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20 July 2020, Volume 18 Issue 4 Previous Issue    Next Issue

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Expert Consensus

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Guideline on pathological diagnosis of oral and oropharyngeal squamous cell carcinoma Society of Oral Pathology, Chinese Stomatological Association 2020, 18 (4):  289-296.  doi: 10.3760/cma.j.issn.1002-0098.2020.03.001 Abstract ( 1293 )   PDF (7417KB) ( 831 )   Oral and oropharyngeal squamous cell carcinomas are the most common malignant tumours of the oral and maxillofacial region. A standardized pathological diagnosis report for oral and oropharyngeal squamous cell carcinoma should provide not only the pathological diagnosis itself as much accurate as possible, but also the information related to assessment of prognosis and strategy of treatment for the patient. An expert group organized by Society of Oral Pathology, Chinese Stomatological Association has set a guideline for the tissue fixation, gross examination and format of the pathological diagnosis report of oral and oropharyngeal squamous cell carcinoma. The guideline covers the important changes in clinical and pathological aspects of oral and oropharyngeal squamous cell carcinomas in recent years, such as depth of invasion in T category, extranodal extension in N category and human papilloma virus-associated squamous cell carcinoma in oropharyngeal carcinomas. Hopefully the guideline will improve the quality of pathological reports of oral and oropharyngeal squamous cell carcinomas and provide reliable data on clinical therapy and prognosis evaluation of patients with oral and oropharyngeal squamous cell carcinomas in China. References | Related Articles | Metrics

Original Articles

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Expression and significance of pyruvate kinase M2 and CD276 in head and neck squamous cell carcinoma CHANG Han-yue, MA Hai-long, YANG Xi, ZHANG Zhi-yuan 2020, 18 (4):  297-301.  doi: 10.19438/j.cjoms.2020.04.002 Abstract ( 387 )   PDF (3648KB) ( 199 )   PURPOSE: To investigate the expression and correlation between pyruvate kinase M2 (PKM2) and B7H3 (CD276) in head and neck squamous cell carcinoma (HNSCC) patients. METHODS: Immunohistochemical staining was used to detect the expression of PKM2 and CD276 in 70 HNSCC tissues and 18 normal oral mucosa tissues. The relationship between the expression of PKM2 and CD276 in OSCC tissues and clinical pathological characteristics were analyzed using SPSS13.0 software package. RESULTS: The expression of PKM2 and CD276 in HNSCC was significantly higher than that in normal oral mucosa. The expression of PKM2 and CD276 was strongly associated with TNM stage (P<0.05), while no correlation with gender, age, pathological differentiation grade(P>0.05). The expression of CD276 was positively correlated with the expression of PKM2 in HNSCC. CONCLUSIONS: High expression of PKM2 and CD276 in HNSCC was closely related with malignant progression, and PKM2 may participate in immune regulation by promoting CD276 expression. References | Related Articles | Metrics

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Effects of different MEK1/2 inhibitors on proliferation of NF1 knockdown Schwann cells LIU Jia-liang, DU Zhong, ZHENG Jia-wei, YOU Yuan-he, WANG Yan-an 2020, 18 (4):  302-307.  doi: 10.19438/j.cjoms.2020.04.003 Abstract ( 328 )   PDF (4924KB) ( 280 )   PURPOSE: To establish a stable RSC96 cell line with knockdown of neurofibromin 1(NF1) gene by lentiviral vectors, and assess the influence of different MEK1/2 inhibitors on proliferation of NF1 knockdown RSC96 Schwann cell. METHODS: Lentivirus was used to construct a Schwann cell model with decreased expression of NF1 gene. qRT-PCR and Western blot (WB) were used to verify the expression level of NF1 gene. Five MEK1/2 inhibitors were included in this experiment: Selumetinib, Binimetinib, Cobimetinib, Trametinib and PD0325901. CCK-8 assay was used to detect the inhibition of different MEK1/2 inhibitors under time gradient and concentration gradient. IC50 values in the blank control group and NF1kd group of 5 inhibitors were calculated by Graphpad Prism software package. SPSS 22.0 software package was used for statistical analysis. RESULTS: All MEK1/2 inhibitors could inhibit the proliferation of NF1kd Schwann cells (P<0.05). At 72 h, PD0325901, Cobimetinib and Trametinib had stronger inhibitory effects than Selumetinib and Binimetinib (P<0.05). In IC50 experiment, the drug concentrations of Cobimetinib in NF1kd group and blank control group were (2.35±0.98) mol/L and (14.22±1.67) mol/L, respectively(P<0.05); the drug concentrations of Binimetinib in NF1kd group and blank control group were (18.96±2.37) mol/L and (114.1±5.98) mol/L, respectively; and the differences between the groups were significant (P<0.05). There was no significant difference in IC50 values within Selumetinib, Trametinib and PD0325901 in NF1kd group and control group (P>0.05). CONCLUSIONS: Stable Schwann cell line with knockdown of NF1 gene was successfully constructed. All five MEK inhibitors can inhibit the proliferation of NF1kd RSC96 cell line; PD0325901, Trametinib and Cobimetinib processed longer lasting inhibiting ability. Cobimetinib and Binimetinib can both kill NF1kd Schwann cells more specifically than the blank control group at the same drug concentration. Cobimetinib has both long-lasting efficacy and killing specificity, which may have more clinical prospects. References | Related Articles | Metrics

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Inhibitory effect of carrimycin on biological activity of oral squamous cell carcinoma cells in vitro LIANG Si-yuan, ZHAO Tong-chao, ZHOU Zhi-hang, JU Wu-tong, LIU Ying, ZHANG Zhi-yuan, ZHONG Lai-ping 2020, 18 (4):  308-313.  doi: 10.19438/j.cjoms.2020.04.004 Abstract ( 1552 )   PDF (4438KB) ( 290 )   PURPOSE: As a new macrolide antibiotic with independent intellectual property rights of China, carrimycin not only has good antibacterial effect on a variety of bacteria, but also has the function of regulating cell physiology and proliferation.The aim of this study was to investigate the anti-tumor effects of carrimycin on the biological activity of oral squamous cell carcinoma (OSCC) cells in vitro. METHODS: OSCC cells (HN6/HB96 cell lines) were treated with gradient concentration of carrimycin. Cell proliferation was detected using CCK-8 kit, based on which cell growth curve was drawn. Cell migration ability was analyzed by wound-healing assay. Cell clone formation ability was analyzed by clone formation assay. Cell cycle and apoptosis were analyzed by flow cytometry. SPSS18.0 software package was used for statistical analysis. RESULTS: Carrimycin concentration-dependently inhibited cellular proliferation of OSCC cells of HN6 and HB96 in vitro. With the increase of drug concentration, cell migration and clonal formation ability significantly decreased (P<0.05). The G1 phase ratio of OSCC cells treated with carrimycin significantly increased, while the S and G2/M phase ratio decreased, indicating that the cell cycle was arrested in G1 phase(P<0.001). The apoptosis rate of OSCC cells was significantly increased with the increase of drug concentration (P<0.01). CONCLUSIONS: The activity of OSCC cells can be effectively inhibited by carrimycin, which provides experimental evidence for the application of carrimycin in OSCC. References | Related Articles | Metrics

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CBCT evaluation of second molar distal bone defects after extraction of impacted mandibular third molar LI Chen-lin, XIE Qian-yang, XU Guang-zhou, JIANG Qian 2020, 18 (4):  314-318.  doi: 10.19438/j.cjoms.2020.04.005 Abstract ( 433 )   PDF (3785KB) ( 330 )   PURPOSE: To explore bone defect of mandibular second molar (M2M) and its influencing factors 6 months after M3M extraction. METHODS: The preoperative and postoperative cone-beam CT (CBCT) data of 25 patients with 37 impacted M3Ms were analyzed retrospectively. IBM SPSS 25 software package was used for statistical analysis. Repeated measurement ANOVA was used to compare M2M distal osseous defect depth (ODD) before and after operation. Independent sample t test was used to analyze the influencing factors. RESULTS: M2M distal ODD decreased compared with that before extraction. Age and type of impaction before extraction were the factors influencing postoperative M2M distal bone defect. CONCLUSIONS: After removal of M3M in young patients with high risk, M2M distal bone height recovered. Age and type of impaction are the influencing factors. When M3M can be expected to be removed, early extraction may have a beneficial impact on periodontal health of M2M. When M3M is impacted deeply, bone transplantation materials should be implanted in order to achieve better bone healing. References | Related Articles | Metrics

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Changes of cerebral frontal and temporal lobes after trigeminal ganglion radiofrequency thermocoagulation WEN Ze-hui, WANG Yuan-yin, WANG Hai-bao, SONG Yang 2020, 18 (4):  319-322.  doi: 10.19438/j.cjoms.2020.04.006 Abstract ( 477 )   PDF (3339KB) ( 252 )   PURPOSE: To explore the clinical effects of CT-guided trigeminal ganglion percutaneous radiofrequency thermocoagulation (PRT) on idiopathic trigeminal neuralgia (ITN) and patients' brain function changes. METHODS: Seventeen patients with ITN admitted to the Affiliated Stomatology Hospital of Anhui Medical University and the First Affiliated Hospital of Anhui Medical University were selected as study subjects. Brain function was detected by functional magnetic resonance imaging(fMRI) before and after CT-guided PRT surgery. SPSS 16.0 software was used to compare the changes in low-frequency amplitude (f-ALFF) value, pain condition (VAS score), adverse reaction, and related brain by t test and Pearson correlation analysis before and after treatment. RESULTS: Compared with pre-treatment, VAS score was significantly reduced (P<0.05), and no significant adverse reactions occurred after surgery. At the same time, the f-ALFF values of the left frontal gyrus, right frontal gyrus, left medial frontal cortex, right medial frontal cortex, and left inferior temporal gyrus were significantly enhanced (P<0.001). No significant correlation was found between f-ALFF changes in relevant brain areas and postoperative VAS changes and postoperative numbness. CONCLUSIONS: PRT treatment under CT-guidance can alleviate the pain of ITN patients, and it is safe and reliable. At the same time, the change of f-ALFF value in relevant brain regions provides a certain reference for the judgment of postoperative prognosis. References | Related Articles | Metrics

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Landmarks restore,a machine learning algorithm-aided surgical planning for cross-midline maxillo-mandibular defect ZHOU Zi-jie, ZHU Xiang-yang, HAN Jing, LIU Jian-nan, ZHANG Chen-ping 2020, 18 (4):  323-327.  doi: 10.19438/j.cjoms.2020.04.007 Abstract ( 355 )   PDF (3688KB) ( 343 )   PURPOSE: The distance and angles among characteristic points of normal Chinese jaws were measured and analyzed by an algorithm to explore the morphological correlation between maxilla and mandible,and to guide a personalized preoperative design for cross-midline defects. METHODS: A total of 111 normal maxillary CT data (Dicom format) were collected and delivered to surgical planning software(Proplan CMF 3.0),which included 43 males and 68 females. Each case had 16 key points to mark. The data were analyzed using Mathematical software(MATLAB). The data from male and female jaw bones were analyzed using SPSS 22.0 software package to analyze the difference between genders. RESULTS: There was significant difference (P<0.05) in the size of jaw bones between genders, but no significant difference in angles except for ∠b1ab2(males 136.06°,females 132.18°,P<0.05 ). A machine learning algorithm was programmed based on vector matching model, and it was clinically applied to a patient with cross-midline mandibular defect. CONCLUSIONS: With the benefit of algorithm-aided preoperative design, a more convenient way can be achieved to tailor a similar maxilla or mandible for patients, especially in cases with cross-midline defects. References | Related Articles | Metrics

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The feasibility of facial nerve monitoring during general anesthesia with partial muscular relaxation of cis-atracurium HUANG Hui-min, LIU Jin-xing, QIU Lin, LIU Wen-hui, CHEN Huan, JIANG Hong 2020, 18 (4):  328-332.  doi: 10.19438/j.cjoms.2020.04.008 Abstract ( 299 )   PDF (3422KB) ( 214 )   PURPOSE: To explore the feasibility of facial nerve monitoring when using non-depolarizing muscle relaxant cis-atracurium in craniomaxillofacial surgery, and to determine the appropriate degree of muscular relaxation. METHODS: A total of 107 patients with normal preoperative facial nerve function who were planned to undergo elective craniomaxillofacial surgery and needed facial nerve monitoring during operation were selected. Propofol, midazolam, remifentanil and cis-atracurium were used to maintain general anesthesia by total intravenous anesthesia (TIVA). During operation, the surgeons stimulated the facial nerve when TOF%(T4/T1) and T1%(T1/T0) were in different muscular relaxation ranges, while the response and the value of electromyography(EMG) were recorded under different degrees of muscular relaxation. At the same time, the patient's body movement score and the presence of ventilator confrontation were recorded. SPSS 26.0 software package was used to draw the receiver operating characteristic curve (ROC), to determine the best cutoff points for neuromuscular blockade. The relationship between body movement score,ventilation confrontation and different degrees of neuromuscular blockade was analyzed by chi square test. RESULTS: The best cutoff points of TOF% and T1% were obtained: TOF% was 15%, T1% was 35%,and T1% was better than TOF%; when TOF%> 50% and T1%>60%, the patient might have body movement, and the ventilator confrontation increased during operation（P<0.05）. CONCLUSIONS: Facial nerve monitoring can be effectively performed under partial neuromuscular blockade of cis-atracurium in general anesthesia. The recommended range of muscle relaxation is 15%-50% for TOF% and 35%-60% for T1%. References | Related Articles | Metrics

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Evaluation of the clinical value of the Chinese version of ELPO surgery position-related pressure ulcer risk assessment scale in oral and craniomaxillofacial tumor surgery YING Yuan-jie, ZHANG Li, YANG Xu, XUE Hui-min, HUANG Yan, YANG Yue-lai 2020, 18 (4):  333-337.  doi: 10.19438/j.cjoms.2020.04.009 Abstract ( 459 )   PDF (3913KB) ( 311 )   PURPOSE: To translate and verify the reliability and validity of the risk assessment scale for the development of injuries due to surgical positioning（ELPO）,and to analyze the clinical value of Chinese version of ELPO in oral and craniomaxillofacial tumor surgery. METHODS: After obtaining the consent of the original authors, the ELPO scale follows the process of the Chinese standard scale for translation and back translation. A convenient sampling method was used to select 271 patients with elective surgery for oral and craniomaxillofacial tumors at Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine. The scale was validated by evaluating content validity, structure validity and predictive validity. The internal consistency Cronbach's alpha coefficient and inter-evaluator reliability were used to test the validity of the scale. The reliability of the scale was tested, the patients were assessed for risk by applying a scale, and interventions were implemented. SPSS 23.0 software package was used for statistical analysis. RESULTS: The content validity of the total scale was 0.952. The exploratory factor analysis extracted 3 common factors, the cumulative variance contribution rate was 61.538%. The sensitivity was 86%, the specificity was 83%, the positive prediction rate was 87%, and the negative prediction rate was 60%. The area under the ROC curve was 0.836, the internal consistency of the total table was Cronbach's α coefficient was 0.751, and the inter-rater reliability was 0.812. Only 2 of 271 patients had intraoperative pressure ulcers, the incidence was 0.74%. CONCLUSIONS: The Chinese version of ELPO scale has good reliability and validity. It is used to implement nursing intervention for patients with oral and craniomaxillofacial tumor surgery. It enables the operating room nurses to systematically perform nursing interventions, thereby effectively reducing the incidence of stress injuries and optimizing operating room care services. References | Related Articles | Metrics

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The feasibility of fibular free graft and dental implant after reconstruction of mandible with vascularized fibula flap WANG Ming-yi, FU Zhen, ZHANG Chen-ping 2020, 18 (4):  338-342.  doi: 10.19438/j.cjoms.2020.04.010 Abstract ( 416 )   PDF (3788KB) ( 193 )   PURPOSE: To investigate the effect of increasing vertical bone height for patients of mandible defects reconstructed with vascular fibular flap. METHODS: A total of 12 patients with mandibular defects were selected who wanted to receive dental implantation repairment after vascularized fibular reconstruction. Vertical bone augmentation was performed using the residual fibula segment, and dental implants were implanted in the same stage or second stage, and finally the dentures retained with implants were completed. Postoperative bone level, implant stability and survival rate were statistically analyzed using SPSS 19.0 software package. RESULTS: The bone loss of segment A and B were (0.94±0.18) mm and (0.89±0.15) mm 6 months after surgery, and (1.16±0.21) mm and (1.07±0.17) mm 12 months after surgery, respectively. ISQ values were (67.25±6.43) and (71.08±4.89) 6 and 12 months after implant implantation, respectively. Marginal bone level was (0.65±0.12) mm and (0.76±0.18) mm 6 and 12 months after implantation, respectively. The implant survival rate was 87.1% 1 year after surgery. CONCLUSIONS: Non-vascularized fibula has reliable anti-absorptive capacity, which can provide sufficient bone mass for implant implantation and maintain its long-term stability and survival rate in cases of insufficient vertical bone height after mandibular reconstruction. References | Related Articles | Metrics

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Three-dimensional reconstruction and comparison of temporomandibular joint space before and after orthognathic surgery SUN Hong, ZHAO Jin-long, HE Li-sheng 2020, 18 (4):  343-347.  doi: 10.19438/j.cjoms.2020.04.011 Abstract ( 1138 )   PDF (3420KB) ( 328 )   PURPOSE: Imaging examination of temporomandibular joint(TMJ) space is an important index for the evaluation of temporomandibular joint diseases(TMD). A new method was used to reconstruct three-dimensional(3D) structure of the temporomandibular joint(TMJ) space and compare the volumes before and after orthognathic surgery, in order to provide a reference for functional evaluation of TMJ after orthognathic surgery. METHODS: The CT imaging data of 20 skeletal Class Ⅲ patients who underwent orthognathic surgery were collected and analyzed by Mimics software that was used to reconstruct and calculate the volume of TMJ space, SPSS 22.0 software package was used for statistical analysis. RESULTS: After surgery, the volume of TMJ space increased in both sides, but only the volume of right side and total TMJ space were statistically significant (P<0.05). By linear regression analysis, bilateral joint volume was positively correlated before and after surgery (r=0.54, P=0.014 before surgery; r=0.59, P=0.006 after surgery), and there was no significant difference between genders. CONCLUSIONS: This study proposed a new method to display the 3D structure of TMJ space. By comparison of the volume of TMJ space before and after orthognathic surgery, it was found that the condyle had not been restored to its original position 6 months after surgery. References | Related Articles | Metrics

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Application of the mini vacuum drainage ball in repair of donor site defect after forearm free flap harvest WEN Ke-han, RUAN Min, GUO Huan-huan, HAO Zi-bao 2020, 18 (4):  348-351.  doi: 10.19438/j.cjoms.2020.04.012 Abstract ( 337 )   PDF (2893KB) ( 236 )   PURPOSE: To evaluate the efficacy of mini vacuum drainage in repair of donor site defect after forearm free flap harvest. METHODS: Free forearm skin flaps were applied for repairing defects after tumor resection in 44 patients with oral and maxillofacial carcinoma. Full thickness abdominal flaps were used to repair the donor site defects with mini vacuum drainage (experimental group, n=22) and traditional compression(control group, n=22), respectively. The total drainage in forearm area, healing condition of transplanted flaps and patients' satisfaction were observed after operation. SAS 9.4 software package was used for data analysis. RESULTS: In the experimental group, 20 flaps survived completely with smooth wounds and good healing, meanwhile without scab, exudation and infection. Partial necrosis of the other two flaps occurred on the edge. After simple cleaning and changing dressing, the flaps recovered. All patients were followed up for 6-10 months. In the experimental group, the color of the flaps was closer to the normal skin, the motor and sensory function of hand were normal, while the patients' satisfaction was higher than the control group(P<0.05). CONCLUSIONS: The mini vacuum drainage is safe, effective and low cost for repairing donor site defect after forearm free flap harvest with high patients' satisfaction, it is worth to use and spread. References | Related Articles | Metrics

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Efficacy of Noordhoff surgery combined with PNAM orthodontics for children with cleft lip and palate ZHANG Xiao-min, YANG Ya-xian, ZONG Yuan, LIN Ming 2020, 18 (4):  352-356.  doi: 10.19438/j.cjoms.2020.04.013 Abstract ( 379 )   PDF (3805KB) ( 217 )   PURPOSE: To investigate the efficacy and safety of Noordhoff surgery combined with presurgical nasoalveolar molding (PNAM) orthodontics for children with cleft lip and palate (CLP). METHODS: The clinical data of 80 CLP children admitted to Luohe Central Hospital and The First Affiliated Hospital of Zhengzhou University from July 2014 to January 2019 were reviewed and analyzed. The children were divided into two groups according to different treatment methods. Patients in the combined group (n=61) received Noordhoff surgery combined with PNAM orthodontics, while patients in Noordhoff group (n=19) received Noordhoff surgery alone. The efficacy and safety of the two groups were compared. SPSS 19.0 software package was used for data analysis. RESULTS: The operation time of the combined group was significantly shorter than that of the Noordhoff group, and the intraoperative blood loss was significantly less than that of the Noordhoff group (P<0.05). There was no significant difference in surgical complications between the two groups (P>0.05). During the orthodontic treatment of PNAM in the combined group, mucosal ulcer and bleeding symptoms in the soft palate, maxillary nodule and lining mucosa of the affected side were observed in 18 cases, and contact rash at the adhesion of waterproof adhesive tape on bilateral buccal skin was observed in 42 cases. The height of the lateral lip, the length of the healthy lip and the length of the affected lip were significantly increased in the two groups 3 months after operation (P<0.05), and significantly higher in combined group than in the Noordhoff group (P<0.05). The width of the affected nostrils was decreased in both groups after treatment (P<0.05), and were significantly lower in the combined group than in Noordhoff group(P<0.05). BK horizontal distance, BK sagittal line distance, sagittal line length and MG sagittal line distance were significantly decreased in both groups 3 months after operation (P<0.05), and significantly lower in the combined group than in Noordhoff group (P<0.05). J-(F-G) was increased in both groups after treatment (P<0.05), while no significant difference was found between the two groups 3 months after treatment(P>0.05). CONCLUSIONS: PNAM orthodontic treatment before Noordhoff surgery can effectively alleviate operation difficulty and shorten operation time, with less intraoperative blood loss and better nasolabial morphology; however, there are many complications during the treatment of PNAM. It is recommended that the area of pain and ulcers be fully lubricated and polished during the correction process, and the number of waterproof tape replacements should be reduced to alleviate the pain of the child. References | Related Articles | Metrics

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Effect of different occlusal contacts on occlusal balance of single posterior dental implants YANG Li, LU Wei-qing 2020, 18 (4):  357-360.  doi: 10.19438/j.cjoms.2020.04.014 Abstract ( 483 )   PDF (3116KB) ( 349 )   PURPOSE: To investigate the effect of different occlusal contacts on occlusal balance index of single posterior dental implants, and to provide evidence for clinical improvement of occlusal balance of implant prostheses. METHODS: Twenty-four patients with single posterior teeth implants were selected from December 2018 to December 2019 in Dental and Ophthalmic Clinic of Putuo District. According to the occlusal contact degree between different prostheses and opposite teeth, all implants were randomly divided into two groups: a 12 μm occlusal paper was used to adjust the occlusal degree in group A, while a 20 μm occlusal paper was used in group B. The occlusal paper could be extracted from between the prosthesis and the opposite teeth when clenched. The occlusal force was measured at the intercuspal position(ICP), with T-scan Ⅲ system before and on the day of restoration as well as 3, 6, 12 and 18 months after restoration, and their occlusal balance index were calculated. The data were analyzed with SPSS 21.0 software package. RESULTS: The occlusal balance index of the two groups was(-0.389+0.066) and (-0.368+0.055) before the day of restoration respectively, while (-0.249+0.069) and (-0.283+0.056) respectively on the restoration day. There was no significant difference between group A and group B during these two periods. The occlusal balance index of these two groups was (-0.052+0.022) and (-0.169+0.063) respectively 3 months after restoration, (-0.025+0.015) and (-0.088+ 0.045) respectively 6 months after restoration, (-0.010+0.008) and (-0.029+0.016) respectively 12 months after restoration as well as (-0.000+0.000) and (-0.006+0.008) respectively 18 months after restoration. The absolute value of occlusal balance index in group A was much less than that in group B at the 3rd, 6th, 12th months after restoration. On the contrary, the increase extent of group A was much larger than that of group B. There was significant difference between the two groups (P<0.05). At 18 month after restoration, the occlusal balance index of the two groups were all close to "0" . CONCLUSIONS: Occlusal balance will be obtained gradually after the restoration of a single posterior tooth implant and earlier when a 12 μm occlusal paper was used to adjust the occlusal degree. References | Related Articles | Metrics

Clinical Reports

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Clinical study of condylar fracture with external auditory canal fracture in 34 patients JIANG Yan, WEN Yue-jin, JIANG Can-yang, HUANG Jian-ping, SHI Bin, ZHU Xiao-feng, HUANG Li, LIN Li-song 2020, 18 (4):  361-364.  doi: 10.19438/j.cjoms.2020.04.015 Abstract ( 477 )   PDF (3439KB) ( 243 )   PURPOSE: To investigate the association between condylar fracture and external auditory canal fracture and the necessity of simultaneous operation. METHODS: A total of 230 cases with 320 condylar fractures were divided into 4 clinical types according to the location of fracture line: sagittal fracture of the condyle (type Ⅰ), intracapsular condylar fracture (type Ⅱ), condylar neck fracture (type Ⅲ) and condylar base fracture (type Ⅳ). Chi-square test of SPSS 20.0 software package was used to compare the distribution of ipsilateral external auditory canal fracture between different types of condylar fracture. The prognosis of condylar and external auditory canal fractures were also compared. RESULTS: Forty-six sides in 34 patients were found with condylar fracture combined with external auditory canal fracture, including 12 sides, 16 sides, 7 sides and 5 sides in type I to type Ⅳ of condylar fractures, and 6 sides without condylar fracture. The incidence of type Ⅲ condylar fracture combined with ipsilateral external auditory canal fracture was significantly lower than other three types(P<0.05). Type I condylar fracture was found with significantly higher incidence of external auditory canal fracture compared to type Ⅳ(P<0.05). No significant difference was observed between any other two types. Thirty sides in 22 patients were followed up for 6 months after injury. Among these followed-up patients, eight sides in 5 patients without cerebrospinal leakage were treated with operations simultaneously. No traumatic stenosis and atresia of the external auditory canal and no decrease of hearing within 6 months was found after operation. In another 17 patients, twenty-two sides of the external auditory canal showed stenosis of varying degrees. Furthermore, among these 17 patients, five sides in 4 patients had severe hearing impairment (all of them were diagnosed as comminuted fractures of the external auditory canal). CONCLUSIONS: The incidence of external auditory canal fracture was observed lower in condylar neck fracture compared to sagittal condylar fracture. Treatment of maxillofacial fractures should be accompanied by early treatment of external auditory canal fractures, and active prevention of external auditory canal stenosis, hearing loss and other complications are necessary. References | Related Articles | Metrics

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Application of transoral robotic surgery in oral and maxillofacial surgery: a report of 9 cases XI Qing, ZHANG Ming, FENG Lin, XING Shao-wen, SU Cui, LI Bing, SUN Hui 2020, 18 (4):  365-368.  doi: 10.19438/j.cjoms.2020.04.016 Abstract ( 637 )   PDF (2762KB) ( 372 )   PURPOSE: To provide experience in 9 cases of transoral robotic surgery (TORS), and to explore the future application of robot in oral and maxillofacial surgery. METHODS: Nine cases with tumors in deep oral cavity were resected by using Da Vinci robotic surgery system in the Department of Stomatology, PLA General Hospital. RESULTS: All the patients completed the operation successfully. The shortest time of the operation area exposure was 20 min, the longest time was 90 min, the average time was 42.2 min. The shortest operation time was 5 min and the longest was 90 min, the average time was 40.9 min. Except for 1 case, who underwent bilateral neck dissection, there were 8 patients who were operated only by TORS. The average postoperative time was 3.25 d, and the average hospitalization time was 7.75 d. CONCLUSIONS: Resection of the tumors in deep oral cavity can be completed dependently by Da Vinci robotic surgery system, but there are still some difficulties in the operation of tongue base tumor in special patients, which needs a long exposure time of the operation area. References | Related Articles | Metrics

Review Articles

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Research advances in postoperative delirium after head and neck reconstruction LI Xiao-dong, ZHANG Ling, MENG Jian, YE Wei-min 2020, 18 (4):  369-374.  doi: 10.19438/j.cjoms.2020.04.017 Abstract ( 407 )   PDF (5403KB) ( 281 )   Postoperative delirium (POD) is an disordered brain function. It happens occasionally in patients after head and neck reconstruction(HNR). If discovered and treated in time, the prognosis of patients will be greatly improved, otherwise it is likely to be transformed into long-term cognitive impairment , extended hospital stay and increased medical expenses. For most medical staff of head and neck surgery, the definition, diagnosis, and management of postoperative delirium need to be strengthened. This article reviewed the definition, diagnosis, influence, prevention and treatment of delirium, which will help head and neck surgeons to diagnose and treat delirium early. References | Related Articles | Metrics

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Progress in topical of application β-blockers in the treatment of infantile hemangioma GU Da, HUO Ran, XU Guang-qi, BI Jian-hai, LI Shang-bin 2020, 18 (4):  375-380.  doi: 10.19438/j.cjoms.2020.04.018 Abstract ( 391 )   PDF (4846KB) ( 194 )   Hemangioma is the most common benign tumor in infants and young children. It is mainly treated by topical and systemic medication, supplemented by laser therapy, depending on the location, size, extent, depth, stage, functional and psychological impact on children. Oral propranolol is currently the first-line treatment for superficial hemangioma. However, topical β-blockers are more likely to be accepted by children's parents, and their use is gradually increasing. This article reviewed the research progress of β-blockers in the treatment of infantile hemangiomas in recent years, with the aim to provide a theoretical basis for the treatment of infantile hemangiomas. References | Related Articles | Metrics

Case Reports

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Gingival metastasis from rectal adenocarcinoma: A case report and literature review SHE Yang-yang, LIN Yi-jia, LIU Zhi-yong, CHEN Jie-yu, CHEN Xue-ying, GE Ya-ping 2020, 18 (4):  381-384.  doi: 10.19438/j.cjoms.2020.04.019 Abstract ( 724 )   PDF (3080KB) ( 211 )   Rectal adenocarcinoma rarely metastasizes to the gingiva. An unusual case of an 81-year-old woman with gingival metastasis originating from the rectal adenocarcinoma two years after colon carcinoma resection was presented. The diagnosis was confirmed by histopathologic examination and immunohistochemical analysis. Because oral metastases are rare and often mimic much more common benign lesions, they should be considered as a possibility in differential diagnosis. Careful examination with a high degree of clinical suspicion, as well as a multidisciplinary approach is suggested. References | Related Articles | Metrics