复旦大学附属口腔医院

Objective To explore the clinical and pathological characteristics, diagnosis, and differential diagnosis of oral verruciform xanthoma, and to provide a reference for accurate clinical identification and treatment. Methods Two cases of verruciform xanthoma occurring on the gingiva and vestibular mucosa are reported. The clinical features and pathological characteristics of both cases are described in detail, and information from a literature review on verruciform xanthoma is provided. Results Case 1: a 37-year-old female patient presented with a pink, rough lesion on the gingiva of the right mandibular posterior teeth for one month. The lesion measured approximately 14 mm × 7 mm, and it was firm and painless. After periodontal therapy, the lesion was excised under local anesthesia. Postoperative pathological examination showed that the epithelial nail protruded and was elongated, and a large number of foam cells filled the connective tissue papilla, leading to the diagnosis of verrucous xanthoma. Case 2: a 36-year-old male patient presented with a pale pink lesion on the right lower vestibular mucosa for three months. The lesion measured approximately 18 mm × 10 mm with irregular margins, and it was firm and painless. The lesion was excised under local anesthesia, and postoperative pathological examination showed parateratosis of epithelium, hypertrophy and elongation of the nail process, and more foam cells in the lamina propria papilla area. The diagnosis was xanthoma verrucosa. The results of a literature review show that the incidence of verruciform xanthoma is 0.025%-0.094%, it primarily occurs in patients aged 50-70 years, the incidence in males is slightly higher than that in females, and it primarily occurs in areas of the oral cavity that include the hard palate and gums. It is generally non-invasive. The etiology and pathogenesis remain unclear. Clinically, verruciform xanthoma lacks specific characteristics, so these lesions are frequently misdiagnosed as other conditions, such as papilloma, common warts, condyloma acuminatum, squamous cell carcinoma, or verrucous carcinoma. The key to diagnosis lies in histopathology, with the hallmark feature being the accumulation of foam cells in the connective tissue papilla beneath the epithelium. Conclusion Verruciform xanthoma is a rare oral mucosal lesion with non-specific clinical manifestations and a high rate of misdiagnosis. It must be differentiated from conditions that include squamous papilloma, common warts, condyloma acuminatum, squamous cell carcinoma, and verrucous carcinoma. Definitive diagnosis depends on histopathological examination, and the primary treatment is surgical excision, with a low recurrence rate and minimal risk of malignant transformation.

ObjectiveTo investigate the prevalence and associated factors of malocclusion among preschool children in Fengxian District, Shanghai, and to provide a scientific basis for local medical and public health departments to formulate targeted interventions.MethodsA cross-sectional study was conducted from September to December 2024. A total of 1 172 children aged 3‒5 years were recruited from 10 kindergartens across 5 townships in Fengxian District, using stratified cluster random sampling method. Clinical examinations were conducted to record occlusal parameters such as the relationship of the second deciduous molars, canine teeth relationship, anterior overbite and overjet, anterior and posterior crossbite, and crowded dentition. A questionnaire survey was performed to the parents to collect information on factors influencing malocclusion, including genetic predisposition, poor oral habits, dietary patterns, and sleep-related breathing conditions. Data were statistically analyzed using IBM SPSS Statistics 27 software, with chi-square test for categorical data and binary logistic regression analysis for influencing factors.ResultsThe overall prevalence of malocclusion among 3‒5-year-old children in Fengxian District of Shanghai was 70.73%, with no statistically significant differences between genders (P>0.05). Deep overbite accounted for the highest proportion (49.66%), followed by Angle Class Ⅱ malocclusion of the second deciduous molars (17.83% on the left, 19.11% on the right), midline deviation (13.23%), anterior crossbite (6.74%), and crowding of the maxillary and mandibular anterior teeth (16.38% for the maxillary dentition, 17.58% for the mandibular dentition). Multivariate analyses showed that habitual mouth breathing during the day (OR=0.509, P=0.009) and morning dry mouth upon waking (OR=1.455, P=0.023) were independent influencing factors for malocclusion.ConclusionThe prevalence of malocclusion is relatively high among preschool children in Fengxian District, Shanghai,with deep overbite being the dominant trait. Sleep-related breathing conditions (such as habitual mouth breathing during the day and morning dry mouth) is an important influencing factor for malocclusion. Public health authorities should strengthen oral health education and promote the correction of bad habits to reduce the prevalence of malocclusion and improve children’s oral health.

Mouth breathing in children not only affects the growth and development of teeth and maxillofacial, but also may seriously affect the physical and mental health of children with sleep disordered breathing. Mouth breathing can be divided into obstructive mouth breathing and habitual mouth breathing. Its occurrence and development may be related to various systemic diseases such as allergy, inflammation, immunity, genetics, etc. It also involves changes in the structure of the oral temporomandibular joint, perioral muscle group, dental arch morphology, and development of the upper and lower jaws. Therefore, the treatment of mouth breathing in children should be a multidisciplinary combined sequential treatment plan based on the causes associated with different organs or systems. From the perspective of orthodontists, this paper analyzes the diagnosis and treatment process of different types of mouth breathing, so as to provide reference for clinicians.

Objective:To construct a continuous nursing program for adolescent fixed orthodontic patients and to pro-vide guidance for the development of continuous nursing practice for adolescent fixed orthodontic patients.Methods:Based on the literature review and demand survey,two rounds of questionnaires were sent to 16 experts from the field of dental medicine and nursing using the Delphi method.Results:The expert active attitude coefficient of the two-round Delphi methods were 100%.The expert authority coefficient were above 0.8.The resulting continuous nursing program consists of five implementa-tion phases.Each phase contains four dimensions of implementation time,personnel,methods,and content.There were 18 im-plementation contents and a total of 60 details for implementation content.Conclusion:Based on the five treatment stages of fixed orthodontics,this study established a patient-centered,demand-oriented,comprehensive,refined,and actionable continu-ous care program,which established specific implementation time,implementation personnel,implementation methods and im-plementation contents,and was scientific and clinically practical.

Objective To study the effect of perioperative allogeneic blood transfusion on patients with oral squamous cell carcinoma (OSCC) after first-stage free flap transplantation. Methods A total of 306 OSCC patients who accepted primary repair and reconstruction using free flap admitted to our affiliation from January 2010 to January 2019 were selected as the research objects and retrospectively analyzed. According to their clinical data, they were divided into three groups: no transfusion group (n=98), 1-2 U transfusion group (n=131) and 3 + U transfusion group (n=77), respectively. The incidence of complications including flap infection, blood circulation disorder and hematoma in the three groups were compared. The five-year survival rate of the three groups was calculated by Kaplan-Meier analysis, and the relative risk of death was analyzed by Cox regression. Results There was no statistically significant difference among the three groups of patients (P>0.05) regarding such baseline data as embracing gender, age, primary location, degree of differentiation, adjuvant radiotherapy and chemotherapy. The complication rate of patients with 3 + U transfusion (25.97%) was significantly higher than that of no transfusion (6.12%) and 1-2 U transfusion (10.86%) (P<0.05); and the five-year survival rate of patients with 3 + U transfusion (51.95%) was significantly lower than that of no transfusion (69.38%) and 1-2 U transfusion (62.60%) (P<0.05). The results of univariate analysis showed that age, adjuvant radiotherapy, degree of tissue differentiation, collateral infiltration, vascular invasion and blood transfusion were all factors influencing the quality of prognosis after repair and reconstruction of first-stage free flap transplantation treating OSCC (P<0.05). The results of multivariate analysis showed that adjuvant chemoradiotherapy was an independent protective factor for the prognosis and survival quality of postoperative OSCC patients (P<0.01); the degree of differentiation, vascular invasion and blood transfusion were independent risk factors for the prognosis and survival quality of postoperative OSCC patients (P<0.05). Conclusion Perioperative allogeneic transfusion in OSCC patients can increase the risk of postoperative complications and directly affect their prognostic quality. It can be regarded as an important risk factor for OSCC patients.

Objective To establish a performance management model with “key diseases” as the starting point, “excellent cases” as the basis, and “performance incentives” as the driving force to strengthen the functional positioning of the tertiary specialty hospital for the diagnosis and treatment of difficult oral cases, and to enhance the overall competitiveness of the hospital. Methods Big data analysis, literature review and expert consultation were used to determine the catalogue of key diseases; the relative weight（RW） value of each key disease was determined based on related factors such as medical expenses, time and resource consumption, and it was continuously improved in clinical application management. Results Through the practice of disease-case-performance management, from 2018 to 2021, the total number of key diseases in clinical disciplines in the hospital was 853, with a cumulative RW value of 5 276.51, covering 7 major departments and 19 key diseases in the hospital, and the difficulty and quality of diseases have been improved year by year. Conclusion Performance management based on key diseases is conducive to promoting the optimization of the clinical business structure of stomatology specialist hospitals, assisting the construction of hospital connotation and quality, and improving hospital management level.