OBJECTIVE: Bone marrow derived mesenchymal stem cells (BM-MSCs) are multipotential cells. However, the harvest of autologous MSCs can be difficult due to the age or poor physical status of patients. The aim of this study was to investigate the reconstructive effect of allogeneic BM-MSCs on segmental mandibular defects. STUDY DESIGN: Freeze-dried and perforated mandibles of beagles were prepared as scaffolds. The right mandibular body of 24 female beagles was cut into 30 mm to create a segmental defect. The defects were randomly repaired with allogeneic freeze-dried bone (group A) or allogeneic MSCs and freeze-dried bone (group B). The reconstructive effects on the 2 groups were assessed by conducting computerized tomography scanning and histological analyses. RESULTS: The continuity and integrity of both groups were restored. The osseous maturation of group B was higher than that of group A. CONCLUSION: Allogeneic MSCs can promote new bone formation and improve the reconstructive effect on segmental defects.

OBJECTIVE:To investigate the effect of segmental defects reconstruction of canine mandible with allogenenic bone marrow mesenchymal stem cells (BMSC) combined with lyophilized bone.METHODS:A 30 mm segmental defect was created on the left mandibles of beagles. Beagles were randomly divided into three groups. Allogeneic bone marrow mesenchymal stem cells with lyophilized bone were used for segmental defects reconstruction in group A. Autologous bone marrow mesenchymal stem cells with freeze- dried bone were used for segmental defects reconstruction in group B. The defects of group C were repaired with lyophilized bone only. Every three beagles were sacrificed 4, 12, 24, and 48 weeks after surgery respectively. The reconstruction effect was evaluated by CT and histopathological examination.RESULTS:CT examination showed that new bones formed in group A and group B 12 weeks after surgery, but not in group C. The form of the reconstructed mandibles in the three groups recovered in 48 weeks. The small pores on the bone graft were filled with new bones in group A and group B. In group C, the pores were still evident. Histopathological examination showed that bone trabecula between allogeneic bone and autogenous bone was completely joined in group A and group B. A large number of fibrous tissue appeared around the implanted bone and new bones were formed. In group C, the lyophilized bone resorption was still not obvious, the new bone formation was significantly slower than the other two groups. There was no difference between group A and group B.CONCLUSIONS:Both allogeneic bone marrow mesenchymal stem cells and autologous mesenchymal stem cells could accelerate the bone formation.

BACKGROUND:Al ogeneic bone has anatomical appearance and biological features similar to autogenous bone, which is an excel ent biological scaffold material. Mesenchymal stem cel s originating from autogenous bone marrow have mutli-lineage differentiation potential, can differentiate into osteoblasts and chondrocyte, and thus can accelerate the formation of bone tissue and cartilage tissue. OBJECTIVE:To establish the osteogenic ability of al ogeneic bone with autogenous bone marrow mesenchymal stem cel s for repairing major mandibular defects. METHODS:The left mandibular teeth of 24 beagles were extracted, and at 2 months after wound healing, mandibular defects were made artificial y. The beagles were divided into two groups:control group treated with lyophilized al ogeneic bone, and experimental group with autogenous bone marrow mesenchymal stem cel s and lyophilized al ogeneic bone. Densitometry with CT and Micro-CT was conducted 4, 12, and 24 weeks after surgery. RESULTS AND CONCLUSION:Compared with the control group, the bone density of the mandible was significantly higher in the experimental group at 12 weeks after transplantation (P<0.05). Over time, the bone densities in the two groups were both increased, but the bone density in the experimental group was always higher than that in the control group. Bone structure parameters were progressively increased or decreased in the two groups, especial y in the experimental group. At 24 weeks after surgery, the degree of trabecular separation in regions of interest was higher in the experimental group than the control group (P<0.05), but the bone volume fraction, number of trabecular bone, and bone trabecular thickness were significantly lower in the experimental group than the control group (P<0.05). These findings indicate that bone marrow mesenchymal stem cel s are capable of accelerating the reconstruction of al ogeneic bones.

PURPOSE To evaluate the effect of computer-aided surgical techniques in surgical treatment of cranio-maxillofacial fibrous dysplasia. METHODS Twenty-two patients from January 1999 to December 2012 with cranio-maxillofacial fibrous dysplasia were treated in our department. According to the patients' specific conditions, surgeons designed surgical programs, and used computer-assisted surgical techniques to produce skull model and navigation template individually. The effects after surgery were evaluated. RESULTS Twenty-two patients with resection of the bone lesions restored facial symmetry partially. The patients were followed up for 3 to 36 months, and the treatment effects were satisfactory. CONCLUSIONS With preoperative planning, intraoperative navigation and postoperative prediction, computer-aided surgery shows its great value in improving the accuracy of cranio-maxillofacial surgery, shortening operating time and restoring facial symmetry. It is regarded as a valuable and safe surgical technique in cranio-maxillofacial surgery. Supported by Beijing Natural Science Foundation (7112124).

Objective Massive bone allografts are frequently used in orthopedic reconstructive surgery, but carry a high failure rate of approximately 25%. We tested whether treatment of graft with mesenchymal stem cells (MSCs) can increase the integration of massive allografts (hemi-mandible) in a large animal model. Methods Thirty beagle dogs received surgical left-sided hemi-mandibular defects, and then divided into two equal groups. Bony defects of the control group were reconstructed using allografts only. Those of the experimental group were reconstructed using allogenic mandibular scaffold-loaded autologous MSCs. Beagles from each group were killed at4 (n = 4), 12 (n = 4), 24 (n = 4) or 48 weeks (n = 3) postoperatively. CT and micro-CT scans, histological analyses and the bone mineral density (BMD) of transplants were used to evaluate defect reconstruction outcomes. Results Gross and CT examinations showed that the autologous bone grafts had healed in both groups. At 48 weeks, the allogenic mandibular scaffolds of the experimental group had been completely replaced by new bone, which has a smaller surface area to that of the original allogenic scaffold, whereas the scaffold in control dogs remained the same size as the original allogenic scaffold throughout. At 12 weeks, the BMD of the experimental group was significantly higher than the control group (p<0.05), and all micro-architectural parameters were significantly different between groups (p<0.05). Histological analyses showed almost all transplanted allogeneic bone was replaced by new bone, principally fibrous ossification, in the experimental group, which differed from the control group where little new bone formed. Conclusions Our study demonstrated the feasibility of MSC-loaded allogenic mandibular scaffolds for the reconstruction of hemi-mandibular defects. Further studies are needed to test whether these results can be surpassed by the use of allogenic mandibular scaffolds loaded with a combination of MSCs and osteoinductive growth factors.

下颌骨是唯一能活动的面颅骨,是构成面下1/3形态的骨性基础,是牙齿和舌等重要组织的支持结构.肿瘤切除、创伤及感染等因素常造成下颌骨缺损,导致面部畸形和相应功能障碍.多年以来,大块下颌骨节段性缺损的修复一直是困扰颌面、头颈及整形等多个学科的难题.

Understanding the microanatomy of the facial nerve is vital to functional restoration of facial nerve injury. This study aimed to locate the spatial orientation of five branches in the extratemporal trunk of the rat facial nerve (ETFN). Fifteen adult Sprague-Dawley albino rats were divided randomly into five groups corresponding to the five facial nerves. Fluoro-Gold(™) (FG) was applied to one branch in all three rats in each group. The trunk of the facial nerve was cut at three points for fluorescence detection. Staining results showed that each branch of the facial motor nerve had a topographical orientation in the distal part of the ETFN. The temporal branch was located in the medial and acroscopic quadrant of the nerve trunk. The zygomatic branch was located in the lateral and acroscopic quadrant. The buccal branch occupied the upper half of the nerve trunk, whereas the mandibular branch occupied the lower half. The cervical branch presented a square-shaped distribution in the lateral nerve trunk. In the middle part of the ETFN, the topographical orientation remained clear, but the FG-labeled zone was extended to some extent. In the stylomastoid foramen region, all branches diffused, thereby blurring the orientation. In conclusion, each branch of the facial motor nerve had a topographical orientation and distribution in the crotch and middle part of the ETFN, but the branches diffused near the stylomastoid foramen.

Objective The aim was to study the feasibility of the chin augmentation with the bone from the mandible angle osteotomy.Methods Two parts were including in the article.The first part was animal experiment.The chinese miniatrue pigs were performed the operations of mandible angle osteotomy.The mandibular angle bone was transplanted freely on the pig's mental fixed with titanium nail.After the procedure,the effects were assessed by three dimensional computerized tomography.The second part was the applications in clinique.46 patients were obtained the operations of the mandible angle osteotomy and chin augmentation with the bone from the mandibular bone.The patients were followed up and checked by X-ray.Results The bones grafted were absorbed totally in animal experiments.Over 50% resorption of the free bone grafts took place in 73.9% of the patients in clinic.Conclusions From the animal experiment and experience in clinic,we consider that the chin augmentation with free bone grafts from mandible angle osteotomy need to be performed prudently.

Objective To explore a new method for the reconstruction of the orbital bursting fracture and orbital floor defect.Methods Totally 6 cases received the operation.During the operation,the subciliary approach was made to expose the orbital floor defect,then the entrapped or prolapsed orbital tissues were repositioned under direct vision.Through a hairline incision,a 3cm×5 cm deep temporal fascial strip was cut.A titanium mesh was shaped to fit the defect and embedded with the deep temporal fascial strip.Then the complex was implanted into the orbit and repaired the orbital floor defect.Results All the operations had been done successfully with no complications.The follow-up time was 6 months.The globe appearance and motor function were satisfied.Conclusion This study has demonstrated that titanium mesh combined with deep temporal fascia is an ideal method for the reconstruction of orbital floor defect.

目的 评价重组人p53腺病毒(tad-p53)注射液联合手术、放射线治疗口腔鳞癌的疗效及安全性.方法 对自2005年1月至2008年4月,在解放军总医院手术后接受rAd-p53注射液结合放射线治疗的10例舌癌、12例牙龈癌患者及手术后仅接受单纯放疗的12例舌癌、14例牙龈癌患者进行回顾性调查,并对其疗效及不良反应进行定期复查或电话随访,分析tad-p53注射液结合放射线治疗的疗效及安全性.结果 rAd-p53注射液联合手术、放疗对舌癌、牙龈癌疗效满意,3年局部复发率分别为0%、8.3%,较仅接受放疗的对照组局部复发率(25%、28.6%)明显偏低.除注射药物后 发热及注射部位疼痛外,无其他严重不良反应,疗效优于仅接受放射治疗患者.结论 rAd-p53注射液联合手术及放疗治疗舌癌、牙龈癌安全、有效.

OBJECTIVE:To study the clinical characteristics and the treatment of periorbital injuries.METHODS:61 cases were treated, including 30 cases orbitozygomatic fracture, 6 cases of frontal-orbital fracture, 8 cases of naso-ethmoid-orbital fracture, 7 cases of blow -out fracture and 10 cases of complicated fracture. The patients were diagnosed after physical examination and other examination, like CT. Through bicoronal or local mini incision at the end of eyebrow, combined with subciliary incision and local wound approach, the fractured sites were exposed completely. Then the fractured fragments were repositioned and fixed rigidly. The orbital wall was reconstructed with titanium net and Medpor.RESULTS:The wounds healed primarily. Good cosmetic and functional results achieved in most of the patients. 4 cases underwent second-stage ophthalmectomy. 2 patients had diplopia after operation, but improved gradually. 3 cases of blepharoptosis needed further treatment.CONCLUSIONS:Early diagnosis and treatment is very important for periorbital injuries. Fracture reposition and orbital wall reconstruction should he performed at early period.

>严重全颜面骨折涉及面颅骨多个部位,不仅危及患者的生命,而且对颅面功能和外观常产生巨大影响。自2004年2月至2007年2月,我科共收治40例此

Objective To explore the repair of the open compound wounds in lower extremities caused by multiple factors. Methotis Transplantation of cutaneous.musculo-cutaneous or greater omentum flaps were applied to 155 patients of open compound lower extremity wounds. Results The wound healing rate following first operation was 50% and that following two operations was 14.8%.While the wounds were healed in 7.7% of patients after three operations. Conclusion Transplantations of cutaneous,musculo-cutaneous or greater omentum flaps ale effective to repair and reconstruct the open compound lower extremity wounds.

Objective To explore the time and method for the reconstruction of the orbitozygomatic fracture.Methods Forty-one patients accepted open reduction and rigid internal fixation in one-stage after the accidents.We chose different operation approaches and fixation methods according to the injuries.Results The postoperative results of all the cases were satisfactory.Follow-up 6 to 12 months,no complications were found.Conclution The fracture of the orbit-zygoma should be reconstructed in one-stage.

目的 探讨咬肌与颅面形态之间的关系,了解咬肌体积与邻近骨骼结构的大小及形态的相关性.方法 对40例要求改变脸型者进行磁共振成像(MRI)测量,人体测量,头部正位、侧位和下颌骨曲面断层X线检查,测量并计算咬肌体积(MsV),测量头长(HL)、头宽(HB)、面长(FL)、面宽(FB)、下颌角间宽(IB)、下颌骨体长(CL)、下颌角切线长(MAL)、下颌角角度(JA),计算颜面形态指数FI(FL/FB)、头颅指数C(IHB/HL).用SPSS11.5软件统计分析MsV与HL、HB、FL、FB、IB、CL、MAL、JA、FI、CI之间的相关性.结果 MsV与JA呈明显负相关,与CI、MAL、IB、FB、HL呈明显正相关,与CL、FL、HB无明显相关性.结论 咬肌肥大可能是方脸面型的成因之一,是影响面型的重要因素。

OBJECTIVE:To investigate a technique for correction of severe microgenia.METHODS:The mandibular symphysis was exposed through intraoral mucous incision. Two parallel osteotomies were performed under mental foramen. The mobilized segments were advanced like two steps and fixed rigidly with miniplate.RESULTS:From June, 2004 to Dec, 2005, 10 cases with severe microgenia were treated with this technique. The duration of follow-up was six months. The mean chin advancement was 1.1 cm and the mean chin vertical increase was 0.7 cm. All the patients healed very well with satisfactory aesthetic result.CONCLUSIONS:With this two-step genioplasty, the chin can be moved to ideal position with a natural appearance. It is a reliable method for severe microgenia.

>在颅颌面外科的实际工作中,颅骨缺损的修复是比较常见的困难课题之一。常见的修复方法有两大类:一是自体骨修复;二是人工修复材料的重建。笔者收集了1995-2004年我院颅颌面外科治疗的创伤后颅骨缺损重建患者84例。根据患者的具体情况,分别采用自体颅骨外板、自体下颌骨外板、钛网及钛合金个性化修复体等方法和材料进行修复重建。现报告如下。

OBJECTIVE:To investigate the causes and the prophylactic for the complications following mandibular distraction osteogenesis using internal distractors.METHODS:From 1997 to 2004, a total of 46 patients (61 sides) suffering from malformations or defects of mandible who underwent mandibular distraction osteogenesis were analyzed. The diseases included hemifacial microsomia in 27 cases, congenital or acquired mandibular hypoplasia and micrognathia bilateral in 8 cases and unilateral in 4 cases, electronical injury or postoperative mandibular defects in 3 cases, Treacher Collins syndrome in 2 cases, obstructive sleep apnea syndrome in 2 cases.RESULTS:Of them, 9 patients had postoperative complications, which included 3 patients had complications associated with distractors, local infection occurred in 2 cases, apertognathia of anterior teeth in 2 case, 2 patients had sinus of the skin of the lower lip. 9 patients had been aggressivly managed and obtained satisfactory results.CONCLUSIONS:The pivotal points to reduce complications are to understand the mechanism of mandibular distraction osteogenesis completely, and to be familiar with the anatomy of mandible and adjacent tissues. It is necessary to treat with it preoperatively and postoperatively.

Objective To explore a new effective and minimally invasive method for correction of inverted nipples. Methods An instrument was made of steel wire, spring and plastic syringe, by use of its elastic distraction, continuously distracted the inverted nipples with the consolidation of 3～6 months. Results All 14 cases were followed up about 6～12 months, only one instrument was replaced 2 weeks after operation because of the steel wire out. All obtained satisfactory results. Conclusion The adjustable elastic distraction is a simple, safe, and effective method for correcting inverted nipples. But a long term follow up is needed.