The insufficient fibular height after mandibular reconstruction using vascularized single-barrel free fibular flap is a Gordian knot for implantation. Numerous studies have demonstrated that sandwich osteotomy is an effective technique for bone augmentation,so it is worth investigating whether it can achieve the same result used for transplanted fibula.A total of 18 patients were retrospectively enrolled. All patients underwent single-barrel free fibula flap repair for segmental mandibular defects but the fibular height was not sufficient for subsequent implantation, so sandwich osteotomy was used to increase the height of the fibula. Cone beam computed tomography was performed prior to and 1 day, 3 months, 6 months after sandwich osteotomy. Mimics 21.0 software was used to measure the bone height obtained.The mean vertical bone augmentation was 5.15 ± 0.4 mm (range, 3.3-6.92 mm) on the 1st day post-operation and gradually decreased, eventually stabilized about 6 months post-op.All patients received implants 6-8 months post-op. The implants achieved clinical osseointegration approximately 3 months after placement, and all patients successfully completed the subsequent crown restoration. In this study, the bone augmentation of the fibula and subsequent implant restoration were both successful. We believe that sandwich osteotomy is a convenient, safe and effective technique for fibular augmentation.

Objective: This study aimed to compare the biomechanics of implant prostheses and peri-implant bone among 6 different mandibular reconstruction models based on patient data involving the use of an upper free-end double-barrel fibula. Methods: This study was an observational study. Five models were reconstructed using fibular-supported and implant-supported partial dentures. Two of these models were double-barrel fibula models with different gaps between the upper and lower segments. The other 2 were single-layered fibular models (the fibula was placed at the inferior or superior mandibular borders). The fifth model was a double-barrel fibula with a free distal end on the upper segment. In addition, a typical mandibular model was created for comparison. Two fixed partial-denture models were used in this study. The von Mises stress and strain of the models were analyzed. Results: The maximum stress decreased with increasing gap between the upper and lower fibula. The distal free-end double-barrel fibula showed a potential to reduce the maximum stress around the implant apex while increasing it around the implant neck compared with a fixed distal-end double-barrel fibula. Conclusions: Utilizing a free distal end on the upper fibula may be a viable option for mandibular reconstruction, especially when the fibula length is limited.

BackgroundCowden syndrome (CS) is a rare genetic disorder associated with PTEN gene mutations. It is characterized by macrocephaly, specific mucocutaneous features, and a predisposition to benign and malignant tumors. Cases of CS primarily presenting with oral clinical manifestations are relatively uncommon.Methods/ResultsWe report the case of a 41-year-old male proband who presented with bilateral commissural and lingual externally projecting symmetric lesions for over two years. The proband also exhibited other features, including macrocephaly, communication difficulties, and obesity. Similar oral clinical manifestations were observed in family members. Whole exome sequencing analysis revealed PTEN gene mutations associated with CS in both the proband and his younger brother. This case serves as a reminder to be aware of the diverse presentations of CS in oral clinical practice and highlights the importance of genetic testing for guiding diagnosis and treatment.ConclusionThere are few reported cases of CS primarily presenting with oral lesions. This finding contributes to further understanding of certain aspects of the pathogenesis of CS and enhances awareness of CS cases primarily exhibiting oral clinical manifestations.

BACKGROUND Oral Squamous Cell Carcinoma (OSCC) is one of the most severe cancers in the world, and its early detection is crucial for saving patients. There is an inevitable necessity to develop the automatic noninvasive OSCC diagnosis approach to identify the malignant tissues on Optical Coherence Tomography (OCT) images. METHODS This study presents a novel Multi-Level Deep Residual Learning (MDRL) network to identify malignant and benign(normal) tissues from OCT images and trains the network in 460 OCT images captured from 37 patients. The diagnostic performances are compared with different methods in the image-level and the resected patch-level. RESULTS The MDRL system achieves the excellent diagnostic performance, with 91.2% sensitivity, 83.6% specificity, 87.5% accuracy, 85.3% PPV, and 90.2% NPV in image-level, with 0.92 AUC value. Besides, it also implements 100% sensitivity, 86.7% specificity, 93.1% accuracy, 87.5% PPV, and 100% NPV in the resected patch-level. CONCLUSION The developed deep learning system expresses superior performance in noninvasive oral squamous cell carcinoma diagnosis, compared with traditional CNNs and a specialist.

PURPOSE:Double-barrel vascularized fibula graft is one of the most common surgical techniques to augment or maintain the height of the neo-mandible. The purpose of this study was to investigate whether the gap completely disappeared and gap ossification ultimately achieved between the double barrels.METHODS:Six rabbits were used in the study. Each animal's tibia was vertically osteotomized at its midpoint, folded onto each other and fixed by mini-titanium plate, thus an animal model of "double barrel" was established. Specimens were obtained at 3 months and 6 months postoperatively, then the gap ossification between the double barrels was evaluated by radiography and histomorphology. Measurements of the gap width between the two tibial struts on X-ray films were performed 3 months after the operation at three sites: distal, middle and proximal site. Measurements were compared with those obtained immediately after operation using SPSS 19.0 software package.RESULTS:Three months after operation, radiography demonstrated that the gap between the double barrels gradually became vague. Histological study showed that irregular new woven bone formed in the gap between the two struts. There was significant difference in mean gap width at the distal and proximal site (P<0.05), but there was no significant difference at the middle site(P=0.552). Radiological and histological study showed cortical bone resorption in the contact area and two thin tubular bones fused into a thicker one 6 months postoperatively.CONCLUSIONS:The double-barrel tibia fixed with titanium microplate can fuse into a large, unique, continuous bone barrel.

Purpose: Partial superficial parotid (PSP) resection is the mainstay of treatment for benign parotid tumor. Unfortunately, the post-surgical formation of sialocele or salivary fistula is a well-recognized complication of parotid surgery. The aim of this study was to determine the predictors of sialocele or salivary fistula after PSP resection for parotid benign tumor. Methods: This retrospective cohort study includes patients who underwent PSP resection for benign parotid tumors from January 1, 2015 to December 31, 2019. The predictor variables were demographic data, systemic disease, smoking history, tumor size and type, surgical approach, and area. The outcome variables were the occurrence of sialocele or salivary fistula after PSP resection. Each possible risk factor was then examined using univariate analysis. Variables associated with sialocele or salivary fistula in the univariate analysis were then included in a multiple logistic regression model, and analyzed for possible factors related to the occurrence of sialocele or salivary fistula after partial superficial parotid resection. Results: The sample was composed of 872 subjects with a mean age of 51.0 +/- 8.3, and 59.5% were male. The frequency of sialocele or salivary fistula after partial superficial parotid resection was 10.4% (n = 92). Based on the multiple logistic regression model, hypertension and location of the lesion were associated with sialocoele formation. Hypertension was associated with a decreased risk for the formation of sialocele or salivary fistula (ORs = 0.6, 95% CI = [0.4,1.003], P = .051). When compared the superior lesions, anterior lesions were associated with a decreased risk for the formation of sialocele or salivary fistula (ORs = 0.32, 95% CI = [0.111,0.92], P = .034) and lesions in the middle were associated with an increased risk for sialocele or salivary fistula development (ORs = 2.315,95% CI = [1.199,4.469], P = .012). Conclusions: The incidence of sialocele or salivary fistula development was 10.4% in patients undergoing partial superficial parotidectomy in this study. Moreover, middle and anterior tumor location was shown to increase sialocele or salivary fistula risk. (C) 2021 The American Association of Oral and Maxillofacial Surgeons.

Background: Tumor recurrence is one of the major problems that affect the postoperative efficacy of oral squamous cell carcinoma (OSCC) treatment. Autophagy is known to have a dual-sided effect on tumors. However, studies on autophagy and prognosis are limited. The purpose of this study is to analyze the relationship between autophagy and OSCC recurrence. Materials and Methods: 72 patients with OSCC were followed for 5 years after curative surgery. Tissue specimens from each patient were divided into tumor, normal, and marginal groups. Autophagy protein expression was assessed by western blotting and immunofluorescence. Statistical significance was evaluated using the chi-square test. The Kaplan-Meier method was employed to construct a survival curve, and the log-rank test was used to compare survival rates. Cox regression was utilized to describe independent prognostic risk factors. ROC analysis was performed to evaluate the utility of p62 and LC3II expression in assessing OSCC recurrence. Results: Correlations were observed between survival rates and T stage (p = 0.00439), lymph node metastasis (p < 0.001), tumor differentiation (p = 0.00423), and changes in p62 expression (p < 0.001). Multivariate analysis showed lower p62 protein expression in the tumor group compared to the normal group with a higher risk of recurrence (RR = 3.713), and lower p62 protein expression was found in the marginal group compared to the tumor group, with a lower risk of recurrence (RR = 0.170). Conclusion: Expression of p62 protein is one of the important factors influencing relapse in OSCC patients and can be used as an early predictor of OSCC relapse.

OBJECTIVE:The objectives of this study were to estimate the prognostic value of the tumour-stroma ratio (TSR) and tumour budding (TB) in oral tongue squamous cell carcinoma (OTSCC) and to establish a reliable model to predict the outcome of OTSCC patients. METHODS:A total of 103 patients surgically treated at our hospital were enrolled in this study. Chi-square tests, Kaplan-Meier analyses and Cox proportional hazards regression models were performed for statistical analysis. RESULTS:Fifty-six patients were categorized as stroma-rich, and 47 patients were categorized as stroma-poor. Only pathological grade was associated with the TSR (p = 0.017). Kaplan-Meier analysis showed that stroma-rich, high-intensity budding and high risk groups were associated with worse prognosis. The Cox regression model showed that the TSR was an independent risk factor for OTSCC patients prognosis, and the high risk group was also related to poor prognosis (p < 0.05). TB was significantly associated with poor prognosis but was not an independent risk factor. CONCLUSIONS:We found that patients in the stroma-rich group had a worse long-term prognosis. The TSR is an independent risk factor for OTSCC patients' outcome. In addition, a risk model that combined the TSR and TB proved to be valuable for predicting OTSCC patients' outcome.

目的 探讨耳周V形切口在腮腺良性肿瘤切除中的临床应用效果.方法 收集2017年9月至2019年9月期间于我院头颈肿瘤外科行手术治疗的腮腺良性肿瘤患者36例,均行耳周V形切口切除肿瘤,总结临床效果.结果 36例患者均一期愈合,无涎瘘、Frey's综合症的发生,2例患者出现暂时性面瘫症状.所有患者术后均出现不同程度的耳垂麻木情况,术后3周左右恢复正常.术后随访均未出现永久性面瘫及肿瘤复发等并发症.所有患者面部无明显瘢痕或线性瘢痕,美观满意度评分9.4分,均达到预期美容效果.结论 耳周V形切口对于腮腺良性肿瘤是一种安全可靠的手术入路,且能够较好的满足患者对美观的要求.

CONTEXT:The safety and efficacy of irreversible electroporation (IRE) for locally advanced pancreatic carcinoma (LAPC) are well established. However, whether adjuvant chemoradiotherapy after IRE increases, the survival rate remains unknown. Therefore, this study evaluated the effect of chemoradiotherapy combined with IRE in patients with LAPC.SUBJECTS AND METHODS:We retrospectively analyzed 42 patients with LAPC between July 2015 and December 2016 at PLA General Hospital treated with IRE or IRE combined with radiation and/or chemotherapy. These patients were divided into the IRE group and the combined-therapy group. All patients underwent computed tomography (CT), magnetic resonance imaging, and positron-emission tomography-CT and no signs of metastases were found. The prognosis of these patients was observed.RESULTS:The times after operation and after diagnosis in the combined-therapy group (304.20 ± 118.54) and (334.40 ± 114.07) days, respectively, were better those than in the IRE group (214.36 ± 95.68) and (244.68 ± 110.61) days, respectively. Moreover, patients in the combined-therapy group had a significantly better survival rate than the IRE group (80 vs. 45.45%, P < 0.05).CONCLUSIONS:IRE combined with radiotherapy or chemotherapy was superior to IRE alone for the treatment of LAPC, as it prolonged the survival time and improved the survival rate, making it worthy of wide dissemination and clinical application.

Objectives: The purpose of this study was to evaluate the effectiveness of ablating postganglionic parasympathetic fibers of the submandibular ganglion in combination with sublingual gland excision in the treatment of primary sialorrhea. Materials and methods: Healthy volunteers were initially chosen to determine a basic saliva flow rate value by saliva collection. Next, unstimulated and stimulated saliva flow rates, and a visual analog scale index for sialorrhea were recorded in all the patients pre- and postoperatively. In addition, the generalized anxiety disorder scale was used to assess preoperative anxiety symptoms. The follow-up durations ranged from 24 to 36 months after surgery. Results: A total of 10 patients were included in this study. Preoperatively, the mean unstimulated saliva flow rate for the 10 patients was 11.26 +/- 4.19 ml/10 min, the stimulated saliva flow rate was 16.76 +/- 3.49 ml/6 min, and the visual analog scale index was 66.29 +/- 14.86. Postoperatively, the mean unstimulated and stimulated saliva flow rates were significantly reduced to 5.99 +/- 1.33 ml/10 min (p = 0.001) and 13.28 +/- 1.86 ml/6 min (p = 0.013), respectively, and the visual analog scale index was 25.41 +/- 5.6 (p < 0.001). No complications were found after operation. Conclusion: This study demonstrates that ablation of postganglionic parasympathetic fibers of the submandibular ganglion in combination with sublingual gland excision by an intraoral approach is a simple, safe, and efficient approach for treating primary sialorrhea. (C) 2020 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

BACKGROUND:Ligamentoid fibromatosis is a rare borderline tumor that occurs in the muscles, fascia, and aponeurosis. It is a kind of soft tissue tumor of fibrous origin, also known as invasive fibromatosis, desmoid fibroma, neurofibromatosis, etc. The tumor is between benign and malignant tumors and rarely has distant metastasis. Its characteristics are mainly local invasion, destruction and growth and easy recurrence. The World Health Organization defines it as a fibroblast cloning value-added lesion originating from deep soft tissue, which causes local invasion and growth leading to tissue reconstruction, extrusion and destruction of important structures and organs. The incidence rate accounts for 0.03% of all tumors and less than 3% of all soft tissue tumors. Definite diagnosis mainly depends on postoperative pathology. Surgical resection is still the main way to treat the disease, and a variety of nonsurgical treatment methods are auxiliary. Combined treatment can effectively reduce the risk of postoperative recurrence.CASE SUMMARY:The patient is a 57-year-old female. One week ago, she accidentally found a mass in the left upper abdomen while lying flat. There was no abdominal pain and abdominal distention, no fever, no black stool and blood in the stool and no nausea and vomiting. She had a 10-year history of glaucoma on the left side, underwent hysterectomy for uterine fibroids 5 years ago, had no hypertension, heart disease, diabetes, hepatitis or tuberculosis, had no history of smoking and had been drinking for 20 years.CONCLUSION:Accurate preoperative diagnosis is difficult, surgical resection is the main treatment, and a variety of nonsurgical treatment methods are auxiliary. Combined treatment can effectively reduce the risk of postoperative recurrence. The prognosis is still good, and the risk of recurrence of secondary surgery is greatly increased.

Objective To identify risk factors associated with surgical site infection (SSI) after major oral oncological surgery. Methods This retrospective study reviewed data from patients that underwent major surgery for oral cancer at a tertiary referral hospital in China between January 2005 and July 2016. SSI was diagnosed within 30 days. Demographic, cancer-related, preoperative, perioperative and postoperative data were analysed using descriptive statistics and univariate and multivariate analyses of the risk factors for SSI. Results A total of 786 patients were enrolled, of whom 125 had SSI (15.9%), which were all incisional. Independent risk factors for SSI, identified by multivariate analysis, were diabetes mellitus (odds ratio [OR] 2.147, 95% confidence interval [CI] 1.240, 3.642), prior radiotherapy (OR 4.595, 95% CI 1.293, 17.317) and oral–neck communication (OR 2.838, 95% CI 1.263, 7.604); and factors reflecting large extent resections were tracheostomy (OR 2.235, 95% CI 1.435, 3.525), anterolateral thigh flap (OR 1.971, 95% CI 1.103, 3.448) and latissimus dorsi flap (OR 4.178, 95% CI 1.325, 13.189). Conclusions Multiple risk factors were associated with SSI after major oral oncological surgery. To minimize SSI risk, surgeons managing oral cancer patients should have a better understanding of the risk factors, including diabetes mellitus, prior radiotherapy, tracheostomy, oral–neck communication and flap reconstruction.

目的 总结159例先天性鳃裂畸形病例资料,对其诊断、治疗及预后进行探讨.方法 回顾分析2005年1月至2016年12月经手术治疗的159名鳃裂畸形患者的临床资料.纳入研究的项目包括患者年龄、性别、部位、畸形类型、治疗历史、手术治疗、并发症和复发情况等.结果 其中男性患者73人,女性患者86人,儿童患者占15.7％.在所有患者中,诊断为第一鳃裂囊肿的为34人(21.4％),诊断为第二鳃裂囊肿的为112人(70.4％),诊断为第三、第四鳃裂囊肿的为13人(8.2％).所有患者均于我院进行了手术.儿童患者、曾行切开引流或复发的成人患者进行了显微镜下的手术操作,精确切除的复发率明显降低.面神经颞支损伤和伤口感染是外科治疗的主要并发症.本组患者的总体复发率为3.8％.结论 相对于以往的报道,本研究鳃裂畸形的术后复发率更低.利用显微镜的显微手术和精细的操作器械在鳃裂囊肿手术中发挥重要作用.

Purpose: We aimed to determine the risk of occult cervical metastasis of maxillary gingival squamous cell carcinoma (SCC), the predisposing factors for occult cervical metastasis and the therapeutic value of elective neck dissection (END) in survival of clinically negative neck node (cN0) patients. Methods: A retrospective study of patients with maxillary gingival SCC was conducted in our hospital. Clinical information including age, gender, TNM staging, pathological staging, as well as other demographic and clinical data was acquired and analyzed. The Kaplan-Meier method was used to evaluate overall survival rate. Descriptive and bivariate statistics were computed. Results: The sample was composed of 107 patients (43 men, 64 women). The overall lymph node metastasis (LNM) rate was 28%. The LNM rates were 7.1%, 15%, 41.7% and 44.8% for T1 to T4 stage tumors, and were 9.3%, 46.8%, and 50% for pathological grades I to III. The tumor stage and pathological grade showed a significant relationship with cervical metastasis (P < 0.01). The 5-year survival rate was higher in those who had an END (76%) when compared to those who did not receive an END (46.4%; P < 0.05). With regard to the nodal status, pN0 group had a higher survival rate than pN + group (P < 0.01). Conclusion: The results of this study suggest that the risk of LNM for SCC originating from the maxillary gingiva is higher than expected and comparable to that for other oral sites. We recommend END for T3 and T4 stage cN0 patients, especially for moderately and poorly-differentiated tumors. (C) 2018 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Purpose: Submandibular gland cancer is relatively rare. The purpose of this study was to estimate 5-year overall survival (OS) and disease-free survival (DFS) and to identify prognostic factors associated with OS and DFS for submandibular cancer. Materials and Methods: The authors implemented a retrospective cohort study and enrolled a sample of patients with submandibular gland cancer. The predictor variables were age, gender, tumor stage, nodal stage, margin status, and extracapsular spread. The outcome variables were 5-year OS and 5-year DFS. Kaplan-Meier methods were used to estimate survival and Cox hazards models were used to identify prognostic variables. Results: The sample was composed of 52 patients with submandibular gland cancer (mean age, 47.4 yr; 51.9% men). The median follow-up was 81 months (range, 11 to 159 months). The 5-year OS and DFS rates were 76.9 and 67.3%, respectively. Fixed mass, positive neck node, and positive margin status were relevant predictors of OS and DFS. Nodal stage was the relevant independent predictor affecting the disease outcome of submandibular gland cancer. Conclusion: These results identified several important prognostic factors associated with survival rate in patients with submandibular gland cancer. These prognostic variables include symptoms at presentation, pathologic nodal status, and margin status. These outcomes suggest that heightening vigilance of clinical characteristics for this disease might provide the impetus for improving the survival rate. (C) 2018 Published by Elsevier Inc on behalf of the American Association of Oral and Maxillofacial Surgeons

Purpose: The present study identified the prognostic factors and outcomes for malignant sublingual salivary gland tumors, which are rare.Materials and Methods: A retrospective cohort study of patients treated for malignant sublingual salivary gland tumors from 1997 to 2011 was performed. The predictor variables, including age, gender, tumor stage, nodal stage, perineural invasion, margin status, and lymphovascular invasion, were analyzed. The Cox regression model was used to determine the prognostic factors for locoregional recurrence, distant metastasis, and survival.Results: Of the 38 patients, 16 (42.1%) were men. Their mean age was 53 years (range 36 to 75). A total of 11 patients (28.9%) had T3-T4 tumors, and 6 (15.8%) had positive neck lymph nodes. The recurrence rate at 5 years was 18.4%. The distant metastasis rate at 5 years was 23.7%. Multivariable analysis confirmed the independent prognostic importance of patient age, N stage, and limited tongue mobility in locoregional recurrence and mortality at 5 years.Conclusions: Our results suggest that patient age, N stage, and limited tongue mobility are useful as independent predictors of locoregional recurrence and mortality in patients with malignant sublingual salivary gland tumors. (C) 2016 American Association of Oral and Maxillofacial Surgeons

Purpose: Acinic cell carcinoma (ACC) of the parotid gland is relatively rare. This study aimed to estimate 5-year survival and to identify prognostic factors associated with survival of ACC of the parotid gland.Materials and Methods: Thirty-seven patients with ACC of the parotid gland were included in this retrospective cohort study. They were treated in Beijing Stomatological Hospital from January 2000 to December 2011. Predictor variables, including age, gender, tumor stage, nodal stage, perineural invasion, and margin status, were analyzed. The Cox regression model was used to determine prognostic factors for overall survival (OS) and disease-free survival (DFS).Results: Of the 37 patients, 20 were men (54.1%). Mean age was 42 years (range, 13 to 73 yr). Six patients (16.2%) had T3 or T4 tumors and 5 (13.5%) had positive neck nodes. The 5-year OS and DFS were 86.5 and 78.3%, respectively. Positive margin status was associated with worse OS. Patients older than 60 years with a fixed mass, high-grade tumor and nodal stage, perineural invasion, and angiolymphatic invasion had adverse OS and DFS (P <.05).Conclusions: The present study identified several important prognostic factors associated with OS and DFS in patients with ACC. These prognostic variables include symptoms at presentation, clinical tumor stage and pathologic nodal status, and histopathology-related factors. All these factors were important in patient therapy and could prolong survival rate. (C) 2016 Published by Elsevier Inc on behalf of the American Association of Oral and Maxillofacial Surgeons

Objective To investigate the function and regulatory mechanism of human SH3PXD2B gene, aiming at providing evidence for further validation of the gene function in the oral and maxillofacial region.Methods Based on SH3PXD2B sequences from GenBank, the differences in various species, subcelluar location, secondary structure, functional domains and epitopes were analyzed by bioinformatics.Results The gene encoded a length of 911 amina acid protein with five functional domains, including 1 PX and 4 SH3 domain.The molecular weight was 101579.0, theoretical isoelectric point was 8.82, α-helix secondary structure accounted for 21.62%, β-fold for 6.70%, and random coil for 58.95%.There was no signal peptide in SH3PXD2B.However, 4 transmembrane and 8 epitopes structure were predicted in the sequence.Based on network, most interact proteins were related to pseudopodia formation and cell adhesion.Phylogenetic analysis revealed that SH3PXD2B genes of pig and rabbit were similar with human.Conclusion Structure and function prediction of human SH3PXD2B provided the basic information for further research in oral and maxillofacial-head and neck region.

Objective. To evaluate the clinicopathologic features, prognostic factors, and management of patients in the North Chinese population with head and neck squamous cell carcinoma (HNSCC) who developed a second primary malignancy (SPM).Methods. This was a retrospective study including 1818 eligible patients between June 1999 and April 2011.Results. A total of 188 HNSCC patients developed SPM. Multiple oral dysplastic lesions (MODLs) (P < .001) were among the risk factors for occurrence of SPM. However, MODLs were closely associated with many mild pathologic features, such as early T stage (P < .001), early N stage (P = .036), good pathologic differentiation (P < .001), and mild growth pattern (P < .001). Interestingly, multivariate survival analysis showed that SPM patients had a better prognosis if they had the characteristics of MODLs (P = .020).Conclusions. MODLs were a crucial risk factor leading to the occurrence of oral SPM after an index HNSCC in patients in Northern China. However, SPM patients with the characteristics of MODLs had a better prognosis.