Objective To evaluate the clinical outcome of the buccal fat pad flap in reconstruction of defects of the oral mucosa. Methods From May 1998 to July 2004, 42 patients with oral mucodefects were treated with buccal fat pad flap. Of them, there were 26 males and 16 females, aging 25-76 years. The defect was caused by buccal squamous carcinoma in 7 cases, by buccal leukoplakia in 5 cases, by squamous carcinoma of soft palate in 7 cases, by adenoid cystic carcinoma of palate in 8 cases, by carcinoma of maxillary sinus in 6 cases, by maxillo-alveolar angioma in 5 cases and by keratocyst of maxilla in 4 cases. The locations were buccal mucosa, maxillary sinus and soft palate. The size of defect ranged from 3.0 cm×3.0 cm to 6.5 cm×4.0cm.Results Forty-one cases achieved healing by first intention, except one case because of large defect. Edema faded and epithelization occurred after 4 weeks of operation. Complete epithelization was observed after 6 weeks of operation. Thirty-five cases were followed up 3 months to 5 years. Therewere no obvious differences in layers, color, elasticity, and texture between repaired region and adjacent mucosa. Conclusion The buccal fat pad flap is useful in reconstructing the muco-defects (less than 6.5 cm in diameter) of the posterior maxilla and buccal region without considerable complication. The multiplex blood supply, facility in accessing and minimal donor site morbidity make it a reliable soft tissue graft. The main shortcoming is its limited size.
ObjectiveTo systematically evaluate the reliability and stability of transoral endoscopic thyroidectomy vestibular approach (TOETVA) and conventional open thyroidectomy (COT) in the treatment of differentiated thyroid cancer.MethodsThe clinical studies of TOETVA and COT in the treatment of differentiated thyroid cancer were retrieved from major databases including PubMed, Embase, Cochrane Library, Wanfang, and CNKI by computer. The search date ended on March 1, 2020. Two investigators screened the literatures strictly and extracted the data following the pre-defined inclusion and exclusion criteria, and then used RevMan 5.3 software for meta-analysis.ResultsA total of 7 studies including 1 465 patients were included in this meta-analysis. The results showed: compared with the COT group, the operation time of the TOETVA group was longer [WMD=35.18, P=0.000 1], and the number of lymph node dissections in the central area was larger [WMD=1.42, P=0.000 5]. But the intraoperative blood loss [WMD=–5.32, P=0.39], the length of hospital stay after operation [WMD=0.05, P=0.94], the incidences of transient recurrent laryngeal nerve palsy [OR=0.81, P=0.43], transient hypocalcemia [OR=0.55, P=0.35], permanent hypocalcemia [OR=0.39, P=0.22], permanent recurrent laryngeal nerve palsy [OR=1.34, P=0.73], and hematoma [OR=1.29, P=0.69] were not statistically significant between the two groups.ConclusionsTOETVA has a higher stability. Although the COT has a shorter operation time, the former has a higher central lymph node dissection rate, and there is no scar on the neck after surgery and no significant difference in the incidence of postoperative complications.
To evaluate the long-term result of free forearm skin flap in the repair of soft tissue defects of the oral and maxillofacial regions, 26 cases which had received radical resection of maxillofacial tumors were follow-up for 4.5 years. Twenty cases, having complete data were analyzed. In this series, There were 8 males and 12 females, with ages ranged from 40 to 69 years old. The size of the flaps ranged from 4 cm x 5 cm-6 cm x 13 cm. The radial artery and the cephalic vein were used as the donor vessels, and the maxillary artery, superior thyroid artery, external jugular vein and the anterior jugular vein were prepared as the recipient vessels. According to the shape, colour, temperature, sensation, mucosoid degree of the flap, the blood supply and function of hand and the configuration of the forearm, the overall results of the recepient regions in 20 cases were all satisfactory and the overall results of 16 cases donor regions were satifactory in 16 cases. The results were poor in 4 cases. The conclusion were: 1. Free forearm skin flap was worth trying in the repair of soft tissue defects of oral region; 2. The radial artery need not to be reconstructed because of the abandant vascular net-work in the upper limb and 3. The residual scar on the forearm was the main shortcoming, but most of the patients could tolerate it because of the obvious advantages received from the operation.
Objective To systematically evaluate the effectiveness and safety of minimally invasive video-assisted thyroidectomy (MIVAT) and conventional open thyroidectomy (COT) in treatment of thyroid carcinoma without lymph node metastasis. Methods Databases including PubMed, EMbase, The Cochrane Library (Issue 3, 2015), WanFang, CBM, VIP and CNKI were searched to collect the randomized controlled trails (RCTs) and non-RCTs about MIVAT and COT in treatment of thyroid carcinoma without lymph node metastasis. The retrieval time was from inception to October 2015. The studies were screened according to the inclusion and exclusion criterias, and the data was extracted and the quality of studies was evaluated by 2 reviewers independently. Then the Meta-analysis was conducted by using RevMan 5.2 software. Results A total of 13 non-RCTs involving 3 083 cases were included. The results of Meta-analysis showed that: compared with COT group, operative time of MIVAT group was longer (MD=31.36, 95% CI: 27.68-35.03, P<0.05), hospital stay (MD=-0.16, 95% CI: -0.28--0.04, P=0.01) and length of scar (MD=-1.51, 95% CI: -1.63--1.39, P<0.05) of MIVAT group were shorter, but there was no significant difference in the incidences of transient hypocalcemia (OR=1.29, 95% CI: 0.93-1.78, P=0.13), transient laryngeal nerve palsy (OR=1.42, 95% CI: 0.93-2.17, P=0.11), hemotoma (OR=1.21, 95% CI: 0.64-2.29, P=0.56), recurrence (OR=0.61, 95% CI: 0.28-1.33, P=0.22), number of retrieved central lymph nodes (MD=-0.10, 95% CI: -0.98-0.78, P=0.82), and the size of tumors (MD=-0.02, 95% CI: -0.06-0.02, P=0.39) between the 2 groups. Conclusion MIVAT is safe and feasible in treatment of thyroid carcinoma without lymph node metastasis when its indications are strictly controlled.
Objective To explore the feasibility of one-stage repair of hypospadias using the meatalbased flap overlapping with buccal mucosal graft. Methods From March 2002 to May 2004, 21 patients with hypospadias were treated with the meatal-based flap overlapping with buccal mucosal graft. Their ages ranged from 14 months to 8 years. The procedure were as follows:urethralplate at proximal corona was cut to correct glandular tilt and chordee; the buccal mucosa taking from inner cheek was then fixed on tunica albuginea of ventral shaft with suture; and the meatalbased flap was rotated distally and overlaid with buccal mucosal graft to repair urethra.Results All patients were followed up 318 months (7 months on average). A cosmetic glans and a vertically oriented, normal appearing slit meatus were achieved. Two patients had fistulas on lateral corona. Fistula spontaneously healed in 1 case and the other one was repaired after 6months. Conclusion The technique of meatal-based flap overlapping with buccal mucosal graft can completely correct glandular tilt and chordee, prove good cosmetic and functional glans and meatus.
Objective To report 4 methods of reconstructing soft tissue defects in oral and maxillofacial regions after tumors resection using cervical pedicle tissue flaps. Methods One hundred seventy-two soft tissue defects were repaired with cervical myocutaneous flaps after resection of oral and facial cancer( 165 cases of squamous cell carcinoma and 7 cases of salivary carcinoma). The clinical stage of the tumors was stage Ⅰ in 21 cases, stage Ⅱ in 116 cases and stage Ⅲin 35 cases. Primary sites of the lesions were the tongue (59 cases), buccal mucosa (55 cases), lower gingiva (26 cases), floor of the mouth (25 cases), parotid gland (4 cases) and oropharynx (3 cases). Infrahyoid myocutaneous flaps were used in 60 cases, platysma flaps in 45 cases, sternocleidomastoid flaps in 59 cases and submental island flaps in 8 cases. The sizes of skin paddle ranged from 2.5 cm×5.0 cm to 5.0 cm ×8.0 cm. Results Among 153 survival flaps, there were55 infrahyoid myocutaneous flaps, 40 platysma flaps, 52 sternocleidomastoid flaps and 6 submental island flaps. There were 11 cases of total flap necrosis and8 cases of partial flap necrosis. The success rates were 91.67%(55/60) for infrahyoid myocutaneous flap, 88.89%(40/45) for platysma flap, 88.14% (52/59) for sternocleidomastoid flap and 75%(6/8) for submental island flap. After a follow-up of 3 11 years(5.7 years on average) among 101 cases local reccurence in 18 cases, cervical reccurence in 4 cases, distance metastasis in 2 cases. The survical rate at 3 years were 83.17%(84/101). Conclusion Cervical pedicle tissue flaps haveclinical value in reconstruction of small and medium-sized soft tissue defects after resection of oral and maxillofacial tumors.
目的 探讨股前外侧皮瓣用于修复口腔颌面部缺损的护理方法。 方法 对2011年8月－12月行手术治疗的42例口腔颌面部缺损患者使用股前外侧皮瓣修复，重点加强皮瓣血运的观察和血管危象的处理。 结果 39例皮瓣成活，1例皮瓣坏死；2例出现血管危象，经积极抢救后成活。 结论 股前外侧皮瓣修复口腔颌面部缺损术后加强皮瓣血运的观察和血管危象的处理对保证皮瓣成活至关重要。
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.