Introduction:Temporomandibular joint (TMJ) ankylosis severely compromises mandibular mobility and overall oral function. Gap arthroplasty remains the standard surgical treatment. However, the accuracy of navigation-assisted procedures is frequently limited by anatomical registration challenges, particularly when relying on dental surface matching. Methods:This single-center prospective study enrolled 30 patients with unilateral bony TMJ ankylosis. Participants were randomly assigned to either a dental surface registration group (n = 18) or a guide plate registration group (n = 12). The patient-specific guide plate integrated both osteotomy slots and fiducial markers. Primary outcomes included registration time and target registration error (TRE). Secondary outcomes were operative time, mouth opening at three months, and perioperative complications. Results:The guide plate group achieved significantly shorter registration times (56.23 ± 11.33 s; 95% CI: 49.35-63.11) compared with the dental registration group (935.03 ± 85.40 s; 95% CI: 894.55-975.51; P < 0.001). TRE was also significantly lower in the guide plate group (0.69 ± 0.10 mm; 95% CI: 0.62-0.76) than in the dental registration group (2.82 ± 0.45 mm; 95% CI: 2.60-3.04; P < 0.001). Average operative time was reduced in the guide plate group (124.63 ± 5.39 min; 95% CI: 121.44-127.82) compared with the dental group (134.31 ± 12.76 min; 95% CI: 128.10-140.52; P = 0.009). Postoperative mouth opening at three months was comparable between groups (31.5 ± 4.23 mm; 95% CI: 28.94-34.06 vs. 31.33 ± 3.34 mm; 95% CI: 29.65-33.01; P = 0.905). No major intraoperative or postoperative complications were observed. Discussion:Integration of an individualized osteotomy and registration guide plate significantly improved intraoperative efficiency and spatial accuracy in TMJ gap arthroplasty without compromising functional outcomes. These pilot findings support the clinical feasibility of the guide plate system, though larger multicenter studies and evaluation of inter-operator variability are required for broader validation.

OBJECTIVE:To compare the efficacy of the superficial inferior epigastric artery perforator (SIEA) flap and radial forearm (FA) flap in reconstructing oral and maxillofacial soft tissue defects, with emphasis on donor site complications, functional recovery, aesthetic outcomes, and quality of life. METHODS:A retrospective analysis was conducted on 204 patients who underwent SIEA (n = 104) or FA (n = 100) flap reconstruction between 2014 and 2023. Outcomes assessed included flap survival, donor site complications (scarring, sensory abnormalities), functional recovery (mouth opening, speech clarity), and quality of life (based on UW-QOL). Statistical analysis included chi-square tests, t-tests, and logistic regression. RESULTS:Flap survival rates were similar between groups (P = 0.411). However, the SIEA group exhibited significantly better donor site outcomes: fewer sensory abnormalities (P < 0.001), less severe scarring (P < 0.001), and greater aesthetic satisfaction (P = 0.027). Functional outcomes also favored the SIEA flap, with improved mouth opening (P = 0.024) and speech clarity (P < 0.001). However, SIEA reconstruction required longer operative time (P < 0.001). Independent risk factors for delayed donor site healing included age ≥ 60 years, BMI ≥ 23 kg/m2, smoking, diabetes, and extended hospitalization. CONCLUSION:The SIEA flap offers superior donor site aesthetics, sensory preservation, and functional recovery compared to the FA flap, though it is associated with longer operative time. The FA flap remains a reliable option. Preoperative planning should consider individualized flap selection based on vascular anatomy, comorbidities, and aesthetic goals.

STATEMENT OF PROBLEM:There is an urgent need for an effective infection model to distinguish peri-implantitis from periodontitis because of the limited understanding and differing pathogenesis of these diseases. PURPOSE:The purpose of this preclinical study was to establish a peri-implantitis model using New Zealand White rabbits, develop implants suitable for small animals, simulate implantation and healing, and evaluate peri-implantitis progression and healing outcomes. MATERIAL AND METHODS:Self-developed titanium implants were inserted bilaterally into the maxillae of New Zealand White rabbits and allowed to heal for 4 weeks. After osseointegration, a peri-implantitis model was created by using an orthodontic ligature. The animals were divided into inflammation and antibiotic treatment groups. Inflammation progression, bone defects, and regeneration were analyzed by using microcomputed tomography (µCT) and immunohistochemistry. Groups were compared using the t test or 1-way analysis of variance for more than 2 groups. RESULTS:The implants achieved osseointegration after 4 weeks, establishing a stable peri-implantitis model. The µCT analysis showed that horizontal bone absorption accounted for 31.25%, vertical absorption for 12.50%, and combined absorption for 56.25% of the defects. Circular defects were the most common, accounting for 60% of all the defects. Linear and peri-implant bone defect volume measurements revealed a significant reduction in bone defects and increased implant stability quotient values after antibiotic treatment (P<.01). Histological staining showed reduced inflammation and increased trabecular bone structure after antibiotic treatment. Immunohistochemical analysis indicated the increased expression of osteogenic-related proteins and decreased tartrate-resistant acid phosphatase staining in osteoclasts after antibiotic treatment. CONCLUSIONS:A rabbit model of peri-implantitis was successfully established. This study provided a novel animal model for future studies on peri-implantitis and the development of new treatment modalities.

ObjectiveGiant cell-rich lesions in the maxillofacial region are relatively rare, and comprehensive clinical differential diagnostic protocols are currently lacking. This article aims to provide a reference for the clinical diagnosis and treatment of giant cell-rich lesions.MethodsThis study investigates the distinguishing features of four types of giant cell-rich lesions in differential diagnosis and treatment: giant cell tumor of bone (GCT), aneurysmal bone cyst (ABC), tenosynovial giant cell tumor (TGCT), and giant cell reparative granuloma (GCRG).ResultsImmunohistochemical (IHC) analysis reveals strong p63 positivity in the mononuclear stromal cells of GCT, but not in GCRG. The “fluid-fluid level” observed in magnetic resonance imaging (MRI) is a diagnostic indicator for ABC, reflecting variable signal intensities. TGCT is characterized by the presence of synovial monocytes, multinucleated giant cells, foam cells, and hemosiderin-laden cells.ConclusionAccurate diagnosis requires a comprehensive evaluation of clinical, imaging, and pathological data. While complete resection is crucial for GCT to prevent recurrence and malignant transformation, GCRG typically responds well to curettage due to its benign nature. Early surgical intervention is essential for TGCT to control its aggressive progression and minimize complications.

BACKGROUND:Oral mucosal leukoplakia, a prevalent precancerous condition, poses significant challenges in clinical management. Photodynamic therapy (PDT) is a common therapeutic strategy, its efficacy in clinical practice is often constrained. There is a pressing demand for innovations that can enhance the effectiveness of PDT and minimize its side effects in addressing oral precancerous lesions. MATERIALS AND METHODS:This study employed m-THPC as a photosensitizer and developed a novel light source with dual wavelengths of 410 nm/653 nm tailored to excite the photosensitizer. We conducted photodynamic experiments using oral precancerous cell lines, OSCC cell line and animal models. In vitro cellular responses were assessed using colony formation, and cell apoptosis assays. An oral precancerous mouse model was established to appraise the therapeutic efficacy of the treatments. Histopathological evaluation of apoptosis was performed using TUNEL and immunohistochemical staining. RESULTS:The development of a dual-wavelength laser device is reported. m-THPC demonstrated an affinity for precancerous cells, preferentially accumulating in precancerous tissue in vitro. Activation of m-THPC with a 410 nm laser showed a robust photochemical effect, effectively inhibiting the proliferation and promoting the apoptosis of precancerous cells in vitro. The combined application of 410 nm/653 nm wavelengths yielded superior therapeutic efficacy, compared to the individual emissions at 410 nm and 653 nm, in a precancerous lesion mouse model and was associated with fewer adverse reactions. Despite spectral mismatch with m-THPC, high-dose 532 nm irradiation achieved therapeutic efficacy comparable to dual-wavelength PDT in vivo. However, this dose-dependent enhancement was accompanied by exacerbated photothermal effects, resulting in significant adverse reactions including localized hyperthermia and nonspecific tissue damage. CONCLUSION:The dual-wavelength PDT, optimized for m-THPC, exhibits superior photodynamic characteristics and excellent biosafety. It aligns well with realistic clinical applic ation scenarios and presents as an innovative and promising therapeutic modality for the treatment of oral leukoplakia.

A semi-autonomous oral implant robot was used to address severe bone defects in the maxillary anterior region. A 68-year-old woman underwent robot-assisted surgery, which included cyst excision and implant placement with immediate functional loading. Postoperative radiographs confirmed the alignment of the implant with the preoperative plan, highlighting the system's efficacy in complex treatments and enhancing the success rates and safety of implant surgeries.

OBJECTIVE:Profunda femoris artery perforator flaps (PAPFs) have not been widely used in head and neck reconstructions. The feasibility and outcomes of PAPFs for various head and neck reconstructions need to be investigated.STUDY DESIGN:Retrospective analysis.SETTING:A single-institution review.METHODS:PAPFs were utilized in head and neck reconstructions from 2019 to 2021. Local anatomy, surgical technique, and complications were discussed. Chimeric PAPF applications with muscle components were described for coverage of extensive multiunit defects. Additionally, aesthetic and functional outcomes were compared with anterolateral thigh perforator flaps.RESULTS:A total of 33 cases were included. The average age was 54.2 years (range, 30-74). The most common underlying pathology was oral squamous cell carcinoma (n = 26, 78.8%), while the mean ± SD body mass index was 25.4 ± 2.8 kg/m2 . Middle perforators (n = 14, 42.4%) were the most commonly utilized ones. The perforator-based chimeric/composite applications were used in 9 (27.3%), with the muscular components consisting of gracilis (n = 3, 9.1%), adductor magnus (n = 5, 15.2%), or semimembranosus muscles (n = 1, 3.0%). Venous thromboses of the PAPFs were found in 2 (6.1%), though salvaged. The occurrence of postoperative 90-day morbidity (complication) was related to mandibulectomy/maxillectomy (P = .020). Postoperative validated questionnaires showed a trend of intermediate to high scores, indicating noninferior outcomes in several categories, when compared with the anterolateral thigh perforator flap counterparts.CONCLUSION:PAPFs are a good reconstructive alternative for intermediate to large head and neck reconstructions. Besides, PAPFs can provide sufficient tissue volume and versatility of potentially incorporating adjacent muscle components.

Background: Left atrial appendage (LAA) closure (LAAC) in atrial fibrillation (AF) patients with the reversed chicken-wing (RCW) LAA is challenging.Aims: To elucidate the LAAC strategy of the RCW-LAA.Methods: A total of 802 AF patients who were enrolled in the LAACablation registry for LAAC procedure were included, 55 of whom presented with the RCW-LAA. The WATCHMAN device was implanted using the standard protocol when the sheath depth was no less than the device depth (the simple group). For those with a sheath depth of less than the device depth (the complex group), device deployment was attempted with acceptable protrusion or after a repeated atrial transseptal puncture (re-ATP) at a more inferior and anterior position. The anatomical and procedural features were compared between groups and before and after the re-ATP.Results: The success rate of LAAC was significantly lower in patients with the RCW-LAA than with the other morphologies (92.7% vs. 98.8%, p = 0.001). Compared with the simple group, the complex group had shorter root depth and shorter neck length, and more LAAs in the complex group were at lower position (all p < 0.05). The sheath depth after the re-ATP was significantly greater than that before the re-ATP (18.8 +/- 3.4 mm vs. 14.7 +/- 2.6 mm, p < 0.001). For the patients who underwent re-ATP, the sheath went significantly deeper in successful procedures than in aborted procedures (19.7 +/- 3.3 mm vs. 15.8 +/- 1.8 mm, p = 0.040).Conclusions: The anatomical features of the RCW-LAA were related to the complexity of the LAAC procedure. The re-ATP at an inferior and anterior location could increase the success rate of LAAC. ClinicalTrials.gov: NCT03788941.

The transcription factor Dlx2 plays an important role in craniomaxillofacial development. Overexpression or null mutations of Dlx2 can lead to craniomaxillofacial malformation in mice. However, the transcriptional regulatory effects of Dlx2 during craniomaxillofacial development remain to be elucidated. Using a mouse model that stably overexpresses Dlx2 in neural crest cells, we comprehensively characterized the effects of Dlx2 overexpression on the early development of maxillary processes in mice by conducting bulk RNA-Seq, scRNA-Seq and CUT&Tag analyses. Bulk RNA-Seq results showed that the overexpression of Dlx2 resulted in substantial transcriptome changes in E10.5 maxillary prominences, with genes involved in RNA metabolism and neuronal development most significantly affected. The scRNA-Seq analysis suggests that overexpression of Dlx2 did not change the differentiation trajectory of mesenchymal cells during this development process. Rather, it restricted cell proliferation and caused precocious differentiation, which may contribute to the defects in craniomaxillofacial development. Moreover, the CUT&Tag analysis using DLX2 antibody revealed enrichment of MNT and Runx2 motifs at the putative DLX2 binding sites, suggesting they may play critical roles in mediating the transcriptional regulatory effects of Dlx2. Together, these results provide important insights for understanding the transcriptional regulatory network of Dlx2 during craniofacial development.

Purpose Metastatic involvement of the lingual lymph nodes (LLNs) in oral cavity squamous cell cancer (SCC) has recently been proven to significantly reduce locoregional control and survival. Despite recent refinements in the detection of these lesions, the understanding of the LLN topographic anatomy among clinicians is limited. A proposition of a topographic division on LLN based on a comprehensive literature search and synthesis may be helpful in this condition. Methods A literature search and election based on contemporary PRISMA guidelines was performed for sources on LLN anatomy with special attention on their subdivision. Results Four topographic LLN subgroups were defined: median-between genioglossal and geniohyoid muscles; intermediate parahyoid-medial to the hyoglossal muscle, at the greater cornu of the hyoid bone; lateral sublingual (paraglandular) LLNs-at the sublingual salivary gland; lateral submandibular (paraglandular) LLNs -lateral to the hyoglossal muscle, at the deep surface of the submandibular salivary gland. Conclusion The development and implementation of a unified anatomical topographic classification of LLN subgroups may be among the important conditions for improving the detection and treatment of LLN lesions.

The hostile oxidative wound microenvironment, defective angiogenesis, and uncontrolled release of therapeutic factors are major challenges in improving the diabetic wound healing. Herein, adipose-derived-stem-cell-derived exosomes (Exos) are first loaded into Ag@bovine serum albumin (BSA) nanoflowers (Exos-Ag@BSA NFs) to form a protective "pollen-flower" delivery structure, which are further encapsulated into the injectable collagen (Col) hydrogel (Exos-Ag@BSA NFs/Col) for concurrent remodeling of the oxidative wound microenvironment and precise release of Exos. The Exos-Ag@BSA NFs can selectively dissociate in an oxidative wound microenvironment, which triggers sustained release of Ag ions (Ag+) and cascades controllable release of "pollen-like" Exos at the target site, thus protecting Exos from oxidative denaturation. Such a wound-microenvironment-activated release property of Ag+ and Exos effectively eliminates bacteria and promotes the apoptosis of impaired oxidative cells, resulting in improved regenerative microenvironment. Additionally, Exos-Ag@BSA NFs/Col markedly accelerates wound healing and regeneration in vivo in a diabetic murine silicone-splinted excisional wound model by promoting blood perfusion, tissue granulation, collagen deposition, neovascularization, angiogenesis, and re-epithelization. It is anticipated that this work will inspire the development of more delicate and disease-specific therapeutic systems for clinical wound management.

Background To determine the association between tumor location and both clinicopathological characteristics and the survival of patients with M0 squamous cell carcinoma of the penis (SCCP). Methods Data of 455 patients diagnosed with M0 SCCP between 1975 and 2018 were collected from the Surveillance, Epidemiology, and End Results (SEER) database of the United States National Cancer Institute. The effects of tumor location on overall survival (OS) and penile carcinoma-specific survival (PCSS) were analyzed using the Kaplan–Meier method. The Cox proportional hazards regression model was used to determine the impact of tumor location on PCSS. Results SCCP was more likely to occur in the prepuce or glans (90%). Although no significant difference was observed between the OS of patients with M0 SCCP in the prepuce or glans and those with M0 SCCP in the body of the penis (p = 0.307), the former had better PCSS (p = 0.024). Moreover, M0 SCCP in the prepuce or glans was also significantly associated with better PCSS in patients with advanced age (age ≥ 60 years, p = 0.011), other ethnicities (p = 0.003), T2–T4 stage (p = 0.036), larger tumors (≥3 cm, p = 0.001), no regional lymph nodes removed (p = 0.044), and radical surgery (p = 0.027). Multivariate analysis confirmed that tumor location is an independent prognostic factor for patients with M0 SCCP [hazard ratio (HR) 1.881, p = 0.026]. Conclusions Tumor location is an independent prognostic factor for patients with M0 SCCP, and tumors in the prepuce or glans portend better PCSS.

Background. Fructose-1,6-bisphosphatase 2 (FBP2), known as a rate-limiting enzyme in gluconeogenesis, is a tumor suppressor downregulated in various cancers. However, the role of FBP2 in oral squamous cell carcinoma (OSCC) remains largely unclear. Methods. The level of FBP2 in OSCC tissues and matched adjacent normal tissues was determined by western blot and RT-qPCR assays. In addition, analysis of FBP2 function in OSCC cells was assessed using both gain-of-function and loss-of-function studies. Results. In this study, we found that the expression of FBP2 was remarkably downregulated in OSCC tissues and OSCC cells. Overexpression of FBP2 suppressed the viability, proliferation, migration, and glycolysis of OSCC cells, whereas FBP2 knockdown exhibited the opposite results. Moreover, downregulation of FBP2 promoted the growth and glycolysis of OSCC cells in nude mice in a xenograft model. Specifically, FBP2 colocalizes with the c-Myc transcription factor in the nucleus. Significantly, inhibitory effects of FBP2 overexpression on the viability, proliferation, migration, and glycolysis of OSCC cells were reversed by c-Myc overexpression. Conclusion. Collectively, FBP2 could suppress the proliferation, migration and glycolysis in OSCC cells through downregulation of c-Myc. Our study revealed a FBP2-c-Myc signaling axis that regulates OSCC glycolysis and may provide a potential intervention strategy for OSCC treatment.

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目的:通过临床及影像学方法,评估种植联合血管化髂骨移植重建下颌骨缺损的长期疗效.方法:对上海交通大学医学院附属第九人民医院1995—2005年收治的14例患者47颗植入血管化髂骨的种植体进行随访,其中10例30颗种植体为下颌骨血管化髂骨重建术中同期植入,4例17颗种植体为术后二期植入,上部结构均采用种植支持式固定义齿修复.评估分析种植体15年累积生存率及修复体生存率,修复完成后5年及10年分别进行临床评价.采用SPSS 26.0软件包对数据进行统计学分析.结果:种植体均未发生愈合期内失败.种植体10年、15年累积生存率分别为90.44％和86.67％,修复体15年累积生存率为78.32％.种植体5年及10年边缘骨吸收分别为(2.08±0.27)mm和(4.22±0.48)mm,两者有显著差异(P<0.0001).生物学并发症主要为种植体周围炎及软组织增生,机械并发症主要为修复体磨耗.结论:种植联合血管化髂骨移植重建下颌骨缺损的长期疗效较为稳定,是下颌骨缺损重建的有效方法;但种植体周围炎发生率较高,维护种植体周围软、硬组织的稳定是种植体远期疗效的重要保证.

The aim of the study was to evaluate the efficacy and preliminary outcomes of using a postauricular-groove approach without endoscopic assistance for the excision of parotid tumors. Patients who underwent parotidectomy using a postauricular-groove incision were selected for this study. For patients in which parotidectomy was difficult, namely, for tumors located in the deep lobe area, the parotid gland sternocleidomastoid space was fully utilized, and the tumor was resected from the posterior plane. A total of fifty-eight patients with parotid tumor were enrolled and divided into superior lobe group (n = 46) and deep lobe group (n = 12). The difference in operation time (94 vs 119 min) and postoperative drainage (20.18 vs 45.33 mL) was statistically significant between the tumors in the superficial and deep lobes. However, postoperative cosmetic VAS score was 10 (extremely satisfied) for all patients. The incidence of transient facial nerve paralysis was comparable (8.7% vs 16.7%), and all of them resolved spontaneously within 3 months. No recurrence of tumors was found in either group in the median follow-up interval of 26.45 months (range 22.2-35.3 months), which was comparable to the result using the conventional "S" approach. After making full use of the parotid gland sternocleidomastoid space, the postauricular-groove approach demonstrated satisfactory facial nerve protection, as well as easy maneuverability without the risk of surgical complications for tumors located in the deep lobe area. Importantly, the postauricular-groove approach showed excellent cosmetic outcomes for all patients and should be considered an alternative approach for parotidectomy of selected cases. (c) 2021 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Although nutrient-starvation therapies can elicit strong anti-tumor effects in multiple carcinomas, it has been convincingly demonstrated that cancer cells exploit the tumor microenvironment to thrive in nutrient-poor environments. Here, we reveal that cancer cells can co-opt nociceptive nerves to thrive in nutrient-poor environments. Initially examining the low-glucose environment of oral mucosa carcinomas, we discovered that cancer cells employ ROS-triggered activation of c-Jun to secrete nerve growth factor (NGF), which conditions nociceptive nerves for calcitonin gene-related peptide (CGRP) production. The neurogenic CGRP subsequently induces cytoprotective autophagy in cancer cells through Rap1-mediated disruption of the mTOR-Raptor interaction. Both anti-glycolysis and anti-angiogenesis-based nutrient-starvation therapies aggravate the vicious cycle of cancer cells and nociceptive nerves and therapeutically benefit from blocking neurogenic CGRP with an FDA-approved antimigraine drug. Our study sheds light on the role of the nociceptive nerve as a microenvironmental accomplice of cancer progression in nutrient-poor environments and upon nutrient-starvation therapies.

Purpose Epstein-Barr virus (EBV) infection has been shown to contribute to oncogenesis and often causes acute clinical manifestation of Infectious mononucleosis (IM). It is unknown whether IM could increase the risk of subsequent malignancies. We aimed to evaluate the association of IM caused by EBV (EBV-IM) with overall and subtypes of malignancy in a large population-based cohort study. Methods This study included 1,419,407 individuals born in Denmark between 1973 and 2016 identified from national registers and 23,057 individuals had IM. The 5,394 of them had confirmed EBV-IM and they were birth date- and sex- matched (1:63) to 1,396,350 non-IM individuals. Cox regression was used to examine the associations of EBV-IM with malignancy. Results Individuals with a history of confirmed EBV-IM had an 88% increased overall risk of malignancy (hazard ratio [HR]:1·88, 95% confidence interval [CI]: 1·42–2·49) and a five-fold risk of hematologic malignancies (HR 5·04, 95% CI: 3·07–8·25), compared to those without IM. Similar estimates were observed in the sibling analysis. The overall risk of malignancy was greater for EBV-IM with complications (HR 8·93, 95% CI: 3·35–23·81) than that for EBV-IM without complications (HR 1·35, 95% CI: 1·20–1·53). EBV-IM duration was related to increased risk of malignancy in a dose-response way. Notably, the significant elevated risk of overall malignancy was observed in the first two years after EBV-IM onset (rate ratio [RR] 4·44, 95% CI: 2·75–7·17) and attenuated thereafter. Conclusion EBV-IM was associated with an increased risk in malignancy, particularly hematologic malignancies and in the first two years following IM exposure. Our findings suggest an important time-window for early screening of the EBV-attributed malignancy.

BACKGROUND:Anterolateral thigh perforator flaps (ALTPFs) have long been considered workhorse flaps for head and neck reconstructions. However, in some instances, anteromedial thigh septocutaneous perforator flaps (AMTPFs) are easier to harvest than ALTPFs. This study aimed to determine when and how the AMTPF should be considered the first choice as a reconstructive tool. METHODS:A retrospective cohort study was performed in the Department of Oral and Maxillofacial Surgery-Head & Neck Oncology, Shanghai Ninth People Hospital, from January 2014 to December 2018. Both the perforator-pedicle relationships and postoperative functional outcomes were compared. RESULTS:A total of 168 patients were included in this study, among whom 49 underwent AMTPF reconstructions. The AMTPF perforators in this study were mostly septocutaneous (n = 38, 77.5%). Notably, the AMTPF perforators mainly originated from the medial branch of the descending branches of the lateral circumflex femoral arteries (n = 44, 89.8%), while for the other 5 patients, the perforators were found to originate from the superficial femoral arteries. Additionally, the average pedicle length of the AMTPFs was 8.7 cm (range: 6.0 to 13.0 cm), which was comparable to that of the ALTPFs (8.9 cm) (p = 0.442). The postoperative complication rate and functional outcomes were comparable between the two groups. The algorithm and harvesting approaches are presented. CONCLUSIONS:The role of AMTPF should not be downplayed. After careful preoperative evaluation, we believe that AMTPF should not be considered a second choice in patients with sizable septocutaneous perforators.

Objective:To compare the effect of temporal external fixator and digital guide plate in the immediate reconstruction of mandibular defect after segmental mandibulectomy.Methods:The clinical data of all patients who received segmental mandibulectomy and immediate mandibular reconstruction with free vascularized bone graft by a single surgical team in the Department of Oral & Maxillofacial-Head & Neck Oncology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine from August 2016 to December 2017 were retrospectively analyzed. According to different auxiliary methods, the patients were divided into temporal external fixator (TEF) group and computer aided design-manufacture (CAD-CAM) group. The width of mandible, length of mandibular body and vertical dimension of inferior 1/3 face were measured by CT before and one month after surgery, and the difference before and after surgery was calculated to evaluate the surgical effect. SPSS 19.0 was used for statistical analysis, and the data were expressed as Mean ± SD. Independent sample t-test was used for comparison of indexes of surgical time and surgical effect evaluation between the two groups, and P<0.05 indicated statistically significant differences. Results:A total of 29 patients were enrolled, including 13 patients in TEF group, 4 males and 9 females, aged (47.7±14.5) years, including 7 ameloblastomas, 2 squamous cell carcinomas, 2 abnormal proliferation of bone fibers, 1 rhabdomyosarcoma and 1 osteosarcoma. In the CAD-CAM group, there were 16 cases, including 11 males and 5 females, aged (42.4±19.7) years, including 10 ameloblastomas, 3 squamous cell carcinomas, 1 osteoblastoma, 1 otogenic fibromyxoma and 1 osteosarcoma. The bone grafts in 29 patients were all alive, the wounds healed primarily, and the occlusal relationship and facial contour of the patients were fine. After 3 years follow-up, there were no postoperative complications and tumor recurrence. The function of the supply area was not affected. The operative time was (7.12±1.40) h in the TEF group and (4.72±1.10) h in the CAD-CAM group, and the difference between the two groups was statistically significant ( P<0.01). In the TEF group, the difference of the width of mandible, length of mandibular body and vertical dimension of inferior 1/3 face were (1.08±1.12) mm, (2.08±1.61) mm, (1.77±3.15) mm, respectively; CAD-CAM group were (0.88±1.15) mm, (0.94±1.34) mm, (0.87±1.47) mm, respectively, and there was no statistical significance between the two groups ( P>0.05). Conclusions:It took significantly longer to perform immediate mandibular reconstruction assisted by TEF than that assisted by CAD-CAM in surgery, but both groups achieved better surgical results. It is simpler and more effective to use TEF when time is urgent or technology is too limited to carry out preoperative digital design.