China Journal of Oral and Maxillofacial Surgery

Effect of epigallocatechin-3-gallate on proliferation and apoptosis of human odontogenic keratocyst epithelial cells

YANG Shao-bin, XUE Jiao, PANG Bao-xing, YUAN Rong-tao

2018, 16 (6): 481-487. doi: 10.19438/j.cjoms.2018.06.001

Abstract ( 306 )

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PURPOSE: To investigate the effects of EGCG on proliferation, apoptosis and Wnt pathway-related genes, FZD3 and JNK3, of human odontogenic keratocyst (OKC) epithelial cells in vitro. METHODS: OKC epithelial cells isolated from human odontogenic keratocyst tissue were primarily cultured. Cells were treated with different concentrations of EGCG (0, 20, 40, 80, 160, 320 μmol/L) for 24, 48 and 72 h. The proliferation of OKC epithelial cells was evaluated by CCK-8 assay. Cell apoptosis and cell cycle distribution were detected by flow cytometry. mRNA expression of Wnt signaling pathway correlated genes, FZD3 and JNK3, was determined by RT-PCR. The proteins expression was determined by Western blotting. Statistical analysis was performed using SPSS 22.0 software package. RESULTS: EGCG inhibited cell proliferation in a dose and time-dependent pattern. Low-concentration EGCG (0-20 μmol/L) had no obvious effect on OKC epithelial cells (P>0.05), while high concentrations of EGCG (40-320 μmol/L) had suppressive effect on OKC epithelial cells (P<0.05). With increasing concentration and prolonged action time, the inhibition rate increased (P<0.05). EGCG (20, 160, 320μmol/L) induced apoptosis of cells (P<0.05), and cell cycle was arrested in G1 phase. In addition, both mRNA and protein expression of Wnt pathway related genes, FZD3 and JNK3, was down-regulated significantly (P<0.05). CONCLUSIONS: EGCG inhibits proliferation, induces apoptosis and arrests cell cycle in G1 phase of OKC cells by a possible mechanism of blocking Wnt signaling pathway.

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Effect of hyperthermia combined with silencing Id-1 gene on proliferation and invasion of tongue squamous cell carcinoma cell line CAL-27

LUO Dan, SUN Qiao-zhen, LIU Shao-hua, SUN Jun-wei, WANG Sheng-zhi

2018, 16 (6): 488-492. doi: 10.19438/j.cjoms.2018.06.002

Abstract ( 356 )

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PURPOSE: To investigate the effects and regulatory mechanisms of hyperthermia combined with silencing Id-1 gene on proliferation and invasion of tongue squamous cell carcinoma in vitro. METHODS: Cal-27 cells were divided into 4 groups. In silencing Id-1 group (Id-1-siRNA), siRNA was used to silence the expression of Id-1 in the CAL-27 cells, and the mRNA expression of Id-1 was detected by RT-PCR. In hyperthermia group (HT), CAL-27 cells were placed into constant temperature incubator at 42.5℃ for 40 minutes. In combined group (HT+Id-1-siRNA), hyperthermia combined with silencing Id-1 gene were exerted on CAL-27 cells. Normally cultured CAL-27 cells were used as control group. The proliferation and invasion ability were analyzed by CCK8 assay and Transwell chamber test,and the protein expression of PI3K, p-Akt was detected by Western blotting. SPSS 19.0 software package was used to analyze the data. RESULTS: The expression level of Id-1 mRNA decreased by 81.6% in the Id-1-siRNA group, compared with the blank control group. Both silencing Id-1 and hyperthermia not only inhibited the proliferation and invasion of CAL-27 cells（P<0.05）, but also down-regulated the protein expression of PI3K, p-Akt; however, the combination of hyperthermia and Id-1-siRNA contributed to more significant results. CONCLUSIONS: Hyperthermia in conjunction with silencing Id-1 could reduce the proliferation and invasion of CAL-27 cell line of tongue squamous cell carcinoma by down-regulating PI3K/Akt signaling pathway.

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The effect of apoptosis and epithelial-mesenchymal transition during palatal fusion

MA Li, SHI Bing, ZHANG Dong-sheng, ZHENG Qian

2018, 16 (6): 493-497. doi: 10.19438/j.cjoms.2018.06.003

Abstract ( 310 )

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PURPOSE: Disappearance mechanism of the medial edge epithelium (MES) in the process of palatal fusion is still unknown. The aim of this study was to investigate the effect of apoptosis and epithelial-mesenchymal transition (EMT) during palatal fusion. METHODS: 8-week-old C57BL/6J inbred mice were selected as the experimental mouse. The palatal shelves were acquired at E13.5, E14.0, E14.5, E15.5 and E17.5. Immunohistochemistry and TUNEL were used to explore the protein expression and cell apoptosis during the key process of palatal fusion. Three pictures were randomly selected at each time point, and gray images were analyzed by Image J software. SPSS12.0 software package was used for statistical analysis. RESULTS: Immunohistochemistry and TUNEL assay found that the expressions of fibronectin and vimentin in MES and apoptosis were detected during the critical stage of palate fusion (E14.5), and the two processes were detected in the anterior, middle and posterior palate shelves. CONCLUSIONS: EMT and apoptosis were involved in the degeneration of MES, and the fusion mechanism of the anterior palate was the same as the posterior palate.

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Application of swallowing training in enhanced recovery after surgery of oral cancer

JIANG Tong-hui, WANG Yan, ZHUANG Hai, ZHANG Ji-sheng, BU Shou-shan

2018, 16 (6): 498-504. doi: 10.19438/j.cjoms.2018.06.004

Abstract ( 528 )

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PURPOSE: The purpose of this study was to evaluate the influence of swallowing training on early swallowing function in patients with oral cancer after radical mastectomy and related factors that influence the effect of swallowing training, and to enhance recovery of patients. METHODS: Thirty-one patients with oral cancer participated in the experimental study. All patients underwent surgery and dysphagia assessment and training. Water swallow test rating, MASA score and tongue muscle rating were recorded before and after swallowing training. After swallowing training, swallowing angiography was used to confirm swallowing function and guide removal of nasogastric tube. The data were analyzed with SPSS 12.0 software package. RESULTS: Swallowing function after swallowing training was significantly improved in 31 patients with oral cancer after radical mastectomy. The ratings of water swallow test, MASA score, and tongue muscle score were all significantly different before and after training. We found tumor T stage was the only factor that significantly affected the patient's swallowing prognosis (P=0.029). In addition, the average time for removal of nasogastric tube after surgery was 7.6 days after surgery. The standards for nasogastric feeding tube removal after radical oral cancer treatment were initially proposed. CONCLUSIONS: Patients with oral cancer after radical mastectomy were significantly improved after receiving early swallowing training, which helped patients return to normal life as soon as possible and accelerate recovery. Early diagnosis and intervention of dysphagia in patients with oral cancer after radical mastectomy have a positive impact on final prognosis, which provide reliable guidance for patients to remove nasogastric tube and safe oral intake. Early swallowing training after radical oral cancer surgery is worthy of clinical promotion.

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Applied anatomic study and clinical application of medial sural artery perforator flap

SUN Qiuwangyue, GAO Peng-fei, WANG Chen-xing, SONG Xiao-meng, DING Xu, LI Huai-qi, WU He-ming, WU Yu-nong, YUAN Ye, YE Jin-hai, LI Zhong-lian

2018, 16 (6): 505-510. doi: 10.19438/j.cjoms.2018.06.005

Abstract ( 475 )

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PURPOSES: To provide anatomic evidence for clinical application of medial sural artery perforator flaps (MSAP), this study compared the contour and function of donor site and recipient site pre- and post-operatively in order to investigate the clinical value in reconstruction of oral and maxillofacial defects. METHODS: Six lower limbs of Chinese adult cadavers were micro-surgically dissected and the number of perforators was recorded based on medial sural artery perforator flaps, the external diameters, pedicle lengths, and locations were measured. Sixteen clinical cases using medial sural artery perforator flaps for reconstruction were selected from May 2011 to May 2014, the flap size ranged from 3 cm×4 cm to 6 cm×8 cm. The patients were evaluated at 3, 6 and 12 months postoperatively including flap survival number, contour and function of recipient and donor site, and their swallowing and speech function after reconstruction of the tongue and/or floor of mouth. RESULTS: Totally 14 medial sural artery perforators (each leg had 2.3 on average) were found in 6 legs. The average longitudinal distance from the medial sural artery perforators to popliteal crease was (9.15 ±4.05) cm, and (2.82±0.91)cm to posterior midline of the leg. The external diameter of vessel pedicle was (2.11±0.17) mm, and the pedicle length was (12.61±3.15) cm. Among the 16 medial sural artery perforator flaps, two flap had venous crisis and eventually developed necrosis, two patients were lost to follow up. All the cases were followed up for 10-47 months (mean 24 months), two cases with flap necrosis were excluded. Medial sural artery perforator flap was favorable in donor site morbidity, swallowing and speech function. CONCLUSIONS: Medial sural artery perforator flap has a good anatomic stability, with vascular pedicle length and diameter completely meeting requirements of the clinic, which is an ideal choice to reconstruct small or medium-sized oral and maxillofacial defects.

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Value of multi-voxel ¹H-MRS combined with DWI and DCE in diagnosis of squamous cell carcinoma of tongue

WANG Bo-cheng, AI Song-tao, LIANG Hai-sheng, WU Li-zhong, GAO Wei-qing, TAO Xiao-feng, MI Jun

2018, 16 (6): 511-517. doi: 10.19438/j.cjoms.2018.06.006

Abstract ( 330 )

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PURPOSE: To explore the value of multi-voxel ¹H-MRS with DWI and DCE in clinical diagnosis of squamous cell carcinoma (SCC) of the tongue. METHODS: A group of 45 cases that were pathologically determined with SCC and a control group of 25 cases, from June 2016 to October 2017, were selected for retrospective analysis. Both groups underwent routine MR, ¹H-MRS, DWI and DCE examinations. We compared the metabolites of ¹H-MRS (Cho,Cr,Cho/Cr ratio and LL), the variation of ADC value, maximum DCE slope and TIC curve type in focus, relative and distant areas of the SCC, and investigated the relationship of LL peak to ADC value and the maximum DCE slope, as well as its value in diagnosis of SCC. The parameters were analyzed with SPSS 22.0 software package for independent sample t test, paired t test and Chi-square test. RESULTS: The patients group showed significantly higher Cho and LL signals than the control group (P<0.01). The ADC value, maximum DCE slope and TIC curve type were significantly different in focus, relative and distant areas of SCC (P<0.01). The LL signal in the focus SCC area showed inverse linear correlation to ADC value (P<0.01), whereas it was linearly correlated to the maximum DCE slope (P<0.01). Multi-voxel ¹H-MRS combined with DWI and DCE improved the diagnostic accuracy of SCC of the tongue. CONCLUSIONS: Multi-voxel ¹H-MRS is a noninvasive method to acquire metabolic signals of SCC. It offers reliable and valuable approach to diagnose SCC of the tongue when combined with DWI and DCE imaging.

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Clinical effect of mandibular manipulation combined with comprehensive physical therapy for treatment of acute anterior disc displacement without reduction

FANG Zhong-yi, LIU Li-kun, CAI Bin, FAN Shuai, JIANG Xin

2018, 16 (6): 518-522. doi: 10.19438/j.cjoms.2018.06.007

Abstract ( 1275 )

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PURPOSE: To evaluate the clinical effect of mandibular manipulation combined with comprehensive physical therapy for treatment of acute anterior disc displacement without reduction of temporomandibular joint(TMJ). METHODS: Forty patients (36 females, 4 males) of acute TMJ disc displacement without reduction with limited opening from Jan. 2017 to Dec. 2017 in the Department of Rehabilitation Medicine, Shanghai Ninth People'S Hospital, Shanghai Jiao Tong University School of Medicine, were included in the study. All patients received education, electrotherapy (ultra-short wave diathermy, ultrasound and laser), mandibular manipulation followed by anterior repositioning splint and exercise therapy (disc reposition exercise stabilization exercise and cervical posture exercise). The treatment was continued for 2 weeks, 5 times a week. The baseline and endpoint outcome assessment measures were active maximum mouth opening(MMO), visual analogue scale(VAS) score and mandibular function impairment questionnaire(MFIQ). Consecutive MRI were performed after treatment. SPSS 22.0 software package was used for statistical analysis. RESULTS: After 2 weeks of treatment, MMO increased from (24.5±6.4) mm to (40.1±4.4) mm (P<0.05), VAS at rest dropped from 0(0,0) to 0(0,0)( P>0.05),VAS with opening dropped from 2(0,3) to 0(0,0) (P<0.05), VAS with chewing dropped from 1(0,3) to 0(0,0) (P<0.05) and MFIQ dropped from(25.0±6.5) to (12.3±6.4) (P<0.05). (3.6±3.1) weeks after treatment, 23 patients (57%) were normal, 9 patients (23% ) displayed displacement with reduction and 8 patients(20%) had displacement without reduction. CONCLUSIONS: Mandibular manipulation combined with comprehensive physical therapy can immediately increase mouth opening, relieve pain, improve mandibular function and maintain disc-condyle relationship after successful reposition in the treatment of acute anterior disc displacement without reduction .

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Evaluation of the dental spectral cone beam CT for metal artifact reduction

GAO Wei-qing, CHEN Yi, WANG Jing-bo, FAN Lin-feng, ZHAO Huai-ping, TAO Xiao-feng, XI Yan, ZHU Ling

2018, 16 (6): 523-527. doi: 10.19438/j.cjoms.2018.06.008

Abstract ( 387 )

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PURPOSE: To study virtual monochromatic imaging by a recently introduced dental spectral cone beam CT (CBCT) for metal artifact reduction. METHODS: The study included 46 patients with metallic dental materials, they were randomly divided into 2 groups, with one group scanned with spectral CBCT, and another group scanned with traditional CBCT. Standard deviation (STD) and metal artifact index (MAI) were analyzed using independent sample t test or paired t test with SPSS 25.0 software package. RESULTS: Patient study showed that MAI of the virtual monochromatic images by spectral CBCT was significantly lower than that of the traditional images from the same imaging device and patient group (P<0.05). MAI of the virtual monochromatic images by the spectral CBCT was also significantly lower than that of the traditional images by traditional CBCT (P<0.05). CONCLUSIONS: Virtual monochromatic imaging by spectral CBCT reduces metal artifact around dental metallic fillings.

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Clinical analysis of 5 cases of SAPHO syndrome with mandible osteomyelitis as initial presentation

GAO Bing-ju, LI Jun, PAN Li-zhen, QIU Yu, LIN Li-song

2018, 16 (6): 528-532. doi: 10.19438/j.cjoms.2018.06.009

Abstract ( 413 )

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PURPOSE: To discuss the diagnosis and treatment of SAPHO patients whose main symptoms were painful swelling and inflammation of the mandible, with or without restriction of mouth opening. METHODS: The clinical data of 5 patients with SAPHO in our department were reviewed, clinical manifestations, diagnosis and treatment of SAPHO related osteomyelitis of the mandible were discussed in combination with reported cases. RESULTS: SAPHO patients whose main symptoms were painful swelling and inflammation of the mandible, with or without restriction of mouth opening, were similar to diffuse sclerosing osteomyelitis of the mandible. For such disease, conservative treatment was the main treatment, and surgical treatment was not recommended. CONCLUSIONS: SAPHO is a rare disease, especially on the mandible. We should enhance our understanding of SAPHO and master the diagnostic criteria to improve early diagnosis rate and reduce unnecessary operation.

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Interpretation of the new TNM classification and the NCCN guidelines for cancers of the oral cavity and oropharynx

SHANG Wei, ZHENG Jia-wei

2018, 16 (6): 533-546. doi: 10.19438/j.cjoms.2018.06.010

Abstract ( 2156 )

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The AJCC Cancer Staging Manual and the NCCN Clinical Practice Guidelines in Oncology are widely used in clinical practice. NCCN diagnosis and treatment guidelines are closely related to TNM staging, and the guidelines provide more detailed diagnostic and therapeutic criteria for cancers with different TNM staging as a basis for guiding clinical application. The 8th edition TNM staging system for cancers of the oral cavity and oropharynx introduced a number of significant changes, such as depth of invasion(DOI), extranodal extension (ENE), human papillomavirus(HPV) and other indicators were used in the new stage, and a new chapter describing the staging of HPV-associated oropharyngeal cancers had been added. The 2018 NCCN guidelines for cancers of the oral cavity and oropharynx timely reflected the new changes in the 8th edition TNM staging, and the panel also created separate algorithms for HPV-associated (p16-positive) oropharyngeal cancer. The new TNM staging and NCCN guidelines are of great guiding significance in the treatment strategies and plans for patients with cancers of the oral cavity and oropharynx. The treatment recommendations were provided and the interpretation was made for the needs of clinical practice in this paper.

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Development of orthognathic surgery: an overview

ZHANG Tian-jia, XU Yu-ting, SHEN Guo-fang, WANG Xu-dong

2018, 16 (6): 547-552. doi: 10.19438/j.cjoms.2018.06.011

Abstract ( 656 )

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As the most common disease, dentomaxillofacial deformities refers to the abnormal shape and volume of jaws and even malocclusion or dysfunction of stomatognathic system caused by anomalous jaws or maxillofacial relationship. There is a long history of the development of orthognathic surgery to treat dentomaxillofacial deformities, along with great painstaking efforts from many scholars and investigators. This paper briefly reviewed the development history of orthognathic surgery, and introduced the milestone events and representative figures, in order to provide a reference for professional workers.

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