Oral(oropharyngeal) cancer is a type of malignant tumors of the head and neck with the highest incidence. Many patients have been clinically advanced, and most of them need to be treated by surgery combined with radiotherapy and chemotherapy. Many patients with oral(oropharyngeal) cancer will have local recurrence or metastasis after the first surgical or chemoradiotherapy, and the second treatment is more difficult with the poor prognosis. How to effectively treat these patients with advanced or recurrent oral(oropharyngeal) cancer has become the focus of clinical attention. However, there is no basis to follow about how to carry out therapeutic surgical treatment, and non-standard diagnosis and treatment are also common. Therefore, we formulated this consensus in the fields of definition, indications, perioperative evaluation, surgical classification, adjuvant therapy, functional rehabilitation and other fields of advanced or recurrent oral (oropharyngeal) cancer, based on evidence-based medical evidence and national maxillofacial head and neck surgery expert suggestion, for reference by oral and maxillofacial, and head & neck surgeons across the country.

PURPOSE: To isolate and identify Capnocytophaga sputigena(C. sputigena) from tongue squamous cell carcinoma(TSCC), then analyze the drug resistance and virulence genes at genome-wide level. METHODS: The bacterial strains n105 and n106 were isolated and cultured from the cancer tissue mucosa of TSCC patients. Bacterial species were determined through colony morphology, Gram staining, 16S rRNA sequence, and construction of evolutionary tree. Then the drug sensitivity of bacterial strains to 4 antibiotics(clarithromycin, metronidazole, penicillin and levofloxacin) was detected by disk diffusion method. Whole genome sequencing and functional annotation of virulence and resistance genes were performed on strain n106 by the third-generation sequencing technology. RESULTS: Strains n105 and n106 were identified as C. sputigena through 16S rRNA sequence BLAST alignment and construction of Neighbor Joining evolutionary trees. The results of drug sensitivity test showed that C. sputigena strains n105 and n106 were sensitive to clarithromycin, while resistant to metronidazole, penicillin, and levofloxacin. Whole genome sequencing results showed that the genome length of C. sputigena strain n106 was 2.86 Mb, with 38.36% of guanine cytosine(GC) content, encoding 2 609 genes. Six virulence genes (tufA, app, clpV, cpsA, acpXL and fHbp) and two drug resistance genes [blaCSP-1and erm(F)] were predicted. CONCLUSIONS: C. sputigena isolated from TSCC is resistant to metronidazole, penicillin, and levofloxacin, carrying multiple virulence and resistance genes, which possessing potential pathogenic characteristics. This study provides new strategies for effective prevention, control, and treatment of TSCC from a microbial perspective.

PURPOSE: To investigate the expression of human beta-defensin 2(HBD-2) and human beta-defensin 3 (HBD-3) in tissue engineered oral mucosa equivalents under the stimulation of Escherichia coli lipopolysaccharide (LPS) and recombinant human interleukin-1(IL-1β), and to evaluate the possibility of using tissue engineered oral mucosa in the treatment of infectious oral diseases. METHODS: Real-time fluorescent quantitative reverse transcription PCR(RT-qPCR) and Western blot were used to evaluate the mRNA and protein expression of HBD-2 and HBD-3 in tissue engineered oral mucosa substitutes under the stimulation of LPS and IL-1β. SPSS 26.0 software package was used for data analysis. RESULTS: LPS and IL-1β stimulated the mRNA and protein expression of HBD-2 and HBD-3 in tissue-engineered oral mucosa, and showed a dose-dependent increase after 24 hours of culture(P<0.05). At 100 ng/mL, LPS induced HBD-2 mRNA by about 2.7-fold and HBD-3 mRNA by about 5-fold, respectively. The maximal production of HBD-2 mRNA was about 1.6-fold and HBD-3 about 4.8-fold by 20 ng/mL IL-1β. As to the results of western blot analysis, both LPS and IL-1β induced HBD-2 protein secretion at the maximal concentration in this study. HBD-3 protein was hardly observed without any treatment. After incubation with LPS and IL-1β, HBD-3 protein was significantly up-regulated(P<0.05). CONCLUSIONS: Tissue engineered oral mucosa equivalents are armed with defense activity against invading microorganisms in a sense, which may provide a therapy substitute for infectious oral diseases in the future.

PURPOSE: To explore the relationship between tertiary lymphoid structure(TLS) and clinicopathological characteristics, programmed death ligand 1(PD-L1), CD8 positive infiltrating cells, and prognosis in head and neck squamous cell carcinoma(HNSCC). METHODS: A total of 72 patients diagnosed with HNSCC in the Department of Oral Pathology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from May 2017 to September 2022 were enrolled in this study. The expressions of CD20, CD3, CD21, PNAd, PD-L1 and CD8 in tumor tissues were detected by immunohistochemistry, and combined positive score(CPS) was used to evaluated the PD-L1 expression level. The Caseviewer software was used to calculate the infiltration degree and proportion of CD8 positively staining cells. Statistical analysis of the correlation between TLS status and clinicopathological characteristics, PD-L1 expression, tumor immune microenvironment, and prognosis was performed using SPSS 25.0 software package. RESULTS: Of the 72 patients with HNSCC, TLS positive rate was 41.7% (30/72). The TLS positive rate in patients <58 years old was significantly higher than that in patients ≥58 years old (P=0.004). There was no significant correlation between TLS status and other clinicopathological characteristics. The positive rate of TLS in the PD-L1 high expression group was significantly higher than that in the PD-L1 low expression group (60.7% vs. 29.5%, P=0.014). The infiltration degree and proportion of CD8 positive cells in TLS positive HNSCC cases are significantly higher than those in TLS negative HNSCC cases. The PD-L1 high expression group and TLS positive patients have a higher overall survival rate. CONCLUSIONS: TLS structure is significantly positively correlated with PD-L1 expression, CD8 positive cell infiltration degree, and infiltration proportion in HNSCC. Patients in the TLS positive group had a significantly better prognosis than those in the TLS negative group, indicating a close relationship between TLS and the tumor immune microenvironment, tumor immunotherapy response, and prognosis in HNSCC.

PURPOSE: To evaluate the clinical efficacy of concentrate growth factors(CGF) combined with autobone and Bio-Oss in the long-term stability of alveolar bone repair after mandibular third molar extraction. METHODS: Sixty-six patients who underwent extraction of mandibular third molars at Tongren Hospital of Shanghai Municipality from September 2020 to December 2021 were selected and divided into 3 groups, blank group(n=22), experimental group A (autogenous bone, Bio-Oss, and oral repair film, n=23), and experimental group B(autogenous bone, Bio-Oss, CGF gel + CGF film, n=21). The Postoperative Symptom Severity Scale (PoSSe) was used to assess the clinical symptoms of the 3 groups of patients 1 week postoperatively. Additionally, probing depth (PD), vertical and horizontal distances of bone resorption were measured 3, 6, and 12 months postoperatively for the distal aspect of the second molar. SPSS 19.0 software package was used for data analysis. RESULTS: CGF could significantly reduce the pain time after tooth extraction (P<0.05). PD of the experimental group B was significantly lower than that of the blank group 3, 6 and 12 months after surgery(P<0.05), and significantly lower than that of the experimental group A 12 months postoperatively(P<0.05). At 3 and 6 months after operation, the vertical height of bone defect absorption in the experimental group B was significantly lower than that in the experimental group A(P<0.05). In terms of the horizontal distance of bone defect absorption, at 3, 6 and 12 months after surgery, the results of the experimental group B were significantly lower than those of the blank group(P<0.05); at 3 months after surgery, the experimental group B was significantly lower than the experimental group A(P<0.05), but at 6 and 12 months after surgery, there was no significant difference between the two groups (P>0.05). CONCLUSIONS: Autologous bone and Bio-Oss can achieve good results in restoration of alveolar bone after mandibular third molar extraction, but CGF combined with autologous bone and Bio-Oss has better clinical efficacy and is worthy of recommendation.

PURPOSE: To quantitatively evaluate the effect of augmented corticotomy assisted orthodontics in adult patients with moderate to severe periodontitis. METHODS: The sample comprised 102 mandibular incisors of 35 adult patients with moderate to severe periodontitis in mandibular anterior region who accepted augmented corticotomy assisted orthodontic treatment selected from consecutive patients at the Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital since Jan.2017. Periodontal soft and hard tissue measurements were appraised with the help of periodontal clinical assessment and cone-beam CT(CBCT) examination at different time points. SAS 9.1 software package was used for data analysis. RESULTS: Facial appearance aesthetics, fine occlusal relationships, and effectively controlled periodontal inflammation were realized for all patients after treatment; moderate to severe, favorable bone augmentation on the labial side at root apex level was achieved with minimal root resorption, bone thickness on the labial side at 1/2 and 3/4 root length level was maintained as well as vertical alveolar bone level on both labial and lingual sides. CONCLUSIONS: Augmented corticotomy assisted orthodontics is a promising approach for the treatment of adult patients with moderate to severe periodontitis.

PURPOSE: To explore the clinical value of integrated model of medical caregiver and patient in postoperative oral function rehabilitation of patients with oral cancers. METHODS: Forty patients with oral cancer admitted to Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from January to March 2023 were selected as the control group, and 40 patients with oral cancer admitted from April to June 2023 were selected as the experimental group. Conventional nursing care was given to the control group, while the experimental group was given nursing care with integration of healthcare professionals and patients. All patients were followed up for 3 months, oral function and mental health were compared between the two groups. SPSS 23.0 software package was used for data analysis. RESULTS: The scores of swallowing function and speech function in the experimental group were (2.20±0.90) and (76.50±9.7), and mouth opening degree was (39±2.2) mm, respectively, while those in the control group were (2.70±0.7), (64.57±8.2) and (38±4.3) mm, respectively and the differences between the two groups were statistically significant(P<0.05). The number of qualified oral hygiene examination, the number of qualified dental cleaning and the number of qualified dental flushing in the experimental group were 87.5%(35/40), 97.5%(39/40), 92.5%(37/40), and 67.5%(27/40), 57.5%(23/40), 75.0%(30/40) in the control group, respectively; the differences between the two groups were statistically significant(P<0.05). The anxiety and depression scores were (42.10±3.37) and (40.33±3.56) in the experimental group and (45.26±3.27) and (46.39±3.10) in the control group, respectively; the differences between the two groups were statistically significant(P<0.05). CONCLUSIONS: Integrated model of medical care can promote the rehabilitation of oral function, improve oral health, relieve anxiety and depression, and improve postoperative nutritional status of patients with oral cancer.

PURPOSE: To investigate the prognostic value of lymph node yield(LNY) and lymph node ratio (LNR) in patients with clinically node-negative (cN0) oral squamous cell carcinoma(OSCC). METHODS: A total of 151 patients diagnosed with cN0 OSCC at the First Affiliated Hospital of the University of Science and Technology of China from January 2008 to January 2018 were included. Based on the presence or absence of lymph node metastasis after surgery, the patients were divided into two groups: pathologic node-negative (pN0) and pathologic node-positive (pN+). The factors influencing lymph node metastasis and the factors affecting recurrence and overall survival in pN0 and pN+ group were analyzed. LNY after neck lymphadenectomy was based on the recommended value of 16 in the literature, and the optimal cutoff value for LNR was calculated using receiver operating characteristic(ROC) curve analysis to classify the patients into two groups. Chi-square test was used for univariate analysis, multivariate analysis for recurrence and overall survival was performed using binary logistic regression and Cox regression models, respectively. Nonparametric Kaplan-Meier survival curves were used to compare the differences in overall survival (OS) and disease-specific survival (DSS). SPSS 26.0 software package was used for data analysis. RESULTS: Among 151 cN0 OSCC patients, totally 109 were pN0(72.2%) and 42 were pN+ (27.8%). The 5-year OS and DSS in pN0 group were significantly higher than those in pN+ group (P<0.05). In the multivariate analysis of recurrence and overall survival in the pN0 group, LNY was an independent risk factor for recurrence(P<0.05), and depth of invasion (DOI) and LNY were independent risk factors for survival(P<0.05). OS and DSS survival curves showed that patients with LNY<16 had significantly lower 5-year survival rates(OS: 65%, DSS: 53%) compared to those with LNY≥16(OS: 80%, DSS: 82%)(P<0.05), allowing for risk stratification of this subgroup of patients. In pN+ group, LNR was identified as an independent risk factor for recurrence and overall survival. Survival analysis of LNR showed that the 5-year survival rate of patients with LNR≤0.075(OS: 80%, DSS: 80%) was significantly higher than that of patients with LNR > 0.075(OS: 25%, DSS: 33%)(P<0.05). CONCLUSIONS: In cN0 OSCC, there are differences in prognosis between pN0 and pN+ patients, and these differences are associated with recurrence and survival. In pN0 group, there are survival differences among patients who experience recurrence. LNY is an independent prognostic factor that affects both recurrence and survival, and a LNY value of ≥16 is associated with a better prognosis compared to LNY<16. In pN+ group, patients who experience recurrence also exhibit survival differences. LNR is an independent prognostic factor for recurrence and survival in these patients, and it allows for risk stratification of this subgroup of patients.

PURPOSE: To analyze the occurrence and type of dental injuries(DIs) in children and adolescents with mandibular fracture by cone-beam computed tomography(CBCT), and to explore the correlation between DIs and mandibular fracture. METHODS: The data of 81 patients with mandibular fracture admitted to the Third Hospital of Hebei Medical University from January 2021 to December 2023 were reviewed, the mandibular fracture type, DIs type and dental position were obtained according to CBCT images, and the relationship between mandibular fracture type and DIs was analyzed. SPSS 26.0 software package was used for statistical analysis. RESULTS: DIs occurred in 63 patients(77.78%), with a male/female ratio of 2:1. A total of 247 DIs occurred in 231 teeth, the most common type of DIs was extrusive luxation in primary teeth(29.17%) and immature permanent teeth(40.00%), and crown fracture(39.60%) in permanent teeth. Maxillary anterior teeth were the most common damaged tooth sites, and the difference between fracture types and DIs sites was statistically significant (P=0.047). The lesions involving soft tissue were more common in primary teeth (83.30%), and the difference between tooth development type and DIs type involving soft and hard tissue was statistically significant(P<0.001). There were more mild injuries in immature permanent teeth(88.00%). The difference between the type of tooth development and the severity of DIs was statistically significant(P=0.001). CONCLUSIONS: CBCT can be used for comprehensive diagnosis of mandibular fracture and DIs. The occurrence and type of DIs are closely related to mandibular fracture.

PURPOSE: To measure and analyze the detection rate, position, direction and height of the maxillary sinus septa by CBCT, and to provide reference for guiding lateral wall approach in maxillary sinus floor elevation to reduce mucosal perforation. METHODS: A total of 987 patients who underwent implant surgery at Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from January 2020 to February 2022 were selected and the maxillary sinus septa in bilateral maxillary sinuses were observed and measured on CBCT. According to the relationship between the maxillary sinus septa and the maxillary sinus floor, they were divided into 3 types: type Ⅰanterior, type Ⅱ middle, and type Ⅲ posterior. According to the direction of the septa, they were divided into 3 types: transverse position (type 1), coronal position (type 2) and sagittal position (type 3). The distance from the highest point of the bone septa downward to the tangent point of the floor wall was measured. Statistical analysis of the detection rate of maxillary sinus septa, the relationship between the septa and the floor of the maxillary sinus, and the direction of septa in different gender and age groups was performed using SPSS 26.0 software package. RESULTS: In 987 patients with a total of 1 974 maxillary sinuses, 288 (9.18%) had septa, with 154 males and 134 females. There was no significant difference in septa detection rate between males and females (P>0.05). A total of 116 were detected in the young population, 110 in the middle-aged population, and 62 in the elderly population. The total septa detection rate in the elderly group was significantly lower than that in the middle-aged group and young group(P=0.000), and the single-side septa detection rate in the elderly group was lower than that in the young group(P=0.005). A total of 348 maxillary sinus spacer heights were measured, and the mean height was (6.63±2.75) mm. There were 7 spacers in typeⅠ(2.01%), 211 in type Ⅱ(60.63%), and 130 in type Ⅲ(37.36%). The average height of typeⅠ interval was (7.94±4.94) mm, type Ⅱinterval was (6.75±2.72) mm, and type Ⅲ interval was (6.39±2.72) mm. Among the 348 maxillary sinus spacers, there were 12 spacers of type 1 (3.45%), 302 spacers of type 2 (86.78%) and 34 spacers of type 3 (9.77%). The average height of spacers of type 1 was (9.30±4.12) mm, type 2 was (6.47±2.62) mm and type 3 was (7.27±3.01) mm. The average height of maxillary sinus interval was (6.89±2.94) mm in males and (6.32±2.49) mm in females. The average height of maxillary sinus interval was (6.40±2.70) mm in young people, (6.69±2.60) mm in middle-aged people and (6.99±3.07) mm in elderly people. There was no significant differences in the height of maxillary sinus interval among different gender, age, location and direction(P<0.05). CONCLUSIONS: Maxillary sinus septa is a common anatomical structure in the maxillary sinus, in Shanghai area, with a lower detection rate in the elderly compared to the young and middle-aged population. The position relationship between the maxillary sinus septa and the maxillary sinus floor is more common in type Ⅱ, and the direction is more common in type 2. A small portion of the maxillary sinus has double septa and complete septa. The height of the maxillary sinus septa is independent of gender, age, position, and direction.

PURPOSE: To investigate the effect of increment of gantry(INC) in the Monaco treatment planning system on VMAT plan, and provide reference for optimizing the parameters of radiotherapy plan. METHODS: A total of 15 patients with parotid gland cancer and 15 patients with tongue cancer requiring postoperative radiotherapy were selected from Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from January to December 2022. Bilateral irradiation was used in tongue cancer group and unilateral irradiation in parotid gland cancer group. Except for changing the Inc parameters, the planning design parameters of the same case should not be changed, and the optimization results of planned dose should meet the requirements of clinical use. The optimization grouping angles of 20, 25, 30, 35, and 40 were compared, and the plan made from the optimization grouping angle of 30 was used as a reference plan. D_98%,D_5% and D_2%, as well as the conformity index(CI) and homogeneity index(HI) were calculated and compared. The organ at risk dose parameters and planned jumps caused by different Inc parameter plans were also compared. SPSS 22.0 software package was used for data analysis. RESULTS: The results of tongue cancer group with bilateral irradiation showed that when the Inc parameter was set to 30, the normalization of the target area was better. Compared with the control group, the target area HI of the other Inc parameter plans were significantly different. Except for the Inc35 plan, all other CI had significant differences. In terms of organ endangerment, except for the left parotid gland, the optimal angle of 30 for the right parotid gland and larynx was the best(P<0.05). There was no significant difference in the spinal cord, while 20 and 35 for the left parotid gland were the best(P<0.05). The results of the parotid gland cancer group plan with unilateral irradiation showed that the optimal angle of 30 had better performance and better normalization of the target area. There was significant difference (P<0.05) in the evaluation results of HI. The ipsilateral middle ear Inc was 20, and 25 performed better(P<0.05). The results were better when the distance between laryngeal tissue angles was 20, 25, and 40(P<0.05), and the best performance was when the distance between mandibular angles was 25(P<0.05). There was no significant difference in the spinal cord, brain stem, and contralateral parotid gland. The number of hops for all plans increased with the increment of Inc, and there was no significant difference in the monitor units for both unilateral and bilateral irradiation plans. CONCLUSIONS: The Inc selection of volumetric modulated arc therapy plan needs to be reasonable based on the irradiation range and tumor type. The default value of Inc is 30, which shows more advantages in the tongue cancer target area plan with bilateral irradiation. But for parotid gland tumors with unilateral irradiation, except for certain advantages in the target area, other advantages are not significant.

PURPOSE: To analyze the pathological types and composition ratios of tumors within the parotid gland in order to provide data for epidemiological support. METHODS: Patients diagnosed with parotid tumors were recruited from Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine between 2005 to 2022. The patient sex, age and tumor type were collected. RESULTS: Totally 13 649 cases were enrolled in this study. The patients’ age ranged from 1 to 104 years, with the peak age occurring in the sixth decade. The male to female ratio was 1.3∶1. Among of them, totally 11 008 were benign tumors (80.7%), and 2 641(19.3%) were intermediate/malignant tumors. A total of 12 856 cases (94.2%) originated from epithelium, while 454 cases (3.3%) from soft tissues and 339 cases (2.5%) from haematopoietic and lymphoid tissues. Among 12 228 cases of primary salivary gland tumors, totally 10 289 (84.1%) of them were benign and 1 939(15.9%) were malignant. Pleomorphic adenoma and carcinoma ex pleomorphic adenoma were the most common benign and malignant subtype, respectively. Nasopharyngeal lymphoepithelial carcinoma was the most prevalent among different types of metastatic tumors to the parotid gland. The most common soft tissue and haematopoietic and lymphoid tissue tumor in the parotid gland were Schwannoma and extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue lymphoma(MALT lymphoma). CONCLUSIONS: In southeastern region of China, parotid tumors, pleomorphic adenoma and carcinoma ex pleomorphic adenoma are the most common benign and malignant tumors of the parotid gland. The most prevalent soft tissue tumors and lymphoid hematopoietic system tumors are Schwannoma and MALT lymphoma, respectively.

Limited mouth opening refers to a clinical manifestation that the distance between the upper and lower dentition is significantly reduced when opening mouth. It is mostly caused by limited movement of the temporomandibular joint, which can affect the patient's chewing, swallowing, speech, oral hygiene and other oral and jaw functions. Long-term inability of mouth opening to eat normally may lead to malnutrition, and even severe physical and mental disabilities, affecting the quality of life. Nowadays, clinical medical workers have not yet payed enough attention to the causes and therapies of limited mouth opening. Therefore, this paper reviewed the measurement, classification, etiology, prevention and treatment methods, risk and prognosis of patients with limited mouth opening, aiming to strengthen the attention of medical staff to patients with restricted mouth opening, so as to achieve early diagnosis, prevention and treatment.

With the rapid advancement of artificial intelligence technology, machine learning has become a vital tool in the field of oral healthcare. Machine learning technology for the diagnosis and classification of oral diseases not only provides efficient patient risk assessment and management tools, but also supports personalized treatment planning and medical protocol development. In addition, machine learning also plays an important role in medical image analysis and interpretation, helping physicians quickly and accurately identify oral lesions and their types. This article introduced typical applications of machine learning in oral medical diagnosis, and discussed the technical challenges and possible solutions.

With the evolution of the fourth industrial revolution, the development of more complex intelligent systems has greatly improved the availability and reliability of digital technology. Digital technology has blurred the boundaries between the physical world and the virtual reality through the means of virtual reality and augmented reality. The field of oral implantation has benefited from technological advancements, gradually evolving from digital static guide technology to the use of new dynamic navigation equipment and real-time tracking technology with novel autonomous robots. This article reviewed the principles of various dental robotics and common surgical deviations, aiming to provide relevant references for oral clinical practice and basic research.

Renal clear cell carcinoma（RCCC) is a common kidney tumor with high aggressiveness and metastatic potential, distant metastasis is common in the lung, bone and liver, but metastasis to the head and neck is extremely rare, tongue metastasis is even rarer, which may be related to the tumor microenvironment. In this paper, a 62-year-old male patient with RCCC with tongue mass as the first symptom of metastasis was reported, and the relevant literatures were reviewed.

Ghost cell odontogenic carcinoma(GCOC) is a rare malignant tumor originating in the jawbone, which can exhibit clinically and radiographically malignant features distinct from benign odontogenic tumors, such as large tumor size and adjacent bone destruction, but these features lack specificity; therefore, diagnosis often relies on pathological morphology. Characterized by abnormal keratinized ghost cells, small basaloid cells, and dentin-like deposits, accurate identification of GCOC holds significant clinical importance and is beneficial for patient prognosis. This paper reported a case of GCOC in the left maxilla and reviewed the relevant literature.

Malignant tumors in oral and maxillofacial region are common, but soft tissue sarcomas are rare. Pulmonary sarcoma is a rare malignant tumor, and primary pulmonary sarcoma with gingival soft tissue sarcoma as the initial symptom is even rarest. This paper reported a case of primary pulmonary sarcoma in a 66-year-old woman with gingival soft tissue sarcoma as the initial symptom and reviewed the relevant literatures.