRNA sequencing and RT-qPCR. The effect of miR-125b-5p overexpression on OSCC cell proliferation was detected by CCK-8 and colony formation assays. The effect of miR-125b-5p overexpression on OSCC cell migration was investigated by wound healing assay. The effect of miR-125b-5p overexpression on apoptosis of OSCC cells was evaluated by flow cytometry. Target genes of miR-125b-5p were identified through TargetScan, miRDB and miRTarBase databases. These predictions were validated through Western blotting, and the biological functions of the target genes were explored using KEGG and GO enrichment analyses. RESULTS: The expression of miR-125b-5p was significantly down-regulated in OSCC. Patients with lower expression of miR-125b-5p had significantly shorter overall survival(P=0.007) and disease-specific survival(P=0.022) compared to those with higher expression. Overexpression of miR-125b-5p significantly reduced the proliferative activity(P<0.001), colony formation ability (P<0.01) and migration capacity (P<0.001) of OSCC cells compared to the normal controls. Additionally, the apoptosis rate of miR-125b-5p overexpressing cells was significantly higher(P<0.001). Functional enrichment analysis suggested that the target genes of miR-125b-5p were involved in the regulation of tumor proliferation, apoptosis, migration and tumor immune microenvironment. CONCLUSIONS: The expression of miR-125b-5p is significantly down-regulated in OSCC. Overexpression of miR-125b-5p inhibits the proliferation and migration of OSCC cells and promotes cell apoptosis, may be a potential therapeutic target for OSCC treatment.

PURPOSE: To explore the molecular mechanism by which Porphyromonas gingivalis(P. gingivalis) forms an immunosuppressive microenvironment in oral squamous cell carcinoma(OSCC) through the CCL20-CCR6 pathway. METHODS: Mouse-derived squamous cell carcinoma cell line SCC7 and P. gingivalis were cultured in vitro, and C57BL/6 mice were used to establish a tumor mouse model. Based on the infection status of P.gingivalis and the inhibition of the CCL20-CCR6 axis, C57BL/6 mice were divided into control group(SCC7), experimental group(SCC7+P.g), and intervention group(SCC7+P.g+CCR6 antagonist). The changes in tumor mass and volume among different groups were observed macroscopically, immunohistochemistry was used to detect CD4, FOXP3, PD-1, CTLA-4, LAG3, TIM3 and TIGIT in tumor tissues, ELISA was applied to measure the serum TGF-β levels. RESULTS: Compared to the control group, P.gingivalis infection in the experimental group significantly promoted the tumor tissue volume in OSCC-bearing mice(P<0.05), and the expression of CD4, Foxp3, CTLA-4, LAG3, TIM3, TIGIT, and TGF-β in the tumor tissue immunological microenvironment was significantly increased (P<0.05), while PD-1 expression showed no significant difference (P>0.05). The intervention group showed a reduction in tumor tissue volume compared to the experimental group (P<0.05), the expression of relevant immunosuppressive molecules and immune checkpoints CD4, Foxp3, PD-1, CTLA-4, LAG3, TIGIT, and TGF-β decreased(P<0.05), while TIM3 expression showed no significant difference(P>0.05). CONCLUSIONS: P.gingivalis recruits more Treg cells through the CCL20-CCR6 axis, regulates the expression of tumor-associated suppressive cytokines and immunosuppressive checkpoints, thereby promoting the formation of an immunosuppressive microenvironment in OSCC.

PURPOSE: To observe the effects of two-stage crown-root extraction and conventional single-stage extraction on the complications after high-risk mandibular third molar (M3M) extraction. METHODS: A prospective non-randomized controlled design was adopted, with 145 high-risk M3Ms divided into two groups. For the experimental group (59 M3Ms), the two-stage crown-root extraction method was used: crown amputation was performed in the first stage, and the remaining tooth roots were extracted in the second stage 3-6 months later. For the control group (86 M3Ms), the conventional one-time extraction method was used to remove both the crown and root of M3M. The conditions of bleeding, infection, postoperative reactions (pain, swelling, and trismus), and inferior alveolar nerve (IAN) injury within 7 days after surgery were compared between the two groups. RESULTS: No statistically significant difference in postoperative hemorrhage was observed between the two groups within 7 days(P>0.05). The experimental group exhibited a higher infection rate after the first stage of surgery, but the postoperative reactions such as pain, swelling and trismus were less than that of the control group, with statistically significant differences between the two groups(P<0.05). Notably, no IAN injuries occurred in the experimental group, whereas the incidence of IAN injuries in the control group was 13.95%(12/86), demonstrating a statistically significant difference (P<0.05). CONCLUSIONS: Although the incidence of infection after the first-stage surgery is relatively high, the two-stage crown-root extraction method for removing high-risk M3M can effectively reduce postoperative complications, especially the risk of IAN injuries, providing a new option for the extraction of high-risk M3M with radiographically confirmed inferior alveolar canal compression.

PURPOSE: To investigate the nutritional risk status and dynamic changes of patients with oral cancer at different stages during perioperative period, and to analyze the factors affecting nutritional risk. METHODS: Convenience sampling was used to select 120 patients with oral cancer who underwent surgical treatment in Nantong Cancer Hospital from January 2022 to December 2023 as the research subjects. The nutritional status of the patients was evaluated using the Short-form Mini-nutritional Assessment(MNA-SF) on the day of admission(T1), 7 days after operation(T2), and 1 month after discharge(T3), respectively. The change trajectory and influencing factors of perioperative nutritional risk in patients with oral cancer were analyzed by generalized estimation equation. RESULTS: A total of 120 questionnaires were sent out, and 108 were effectively collected, with an effective recovery rate of 90.00%. At T1 time point, the MNA-SF score of 120 patients with oral cancer was (12.45±3.02), and the incidence of malnutrition was 17.50%. At T2 time point, the MNA-SF score of 115 patients with oral cancer was (11.02±3.25), and the incidence of malnutrition was 40.87%. At T3 time point, the MNA-SF score of 108 patients with oral cancer was (11.86±3.11), and the incidence of malnutrition was 25.93%. The results of generalized estimation equation showed that age, marital status, BMI, smoking status, clinical stage, flap repair and tracheotomy were significant factors affecting nutritional risk(P< 0.05). CONCLUSIONS: The incidence of nutritional risk is higher in perioperative patients with oral cancer, and the trajectory of nutritional risk changes with time. Strengthening nutrition monitoring and management of elderly patients with oral cancer, low education level, BMI less than 18.5, smoking, advanced cancer, flap repair and tracheotomy is of great significance for correcting malnutrition and improving prognosis.

PURPOSE: To introduce a self-developed electric mouth opener and evaluate its efficacy in postoperative mouth-opening exercise following temporomandibular joint disc repositioning surgery. METHODS: Thirty patients with maximal interincisal opening(MIO) <30 mm after open disc repositioning surgery for anterior disc displacement were randomly assigned to three training groups: manual stretching, stretching device group, and electric mouth opener. All groups underwent 6 weeks of home-based rehabilitation: the manual group performed finger-assisted stretching, the stretching device group used a traditional TMJ stretching brace, and the electric group used the self-developed four-speed adjustable electric mouth opener. MIO, pain degree, and mandibular function evaluated with visual analog scale (VAS) before training, at 2 weeks and 6 weeks after training were recorded and compared. RESULTS: No significant differences in preoperative or postoperative MIO existed among three groups. After 6 weeks of training, all groups showed significant MIO improvement versus baseline (P<0.05). The electric mouth opener group achieved optimal recovery [(39.2±1.5) mm], significantly exceeding both the stretching device group [(35.7±2.8) mm] and manual group [(32.1±4.0) mm]. Pain reduction was most pronounced in the electric group. At 6 weeks, both device-assisted groups showed higher mandibular function scores than the manual group, with the electric mouth opener group showing superior efficacy(P<0.05). CONCLUSIONS: The electric mouth opener is safe and effective for accelerating postoperative MIO recovery in TMJ disc repositioning patients, offering advantages in operational simplicity and stability.

PURPOSE: To analyze the correlation between the periodontal tissue status and gingival biotype after orthodontic traction of maxillary impacted molars, and to provide a reference for the optimization of clinical treatment plans. METHODS: A total of 82 patients with maxillary impacted canines admitted to Affiliated Hospital of Qingdao University from October 2019 to October 2023 were selected. The gingival biotype was evaluated by digital imaging technology and periodontal probe,and the patients were divided into the thin gingival biotype group(n=47) and the thick gingival biotype group(n=35). All patients received orthodontic traction treatment. The periodontal tissue indicators such as alveolar bone thickness, height, and attached gingival width after treatment, as well as the periodontal health indicators such as periodontal pocket depth, clinical attachment loss, and gingival index were compared between the two groups. RESULTS: The labial alveolar bone thickness, apical alveolar bone thickness, labial alveolar bone height, and attached gingival width in the thick gingival biotype group were significantly greater than those in the thin gingival biotype group (P<0.05); the differences in labial and apical alveolar bone thickness and height, and the difference in attached gingival width in the thick gingival biotype group were significantly smaller than those in the thin gingival biotype group(P<0.05); periodontal pocket depth, gingival index, and clinical attachment loss in the thin gingival biotype group were significantly higher than those in the thick gingival biotype group(P<0.05). CONCLUSIONS: Patients with thick gingival biotype have smaller changes in periodontal tissue morphology and better recovery of periodontal health status after orthodontic traction of maxillary impacted canines, suggesting that preoperative evaluation of gingival biotype is of great significance for prognosis judgment and treatment plan formulation.

PURPOSE: To compare the impact of different compliance rates of enhanced recovery after surgery (ERAS) measures on the postoperative recovery quality of patients undergoing orthognathic surgery. METHODS: A retrospective cohort study was conducted to collect the information of patients who underwent elective orthognathic surgery at the Third Affiliated Hospital of Air Force Military Medical University from September 2020 to February 2023. According to the compliance rate of ERAS measures, the patients were divided into two groups: the low compliance group (compliance rate <80%) and the high compliance group (compliance rate≥80%). Propensity score matching was used to match the two groups of patients, with 127 cases in each group after matching. The primary outcome was the 40-item recovery quality score scale (Quality of Recovery-40, QoR40) on the first postoperative day. Secondary outcomes included QoR40 scores on postoperative days 3, 5, 7, and 14, the pain scores one day after surgery, and the correlation between ERAS measures and the QoR40 score on the first postoperative day. RESULTS: The QoR40 scores on the first postoperative day in the high compliance group were significantly higher than those in the low compliance group (P<0.05). The comfort score in the five dimensions of the QoR40 score was higher and the pain scores was lower in the former group (P<0.05). There were no significant difference in QoR40 scores on postoperative days 3, 5, 7, and 14 between the two groups(P>0.05). The application of antibiotics during operation, maintenance of intravenous anesthesia, body temperature management, airway management, prevention and treatment of postoperative nausea and vomiting, no agitation during the recovery period, and early postoperative ambulation were positively correlated with the QoR40 score of patients one day after operation (P<0.05). CONCLUSIONS: With the compliance of ERAS measures higher than 80%, the quality of recovery and the comfort on the first postoperative day in patients undergoing orthognathic surgery is significantly enhanced.

PURPOSE: To explore the independent risk factors for postoperative free flap complications in elderly patients with head and neck cancer, and to provide a basis for preoperative risk stratification and individualized management. METHODS: A total of 1 197 elderly patients (≥60 years old) admitted to Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from January 2014 to December 2022 were retrospectively included. All patients underwent radical resection of head and neck cancer combined with free flap reconstruction under general anesthesia. Univariate analysis was used to screen potential risk factors for flap complications, and multivariate logistic regression analysis was performed to identify independent risk factors. RESULTS: The total incidence of postoperative free flap complications was 20.13% (241/1 197). Multivariate logistic regression showed that smoking (OR=1.391, 95%CI: 1.008-1.921, P=0.045), chronic obstructive pulmonary disease (COPD) (OR=1.912, 95%CI: 1.064-3.436, P=0.030), malnutrition [prognostic nutritional index(PNI) ≤47.81, OR=1.362, 95%CI: 1.009-1.838, P=0.043], chronic heart failure (OR=1.988, 95%CI: 1.150-3.437, P=0.014), and prolonged operation duration (OR=1.123, 95%CI: 1.052-1.200, P<0.001) were independent risk factors for postoperative flap complications. CONCLUSIONS: Smoking, COPD, malnutrition, chronic heart failure, and prolonged operation duration are independent risk factors for postoperative free flap complications in elderly patients with head and neck cancer. Clinically, targeted preoperative interventions (such as smoking cessation, nutritional support, and control of underlying diseases) and intraoperative time management should be strengthened to reduce the risk of complications.

PURPOSE: To compare the diagnostic efficacy of ultrasound and enhanced CT in the diagnosis of cervical lymph node metastasis in patients with head and neck squamous cell carcinoma(HNSCC), and establish a predictive model to improve the accuracy of early diagnosis. METHODS: A total of 125 patients with primary HNSCC who underwent neck lymph node dissection at Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from November 2022 to April 2024 were selected. Their ultrasound and enhanced CT data, as well as information on primary lesion pathology and cervical lymph node metastasis, were collected and randomly divided into a modeling group and a validation group in a 7∶3 ratio. In the modeling phase, a multi-factor logistic regression model was used to screen for predictive factors of cervical lymph node metastasis, and a column chart was constructed based on these variables. The area under the ROC curve and calibration curve were used to evaluate the discrimination and calibration of the model. The clinical application value of the model was evaluated using clinical decision curves. RESULTS: The results of multiple logistic regression model showed that the maximum diameter of lymph nodes, the depth of primary lesion infiltration, the degree of differentiation, and the age of the patients had a significant impact on the diagnosis of cervical lymph node metastasis (P<0.05). Based on these risk factors, a risk column chart prediction model was established, and the area under the ROC curve and calibration curve showed good discrimination and accuracy of the model. Clinical decision curve analysis showed that the model has certain clinical practicality within a large threshold. CONCLUSIONS: Overall, ultrasound is superior to enhanced CT in the diagnosis of cervical lymph node metastasis in patients with head and neck squamous cell carcinoma. The column chart model of cervical lymph node metastasis constructed in this study has a good predictive effect and can provide reference for clinical prediction of lymph node metastasis in head and neck squamous cell carcinoma.

PURPOSE: To evaluate the accuracy and clinical outcomes of dynamic navigation for the placement of intentionally tilted implants in the posterior maxilla. METHODS: Twenty-eight patients with maxillary edentulism or continuous multiple posterior maxillary tooth loss who were treated in Affiliated Jiangning Hospital of Nanjing Medical University from February 2023 to June 2024 were selected. All patients were treated with axial and tilted implants under dynamic navigation guidance. Implant three-dimensional deviation was calculated after surgery, and survival rate of axial and tilted implants was compared. Follow up visits were performed every 3 months after rehabilitation with definitive prosthesis, and any complication was noted and the stability of the implants and prosthesis as well as proper occlusion were checked. RESULTS: A total of 97 implants were implanted, including 42 tilted implants and 55 axial implants. The accuracy measurement showed that the neck deviations of the inclined implant and the axial implant were (1.03±0.39) and (1.12±0.25) mm, respectively, the tip deviations were (1.21±0.23) and (1.29±0.32) mm, respectively, and the depth deviations were (0.63±0.20) and (0.54±0.34) mm, respectively, the angular deviations were 2.46°±0.68° and 2.22°±0.57°, respectively. There was no significant difference in the various indicators of implant accuracy between the two groups(P>0.05). No complications such as maxillary sinus injury occurred during operation. One tilted implant and one axial implant failed to fall off before restoration. The implant failure rates were 2.38% and 1.82%, respectively, and the difference was not significant(P=0.885). The patients were followed up for 3 to 12 months. The stability of the implants and restorations was good, the masticatory function recovered well, and no maxillary sinusitis occurred. CONCLUSIONS: Tilted implantation in the maxillary posterior region under the guidance of dynamic navigation has the advantages of high accuracy, good safety, minimal trauma and short treatment cycle. It is an effective method for the treatment of alveolar bone atrophy in the maxillary posterior region.

PURPOSE: Reddish erythemas in the head and neck region are often misdiagnosed as capillary malformations and treated with laser therapy, but the efficacy is poor. Enhanced CT and MRI examinations usually show no obvious abnormalities, while ultrasonic Doppler can detect enhanced arterial murmurs, and angiography reveals dense distribution of arterioles in the lesion. This study aimed to name and classify such occult vascular malformations, and summarize their diagnostic and treatment methods. METHODS: The clinical data of 48 patients with arteriole malformations in the head and neck admitted to Peking University School and Hospital of Stomatology from April 2012 to October 2021 were retrospectively analyzed. Their symptoms, signs, and auxiliary examination results were summarized, and the application effects of percutaneous puncture arteriolar embolization, vascular perfusion therapy, surgical treatment, and sclerotherapy were evaluated. RESULTS: Arteriole malformations could be classified into cutaneous type and mucosal type based on the location of onset, and into central type(type Ⅰ) and divergent type(type Ⅱ) based on the characteristics of the supplying vessels. The clinical manifestations of cutaneous arteriolar malformations were reddish erythemas on the skin, occasional spontaneous bleeding, and slightly increased or normal skin temperature; the mucosal type presented as papillary elevation with central micro-depression accompanied by bleeding. Abnormal arterial murmurs could be heard by ultrasonic Doppler, angiography showed dense arterioles, while CT/MRI were mostly negative. The treatment was mainly percutaneous puncture arteriolar embolization, assisted by perfusion, sclerotherapy or surgical resection. A 5-year follow-up showed that spontaneous bleeding and erythema subsided, abnormal arterial sounds disappeared, and complications included edema, ulcer, recurrence, etc., with significant overall good efficacy. CONCLUSIONS: Some reddish erythemas are occult arteriole malformations, easily confused with capillary malformations. Ultrasonic Doppler is an important differential tool. Individualized treatment regimens (such as embolization combined with perfusion) selected according to typing can effectively control the condition and reduce misdiagnosis and mistreatment.

PURPOSE: To evaluate the value of image-based Q&A assignments in the practical course of oral histopathology, and to provide a reference for optimizing practical teaching modes. METHODS: A total of 137 students from the 2020 and 2021 grades majoring in stomatology at Shanghai Jiao Tong University School of Medicine were selected as the experimental group, and 103 students from the 2018 and 2019 grades as the control group. In the practical teaching of periodontal tissue diseases and oral and maxillofacial tumors (salivary gland tumors, and tumors and tumor-like lesions originating other tissues) in oral histopathology, both groups adopted the same theoretical teaching and practical observation modes. The experimental group completed the assignments designed in advance by the teacher based on images through Wenjuanxing platform, while the control group used traditional drawing assignments. The scores of practical courses and theoretical courses of the two groups were compared, and a questionnaire survey on teaching effect was conducted among the experimental group. RESULTS: The average scores of the experimental group in the practical courses of periodontal tissue diseases and oral and maxillofacial tumors were (95.1±7.4) and (94.9±9.4) respectively, which were significantly higher than those of the control group [(91.3±4.5) and (90.7±4.1), P<0.001]. The average score of the experimental group in the theoretical course of oral, maxillofacial and head-neck tumor module was (87.4±7.4), which was significantly higher than that of the control group [(85.8±7.5), P=0.031]. The questionnaire survey showed that 90.2% of the students preferred image-based Q&A assignments, believing that they were more conducive to consolidating knowledge and making efficient use of class time. CONCLUSIONS: The image based Q&A assignments in the practical course of oral histopathology can effectively improve the scores of practical courses and related theoretical courses, which are more recognized by students, and can be used as an effective supplementary means for practical teaching.

PURPOSE: To visually summarize the keywords of non-tumor research of master's and doctoral theses and analyze the research hotspots and evolution in this field. METHODS: This study collected data from master's and doctoral theses in oral and maxillofacial surgery in China from 1993 to 2023 from the China National Knowledge Infrastructure (CNKI), Wanfang, and VIP databases. Bibliometric summarization and analysis were conducted based on CiteSpace. RESULTS: The number of master's theses continued to grow from 1993 to 2012 and then stabilized, while the number of doctoral theses increased from 1993 to 2000, remained stable after 2001, peaked in 2005, and then slightly declined. At the master's level, institutions such as Shandong University and the Fourth Military Medical University had significant publication outputs, with a wide geographical distribution. At the doctoral level, the Fourth Military Medical University and Sichuan University stood out, with a more concentrated institutional distribution. Comprehensive universities and military medical universities, such as the Fourth Military Medical University, maintained advantages at both the master's and doctoral levels. High-frequency keywords in master's theses included clinical efficacy and cleft lip and palate, while animal models and mandible were high-frequency keywords in doctoral theses. Keyword clustering in master's theses mainly covered ten areas, including clinical treatment and osteoblasts, while doctoral theses focused on ten areas, such as biomechanics and bone transplantation. From 1993 to 2023, the research hotspots in oral and maxillofacial surgery in China gradually expanded from basic surgery and anatomy to diversified fields such as cells, molecules, imaging technology, and advanced clinical treatments. CONCLUSIONS: From 1993 to 2023, the non-tumor research hotspots in oral and maxillofacial surgery in China evolved from clinical practice to advanced technologies and regenerative medicine. However, further research is needed to strengthen studies on jaw development mechanisms, clinical research, and interdisciplinary collaboration.

This study systematically expounded the application status and research progress of trans oral robotic surgery (TORS) in the treatment of oropharyngeal cancer. It elaborated on the indications, contraindications, and postoperative complications of TORS. Compared with traditional open surgery, TORS had significant advantages in terms of visual clarity, operational precision, and aesthetic satisfaction. Clinical data showed that TORS demonstrates good tumor control rates and survival outcomes in early-stage and some advanced-stage oropharyngeal cancers, especially in the diagnosis and treatment of HPV-related oropharyngeal cancers and cervical squamous cell carcinomas of unknown primary origin. At the same time, it also pointed out the shortcomings of TORS, such as the lack of tactile feedback, equipment complexity, and high costs. Future prospects focused on innovative directions such as single-port robotic systems, flexible robotic arm technology, and intraoperative fluorescence navigation imaging. These technological innovations are expected to further improve the oncological efficacy and functional prognosis of oropharyngeal cancer treatment by expanding the scope of anatomical adaptation and optimizing tumor boundary recognition capabilities.

Cone beam CT (CBCT) and digital guide technology have been extensively used in impacted molar treatment, and the application has always a significant meaning for ensuring the surgical accuracy and safety. CBCT has high image resolution and 3D images and can make accurate measurement and evaluation of the tooth root, nerve, blood vessel and bone tissue structures, which is helpful to preoperative design. Digital guiding technology integrates CBCT image with intra-oral scan data to plan personalized guiding instruments for accurate guiding on the path of surgical procedure and minimizing surgical complications. In this article, we reviewed the principle and progress of CBCT and digital guiding technology and their clinical application. It covered the advantages and shortcomings of these technologies and focuses ahead on the future, such as dynamic navigation, AI-assisted treatment, and toward domestic equipment.