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20 July 2024, Volume 22 Issue 4 Previous Issue    Next Issue

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Expert Consensus

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Chinese expert consensus on diagnosis and treatment of localized intravascular coagulopathy TAI Mao-zhong, QIN Zhong-ping, ZHENG Jia-wei, LI Ke-lei, LIU Xue-jian, LI Kai, YUAN Si-ming, FAN Xin-dong, ZHOU De-kai, DONG Chang-xian, JI Yi, GU Song, HUO Ran, YANG Yao-wu, WANG Xu-kai 2024, 22 (4):  313-321.  doi: 10.19438/j.cjoms.2024.04.001 Abstract ( 120 )   PDF (1160KB) ( 80 )   Localized intravascular coagulopathy(LIC) refers to coagulation disorders such as thrombosis and bleeding that occurred in venous malformations(VMs). It is characterized by abnormally elevated D-dimer(DD) levels, with or without decreased fibrinogen(FIB), and generally without thrombocytopenia. LIC can be complicated with acute pain, excessive bleeding, arthrogryposis, etc. Controversies in its diagnosis and treatment still existed. In order to improve the diagnosis and standardize treatment of LIC in China, we invited relevant experts to discuss and formulate Chinese expert consensus. The consensus provides standardized suggestions on the pathogenesis, clinical manifestations, diagnostic methods and treatment process of LIC, which can provide reference for clinical practice. References | Related Articles | Metrics

Original Articles

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Evaluation of neurogenic bone regeneration of thermosensitive bFGF/Dex liposome hydrogel composite scaffold CHU Chen, ZONG Qian, XUN Xing-xiang, ZHAO Qian, YUAN Rong-tao, XU Xiao 2024, 22 (4):  322-328.  doi: 10.19438/j.cjoms.2024.04.002 Abstract ( 87 )   PDF (2212KB) ( 46 )   PURPOSE: Liposomes were used to simultaneously encapsulate basic fibroblast growth factor (bFGF) that can promote nerve differentiation and osteogenic small molecule (Dex). Then, a temperature sensitive and injectable bFGF/Dex liposome-hydrogel composite sustained-release scaffold was constructed by mixing it with sodium alginate solution. METHODS: bFGF/Dex liposomes were prepared by film dispersion method, mixed with sodium alginate solution activated by RGD polypeptide, and thermosensitive bFGF/Dex liposome hydrogel composite scaffolds were synthesized by free radical polymerization. The particle size, polydispersity, and Zeta potential of liposomes were detected by Zeta particle size analyzer. Microstructure of the scaffold was observed under scanning electron microscopy, and mechanical strength of the scaffold was measured using a universal material testing machine. Real time fluorescence quantitative PCR (RT-PCR) and immunofluorescence staining were used to detect the expression of bFGF promoting neural differentiation related genes and proteins in hBMSCs. Rabbit skull defect models were constructed and the effect of the composite scaffold on promoting neurogenic bone regeneration in vivo was evaluated through micro-CT and immunohistochemical staining. SPSS 26.0 software package was used for statistical analysis. RESULTS: Thermosensitive bFGF/Dex liposome hydrogel composite scaffold was successfully constructed. It was in a solution state and had fluidity at normal temperature(25℃), and quickly changed to a gel state when higher than the critical temperature(32 ℃). The surface of scaffold was loose and porous, which could bear certain stress. The expression of genes and proteins related to neurogenesis suggested that bFGF had a strong promoting effect on neurogenesis in hBMSCs. The results of animal experiments showed that the composite had a good neurogenic bone regeneration effect. CONCLUSIONS: The intelligent bFGF /Dex liposome hydrogel composite scaffold with temperature sensitivity and outstanding biological function provides a new material for repair of jaw defects. References | Related Articles | Metrics

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Comprehensive bioinformatics analysis combined with experimental validation to screen biomarkers for head and neck squamous cell carcinoma ZHAO Hui, SHU Xin, ZHANG Fan, REN Wei-wei, LIU Jiao, ZHU Zhu 2024, 22 (4):  329-338.  doi: 10.19438/j.cjoms.2024.04.003 Abstract ( 101 )   PDF (3187KB) ( 23 )   PURPOSE: This study was aimed to identify potential molecular biomarkers in head and neck squamous cell carcinoma (HNSCC) and to determine their functional and clinical significance. METHODS: The GSE58911 dataset was downloaded from Gene Expression Omnibus (GEO) database to screen differentially expressed genes (DEGs) in normal and HNSCC samples. GeneCards and Comparative Toxicogenomics Database(CTD) were used to further determine potential biomarkers of HNSCC. A series of bioinformatic analyses were performed for potential biomarkers of HNSCC. The Cancer Genome Atlas(TCGA) database was then used as an external validation and the infiltration of immune cells was assessed using ssGSEA. Finally, the accuracy of the database analysis results was verified by cell CCK-8, flat panel cloning and RT-PCR experiments. RESULTS: In total, 605 DEGs were screened out of the GSE58911 microarray dataset. Out of these DEGs, SERPINE1, PLAU, PLAUR, and SERPINB2 were developed and validated as hub genes for HNSCC. Compared with normal controls, SERPINE1, PLAU, and PLAUR expression levels were significantly up-regulated, while SERPINB2 expression level was significantly down-regulated in HNSCC. Moreover, the relationship between hub genes and immune cell infiltration may improve the understanding of HNSCC immunotherapy. In addition, RT-PCR results were consistent with the results of the four hub genes in the dataset. In vitro results also showed that SERPINE1 could promote the progression of HNSCC. CONCLUSIONS: SERPINE1, PLAU, PLAUR and SERPINB2 can be used as potential biomarkers for the diagnosis of HNSCC, but further in vitro and in vivo studies are needed to clarify their roles and specific mechanisms in HNSCC. References | Related Articles | Metrics

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Artificial intelligence oral surgeon analyzing the source of resistance of mandibular third molars based on CBCT images HE Yu-long, BAO Chong-yun 2024, 22 (4):  339-345.  doi: 10.19438/j.cjoms.2024.04.004 Abstract ( 123 )   PDF (2079KB) ( 65 )   PURPOSE: To deeply integrate alveolar surgery with artificial intelligence and change the existing diagnosis and treatment mode to guide clinical work better, especially to provide help for primary oral surgeons. METHODS: CBCT data of 214 patients with impacted mandibular third molar admitted to West China Stomatology Hospital of Sichuan University from September 2022 to December 2022 were randomly selected and divided into training dataset and test dataset. According to the clinical experience of human experts, six-type classification of resistance sources were proposed, and patients’ CBCT data were artificially classified. Then, the classification features were deeply learned and tested through the artificial intelligence oral surgeon(AIOS) model. Finally, the confusion matrix graph and Accuracy-Loss-Epoch curve were used to analyze the learning process and results. RESULTS: All model training datasets achieved 99.07%-100% accuracy. In the test dataset, the accuracy of all models reach more than 80%, and some models can reach 100% accuracy. CONCLUSIONS: AIOS has shown promising prospects for predicting the source of resistance of impacted mandibular third molar on CBCT images and assisting clinical oral surgeons in oral image analysis, laying a good foundation for the development of a full set of AIOS with resistance analysis, protocol formulation, and simulated surgery that can be applied in the clinic of oral surgery in the future. References | Related Articles | Metrics

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Construction and preliminary verification of the assessment scale of nurses' oral and maxillofacial trauma emergency response capacity LIU Min, ZHANG Yong-mei, YUAN Wei-jun, HOU Li-li 2024, 22 (4):  346-352.  doi: 10.19438/j.cjoms.2024.04.005 Abstract ( 83 )   PDF (907KB) ( 35 )   PURPOSE: To construct the assessment scale of nurses' oral and maxillofacial trauma emergency response capacity and test its reliability and validity, providing a reliable and practical assessment tool for clinical oral and maxillofacial trauma training. METHODS: The assessment scale of nurses' oral and maxillofacial trauma emergency response capacity was designed based on literature review,expert consultation and Delphi method. Using the convenience sampling method, 328 nurses from Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine were selected in June 2022 for screening items and testing the reliability and validity of the constructed scale. SPSS 24.0 software package was used for data analysis. RESULTS: There were 2 rounds of Delphi expert consultations, including 6 experts, and the effective response rate of the questionnaire was 100%,with the Kendall harmony coefficients of 0.398 and 0.427（P<0.001）,and the authority coefficients of 0.967. The final assessment scale of nurses' oral and maxillofacial trauma emergency response capacity included 8 first-level indicators and 54 second-level indicators. The Cronbach's ɑ coefficient was 0.988, test-retest reliability was 0.817, I-CVI was 0.833 to 1.000, and S-CVI/Ave was 0.944. CONCLUSIONS: The assessment scale of nurses' oral and maxillofacial trauma emergency response capacity has good reliability and validity, which provides a scientific and practical evaluation tool for the development and verification of oral and maxillofacial trauma training system for clinical nurses. References | Related Articles | Metrics

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Analysis of the characteristics of standard alloplastic temporomandibular joint prostheses during mouth opening movement LI Xiang, DING Ruo-yi, WANG Xiu-mei, HE Dong-mei, WANG Dong-mei 2024, 22 (4):  353-359.  doi: 10.19438/j.cjoms.2024.04.006 Abstract ( 87 )   PDF (1291KB) ( 41 )   PURPOSE: To analyze the characteristics of alloplastic temporomandibular joint replacement (ATJR) in mouth opening movement. METHODS: Jaw movement and maxillofacial CT data were collected from 10 normal temporomandibular joint volunteers and 10 patients who underwent unilateral Biomet standard joint replacement surgery. Three-dimensional reconstruction of the jawbone was performed using Proplan CMF 3.0 software, and the jawbone model was exported. The jaw movement data were combined with the jawbone model using Geomagic Wrap 2021 software, and a kinematic model was established using Anybody 7.0 software. Points were taken every 5 mm downward from the condyle/prosthesis apex(P0-P-50) to calculate the trajectory and arc length of each point during mouth opening. The artificial joint prosthesis was simulated to be installed on the non-replaced condyle of normal individuals and patients, and the differences in the range of motion between the prosthesis vertices during mouth opening were compared. SPSS 25.0 software package was used for data analysis. RESULTS: The movement trajectory of the condylar apex in normal individuals was a concave arc upwards, with an arc length of (15.18±2.31) mm, and the shortest movement trajectory was at P-30. The movement trajectory of the alloplastic temporomandibular joint prosthesis(ATJP) apex was a convex short arc upwards, with a significantly shortened arc length compared to the corresponding point of the normal condyle(P-10) [(3.55±0.45) mm vs (11.61±1.63) mm, P=0.00], and the shortest movement trajectory was at P-20. The movement trajectory of the non-replaced condyle apex of the ATJP was similar in shape to that of the normal condyle, with an arc length of (13.35±1.54) mm and no significant difference (P=0.07), and the shortest movement trajectory was at P-40. The range of motion of the ATJP apex was significantly smaller than that of the corresponding point on the non-replaced condyle and the normal condyle corresponding point P-10(P=0.00). CONCLUSIONS: The sliding distance and range of the condylar prosthesis after standard temporomandibular joint replacement surgery are significantly smaller than the movement distance and range of the corresponding points on the normal and non-replaced condyles. References | Related Articles | Metrics

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Head and neck cancer therapy-induced lymphedema: clinical factors and prognostic analysis GUO Yi-bo, LI Chen-yao, FAN Qi, JI Tong, REN Zhen-hu 2024, 22 (4):  360-364.  doi: 10.19438/j.cjoms.2024.04.007 Abstract ( 94 )   PDF (1021KB) ( 32 )   PURPOSE: To analyze the correlation between the severity of lymphedema in patients with head and neck malignancies and relevant clinical data related to the tumors. METHODS: In this paper, a retrospective study was conducted on 79 patients with head and neck cancer who received multimodality treatment. The diagnosis and grading were conducted by MRI results of patients more than 6 months after surgery, and the electronic records and telephone follow-up data were utilized. SPSS 26.0 software package was used for data analysis. RESULTS: As TNM stage increased and the extent of cervical lymph node dissection expanded, the incidence rate of severe lymphedema in patients also rose. Compared to patients who did not receive chemotherapy before surgery, those who underwent preoperative drug-induced chemotherapy had a higher prevalence of severe lymphedema. However, there was no significant difference in the disease-free survival period among patients with varying degrees of severity of lymphedema. CONCLUSIONS: Head and neck lymphedema correlates with tumor stage, extent of lymphatic clearance, and comprehensive treatment modalities. However, further research and attention are still needed. References | Related Articles | Metrics

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Natural course following extraction of impacted mandibular third molars and their effect on mandibular second molars YANG Qing-ran, XU Guang-zhou 2024, 22 (4):  365-372.  doi: 10.19438/j.cjoms.2024.04.008 Abstract ( 126 )   PDF (833KB) ( 81 )   PURPOSE: To observe the natural course after extraction of impacted mandibular third molars(IM3Ms) and their influence on adjacent mandibular second molars (M2Ms). METHODS: Thirty-four patients (51 IM3Ms) with bone impaction of mandibular third molars were selected. The affected teeth were extracted by piezosurgery and pneumatic turbine handpiece. The postoperative reaction and distal bone defect of M2Ms were observed before operation, 1 week and 6 months after operation. The depth of distal bone defect at M2Ms before and after operation was compared, and the influencing factors were analyzed. SPSS 29.0 software package was used for data analysis. RESULTS: Before surgery, no apparent bone defects were observed in the distal mesial bone of M2Ms, but bone defects occurred during IM3Ms extraction due to bone removal and tooth extraction procedures. After 6 months, although some recovery in bone height was observed and the rate of bone defects decreased, it did not reach the preoperative level. The depth of IM3Ms impaction was the main influencing factor for the recovery rate. Probing depth significantly increased compared to preoperative levels. Patients experienced more pain within 24 hours postoperatively, which eased after 1 week, although mild limitation of mouth opening and facial swelling persisted. The extraction of IM3Ms had minimal impact on patients' daily life, emotions, work, and sleep. CONCLUSIONS: After the mandibular third molar extraction, the distal bone height adjacent to the second molar will partially recover, but it doesn't reach the preoperative level. In order to reduce the impact on adjacent teeth and bone tissue, surgeons need to adopt more refined surgical techniques during tooth extraction. At the same time, analgesic drugs should be given after removal of IM3Ms, and health education should be strengthened to improve the comfort of patients. References | Related Articles | Metrics

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The predictive value of modified frailty assessment tool for postoperative complications in elderly patients undergoing flap reconstruction with oral squamous cell carcinoma HUANG Can, LUO Tao, SUN Yu 2024, 22 (4):  373-377.  doi: 10.19438/j.cjoms.2024.04.009 Abstract ( 67 )   PDF (559KB) ( 21 )   PURPOSE: To explore the predictive value of modified frailty assessment for postoperative complications in elderly patients undergoing flap reconstruction with oral squamous cell carcinoma. METHODS: Retrospective analysis was performed on elderly patients(>60 years old) who underwent oral squamous cell carcinoma resection with free-flap reconstruction at Shanghai Ninth People's Hospital ,Shanghai Jiao Tong University School of Medicine from January 2014 to December 2022. The patients' perioperative data were collected. According to the 5 modified frailty index(5-mFI), the individuals were grouped into frail (≥2 points) and non-frail(<2 points) group. The occurrence rate of short-term postoperative complication was calculated to determine the association between frailty and complications. Logistic regression analysis was applied to identify which postoperative complications were related to frailty with R 4.0.5 software package. RESULTS: A total of 1 083 patients were included. The rate of postoperative complications was 34.7%（376 cases）. Among the patients, 235 cases (21.7%) were classified as the frail group, while 848 cases (78.3%) were classified as the non-frail group. The frail group had a higher incidence of postoperative complications, longer stays in intensive-care unit and postoperative hospital, compared to the non-frail group, with significant difference(P<0.05). After adjusting for confounding factors including gender, age, smoking, and alcohol consumption, multiple logistic regression analysis revealed that pulmonary complications(OR=4.76, 95%CI: 3.32-6.83, P<0.001), flap complications (OR=2.65, 95%CI: 1.57-4.42, P<0.001), and acute kidney injury(OR=3.31, 95%CI: 1.13-9.66, P<0.05) were strongly correlated with frailty. CONCLUSIONS: The 5-mFI score is significantly correlated with postoperative complications in elderly patients undergoing flap reconstruction surgery for oral squamous cell carcinoma, which provides a convenient and concise assessment tool for clinical work. References | Related Articles | Metrics

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Application of personalized gingival molding device in maxillary single anterior tooth implantation in patients with different gingival biotypes and keratinized gingival widths QIU Shi, LUO Chang, CAI An-qing, WANG Xiao-fei, ZHU Ting 2024, 22 (4):  378-384.  doi: 10.19438/j.cjoms.2024.04.010 Abstract ( 75 )   PDF (893KB) ( 22 )   PURPOSE: To investigate the effects of personalized gingival formers on bone and soft tissue health and gingival papillae aesthetics around maxillary single anterior dental implants in different gingival biotypes and keratinized gingival widths. METHODS: A total of 85 patients who underwent maxillary single anterior tooth implant restoration in Shaoxing Stomatological Hospital from January 2022 to May 2023 were selected and divided into 4 groups according to keratinized gingival width and gingival biotype: insufficient keratinized gingival width and thick gingival type (keratinized gingival width <2 cm, n=17), insufficient keratinized gingival width and thin gingival type(n=13), sufficient keratinized gingival width and thick gingival type(keratinized gingival width ≥2 cm, n=26), sufficient keratinized gingival width and thin gingival type(n=29). All patients received personalized gingival implants. The effects of different keratinized gingival width and gingival biotype on bone tissue, soft tissue aesthetic effect, gingival papilla aesthetic effect, soft tissue healing degree and satisfaction of aesthetic effect were compared. SPSS 23.0 software package was used for data analysis. RESULTS: On the day after surgery, at the completion of permanent repair, and 6 months after the completion of permanent repair, the bone resorption in patients with keratinized gingiva width <2 mm was significantly higher than patients with keratinized gingival width ≥2 mm under the same gingival biological types(P<0.05). There was no significant difference in bone resorption between patients with thick gingival width and patients with thin gingival width under the same keratinized gingival width (P>0.05). At the completion of permanent repair and 6 months after the completion of permanent repair, the pink esthetic scores(PES), gingival papilae filling index (PFI) score and visual simulation score (VAS) of esthetics from patients with keratinized gingival width ≥2 mm were significantly higher than patients with keratinized gingival width <2 mm(P<0.05) under the same gingival biological types. The scores of PES, PFI and VAS in patients with thick gingival type were significantly higher than those in patients with thin gingival type(P<0.05). At 3 and 7 days after surgery, the mucosal swelling score of patients with keratinized gingival width ≥2 mm was significantly lower than that of patients with keratinized gingival width < 2 mm under the same gingival biological types(P<0.05). When the keratinized gingival width ≥2 mm, the mucosal swelling score of patients with thick gingival type was significantly lower than that of patients with thin gingival type 7 days after surgery(P<0.05). CONCLUSIONS: The bone health around the implant is closely related to the keratinized gingival width, and the gingival biotype has little effect on bone resorption around the implant. Patients with full keratinized gingival width and thick gingival type had better satisfaction with soft tissue health, gingival papillae aesthetics, soft tissue healing degree and final aesthetics. References | Related Articles | Metrics

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Measurements of morphological characteristics of incisal canals in 65 middle-aged and elderly patients by CBCT WANG Jing-fu, ZHANG Ning, YANG Yong, ZHANG Wei-han, CHANG Xin 2024, 22 (4):  385-389.  doi: 10.19438/j.cjoms.2024.04.011 Abstract ( 93 )   PDF (715KB) ( 43 )   PURPOSE: To measure the morphological parameters of the incisive canals in the middle-aged and elderly population using CBCT, to analyze the age-related changes in the position and morphology of the incisive canals, and to investigate the relative position between the incisive canals and the surrounding anatomical structures, in order to provide reference for the design of aesthetic anterior dental implant restorations in this population. METHODS: CBCT data from 69 patients over 50 years of age were measured in the sagittal and coronal planes for the incisal foramen(WIF) along the long axis of the incisal canal, the width of the incisal canal from the median (Wm) to the Stetson's foramen (WSF), the diameter of the incisal canal along the long axis of the incisal canal(DIF), the diameter of the incisal canal from the median (Dm) to the Stetson's foramen(DSF), and the distance from the most concave part of the bone on the labial side to the anterior wall of the incisal canal (A), and the distance from the top of the alveolar ridge to A (B) were measured, respectively. The patients were grouped according to gender and whether or not they were missing upper anterior teeth, and the data were analyzed using SPSS 19.0 software package. RESULTS: The mean width of the incisal canal(W) was (3.93±0.83) mm, the mean diameter(D) was (3.03±0.83) mm, the mean distance from the most concave part of the bone on the labial side to the anterior wall of the incisal canal was (6.15±1.53) mm, and the mean distance from the top of the alveolar ridge to A was (11.98±2.50) mm. DIF in male group [(3.61 ± 0.79) mm] was higher than that in female group[(3.14±0.94) mm], DSF in male group [(2.96±1.22) mm] was higher than that in female group[(2.31±0.92) mm], A value in male group [(6.76±1.43) mm] was higher than that in female group [(5.48±1.36) mm], A value in the edentulous group [(5.73±1.55) mm] was lower than that in the edentulous group [(6.41±1.48)mm], B value in the edentulous group[(10.73±2.64)mm] was lower than that in the edentulous group [(12.78±2.06)mm]. All the differences were statistically significant(P<0.05). CONCLUSIONS: Gender has an influence on the diameter of the incisal canal, the thickness of the alveolar crest bone. The height of the alveolar crest was related to with or without missing upper anterior teeth; and in middle-aged and elderly patients with missing anterior teeth, a more precise control of the implant direction at depth is needed. References | Related Articles | Metrics

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Evaluation of the application of minimally invasive dental implants in patients with missing free ends of dentition YANG Wei-hua, JIANG Sheng-bo, ZHOU Ying-ying 2024, 22 (4):  390-393.  doi: 10.19438/j.cjoms.2024.04.012 Abstract ( 79 )   PDF (490KB) ( 33 )   PURPOSE: To investigate the effect of minimally invasive dental implants in patients with missing free end of dentition. METHODS: Eighty patients with free end loss of dentition who were treated in Jiashan Hospital of Traditional Chinese Medicine from January 2021 to April 2022 were selected, including 42 patients who received minimally invasive dental implant treatment (experimental group) and 38 patients who received conventional dental implant treatment (control group).The differences of operation time, postoperative pain, wound healing time, masticatory function, implant stability and alveolar crest bone resorption were compared between the two groups. SPSS 22.0 software package was used for data analysis. RESULTS: The operative time, wound healing time, postoperative red and swollen time and postoperative pain VAS scores of the experimental group were (24.12± 3.06) min, (3.50± 0.61) d, (1.22± 0.32) d and (2.50± 0.46) points, respectively, which were significantly lower than those of the control group (P< 0.05). The periodontal biting force and masticatory efficiency of the experimental group were (129.87± 20.05) Ibs and (89.96± 9.11) %, respectively, which were significantly higher than those of control group (P< 0.05). Implant stability coefficient (ISQ) of the experimental group was 70.05± 4.15, which was significantly higher than that of the control group (63.35± 5.21) (P< 0.05). Alveolar crest bone resorption of the experimental group was (0.56± 0.14) mm, significantly lower than that of the control group (0.63± 0.12) mm (P< 0.05). CONCLUSIONS: Minimally invasive dental implantation has a good effect in the treatment of missing free end of dentition, which can significantly improve the patient's occlusal efficiency with good implant stability. References | Related Articles | Metrics

Review Articles

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Research progress of application of highly active bone substitute in materialsmaxillofacial bone tissue engineering YUAN Lu-han, CHU Chen, YUAN Rong-tao 2024, 22 (4):  394-399.  doi: 10.19438/j.cjoms.2024.04.013 Abstract ( 97 )   PDF (847KB) ( 34 )   Jaw defect is one of the most common diseases in oral and maxillofacial surgery. Severe jaw defect will cause different degrees of impact on the life and psychology of patients, and needs timely and effective repair. Due to the unique physiologic appearance and individual differences of jaw bones, the repair of jaw defects can't be completely dependent on standardized bone prosthetics. With the development and maturity of related manufacturing technologies, especially the unique advantages of 3D printing technology in bone defect repair, it has attracted wide attention of scholars both at home and abroad. The repair of bone defects is a complex and precise process. The ideal biomaterials for repairing bone defects should have good histocompatibility, suitable mechanical stress, suitable pore size, and solubility. This article briefly reviewed the existing high-active bone replacement materials for jaw tissue engineering. References | Related Articles | Metrics

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Research progress on the application of regional nerve block technique in oral cancer defects repaired with free flaps reconstruction GAO Peng-fei, LIN Jie 2024, 22 (4):  400-403.  doi: 10.19438/j.cjoms.2024.04.014 Abstract ( 79 )   PDF (482KB) ( 50 )   Due to large trauma after oral cancer resection repaired with free flaps reconstruction, patients often experience severe pain after surgery. Opioids are the most powerful analgesics used for postoperative pain alleviation, but they also have adverse effects such as respiratory depression, postoperative nausea and vomiting. In addition, factors including the relatively extensive surgical resection, expected postoperative edema, and accumulation of secretions may contribute to increased airway complications in these patients. On the other hand, vomiting can lead to postoperative bleeding and wound infection. Thus, there is a necessity to find an analgesic strategy with high safety, good analgesic effect and few side effects. To address this dilemma, ultrasound-guided regional nerve block technology, as a part of multimodal analgesia, has been developed in recent years, which can significantly reduce opioids requirement and their side effects. This paper described the anatomy of commonly used free flaps, the researches and operational procedures of ultrasound-guided nerve block, in order to provide reference for the application of this technology in oral cancer resection with free flaps reconstruction. References | Related Articles | Metrics

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Diagnosis and treatment of head and neck sarcoma GUO Yi-fei, ZHANG Yong-hong, REN Zhen-hu 2024, 22 (4):  404-408.  doi: 10.19438/j.cjoms.2024.04.015 Abstract ( 78 )   PDF (595KB) ( 33 )   Sarcoma is a low-occurrence malignant tumor,head and neck sarcoma has a lower incidence rate. Due to the low probability of sarcoma and the lack of obvious early clinical symptoms, it is difficult to diagnose before treatment. Diagnosis needs to integrate clinical symptoms and imaging, pathological findings, and tumor markers, etc. At present, the key technical point for treatment of sarcoma is still wide margin surgery. Chemotherapy, radiotherapy, targeted and immunotherapy can enhance the treatment effect or improve the prognosis. Advances in research on new biomarkers and photodynamic therapy can provide more ways for the diagnosis and treatment of sarcomas in the future. The purpose of this article is to briefly describe the current mainstream diagnosis and treatment methods for head and neck sarcomas and prospects for future diagnosis and treatment. References | Related Articles | Metrics

Case Reports

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Case report of chondromyxofibroma involving the overall structure of the temporomandibular joint: surgical resection and reconstruction LI Chen-xi, FANG Chang, GONG Zhong-cheng, SHAO Bo 2024, 22 (4):  409-412.  doi: 10.19438/j.cjoms.2024.04.016 Abstract ( 90 )   PDF (1137KB) ( 31 )   Chondromyxoid fibroma (CMF) is an exceedingly rare benign bone tumor, to the authors' knowledge, only one case primarily occurred in temporomandibular joint(TMJ) has been reported in the literature. This paper presented a patient with TMJ-CMF involving pterygopalatine space, and the skull base thereof. Digital technique was used to determine the boundary of the lesion and reconstruct the normal glenoid fossa, the temporalis myofascial flap was transplanted between titanium mesh and condyle so as to reconstruct the disk after complete resection of the tumor. The patient's facial profile is symmetrical, with a mouth opening of 45 mm. There was no local recurrence, no complications such as cerebrospinal fluid fistula and cerebral hernia during 1-year follow-up period. References | Related Articles | Metrics

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Inflammatory myofibroblastic tumor of parotid gland: a case report and literature review XU Chen, MA Li-juan, SHI Yao, WEN Yu-zhen, SONG Yong-hai, CHE Zong-gang 2024, 22 (4):  413-416.  doi: 10.19438/j.cjoms.2024.04.017 Abstract ( 77 )   PDF (1467KB) ( 46 )   Inflammatory myofibroblastic tumor(IMT) is a rare mesenchymal tumor composed of a large number of spindle cells with infiltration of inflammatory cells such as lymphocytes and plasma cells. This paper reported a case of IMT in parotid region, and reviewed the etiology, clinical features, diagnosis, treatment and prognosis of IMT in combination with relevant literature, so as to improve the clinician's understanding of IMT in parotid region. References | Related Articles | Metrics