Objective To study the allograft effect of two kinds of tissue engineered oral mucosa lamina proprias on skin fullthickness wounds. Methods The cultured Wistar rat oral mucosa fibroblasts (OMF) were incorporated into collag en or chitosancollagen to construct the tissue engineered oral mucosa laminaproprias, and then the OMFs were labeled with BrdU. The fullthickness round skin defects were made with a round knife (diameter, 0.8 cm) on the backs of 36 Wistar rats (2125 weeks old), which were divided into 2 experimental groups: the fibroblastpopulated collagen lattices (FPCL) group (grafted by FPCLs) and the fibroblastpopulated chitosan collagen lattices (FPCCL) group (grafted by FPCCLs), and the control group (only covered with gauges). All the wounds were observed by the naked eyes or the light microscope, and were measured 4, 7, 14, and 21 days postoperatively. Results There were no infection during the wound healing period. At 7 days after the grafting, the wounds in the 3 groups were covered by scab and/or gauze; at 14 days, the gauze and scab on the wounds in the three groups were all replaced by the new epidermis naturally except one scab each in the FPCCL group and the control groups,which was replaced at 17 days.All the centers of the new epidermis were measurable as the pink red points. At 21 days, all the new skins were smooth without hairs, and their color was similar to the normal one. At 4, 7, and 14 days,there was an indication that the wound diameters became significantly smaller in the three groups; but after the 14th day, there was no significant indication of this kind. At 7 days, the wound diameter in the FPCL group was significantly smaller than that in the FPCCL group and the control group (Plt;0.01). Under the lightmicroscope, at 4 days postoperatively, the decayed tissue on the surfaces of the recipient wounds in the FPCL group and the FPCCL group was separated from the lower granular tissue in which there were many inflammatory cells, fibroblasts, and new vessels. There was a similar-phenomenon in the control group. Each skin wound in the three groups was only partly keratinocyted at 7 days postoperativel y. The recipient wounds were wholly keratinocyted with when rete ridges observed at 14 and 21 days, but in the control group the wounds were keratinocyted with no rete ridges. Fibers in the new dermis were thin. The OMFs with Brdu appeared in the granular tissue and new dermis at 4, 7, 14, and 21 days postoperatively, which could be illustr ated by the immunohistochemical staining. The positive OMFs and the granular tissue joined in the repair of the skin defe cts without any allergic reaction during the period of the wound healing. Conclusion The oral mucosa fibroblasts as the new seed cells can join i n the repair of the skin defects effectively and feasibly. The fibroblastpopul ated collagen lattices and the fibroblastpopulated chitosan collagen lat tices can repair skin defects effectively and feasibly, too. And the quality of the new skins was better in the two experimental groups than in the control group.
Objective To evaluate the quality of clinical studies on dentistry from the Chinese Journals. Methods Clinical studies in Chinese Journal of Conservative Dentistry of 2002 were searched. The quality of the clinical studies on assessment of treatments’ efficacy was evaluated. Results Among 204 related studies from 12 issues, there were 93 (45.58%) restrospective intervention studies, 6 randomized controlled blinded trials (2.94%), 42 randomized trials without blindness (20.58%), 20 controlled trials without randomization (9.80%) and 25 clinical observational studies (12.25%). The statistical analysis showed that 20 studies were with inappropriate methods. Conclusions It is necessary to improve the design and statistical analysis of clinical studies on stomatology in China to produce high-quality research evidence.
ObjectiveTo investigate the feasibility of the bipaddled split pectoralis major myocutaneous flap for immediate reconstruction of oral mucosal defects and neck defects after resection of recurrent oral cancer. MethodsSix patients with oral mucosal defects combined with neck defects after recurrent oral cancer resection were treated with bipaddled split pectoralis major myocutaneous flap between September 2013 and September 2014. There were 5 males and 1 female with an average age of 54.7 years (range, 45-62 years), including 4 cases of recurrent tongue cancer, 1 case of recurrent mandibular gingival cancer, and 1 case of mouth floor carcinoma. All patients underwent local recurrence at 8 to 14 months after first operation, with no distant metastasis. The defects of the intraoral mucosa was 4.0 cm×2.5 cm to 6.5 cm×3.5 cm and the defect of the neck skin was 5.5 cm×3.5 cm to 7.5 cm×5.0 cm. The pectoralis major myocutaneous flaps (14.0 cm×3.5 cm to 17.0 cm×5.5 cm) were incised at the level of the 3rd to the 4th rib, and then split down along the muscle fiber till about 2 cm away from the thoracoacromial vessels, forming 2 independent skin paddles with 1-2 branch vessels to the pedicles of the distal ones. The distal skin paddles were used for oral reconstruction while the proximal paddles for repair of neck defects. The chest donor sites were sutured directly. ResultsCervical haematoma and infection happened in 1 patient respectively after operation, and were cured after symptomatic treatment. All 6 split pectoralis major myocutaneous flaps with 12 skin paddles completely survived. All patients were followed up 6 to 18 months (mean, 11 months). One patient died of pulmonary metastasis at 8 months after operation and the other 5 survived without relapse or metastasis during follow-up. The intraoral paddles showed good shape with satisfactory speech function and swallowing recovery. The paddles also healed perfectly on the neck with flat outlooks, and all patients obtained full appearance and free movement of the neck. No fistula formed on the submandibular region and neck. ConclusionThe bipaddled split pectoralis major myocutaneous flap can complete simultaneous immediate reconstruction of oral mucosal defect and neck defect. It is very useful in the treatment of recurrent oral cancer.
Objective To compare the reconstructive method of oral and maxillofacial defect with free tissue flaps. Methods The clinical materials were collected from 1 973 reconstructive cases between January 2000 and June 2004 and analyzed in terms of the distribution of age, gender,disease type, defect location, reconstructive method and the incidence of vascular crisis of free flaps as well as success rate of free flap respectively. SAS 6.12 was adopted for statistical analysis. Results A total of 1 973reconstructive cases includded 764 in middle age (＞45 years to ≤60 years, 38.72%), 527 in old age (＞60 years, 26.71%), 450 young adults (＞28 years to ≤45 years, 2281%), 187 in young age (＞14 years to ≤28 years, 9.48%) and 45 children(≤14 years, 2.28%). The ratio of male to female was 1.5∶1. The ratio of benign to malignancy lesion was 1∶1.94. The tongue defect accounted for 20.63%, followed by mandibular defect(1738%), parotid defect(13.74%)，buccal defect(12.72%), maxillary defect(8.16%), oral pharynx defect (7.60%), floor of mouth defect(5.68%) and others (14.09%). Vascular free flap transfers accounted for 45.82%(90.4), followed by axial flap(38.17%,753), random flap(10.19%,201), avascularizedbone graft (1.52%, 30) and others(4.30%, 85). The most frequently used flap was the forearm flap(594 cases), followed by the fibula free flap(143 cases) and the pedicled pectoralis major myocutaneous flap(369 cases); these three flaps accounted for 56.06% (1 106/1 973).In 47 free tissue flaps(5.20%) having vascular crisis, 30 were saved (63.83%). The success rate of total free tissue flaps was 98.19%(923/940). Conclusion The majority of reconstructive cases of oral and maxillofacial defects is the middle aged andthe old aged male patients with malignancy. The tongue defect accounts for about one fifth of all the cases. The vascularized free flap has a high success rate, so it is a main method for reconstruction of oral and maxillofacial defects. The forearm flap, the fibular free flap and the pedicled pectoralis major myocutaneous flap are the main management for repairing oral and maxillofacial defects.
Objective To investigate cl inical effect and prognosis of the modified sternocleidomastoid (MSCM) myocutaneous flap for reconstruction of tissue defects in patients with oral carcinomas undergoing tumorectomy. Methods From April 2001 to January 2007, 43 patients with large or medium-sized tissue defects because of oral carcinomas radical operation were treated with MSCM myocutaneous flap. There were 31 males and 12 females with an average age of 58.5 years(25-76 years). The disease course was 25 days to 14 months (4.5 months on average). There were 27 cases of well-differentiated squamous cell carcinoma (SC), 14 cases of poorly-differentiated SC, 1 case of rhabdomyosarcoma, and 1 case of adenoid cystic carcinoma. Affected locations were tongue in 25 cases, mouth floor in 11 cases, lower gingiva in 4 cases, and buccal mucous membranes in 3 cases. According to 2002 International Union Control Cancer criterion for cl inical stage, there were 3 cases of stage I, 13 cases of stage II, 7 cases of stage III, and 20 cases of stage IV. Both the ranges of soft tissue defects and the flap were from 4 cm × 3 cm to 8 cm × 6 cm. The vital ity of the flaps and the heal ing of wounds were observed postoperatively. The function restoration of deglutition and dehisce were observed during the follow-up period. Results Necrosis of quarter MSCM myocutaneous flap occurred in 3 cases 1 week after operation, wounds healed by secondary intention after dressing; other flaps were survival. Infection with fluidify occurred at the donor site of 2 cases, wounds healed by incision and drainage; other incision at the donor sites healed primarily. No arterial or venous crisis occurred in all 43 flaps after 48 hours of operation. Thirty-nine patients were followed up for 6 months to 6 years. The 3 patients with buccal carcinoma could open their mouths normally. The function of deglutition and pronunciation were recovered in 24 patients with tongue carcinoma. Only 3 patients needed to have soft diet after operation. In 26 patients who were followed up above 2 years, oral metaplasia of the the skin flaps epithel ium was observed. Four patients and 2 patients recurred and died after 6 months and 1 year of operation, respectively.Two patients received the second operation after 6 months because of the metastatic lymph node, and survived up to now. The 2-year survival rate was 85%. Conclusion MSCM myocutaneous flap is simple to perform and effective in reconstruction of tissue defects for patients with oral carcinomas. It has active effect to recover the function of oral and axillofacial region and elevate l iving qual ity of patients.
【摘要】目的探讨颌下腺移位术对预防急性放射性口腔黏膜反应及口干燥症的临床效果。方法2007年7月2009年6月间选择40例患者进行前瞻性临床对照研究。治疗组20例,在放疗前将颌下腺移位至颊下区。对照组20例不行颌下腺移位术。观察放疗中两组急性口腔黏膜反应,测定放疗前后唾液分泌量的变化,放疗后3个月进行口干燥程度问卷调查。结果治疗组急性口腔黏膜反应明显轻于对照组(Plt;0.05)。治疗组放疗后3个月移位术侧颌下腺摄取、排泌功能均明显较对照好,两组比较有统计学意义(Plt;0.05)。结论颌下腺移位术预防鼻咽癌放疗后口干燥症的临床近期疗效较好,可改善鼻咽癌患者放疗后的生活质量。
Objective To investigate the clinical effect ofthe pectoralis major myocutaneous flap and Ti-plate system in repairing mandibular defects caused by resection of oral carcinoma.Methods From November 2001 to February 2003, 32patients with mandibular defect caused by resection of oral carcinoma were treated. Combined radical neck dissection with resection of gingival and mandible was performed on 11 patients with carcinoma of the lower gingival, combined radical neck dissection with glossectomy and mandibulectory on 13 patients with carcinoma of tongue, combined radical neck dissection with resection of floor of mouthand mandible on 4 patients with carcinoma of floor of mouth, and combined radical neck dissection with resection of cheek and mandible on 4 patients with carcinoma of buccal mucosa, respectively. The defects of mandible were associated with soft-tissue component, the sizes of defect ranged from 5.5 cm×7.6 cm to 8.2 cm×10.5 cm. The defects were reconstructed with 6 cm×7 cm to 9 cm×10 cm pectoralis major myocutaneous flaps and Tiplate system. The effect was studied retrospectively. Results Thirty-two cases were followed for 219 months; 29 cases offlaps survived and 3 cases of flaps partly necrosed (10% or less of the skin paddle). The appearance of face was satisfactory in 27 patients, and slight deformity of face was observed in 5 patients. The occluding relation and masticatory function were recovered well. Opening mouth extents ranged from 2.7 cm to 3.4 cm. No temporomandibular arthrosis relating to operation was found in all cases. Conclusion A combination of thhe pectoralis major myocut aneous flap and Ti-plate system is an ideal method for reconstruction of mandible defects associated with soft-tissue component after radical operation of oral carcinoma.
In the study of oral orthodontics, the dental tissue models play an important role in finite element analysis results. Currently, the commonly used alveolar bone models mainly have two kinds: the uniform and the non-uniform models. The material of the uniform model was defined with the whole alveolar bone, and each mesh element has a uniform mechanical property. While the material of the elements in non-uniform model was differently determined by the Hounsfield unit (HU) value of computed tomography (CT) images where the element was located. To investigate the effects of different alveolar bone models on the biomechanical responses of periodontal ligament (PDL), a clinical patient was chosen as the research object, his mandibular canine, PDL and two kinds of alveolar bone models were constructed, and intrusive force of 1 N and moment of 2 Nmm were exerted on the canine along its root direction, respectively, which were used to analyze the hydrostatic stress and the maximal logarithmic principal strain of PDL under different loads. Research results indicated that the mechanical responses of PDL had been affected by alveolar bone models, no matter the canine translation or rotation. Compared to the uniform model, if the alveolar bone was defined as the non-uniform model, the maximal stress and strain of PDL were decreased by 13.13% and 35.57%, respectively, when the canine translation along its root direction; while the maximal stress and strain of PDL were decreased by 19.55% and 35.64%, respectively, when the canine rotation along its root direction. The uniform alveolar bone model will induce orthodontists to choose a smaller orthodontic force. The non-uniform alveolar bone model can better reflect the differences of bone characteristics in the real alveolar bone, and more conducive to obtain accurate analysis results.