China Journal of Oral and Maxillofacial Surgery

Review and perspectives of study of hemangiomas and vascular malformations in the head and neck

ZHAO Yi-fang, JIA JUN

2016, 14 (4): 289-301.

Abstract ( 351 )

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[Summary] Infantile hemangioma and vascular malformations are a spectrum of disorders commonly involving the head and neck regions, and their pathogenesis remains poorly understood. Owing to increased academic exchange,introduction of new therapeutic strategies and emerging treatment techniques during the last decade, many complicated vascular malformations are cured or obviously improved by multidisciplinary approach. However, outdated terminology and/or improper management are sometimes used because of diversities of clinical presentation and locations of lesions,age at diagnosis and doctor's experience. Diffuse venous malformations or microcystic lymphatic malformations usually are managed by combined modalities, and surgical resection would lead to poor post-surgical outcomes with a high incidence of complications and recurrences. This paper reviewed the contemporary classification and treatment paradigms, academic activities and achievements in the investigation of vascular anomalies in China, with discussing of up-to-date diagnosis and treatment, and possible perspectives were proposed as well.

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Expression and significance of DLK2 gene during cartilage development

XU Wei-feng, SHEN Pei, FAN Bao-ting, JIAO Zi-xian, LI Hui-ping, ZHANG Shan-yong

2016, 14 (4): 302-307.

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PURPOSE: To study the expression and significance of DLK2 during embryonic cartilage development. METHODS: The expression of DLK2 was detected during the differentiation of ATDC5 cells. ATDC5-DLK2 cells which stably overexpressed DLK2 was constructed by lentivirus transfection, and the effect of DLK2 on the proliferation and differentiation of ATDC5 cells was studied. The temporal and spatial expression of DLK2 in cartilage of C57BL/6 mouse at embryos(E11.5,E16.5,E18.5 days) and postnatal time (P7 and P14 day) was examined by immunohistochemistry. The data was analyzed by paired t test using SPSS16.0 software package. RESULTS: The mRNA and protein levels of DLK2 decreased during the differentiation of ATDC5 cells; ATDC5-DLK2 cell line which stably ovexpressed DLK2 was established and identified, and DLK2 overexpression promoted the proliferation of ATDC5 cells (P<0.05),but significantly inhibited the expression of chondrogenic marker genes (col2a1, acan, col10a1)(P<0.05). DLK2 showed a weak expression in cartilage of early embryo (E11.5 days), while gradually increased during the development of cartilage. DLK2 was expressed in both immature and mature chondrocytes, but the expression of DLK2 in articular cartilage surface decreased (P<0.05), while almost unchanged in the deep of articular cartilage (P>0.05). CONCLUSIONS: DLK2 may be an important factor involved in cartilage development.

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Promoter methylation level affects the expression of E-cadherin in salivary malignant pleomorphic adenoma cell lines

XIA Liang, ZHANG Chun-ye, HU Yu-hua, QIAN Jia-jun, LI Jiang, TIAN Zhen

2016, 14 (4): 308-314.

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PURPOSE: To investigate the effect of promoter methylation on the expression of E-cadherin by changing the E-cadherin gene promoter methylation level in human salivary malignant pleomorphic adenoma cell lines in vitro. METHODS: After appropriate concentrations of 5-Aza-CdR and TGF-β1 treatment, E-cadherin promoter methylation, protein and mRNA expression were detected by bisulfite sequencing, Western blotting, fluorescence quantitative real-time PCR respectively. Wound-healing test and Transwell test were used to identify the corresponding changes of SM-AP4 and SM-AP1 cells when E-cadherin expression was altered. SPSS 13.0 software package was used for statistical analysis. RESULTS: After treatment with 5-Aza-CdR, E-cadherin promoter methylation rate was decreased significantly in SM-AP4 cell (P<0.001). E-cadherin protein and mRNA expression was significantly elevated (P<0.05) and the corresponding ability of cell migration significantly decreased (P<0.05). After TGF-β1 treatment in SM-AP1, vimentin expression was induced. E-cadherin promoter methylation rate significantly increased (P<0.001) and E-cadherin protein and mRNA expression significantly decreased (P<0.05). The corresponding migration ability of SM-AP1 cell significantly increased (P<0.05). CONCLUSIONS: DNA methylation is an important mechanism to regulate the expression of E-cadherin in MPA, which can improve the level of E-cadherin protein expression and decrease the ability of tumor metastasis by reducing the methylation level of E-cadherin gene promoter.

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Anterior maxillary segmental distraction osteogenesis in cleft lip and palate: a three-dimensional finite element analysis

WANG Si-han, QIAN Yu-fen, HUA Cheng, LU Ming-fei

2016, 14 (4): 315-323.

Abstract ( 363 )

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PURPOSE: To investigate the biomechanic properties of anterior maxillary segmental distraction osteogenesis in craniofacial complex with cleft lip and palate undergoing alveolar bone graft resorption. METHODS: Three-dimensional finite element models simulating anterior maxillary segmental osteotomy and graft resorption were constructed. Displacement pattern of surface landmarks and stress distribution over circum-maxillary sutures were analyzed after 6 mm and 0.5 mm of displacement was loaded on bilateral first premolars, respectively. RESULTS: The model with intact graft exhibited the most favorable outcome regarding to symmetry of sagittal displacement, suture stress distribution and counter-clockwise rotation of anterior segment, stability of arch in transversal dimension, elimination of step across graft site and reduction of stress concentration at graft. As the level of resorption lowered and remaining graft volume diminished, asymmetry of displacement, expansion of arch and step across graft site became more obvious. CONCLUSIONS: The more orally graft resorption occurred and the more graft resorbed, the less desirable the result of anterior maxillary segmental distraction osteogenesis would be.

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Association of chromosome 10q25 polymorphisms with non-syndromic cleft lip with or without cleft palate in Chinese population

PENG Li, NIU Zhen-min, HUANG Wei, CHEN Zhen-qi

2016, 14 (4): 324-327.

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PURPOSE: To investigate the causal relationship between single nucleotide polymorphisms (SNPs) rs7078160, rs4752028 on chromosome 10q25 identified by genome-wide association studies (GWAS) in non-syndromic cleft lip with or without cleft palate (NSCL/P) among Chinese population. METHODS: A total of 180 individuals were included as case group and 360 healthy subjects were enrolled as controls. The case group was divided into 4 subgroups: cleft lip only(CL), cleft lip and palate (CLP), cleft palate only (CPO), and cleft lip with or without cleft palate (CL/P) merged by CL and CLP. The peripheral blood of NSCL/P cases and control samples were collected and DNA was extracted. Two SNPs were performed for targeted sequencing and genotyped for a case-control association analysis. Statistical analysis was performed with SPSS 19.0 software package. Differences in genotype and allele frequencies were analyzed between case and control groups using Pearson χ² test. RESULTS: The allele frequency distribution of rs7078160 was significantly different between CL/P subgroup and control group (P=0.008, OR=1.500, 95%CI=1.116-2.016). The difference of allele frequency distribution between CL/P subgroup and control group for rs4752028 also had significant difference (P=0.028, OR=1.424, 95%CI=1.041-1.948). CONCLUSIONS: SNP rs7078160 and rs4752028 are associated with NSCL/P in Chinese population.

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Open surgery assisted with arthroscopy to treat synovial chondromatosis of temporomandibular joint: a retrospective study of 36 consecutive cases

BAI Guo, YANG Chi, QIU Ya-ting, CHEN Min-jie

2016, 14 (4): 328-331.

Abstract ( 313 )

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PURPOSE: Arthroscopy facilitated open surgery was carried out for the treatment of synovial chondromatosis of temporomandibular joint (TMJ), its indications and effects were discussed. METHODS: Patients with synovial chondromatosis of TMJ who were hospitalized from September 2010 to February 2015 were included in this study. Clinical and medical imaging examinations were conducted prior to surgery in order to confirm the diagnosis and range of the tumor. For those with tumors in their upper articular cavities and medial groove expansion of the joint capsule still in between medial crest of the condylar head and inferior temporal gap, shown by their coronal MRI reconstructions, arthroscopy was chosen to assist the open surgery procedure in resecting free substances and performing a thorough clean-up of TMJ capsule and synovium. Post-operative joint-jaw-occlusion relationship examinations and long-term imaging follow-ups were conducted to evaluate the clinical effect of this treatment. RESULTS: Free substances were found in the resected TMJ capsules of 36 patients by open surgery. Further examinations with arthroscopy indicated that more free substances were contained in the medial groove or the anterior and posterior recessus of 14 patients, which were all removed using a cup-shaped clamp. A finishing touch of a thorough clean-up of the joint capsule and synovium was applied with arthroscopy; pathologic examinations proved the diagnosis of synovial chondromatosis. After treatment, all patients experienced good recoveries of their TMJ functions and achieved stable occlusions and face shapes. MRI scans in an average of 33.3 months after surgery indicated no recurrence of the tumor. CONCLUSIONS: Arthroscopy can be a great facilitating tool in open surgery to detect the articular cavity from multiple perspectives. Utilization of this technique has benefits in a complete elimination of the diseased tissues with minimal osteotomy required and reductions of the wounded area and surgical time. Thus, arthroscopy can serve as a powerful complementary to the conventional surgical procedures.

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Location and differential diagnosis of odontogenic cysts intruding into maxillary sinus

HU Ying-kai, YANG Chi, YU Qiang, DONG Min-jun, XU Guang-zhou

2016, 14 (4): 332-336.

Abstract ( 473 )

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PURPOSE: This study was aimed to review the location and differential diagnosis of odontogenic cysts intruding into maxillary sinus, in order to improve accuracy rate of preoperative diagnosis and guide operation planning. METHODS: Cases of odontogenic cysts intruding into sinus diagnosed by spiral CT from 2011.12 to 2014.12 at the Department of Oral Surgery, Shanghai Ninth People’s Hospital were reviewed. The proportion of each sinus wall being invaded was counted using spiral CT images. Then selecting the ones with pathologic diagnosis and analyzing their CT images, along with clinical manifestation to summarize the entities and differential diagnosis of odontogenic cysts. RESULTS: A total of 85 cases were included, the inferior and posterior walls of the sinus were most frequently invaded, and the top three disease entities were dentigerous cyst, radicular cyst and odontogenic keratocystic tumor. Two cases diagnosed as ameloblastoma but turned out to be adenoid cystic carcinoma and mucoepidermoid carcinoma after pathological examination. CONCLUSIONS: Odontogenic cysts often intrudes into inferior and posterior walls of maxillary sinus, diagnosis should depend on CT images and pathological examinations, as well as clinical manifestation.

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Measurement and analysis of the labial and palatal bone thickness of the maxillary anterior (esthetic zone) teeth in Chinese adults with individual normal occlusion

GUO Peng-nv, GUO Hua-yan, ZHONG Hua-xing, HUANG Lan, CHEN Wei-dong, ZHANG Ying-di, HUANG Yuan-liang

2016, 14 (4): 337-343.

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PURPOSE: To measure and analyze the labial and palatal bone thickness of the maxillary anterior (esthetic zone) teeth in Chinese adults with individual normal occlusion, in order to lay a foundation for database and to provide data support and references for preoperative analysis and plan making of implant surgery, especially immediate implantation. METHODS: Sixty subjects who met the inclusion criteria were scanned by KaVo 3D eXam CBCT(cone-beam computed tomography). The three-dimensional reconstruction CBCT data in a Dicom (digital imaging and communication in medicine)format were imported to InVivo 5 software. The data obtained from the measurement of the labial and palatal bone thickness on reference lines (which were perpendicular to tooth long axis) L3, L6, L9, L12 were statistically analyzed with 95% reference range, frequency, paired sample t test, independent sample t test, ANOVA (analysis of variance)and multiple comparison using SPSS 18.0 software package. RESULTS: The data showed that the mean labial bone thicknesses were less than the corresponding palatal bone on every reference line of each tooth (P<0.05), bone absence or thickness less than 1 mm often occurred at the labial bone (40.6%~93.1%), the palatal bone thicknesses were generally more than 2 mm (L6 and upper levels: 60%~100%), and there were diversities of bone thickness between left and right teeth, labial and palatal plate, gender, ages, different teeth positions at same reference line, and different reference lines at same tooth position. CONCLUSIONS: Bone is often insufficient at the maxillary anterior teeth when implanting, particularly at the lateral incisors. The labial bone plates are thinner than the palatal bone and frequently exhibit depression. In order to ensure intact labial bone wall and enough bone thickness, the implants should be placed appropriately palatally after measuring and analyzing with CBCT. Moreover, the bone substitute materials, bone splitting and bone augmentation technique should be applied when necessary.

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Three dimensional survey of trend of inferior alveolar nerve canal and mandibular morphology by cone-beam CT between patients with mandibular deviation and normal individuals

QU Wei-guo, SHENG Lan-lan, LI Yang, QU Zhen-yu, YUE Bai, WANG Ji

2016, 14 (4): 344-351.

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PURPOSE: To analyze the intramandibular course and its adjacent anatomic structure of mandibular canal（MC） through the data of cone-beam computed tomography(CBCT),as well as the mandibular morphology, and compare with the general population to provide anatomical basis for mandibular surgery. METHODS: Twenty nine adults with mandible deviation were selected as the case group, and compared with 29 individuals with normal occlusion. CBCT scans were conducted, InVivo 5 software was used to reconstruct the mandible, anchor the points, measure the jaw shape and the three-dimensional course of MC. All measurements were analyzed with SSPS 17.0 software package, to determine the characteristics and differences in the mandibular morphology and the course of MC between different cases. RESULTS: ①BP in 0,1 and 2 plane of oblique side was significantly smaller than the control group(P<0.05);the maximal measurement value of LC in each level was the oblique side and the control was the minimal, the difference between the oblique side and the control in plane 5 was significant (P<0.01).②Compared with the contralateral side and the control, MC of oblique side was more closer to the buccal side and away from the lingual bone plate, the difference between the oblique side and the control at the first molar was significant(P<0.05).③The mandibular foramen locations, the length of the ramus and the body were all significantly different(P<0.05) between the 2 groups.④There was no significant difference between left and right side in the height,the width and the thickness of the cortical bone of the mandibular body at cross sections and three dimensional shape symmetry in the control group, but significant difference(P<0.05) in some measured values between the 2 groups. CONCLUSIONS: Compared with normal adult,the course of MC in patients with mandibular deviation was closer to the buccal plate; the length of the ramus and the body of oblique side is smaller than the contralateral side, the mandibular morphogenesis in patients with mandibular deviation is asymmetric with torsional deformation on the spatial structure.

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Extended vertical lower trapezius island myocutaneous flap and pectoralis major myocutaneous flap used for reconstruction of patients with recurrent oral and oropharyngeal cancer

WANG You-yuan, LI Qun-xing, ZHANG Da-ming, ZHONG Jiang-long, FAN Song, LIN Zhao-yu, YE Jian-tao, CHEN Wei-liang

2016, 14 (4): 352-356.

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PURPOSE: To compare the use of extended vertical lower trapezius island myocutaneous flap (TIMF) and pectoralis major myocutaneous flap (PMMF) in reconstruction of large defect after radical surgery of advanced recurrent oral and oropharyngeal squamous cell carcinoma (SCC). METHODS: A total of 39 patients with advanced recurrent oral and oropharyngeal SCC underwent salvage surgery followed by placement of either an extended lower vertical TIMF or PMMF for reconstruction. Twenty-one patients received extended lower vertical TIMFs, whereas 18 received PMMFs. SPSS 12.0 software package was used for statistical analysis. RESULTS: The pedicle length of the TIMF was longer than that of the PMMF, and the skin paddle of the TIMF was both wider and longer than the PMMF. No major complications developed in any of the patients. The TIMF group experienced a lower rate of minor flap failure than the PMMF group. CONCLUSIONS: Extended vertical lower TIMF, which has a longer pedicle flap and a larger skin paddle than a PMMF, is an optimal flap for reconstruction of major defects.

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Clinical analysis of surgical incisions for tumors involving lateral skull base

KONG Jie, YANG Hong-yu, WANG Yu-fan, YANG Hui-jun, SHEN Shi-yue, WANG Feng

2016, 14 (4): 357-360.

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PURPOSE: To investigate the surgical procedures and treatment effects for complete and safe resection of tumors involving lateral skull base. METHODS: Twenty-one patients with tumors involving lateral skull base were treated in our department from August 2008 to August 2015. Eight cases were diagnosed as malignant tumors by pathological examinations. Five cases underwent surgery through scalp hemicoronal-anterior auricular incision, eight cases underwent operation through modified Ferguson-Weber incision, seven cases underwent operation through anterior auricular-inframandibular incision, and combined incision was used in 1 patient. RESULTS: Only 1 patient with recurrent fibrosarcoma of the maxillary sinus underwent palliative resection and 20 patients underwent radical resection. No deaths and serious complications were found during perioperative period. In 8 patients with malignant tumors, five received postoperative radiotherapy and 3 underwent postoperative chemotherapy. 3-year survival rate of patients with malignant tumors was 50% (4/8). CONCLUSIONS: Appropriate operation access should be adopted based on anatomical structures. Scalp hemicoronal-anterior auricular, modified Ferguson-Weber, anterior auricular-inframandibular and combined incisions are more commonly used surgical approaches, but with different indications.

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A novel transcondylar approach combined with posterior disc attachment release for neoplasms near temporomandibular joint

YE Zhou-xi, YANG Chi, CHEN Min-jie

2016, 14 (4): 361-365.

Abstract ( 375 )

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PURPOSE: To introduce a novel transcondylar approach and discuss its indications, surgical procedures and preliminary clinical effects. METHODS: The novel approach was used in 5 cases from January 2006 to December 2014. The common characteristics of the 5 masses were: ①non-malignant encapsulated neoplasm involving the postero-medial region to the condyle; ②surgical exposure was incomplete by rotating or moving backward of the condyle based on the digital surgical simulation. RESULTS: All masses were resected successfully by using the novel approach with no damage to the critical nerves and vessels. The average follow-up period was 29.8 months (range 6-56 months). No recurrence, secondary deformity or facial paralysis were found. The average of mouth opening was improved from 27 mm to 34 mm after surgery. The condyles were fixed well with no resorption shown on CT scans. CONCLUSIONS: The transcondylar approach combined with posterior disc attachment release could be used for resection of non-malignant neoplasms involving the postero-medial region to the condyle. 3D reconstruction of CT and surgical simulation can help to determine the indications.

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Use of carbon dioxide laser in the treatment of superficial oral mucosal lesions: an analysis of 73 clinical cases

HUANG Zi-xian, LI Shi-hao, HUANG Zhi-quan, WANG You-yuan, ZHANG Da-ming, CHEN Wei-liang

2016, 14 (4): 366-368.

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PURPOSE: To evaluate the safety and advantages of using carbon dioxide (CO₂) laser in treatment of oral mucosal lesions. METHODS: A retrospective analysis was conducted for 73 patients with oral mucosal lesions who received CO₂ laser treatment during June 2012 to December 2013, including 25 cases of vascular malformations, 22 cases of oral leukoplakia, 18 cases of oral mucosal lichen planus, and 8 cases of oral mucosal and labial mucosal verrucous nevus. The lesions ranged from 0.8 cm×0.8 cm to 4 cm×3 cm. Twenty cases of oral mucosal lesions using scalpel assisted with electric knife were as control. The operation time and bleeding of all patients were recorded. The operation time and bleeding in 2 groups were compared. Statistical analysis was performed by Student's t test using SPSS19.0 software package. RESULTS: The operation time of CO₂ laser group was from 3 to 10 min, with an average of 5.5 min; the average amount of intraoperative bleeding was 5 mL; none of the 73 patients had postoperative infections; and all wounds heal well after surgery. The patients were followed up for 1 year. Two cases of oral leukoplakia showed recurrence after surgery, and a reoperation achieved satisfactory treatment effect. The operation time of the control group was 4 to 15 min, with an average of 9.5 min, and the average amount of intraoperative bleeding was 10 mL. None of the 20 patients had postoperative infections, and the wounds also healed well after surgery. CONCLUSIONS: The application of CO₂ laser in treatment of oral mucosal lesions has the advantages of less bleeding, a clear surgical view during surgery, and a shorter operation time.

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Endoscopic-assisted removal of foreign bodies in the maxillofacial region: report of 15 cases

BAI Zheng-qun, LI Man, WU Li-fang, LIU Jian-bing, CHEN Yu

2016, 14 (4): 369-371.

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PURPOSE: To investigate the efficacy of endoscopic-assisted removal of foreign bodies in the maxillofacial region. METHODS: The data of 15 patients with foreign bodies in the maxillofacial region from 2010 to 2015 in Dafeng People's hospita1 were reviewed. All patients were treated under endoscope. RESULTS: Fifteen patients had satisfied functional results after removal of the foreign bodies. CONCLUSION: Endoscopy plays an important role in the treatment for foreign bodies in the maxillofacial region.

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The development of oral and maxillofacial surgery in Western countries

Stoelinga PJW

2016, 14 (4): 372-377.

Abstract ( 534 )

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[Summary] The development of oral and maxillofacial surgery in Western countries is inseparable with the development of anatomy, surgery and dentistry. This paper reviewed the history of oral and maxillofacial surgery in Western countries, most important people and their contribution, the development of the academy and secondary specialty, journal etc., in order to provide reference for the reader.

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