Objective:To study the clinical effect of dynamic reconstruction of lower lip defect after squamous cell cancer resection by using unilateral Gillies fan flap and perioral muscle restoration.Methods:From Feburary 2017 to January 2020, 8 patients (6 female and 2 male, aged 55-81, 62.9 in average)diagnosed lower lip squamous cell carcinoma were accepted treatment in the Department of Otolaryngology Head & Neck Surgery, the First Affiliated Hospital of Xiamen University. All the moderate lower lip defect after cancer resection were repaired with unilateral Gillies fan flap with perioral muscle restoration under general anesthesia. The length of the vermilion of the upper lip in the Gillies fan flap was designed to be 1/3 of the length of the vermilion of the lower lip defect. The composite axial flap was prepared with the blood supply from contralateral upper lip artery-ipsilateral upper lip artery-mouth corner part of facial artery-ipsilateral lower lip artery.The end of all the perioral muscles were also prepared. After reconstruction of the continuity of the orbicularis oris, the ends of these perioral radiation muscles were restored in the position where they should be in the reconstructed lip.These perioral muscles training were undergone for 6 months after operation. After the reconstructed lip tend to be stable, measurement and calculation were carried out to evaluate the appearance, opening and closing functions of the mouth.Results:In our series of 8 cases, the length of the vermilion of the upper/lower lip was 52.4 mm(46.0-60.0 mm) in average; the circumference of the vermilion was 104.8 mm(92-120 mm)in average; the length of the defect of lower lip was 27.6 mm (21.0-35.0 mm)in average, 52.5% (42.0-67.3%) of the vermilion of lower lip. Six cases were using the right-side flap, and the other 2 cases were left. The length of the vermilion of the upper lip in the Gillies fan flap was 9.5 mm(7.0-12.0 mm)in average.All cases healed well with inconspicuous scar. No infection, hematoma or other surgical complications.No local or distant recurrence of cancer was observed during the follow-up period. Numbness of the lower lip happened posto-peration, and gradually disappeared 6 months later.Evaluation was conducted according to the measurement result preoperatively and 6 months postoperatively. (1) Appearance: the reconstructed lips were naturally symmetrical. Both side of the mouth corner were in the same horizontal level. The upper lip was lengthened with average increase of 6.8 mm and average increase rate of 15.9%. The lower lip was lengthened with average increase of 15.4 mm and average increase rate of 45.3%. In the rest situation, the circumference of the lips decreased by 5.5 mm in average compared with that preoperatively, which was 94.9% of the lip preoperatively, basically rehabilitate to the shape preoperatively.(2) Mouth-opening function: 1 week postoperation, the opening shape of mouth in all the cases was skewed with an about 1.5 fingers mouth-opening. Six months later, the opening shape of mouth was basically symmetrical round with a 3 fingers mouth-opening; in maximum mouth opening situation, the circumference of the lips decreased by 46.5 mm in average compared with that preoperatively, which was 73.1% of the lip in maximum mouth opening situation preoperatively, basically meeting physiological needs. (3) Mouth-closing function: All patient shave complete mouth-closing function and speech function.No leakage when making closed lip sound and whistling. All patients were satisfied with the oral appearance and the function of opening and closing mouth.Conclusions:Unilateral Gillies fan flap with perioral muscle restoration is a reliable method to repair the moderate full-thickness defect of the lower lip after cancer resection. After dynamic reconstruction of the perioral muscle group, the insufficient tissue of lips can be extended to obtain sufficient mouth opening, natural corner of the mouth and symmetrical lip appearance.

目的 研究不同脱矿程度牙本质的拉曼光谱特征,为临床应用拉曼光谱技术检测牙本质脱矿情况提供理论基础.方法 方便收集2016年1—5月间厦门大学附属第一医院口腔门诊拔除的下颌智齿10颗,经过打磨去除表面牙釉质,制备牙本质组织标本,经过不同浓度EDTA溶液和不同时间脱矿处理后,分别检测其拉曼光谱,比较不同脱矿程度牙本质拉曼光谱间的差异,并以差异谱峰的对应波数绘制拉曼光谱图像.同时应用能谱仪检测不同脱矿程度牙本质表面的元素含量,验证拉曼光谱结果 .结果该研究共获得不同脱矿程度牙本质特征拉曼光谱共80例.通过比较研究发现,随着牙本质脱矿程度的增加,拉曼光谱中代表磷酸根的960 cm-1波数处谱峰强度逐渐降低,表示牙本质表面磷酸钙盐减少,而代表C-H键的2950 cm-1波数处谱峰强度逐渐增高,表示牙本质表面有机组织增加.能谱仪元素分析结果也提示随着脱矿程度的增加,牙本质表面钙、磷元素的浓度逐渐降低.结论 不同脱矿程度牙本质组织中磷酸钙盐含量降低,有机组织增加,拉曼光谱可以检测不同脱矿程度牙本质组织成分变化,特别是以2950 cm-1波数处光谱强度值两两比较差异有统计学意义(P<0.05),可以用于鉴别不同脱钙程度的牙本质,具有良好的临床应用潜力.

Purpose: Zygomatic osteotomy is a common method of zygomatic hypoplasia correction. Natural coral is considered to be a good bone substitute. Few studies on unilateral zygomatic hypoplasia correction by zygomatic osteotomy with natural coral have been reported. This study was performed to evaluate the clinical morphological results and surgical outcomes of unilateral zygomatic hypoplasia correction by L-shaped zygomatic osteotomy with natural coral. Methods: From 1996 to 2012, a total of 42 patients with hypoplastic zygomas treated by L-shaped zygomatic osteotomy with natural coral were included in this study. Based on facial analysis results and x-ray and CT measurements, the degradation of natural coral, new bone formation, and clinical outcomes were observed and recorded. Results: All surgical procedures achieved satisfactory results without complications. During the stabilization period of about 12 to 15 months, all natural coral blocks were completely degraded and replaced by new bone. Good mechanical strength and continuity of the new bone and good zygomatic asymmetry were achieved in each patient. No recurrence was observed during the follow-up period. Conclusion: L-shaped zygomatic osteotomy with natural coral is an effective method of unilateral zygomatic hypoplasia correction.

OBJECTIVE:To investigate the long-term effectiveness of microgenia treatment with natural coral, and the volume relationship between the implant and the new bone.METHODS:A retrospective analysis was made on the clinical data of 12 patients with microgenia treated by horizontal genioplasty with natural coral implantation between October 1998 and September 2004. There were 7 males and 5 females with the average age of 18.5 years (range, 15-28 years). The cephalometric data on the photo and X-ray films were collected at pre-operation, immediate after operation, and last follow-up. The vertical distance between lower lip point and inferior mental point, the vertical distance between inferior alveolar point and inferior mental point, the vertical distance of the osteotomic gap, and the distance between pogonion and the line between nasion and inferior alveolar point were measured, and the recurrence rates were caculated.RESULTS:All incisions healed by first intention, and no complication occurred. All patients were followed up 8-12 years (mean, 9.2 years). X-ray films showed that the natural coral was replaced by new bone formation in the mental osteotomic gap; the new bone had good strength and firmly attached to the mentalis and periosteum. At last follow-up, the vertical distance between lower lip point and inferior mental point, the vertical distance between inferior alveolar point and inferior mental point, and the vertical distance of the osteotomic gap were decreased when compared with the ones at immediate after operation, and the mean recurrence rates were 6.1%, 22.9%, and 31.7%, respectively; and no obvious change was observed in the vertical distance between pogonion and the line between nasion and inferior alveolar point. Nine patients were satisfied with operation effectiveness; chin morphology was adjusted again in 3 patients.CONCLUSION:Natural coral is a safe and effective bone substitute with enough stable new bone and good long-term effectiveness.

Many plastic surgeons use mandibular osteotomy (reduction gonioplasty) without masseter resection to correct a square face. However, there is not enough long-term observation of the masseter after reduction gonioplasty, although some researches have already confirmed that the volume of masseter muscle does decrease shortly after reduction gonioplasty.Methods: The Plastic Surgery Hospital database was retrospectively reviewed for patients who underwent reduction gonioplasty. Fifty-six patients with both preoperative and 4 years postoperative 3-dimensional computed tomography (3DCT) were included. The changes in the volume and morphology of the masseter muscle after reduction gonioplasty were assessed quantitatively. The 3DCT data were analyzed using Mimics 10.01 software.Results: All patients were satisfied with the outcome. No complications happened. There were significant differences between the preoperative and 4 years postoperative volume and morphology.Conclusion: After reduction gonioplasty, the masseter muscle atrophied (reduced 20.98% +/- 8.75%), especially the lower part of the masseter muscle in the long-term follow-up. Most patients with prominent mandibular angles should be treated with reduction gonioplasty without approaching the masseter muscle.

The zygomatic bone, which is located on both sides of the midface, significantly contributes to the overall facial form. Asian people usually have a wide midface and prominent zygoma. Reduction malarplasty is one of the most frequently performed facial contouring surgeries in Asian countries. This study aimed to evaluate the surgical outcomes of reduction malarplasty with a modified L-shaped osteotomy.

Background: Distraction osteogenesis has been used to treat diminished skull space caused by craniosynostosis. Our report investigated the relationship between space volume change by computer technology and the intracranial pressure change. Cerebrospinal fluid (CSF) regular test and CSF biochemistry test were also performed to ensure the safety of distraction process.Methods: Seven minipigs, weighing 15 to 20 kilograms, were chosen; 4 x 3 cm bone flap was lifted in the left parietal bone. The dura was carefully protected. The distractor and assisted apparatus were implanted. Distraction was started with 10-day latency, 1 mm/d distraction rates for 10 days. Twelve weeks after distraction, the distraction device and the assist apparatus were removed. All pigs underwent 3-dimensional computerized scans of the craniofacial skeleton, CSF pressure measurement, CSF regular test, and CSF biochemistry test before operation, after 7 days' operation, immediately after distraction was finished, 4 weeks after distraction, 8 weeks after distraction, and 12 weeks after distraction. The 3-dimensional datum was collected, and volume change of skull was measured by 3-dimensional medicine surface rendering software.Results: All pigs tolerated the procedure. The mean volume 12 weeks after distraction was 87.93 +/- 3.11 cm(3), which was also significantly higher than 79.46 +/- 3.15 cm(3) that of before operation (P < 0.001). The CSF pressure becomes maxim after 7 days' operation. The CSF pressure went down immediately after distraction was finished. Then, the CSF pressure kept stable but lower than the CSF pressure before the operation except 1 pig whose CSF pressure after operation was higher than the CSF pressure before the operation. Cerebrospinal fluid regular test and CSF biochemistry test show stable results, and the WBC does not rise during the whole process.Conclusions: The distraction osteogenesis is an efficient and safe method to enlarge the intracranial volume. The assisted apparatus of distraction is useful for rotating distraction. Three-dimensional DICOM datum and 3-dimensional medicine surface rendering are efficient for measurement of skull volume.

Objective To build 3D image of the infraorbital nerve and artery in the lesion of the Fibrous Dysplasia on obital-zygomatic-maxillary region,and display their course and location for resection and plasty surgery to provide a reference.Methods By using a medical image process software,3D reconstruct the infraorbital nerve and artery of the lesions based on the CT scan date of each patient,then show and locate them in 3D reconstructive model of the whole heads.With the guide of the reconstructive images,partial resection of the lesion and reduction malarplasty with L-shaped osteotomy were performed to restore the patients' facial symmetry.Results The 3D images of the infraorbital nerve and artery were clear and accurate to show their course and location.And by follow of this,the operations were well performed with the infraorbital nerves and arteries intact preserved.Conclusion 3D reconstruction of the infraorbital nerve and artery can help the operative design and manipulation of the lesion of the Fibrous Dysplasia on obital-zygomatic-maxillary region.

Objective To research the blood supply and absoption of the central vascularized coralline and explore the mechanism of vascularization in artificial bone for its further clinical application.Methods To determine whether the vascularization of coralline could be evaluated,we built the model by implanting the selected New Zealand Rabbits' femoral artery into the central tunnel of the coralline.We implanted the vascularied coralline into subperiosteum or subcutaneous,and also implanted the non-vascularized coralline as control.The animals were euthanized at 1w,2w,4w,8w and 12w post-operation.The morphology and histology of the implants were investigated.Results The central vascularized corallines were filled with new-born vessels at 4～8w,and get further vascularized at 12w.To compare with,there were only a few new-born vessels in control.Conclusion The vasculariztion of artificial bone graft could be evaluated by using this method.This model can probably be a new method for coralline in clinical use.

<正>源于外伤、先天畸形等疾病所造成的骨缺损的需要,以往多使用自体骨移植来进行修复性治疗,由于自体骨移植的内在局限性及由此带来的相关并发症,寻找一种合适的具有良好理化性质和生物学特性的骨骼替代材料一直是人们努力探索的课题。20世纪70年代初,人们开始致力于多孔生物材料的开发研究工作。

Intracraial aneurysm is the most common cause of subarachnoid hemorrhage.Its incidence varies in different areas,and overall,there is a growing tendency.The incidences and mortalities of ruptured and reruptured intracranial aneurysms remain high,and are influenced by various factors.With the development of diagnostic techniques,the prognosis of intracranial aneurysms is improving increasingly,and the mortality and morbidity have been gradually decreased.