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20 September 2021, Volume 19 Issue 5 Previous Issue    Next Issue

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Expert Consensus

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Expert consensus on application of submental island flap in oromaxillofacial head and neck defect reconstruction CHEN Chuan-jun, CHEN Wei-liang, SUN Chang-fu, HE Yue, JIANG Can-hua, PENG Xin, SHANG Zheng-jun, HAN Zheng-xue, LI Jin-song, HOU Jin-song, LIN Li-song, HAN Xin-guang, WEI Jian-hua, WANG Zhi-yong, WU Yu-nong, ZHENG Jia-wei, LI Long-jiang, WANG Hui-ming, LI Zu-bing, GUO Chuan-bin, YANG Chi, SHI Bing, ZHANG Zhi-yuan 2021, 19 (5):  385-391.  doi: 10.19438/j.cjoms.2021.05.001 Abstract ( 738 )   PDF (5968KB) ( 512 )   Submental island flap (SMIF) is an axial flap that receives its blood supply from the submental artery, a branch of the facial artery. It is in close proximity with many oral and maxillofacial regions, and provides a good texture and color match. The flap is easy to prepare and suitable for repairing medium-sized defects of the oral and maxillofacial region with high survival rates. However, there are still controversies about the application of submental island flap both at home and abroad, mainly focusing on the oncological safety of submental island flap for patients with cervical lymph node metastasis and the preparation method of the flap. In order to unify and standardize the application of submental island flap in repair of oral and maxillofacial head and neck defects, this paper focuses on the collective wisdom of experts in oral and maxillofacial surgery of many medical colleges in China, and reaches an expert consensus, so as to guide the clinical application of submental island flap. References | Related Articles | Metrics

A Century of Commitment to People's Heath by the Communist Party of China

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Effect of COVID-19 pandemic on patient delay of inpatients with squamous cell carcinoma of oral mucosa MA Xiao-kun, WANG Lin, XU Tao, GUO Chuan-bin, WANG Yang, WANG Dian-can 2021, 19 (5):  392-396.  doi: 10.19438/j.cjoms.2021.05.002 Abstract ( 516 )   PDF (3986KB) ( 222 )   PURPOSE: The aim of this research was to investigate whether the pandemic of corona virus disease 2019 (COVID-19) had an impact on patient delay of medical management, using 2019 and 2018 as controls. METHODS: Electronic medical records of inpatients with squamous cell carcinoma (SCC) of oral mucosa in 2020, 2019 and 2018 were reviewed, and the time of the first signs or symptoms and the time of initial professional evaluation was extracted. Their interval, namely the patient delay time, was calculated. Nonparametric rank sum test was used to analyze the difference in patient delay time between 2020, 2019 and 2018 with SPSS 22.0 software package. When the delay time was more than 3 months, the patients were grouped as delayed help-seeking. RESULTS: There were 254 inpatients with SCC of oral mucosa in 2020, 447 in 2019, and 353 in 2018. The mean patient delay time was 3.93 months, 4.10 months, and 4.61 months, respectively. Nonparametric rank sum test found that there was no significant difference in the delay time for hospitalization in 2020, 2019, and 2018. The rate of delayed help-seeking in 2020 patients was 33.3%, lower than 36.5% in 2019 and 38.2% in 2018, but the difference was not significant(P=0.257). CONCLUSIONS: The pandemic of COVID-19 in 2020 probably had no effect on patient delay time for treatment of SCC of oral mucosa. References | Related Articles | Metrics

Original Articles

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Effect of fibrin glue on osteogenesis and mineralization during rapid maxillary expansion ZHAO Han-jiang, WANG Ze-ying, LIN Dan, SHEN Guo-fang 2021, 19 (5):  397-404.  doi: 10.19438/j.cjoms.2021.05.003 Abstract ( 313 )   PDF (7004KB) ( 146 )   PURPOSE: To investigate the effect of accelerating osteogenesis and mineralization during rapid maxillary expansion by in situ injection of fibrin glue. METHODS: In in vitro experiments, rat bone marrow stromal cells (rBMSCs) were co-cultured with fibrin glue fabricated with different concentrations of thrombin. The effects of degradation products of fibrin glue on the proliferation and osteogenic differentiation of rBMSCs were tested by CCK-8, alkaline phosphatase (ALP) staining and ALP activity quantification as well as alizarin red staining. rBMSCs were combined with fibrin glue by co-culture, two-dimensional surface culture and three-dimensional culture, respectively. Cell morphology and adhesion were observed by FITC-phalloidine fluorescence staining. In in vivo experiments, 12 6-week male SD rats were used to establish rapid maxillary expansion (RME) model with 100 g expanding force for 7 days. After 7-day expansion, they were divided into two groups: retention for 14 days as control group (R group) while in situ injection of fibrin glue combined with retention for 14 days as experimental group (R+FG group). Micro-CT scanning for three-dimensional reconstruction and analysis were conducted to compare the difference of new bone volume and bone mineral density. The osteogenesis and angiogenesis in mid-palatal suture were observed by H-E staining, Masson's trichrome staining, TRAP staining and sequential fluorescent labeling. GraphPad Prism 8.0.1 software package was used for statistical analysis. RESULTS: The degradation products of fibrin gel had little effect on cell proliferation and osteogenic differentiation of rBMSCs(P>0.05). In addition, rBMSCs cultured in three ways had great cell tractility. Compared with R group, the relative bone volume(P<0.001) and bone mineral density of trabeculae (P<0.001) were significantly increased in R+FG group. A large number of new trabeculae with higher mineralization degree were observed and the number of osteoclasts was decreased in mid-palatal suture. Mineral apposition rate was significantly accelerated in R+FG group(P<0.001). CONCLUSIONS: The degradation products of fibrin glue had no effect on proliferation and differentiation of rBMSCs. Fibrin glue could promote new bone formation, mineralized rate and inhibit osteo-clastogenesis in mid-palatal suture after RME in SD rats, which might be related to regulation of osteogenic differentiation by the surface structure of fibrin glue. References | Related Articles | Metrics

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The role of microglia in the trigeminal spinal subnucleus caudalis in regulation of orofacial cancer-induced pain in rats WANG Hui, SUN Jin-hu 2021, 19 (5):  405-410.  doi: 10.19438/j.cjoms.2021.05.004 Abstract ( 316 )   PDF (4932KB) ( 248 )   PURPOSE: To explore the role of microglia activation in the trigeminal spinal subnucleus caudalis (Vc) in the development of orofacial cancer-induced pain. METHODS: Adult male Wistar rats(280-300 g) were injected with Walker 256 cell suspension under the tongue mucosa to establish tongue tumor pain model. In experiment 1, the rats were randomly divided into control group (Sham) and tumor group (Tumor) (n=10). Head withdrawal mechanical threshold (HWMT) was measured with Von Frey Hair, and immunofluorescence technology was used to detect the proliferation and activation of microglia in the Vc. In experiment 2, the rats were randomly divided into four groups(n=10), i.e., Sham + Veh (intraperitoneal injection with PBS in group Sham), Sham + Mino (intraperitoneal injection with minocycline in group Sham), Tumor + Veh (intraperitoneal injection with PBS in group Tumor), Tumor + Mino (intraperitoneal injection with minocycline in group Tumor). The proliferation and activation of microglia in the Vc were detected, the mRNA expression level of Iba-1, IL-6, IL-1β and TNF-α in Vc were detected by qRT-PCR, and the orofacial mechanical pain of rats was measured by HWMT. SPSS 19.0 software package was used for data analysis. RESULTS: As the tumors continued to grow, HWMT in the tumor-bearing rats were decreased initially on day 5(P<0.05) versus the sham group and continued to decline until day 10. Marked proliferated and activated microglia were observed on day 5 and day 10 compared with the sparsely ramified microglia in the sham group. Treatment with minocycline (Tumor + Mino) inhibited the proliferation and activation of microglia and the mRNA expression level of Iba-1, IL-6, IL-1β and TNF-α in the Vc. HWMT was significantly higher in tumor-bearing rats receiving minocycline (Tumor + Mino) than in tumor-bearing rats receiving vehicle (Tumor + Veh). CONCLUSIONS: Activation of microglia promoted the release of inflammatory factors, which played a role in the development of orofacial cancer pain. Inhibition of microglia activation could significantly alleviate orofacial cancer-induced pain. References | Related Articles | Metrics

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Differential expression and bioinformation of lncRNA CASC15 in ameloblastoma HE You-ya, ZHANG Yu, DAI Zhen-lin, LIN Cheng-zhong, CAO Wei, JI Tong 2021, 19 (5):  411-416.  doi: 10.19438/j.cjoms.2021.05.005 Abstract ( 294 )   PDF (4482KB) ( 228 )   PURPOSE: To explore the expression of CASC15 and its mechanism in the development of ameloblastoma. METHODS: Second-generation high-throughput full-transcription sequencing data of 8 pairs of ameloblastoma and adjacent normal tissues were analyzed to screen out the target lncRNA CASC15. The co-expression mRNA with significant difference from CASC15 was screened by using DEseq2 algorithm. Gene Ontology (GO) analysis and signal pathway analysis were performed by comparing with the gene annotations in the GO database and KEGG database. The expression of CASC15 in ameloblastoma was detected by qRT-PCR. The data were analyzed with GraphPad Prism 8 software package. RESULTS: A total of 172 differentially expressed CASC15-related mRNA were screened out. GO analysis showed that the differentially co-expressed CASC15 mRNA was mainly involved in cell proliferation regulation, cell signal transduction, cell migration, angiogenesis and other biological behaviors. Pathway analysis showed that the co-expressed mRNA of CASC15 was mainly involved in pathway in cancer, Hedgehog, p53 as well as cancer-related signal pathway in osteocyte differentiation, cell cycle and so on. Five high core genes such as FGF18, EPCAM, PTCH1, SHH and GLI1, which were closely related to CASC15, screened by co-expression network analysis, which can be used to explore the mechanism of recurrence and invasion of ameloblastoma. qRT-PCR results showed that CASC15 was highly expressed in ameloblastoma, which was 11.41 times higher than that in adjacent normal tissues (P<0.0001), and 11.72 times higher than that in dental follicle tissues (P<0.0001). CONCLUSIONS: CASC15 is highly expressed in ameloblastoma, which may participate in the occurrence and development of ameloblastoma by regulating cell proliferation, cell migration and cell cycle. References | Related Articles | Metrics

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ATIP1 and ATIP3a, two isoforms of MTUS1/ATIP, suppressed proliferation and induced apoptosis in oral malignant tumor cells ZHAO Ting-ting, FENG Yan-qing, HE Qian-ting, MO Yun-long, DONG En-en, WANG An-xun 2021, 19 (5):  417-423.  doi: 10.19438/j.cjoms.2021.05.006 Abstract ( 303 )   PDF (5341KB) ( 214 )   PURPOSE: To investigate the role of MTUS1/ATIP in suppression of proliferation and induce apoptosis of oral malignant tumor cells. METHODS: The expression level of MTUS1/ATIP in oral malignant tumor cells (UM1, SACC-83) was detected. Oral malignant tumor cells were transfected with ATIP1 and ATIP3a vector for 48 h. Proliferation analysis was performed with MTT assay. Flow cytometry and immunofluorescence technique were employed to measure cell cycle and apoptosis of oral malignant tumor cells. The expression level of proteins ATIP1, ATIP3a, Caspase3, ERK1/2, pERK1/2 in oral malignant tumor cells transfected with ATIP1 and ATIP3a was detected by Western blotting. The data was analyzed using SPSS 19.0 software package. RESULTS: ATIP1, ATIP3a and ATIP3b were the major isoforms produced by MTUS1 gene and significantly decreased in oral malignant tumor cells [TSCC cell line UM1, parotid adenoid cystic carcinoma (ACC) tissue and cell line SACC-83]. Restoration of MTUS1 (ATIP1 and/or ATIP3a) expression induced anti-proliferative activities against oral malignant tumor cells (UM1 and SACC-83), with a cooperative effect between ATIP1 and ATIP3a. In TSCC cells, the inhibition rate of ATIP1 was approximately 38.8% (24 h) and 57.3% (48 h), the inhibition rate of ATIP3a was approximately 48.1% (24 h) and 56.5% (48 h); however, the inhibition rate increased to 93.5% (24 h) and 88.8% (48 h) with combined action of ATIP1 and ATIP3a in TSCC cell lines (P<0.05). A similar effect was observed in adenoid cystic carcinoma (ACC) cells (P<0.05). Over-expression of ATIP1 led to G1/G0 cell cycle arrest, whereas ATIP3a caused G2/M arrest (P<0.05). Both ATIP1 and ATIP3a induced apoptosis and inhibited phosphorylation of ERK1/2 (extracellular-regulated kinase). CONCLUSIONS: The results suggest that MTUS1 is a promising anticancer agent for oral malignant tumor and has apoptosis-inducing activities via ERK1/2 pathway. References | Related Articles | Metrics

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Effect of MMP-9 inhibitor on invasion and migration ability of human tongue squamous cell carcinoma SCC-25 cell and its mechanism SHUI Wen-jun, GAO Jin-xing, REN Lei 2021, 19 (5):  424-428.  doi: 10.19438/j.cjoms.2021.05.007 Abstract ( 309 )   PDF (4217KB) ( 170 )   PURPOSE: To study the effect of matrix metalloproteinase-9 (MMP-9) inhibitors on invasion and migration ability of human tongue squamous cell carcinoma (TSCC) SCC-25 cells, and explore its related mechanisms. METHODS: SCC-25 cells in the logarithmic phase were taken and treated with 0, 5, 10, and 20 μmol/L MMP-9 inhibitor BB-94 respectively, and divided into control group, experimental group A, B and C. RT-qPCR, Western blot were used to determine the expression of MMP-9. Transwell chamber experiment was used to determine invasion ability. Scratch test was used to determine migration ability. Western blot was used to determine the protein expression of intercellular adhesion molecule-1 (ICAM-1), E-cadherin (E-cad), and connexin 43 (Cx43). SPSS 22.0 software package was used for data analysis. RESULTS: Compared with the control group, the relative expression of MMP-9 mRNA and protein, migration rate, and number of penetrating cells/field of view in experimental A, B, and C group decreased significantly(P<0.05). Compared with experimental group A, the relative expression of MMP-9 mRNA and protein, migration rate, and number of penetrating cells/field of view in experimental B, and C group decreased significantly (P<0.05). Compared with experimental group B, the relative expression of MMP-9 mRNA and protein, migration rate, the number of penetrating cells/field of view in experimental group C decreased(P<0.05). Compared with the control group, the relative expression of ICAM-1 protein in experimental group A, B, and C decreased, while the relative expression of E-cad and Cx43 protein increased significantly (P<0.05). Compared with experimental group A, the relative expression of ICAM-1 protein in experimental group B and C decreased, while the relative expression of E-cad and Cx43 protein increased significantly (P<0.05). Compared with experimental group B, the relative expression of ICAM-1 protein in experimental group C decreased, while the relative expression of E-cad and Cx43 protein increased(P<0.05). CONCLUSIONS: MMP-9 inhibitor can inhibit TSCC cell invasion and migration in a dose-dependent manner. It is speculated that its mechanism of action is related to down-regulation of ICAM-1 expression and up-regulation of E-cad and Cx43 expression. References | Related Articles | Metrics

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A novel EDA gene mutation identified by whole exome sequencing in one patient with HED YU Kang, SHEN Yi-han, JIANG Cai-ling, WANG Feng, WU Yi-qun 2021, 19 (5):  429-433.  doi: 10.19438/j.cjoms.2021.05.008 Abstract ( 357 )   PDF (3717KB) ( 260 )   PURPOSE: This study aimed at revealing a novel ectodysplasin A (EDA) gene mutation in one hypohidrotic ectodermal dysplasia (HED) family. METHODS: Genomic DNA was extracted from peripheral blood of patients, and whole exome sequencing was used for gene sequencing. EDA1 (ectodysplasin A1) wild-type and mutant expression plasmids were constructed. Protein expression levels were detected by Western blotting. The effect on downstream NF-κB pathway activity was detected by dual luciferase analysis. The data was analyzed with SPSS 20.0 software. RESULTS: We identified a novel EDA c.649_666del (p.Pro217_Pro222del) mutation. Compared with wild-type EDA1, the mutant EDA1 protein can be expressed and secreted normally, but its transcriptional activation of downstream NF-κB pathway was significantly decreased(P<0.05). CONCLUSIONS: This study identified a novel deletion mutation of EDA gene, which expanded the mutation spectrum of X-linked hypohidrotic ectodermal dysplasia and can be helpful for prenatal consultation, diagnosis and correction. References | Related Articles | Metrics

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Comparison of advantages and disadvantages of iliac crest in different orientations for reconstruction of dentulous defect of mandible with vascularized iliac bone flaps YANG Zong-yan, KANG Yi-fan, LV Xiao-ming, ZHANG Lei, SHAN Xiao-feng, CAI Zhi-gang 2021, 19 (5):  434-438.  doi: 10.19438/j.cjoms.2021.05.009 Abstract ( 432 )   PDF (4310KB) ( 267 )   PURPOSE: In this study, the symmetry of neomandible and whether meeting the standard of dental implant after reconstruction with iliac bone flap were measured to make sure the advantages and disadvantages of different iliac crest orientations. METHODS: Patients who underwent mandibular defect reconstruction with iliac bone flap at Peking University School and Hospital of Stomatology from January 2017 to December 2019 were included in this study, and divided into iliac crest oriented to alveolar process group (group A) and iliac crest oriented to lower mandibular margin group (group B). The patients' basic information and CT image data after operation were collected. Simplant and Proplan software were used to measure the symmetry, the length of bone segment, the height, the width of alveolar process side and the distance between jaws and iliac crest after reconstruction(opposite to upper incisor,canine and first molar). The data was analyzed using SPSS 25.0 software package. RESULTS: There were 15 patients in group A and B respectively, the average age was 37.7 years old. The asymmetry rate of LC defect type at the lower edge of the mental foramen in group A was less than that in group B. There was no significant difference in bone length between group A (49.43±4.17)mm and group B (52.25±3.79)mm. The widths of occlusal side in group A (opposite to upper incisor, canine and first molar) were (11.40±0.63), (12.15±0.46), (13.15±0.62)mm, and (7.93±0.55), (8.97±0.34), (8.70±0.49)mm(P<0.05) in group B, respectively. The bone height opposite to upper first molar was(29.80±1.17)mm in group A, which was significantly higher than (25.42±1.17)mm in group B(P<0.05). The intermaxillary distance of group A was less than that of group B, the distance of first molar was (10.89±1.07)mm in group A and (14.33±0.76)mm in group B(P<0.05). CONCLUSIONS: When mandibular dentulous defect is reconstructed with vascularized iliac bone flap, the iliac crest oriented to the alveolar process side can get better symmetry, wider alveolar ridge and more suitable intermaxillary distance than iliac crest oriented to the lower margin of the mandible. References | Related Articles | Metrics

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Effect of pre-surgical orthodontic treatment on the position and morphology of articular disc and condyle of temporomandibular joint WANG Tian-ge, ZHOU Zhi-jie, LIN Yi-jun, SUN Yi-ting, CHEN Yu, SUN Hua, MAO Li-xia, LIU Jia-qiang 2021, 19 (5):  439-444.  doi: 10.19439/j.sjos.2021.05.010 Abstract ( 493 )   PDF (4584KB) ( 209 )   PURPOSE: To investigate the effect of pre-surgical orthodontic treatment on the position and morphology of articular disc and condyle of temporomandibular joint(TMJ). METHODS: Thirty patients with skeletal malocclusion was selected. The measurements were taken on MRI of TMJ. The condylar position was determined by measuring the joint space. The condylar morphology was determined by measuring the length, width and height of condyle head. The position and morphology of articular disc was determined by direct observation. The changes of the position and morphology of articular disc and condyle before and after pre-surgical orthodontic treatment in patients with skeletal Class Ⅰ,Ⅱ and Ⅲ malocclusion were observed and analyzed with SPSS 24.0 software package. RESULTS: There was no significant difference in joint spaces and joint space index, the length, width and height of condyle head, the degree of anterior disc displacement and the morphology of articular disc before and after the pre-surgical orthodontic treatment(P>0.05). CONCLUSIONS: Pre-surgical orthodontic treatment does not cause the change of the position and morphology of articular disc and condyle in patients with skeletal malocclusion. References | Related Articles | Metrics

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Evaluation of the effect of blowing exercise on speech therapy in 74 patients with cleft palate JIANG Li-ping, LIU Qiong, LOU Qun, WANG Bi-xia 2021, 19 (5):  445-448.  doi: 10.19438/j.cjoms.2021.05.011 Abstract ( 574 )   PDF (3017KB) ( 215 )   PURPOSE: To investigate the effect of blowing training behavior on speech therapy in patients with cleft palate. METHODS: Seventy-four patients with compensatory speech of velopharyngeal incompetence(VPI) who were treated with pharyngoplasty were recruited in this study, with an average age of 10.98 years old. According to the principle of combining blowing exercise behavior therapy with Chinese speech training, the consonant was further induced, and fricative and plosive were produced to send the air way on the basis of blowing blisters and blowing balloons while holding breath. SPSS 21.0 software package was used for data analysis. RESULTS: The blowing time was increased from 6.37, 7.0 and 9.96 seconds before blowing exercise to 24.87, 26.96 and 29.07 seconds after blowing exercise, respectively, in the three age groups 4-6 years old, 7-12 years and ≥13 years old; the difference was statistically significant (P<0.001). Before exercise, each group of patients could not complete balloon blowing, the success rate of balloon blowing in each group reached 88.9%(4-6 years old group), 84.0%(7-12 years old group) and 90.9%(≥13 years old group) later. Prior to the training of each group of patients, fricative f, s, plosive p were shedding or weakening, while all patients obtained normal pronunciation after exercising, the difference was statistically significant(P<0.001). CONCLUSIONS: Mastering the exercising method of breath when holding up the soft palate is effective in enhancing velopharyngeal closure and inducing pronouncing fricative and plosive. References | Related Articles | Metrics

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Prognostic factors of oral tongue squamous cell carcinoma: a retrospective study of 638 cases YE Chen, CAI Yun, ZHAO Xiao-mei, ZHANG Chen-ping, ZHAO Nai-qing 2021, 19 (5):  449-455.  doi: 10.19438/j.cjoms.2021.05.012 Abstract ( 955 )   PDF (4620KB) ( 245 )   PURPOSE: To investigate the impact of clinical and pathological characteristics on survival of patients with oral tongue squamous cell carcinoma （OTSCC）, and to analyze the factors predicting survival outcome. METHODS: A retrospective analysis of 638 patients diagnosed with OTSCC at Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from January 2003 to December 2013 was performed. Details on patient characteristics and tumor characteristics were recorded by retrospective review of patients' charts. Survival data acquisition was retrieved from Shanghai registry database of resident cancer by Shanghai Center for Disease Control and Prevention. Standard descriptive statistics were used to summarize patient demographic and disease-related data. Pearson Chi-square, Kaplan-Meier, Log-rank test, and Cox proportional hazards regression analysis were performed with Stata/SE 10.0 software package, and only variables with P<0.05 in univariate analysis were included in multivariable regression models. RESULTS: The 1-year, 3-year, and 5-year overall survival of 638 patients were 83.52%, 68.98% and 63.33%, respectively. Univariate analysis indicated that age> 60 years, males below 60 years, base of tongue, higher T stage, N stage were predictors of poor outcome. In multivariate analysis, several predictors of compromised overall survival were T stage, N stage and histopathological grade. T stage and N stage were strong independent predictors of poorer overall survival. CONCLUSIONS: Age, sex, lesion, T stage, N stage and histopathologic grading are prognostic factors for OTSCC patients. References | Related Articles | Metrics

Clinical Reports

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Evaluation of treatment results of 75 patients with comminuted mandibular fractures XU Xiao-feng, ZHU Fang-xing, LIAO Qian, XU Bing, SHEN Guo-fang, ZHANG Wen-bin, SHI Jun 2021, 19 (5):  456-459.  doi: 10.19438/j.cjoms.2021.05.013 Abstract ( 398 )   PDF (3414KB) ( 413 )   PURPOSE: This study aimed at proposing a new treatment-oriented classification and treatment algorithm of comminuted mandibular fractures based on analysis of 75 consecutive cases. METHODS: Seventy-five patients with comminuted mandibular fractures were retrospectively reviewed in this study. The classification was based on whether a stable occlusal relationship could be regained, morphology of mandible after trauma, degree of comminution and whether segmental mandibular bone defect happened. Based on traumatic condition, five classes were categorized and conservative treatment, miniplates fixation, reconstruction plates fixation, staged operations fixation with titanium meshes and bone flap transplantation were used for the management of the fracture. Forty-four patients in the experimental group were treated according to the classification while other thirty-one in the control group were not. RESULTS: After surgery, three patients developed infection, one patient presented malocclusion in the experimental group. Four patients developed infection, two patients had bone un-union, two patients presented malocclusion and one patient had mandibular asymmetry in the control group. CONCLUSIONS: The treatment-oriented classification and algorithm for comminuted mandibular fractures provide guidance for the choice of treatment methods and can decrease complication rate but further clinical research is needed. References | Related Articles | Metrics

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Application of keystone flap in the reconstruction of maxillofacial soft tissue defect：report of 8 consecutive cases WANG Yi, CHEN Chuan-jun, XIANG Xian-wang 2021, 19 (5):  460-463.  doi: 10.19438/j.cjoms.2021.05.014 Abstract ( 384 )   PDF (3186KB) ( 264 )   PURPOSE: To evaluate the effect of keystone flap in reconstruction of maxillofacial soft tissue defects. METHODS: From January 2019 to June 2020, 8 patients with maxillofacial defects after tumor resection were selected, and keystone flap was designed to reconstruct maxillofacial soft tissue defects. The wound areas ranged from 4 cm×3 cm~15 cm×8 cm; the position and shape of the keystone flap were designed flexibly according to the different defect sites during operation, and the long axis of the keystone flap was consistent with that of the adjacent well-known arteries as far as possible. The central 1/3 of the flap was connected to the base of soft tissue, and the remaining portion of the flap could be properly separated from the base of soft tissue, so that the flap could obtain greater freeness and rotation. RESULTS: All flaps survived and healed primarily in this group.The color and shape of the skin flap recovered well during follow-up from 1 to 6 months. No infection, necrosis and obvious scar contracture were observed, which was acceptable to all patients. No significant impairment of facial function was observed. CONCLUSIONS: Keystone flap rich blood supply, decreased morbidity and effective outcomes, simple to be designed and can satisfy the reconstruction of various minor and medium soft tissue defects in maxillofacial area, which is worthy of clinical application. References | Related Articles | Metrics

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A clinical analysis of 279 patients with submucous cleft palate DU Chang-jiang, ZHOU Xia, MA Lian 2021, 19 (5):  464-468.  doi: 10.19438/j.cjoms.2021.05.015 Abstract ( 681 )   PDF (3626KB) ( 225 )   PURPOSE: To analyze the data collected from medical records for 279 submucous cleft palate patients which included age of operation, reasons for admitting into hospital and accompanied diseases. METHODS: A retrospective study was conducted on 279 patients receiving treatment for submucous cleft palate from 2013.01.01 to 2020.12.31 in Peking University Hospital of Stomatology. The following items from medical records were collected: age of operation, reasons for admitting into hospital and the types of accompanied diseases (cleft lip, well-known syndromes, chromosomal diseases, hearing impairment and intelligence retardation). The reasons for admitting into the hospital were divided into three types: speech problem, morphological abnormality on hard and/or soft palate, and others. RESULTS: The average age of operation on submucous cleft palate patients in this cohort was 5 years and 5 months and the median age was 4 years and 2 months old. Age range was from 6 months to 35 years and 2 months. Cleft lip occurred in 34(12.2%) patients, and 15 (5.4%) patients suffered from well-known syndromes. Regarding to the reasons for admitting into hospital, 194(69.5%) patients were due to unclear speech. Morphological abnormality of hard and/or soft palate occurred in 52(18.6%) and 33 (11.9%) patients were due to other reasons for medical treatment. CONCLUSIONS: The operation age of patients with submucous cleft palate was significantly later than cleft palate patients. Patients with cleft lip accounted for more than half of patients with accompanied diseases. More than half of patients with submucous cleft palate admitted into hospital were due to speech problems. References | Related Articles | Metrics

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Application of virtual surgical planning in transoral mandibulectomy and accurate mandible reconstruction: report of 9 consecutive cases YANG Xin, LYU Ming-ming, LI Jun, SUN Jian 2021, 19 (5):  469-473.  doi: 10.19438/j.cjoms.2021.05.016 Abstract ( 325 )   PDF (4007KB) ( 283 )   PURPOSE: This study was aimed to introduce the experience of mandibulectomy and vascularized bone reconstruction via intraoral approach assisted by virtual surgical plan and evaluate the effect of postoperative reconstruction. METHODS: Nine patients with benign tumor in the mandible underwent preoperative virtual surgical planning, then screw-predesignated osteotomy guide plate suitable for intraoral operation was designed and manufactured. Mandibulectomy was performed with cutting guide plate, prebent titanium plate and vascularized bone flap were implanted and fixed via intraoral approach. Intraoperative real-time navigation was used to confirm and correct the spatial location of the neo-mandible. The postoperative appearance and function of the patients were evaluated by clinical and imaging examination, and the accuracy of mandibular reconstruction was evaluated by superimposing postoperative CT on preoperative STL model after six months. SPSS 15.0 software package was used for statistical analysis. RESULTS: Aided with the virtual surgical plan, all patients in this series successfully underwent mandibulectomy and reconstruction with vascularized bone flap via intraoral approach. Intraoperative navigation confirmed the correct location of the reconstructed mandible. All patients showed facial symmetry, no facial paralysis and mouth opening limitation at 6-month postoperative visit were noted. All patients were satisfied with the results of the operation. Image fitting showed that the osteotomy line position was accurate with an error of less than 1 mm [(0.72±0.15)mm], and the reconstructed position of the mandible was highly consistent with preoperative design with an error of (1.76±1.99)mm. CONCLUSIONS: Under the guide of virtual surgical planning, intraoral mandibulectomy and vascularized bone reconstruction could be successfully performed by using screw-predesignated guide plate and prebent titanium plate, avoiding extraoral incision and significantly improving the accuracy of mandibular reconstruction. References | Related Articles | Metrics

Review Articles

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Progress of multidisciplinary team practice in management of oral squamous cell carcinoma YANG Yue-yi, ZHANG Yi-yi, LI Yi-xin, JU Wu-tong, ZHONG Lai-ping 2021, 19 (5):  474-477.  doi: 10.19438/j.cjoms.2021.05.017 Abstract ( 395 )   PDF (3264KB) ( 463 )   Oral squamous cell carcinoma (OSCC) is one of the most common malignancies in the head and neck region. Although the diagnosis and treatment of OSCC have achieved significant improvement, the overall survival has shown little improvement in recent years. Clinical trials are encouraged to promote the diagnosis and treatment as well as update and optimize the clinical guidelines. Multidisciplinary team(MDT) is a model which has demonstrated its superiority in the treatment for intractable OSCC cases, gradually gaining wide adoption and promotion. This paper discussed the role of clinical research MDT in OSCC management. References | Related Articles | Metrics

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Fibromyxoid spindle cell tumor in the pterygopalatine fossa： a case report SHI Fan, XUE Ran, ZHOU Xue-xiao, SHEN Pei, XU Ting, WANG Sheng-zhi 2021, 19 (5):  478-480.  doi: 10.19438/j.cjoms.2021.05.018 Abstract ( 553 )   PDF (2893KB) ( 184 )   To report a rare case of fibromyxoid spindle cell tumor which occurred in the pterygopalatine fossa and discuss its imaging features, pathological diagnosis and treatment. A 58 years old female, CT showed nodular low-density mass in the right pterygopalatine fossa, enhanced CT showed mildly enhanced, with unclear boundaries, adjacent inferior wall of the right maxillary sinus was destructed, patchy enhanced shadow was seen in the posterior margin of the adjacent right maxilla and the right lateral muscle was oppressed. Spindle cell tumor of the right pterygopalatine fossa was confirmed under light microscopy. Morphological features were consistent with proliferative fibromas of bone connective tissue and mucous degeneration around the tumor. Immunohistochemistry showed that CK(-), S-100(-), AE1/AE3(-), SMA(-), CD34(-), Des(-), MUC-4(-), p63(-), STAT-6(-),β-catering (nuclear -), Dog1(-), the positive rate of Ki-67 was 2%. References | Related Articles | Metrics