OBJECTIVETo evaluate the feasibility and outcomes of chimeric deep circumflex iliac artery perforator flap (DCIAPF) applied in the simultaneous reconstruction of the oromandibular defect.

METHODSSix patients underwent simultaneous oromandibular reconstruction using DCIAPF following segmental mandibulectomy in Xiangya Hospital from March 2014 to July 2014. The skin paddle was designed to be centered on the pre-operative perforator mapping. Retrograde dissection was performed through the underlying abdominal wall to raise the skin paddle. The pedicle was isolated from the groin, and the iliac crest was cut. The deep iliac circumflex vessels were dissected until the skin paddle was reached. Finally, the donor site was strictly sutured layer by layer to avoid ventral hernia.

RESULTSThe skin paddles ranged from 3.5 cmx5.0 cm to 7.0 cmx 10.0 cm. The length of the bone components was 5.0 cm to 11.0 cm. All donor sites closed primarily without skin grafting. DCIAPF was harvested successfully in five patients, except for one patient whose perforator originated from the superficial iliac circumflex vessels. An additional pair of anastomoses was performed. All iliac flaps survived. However, slight skin-edge necrosis and exfoliation caused by flap thinning occurred in one patient and healed after pruning and dressing change. The heights of all alveolar ridges were significantly restored, and no serious donorsite complication was observed during the three to six months' follow-up.

CONCLUSIONDCIAPF is a reconstructive option for mandibular defects because of its adequate bone tissue and rich blood supply. Satisfactory alveolar ridge restoration greatly facilitates future denture retention. DCIAPF also has a great degree of mobility between the skin paddle and the bone component when appliedin composite oromandibular defect reconstruction.

Humans ; Iliac Artery ; Ilium ; Mandible ; surgery ; Maxillofacial Abnormalities ; surgery ; Perforator Flap ; Reconstructive Surgical Procedures ; methods ; Skin

Objective To investigate the management of difficult recipient vessel preparation in microsurgical reconstruction for oral and maxillofacial defects with free flaps and to assess the clinical outcome.Methods A total number of 739 patients with oral and maxillofacial defects underwent consecutive free flap reconstruction with 761 free flaps from May,2012 to May,2015.There were 37 patients who could not find or lack of proper recipient vessels for microvascular anastomosis during operation.Among them,22 were recurrent oral cancer after tumor ablation,10 of them undrewent post-operative radiotherapy;5 were second primary oral cancer,7 diagnosed with osteoradionecrosis,and 3 suffered from oral and maxillofacial defect and deformity caused by trauma or inflammation.Forty free flaps including 23 anterolateral thigh flaps (ALT),10 fibular flaps and 7 radial forearm flaps were harvested.Methods and techniques used during the operation,instant patency rate after anastomosis,the overall survival rate of free flaps,and post-operative complications were recorded.Results Ninety-one anastomoses were performed between 87 pairs of vessels in 37 patients.Fifty recepient vessels were located on ipsilateral side of neck,and the most frequently used recipient vessels were those preserved or not being damaged in former operation and radiation,former transferred free flap vascular pedicles and residual ends of the ligated vessels.Thirty-seven recepient vessels were found on the contralateral side of neck.Thirty-one cases of long-pedicle flap harvesting,2 cases of vein and artery grafting,4 cases of vessel transposition,5 cases of phleboplasties,9 cases of end-to-side anastomoses,and 1 case of flow-through technique were applied in recipient vessels preparation alone or in combination.The patency rate of anastomosis during operation was 100％ and the overall survival rate of free flaps was 97.5％.Conclusion Recurrent oral cancer after tumor ablation,second primary oral cancer,osteoradionecrosis and deformity caused by trauma and inflammation are the main reasons of unsuitable recipient vessel conditions in microsurgical reconstruction for oral and maxillofacial defects.Methods including long-pedicle flap harvesting,venous grafting,vessel transposition,phleboplasty,end-to-side anastomosis and flow-through technique applied alone or in combination are still reliable choices for management of neck difficult recipient vessel preparation and anastomosis.

The role of multidisciplinary collaborative diagnosis and treatment (MDT) in improving the prognosis of colorectal cancer, lung cancer, breast cancer and other tumors has been proven, but the research of oral cancer MDT is still in the exploratory stage and has not formed a complete conceptual system and operating mode. Oral squamous cell carcinoma (OSCC) is one of the main malignant tumors of the head and neck, with a 5-year survival rate of less than 50%. This article mainly elaborates on the difficulties of oral cancer treatment, the advantages of MDT, and the progress of oral cancer MDT.

Head and neck squamous cell carcinoma (HNSCC) is the most common pathological type in head and neck tumor. It can evade immune response through various mechanisms such as immune tolerance, immune escape, high expression of immune checkpoint molecules in tumor cells and T cell signal destruction. In recent years, immune checkpoint inhibitor therapy has made a breakthrough in HNSCC patients. From second-line therapy to first-line therapy in recurrent and metastatic HNSCC, then adjuvant therapy in locally advanced HNSCC patients, several clinical studies of immune checkpoint inhibitors (ICIs) therapy have been showed good therapeutic effects. In addition, a variety of combination therapies such as ICI combination with targeted therapy, ICI, radiotherapy and other methods currently being studied. However, the beneficiaries of immune checkpoint inhibitors are still unclear, and how to effectively combine immune checkpoint inhibitors with chemotherapy, radiotherapy, targeted therapy and surgery is currently being explored. In the period of individualized treatment, the treatment strategies for HNSCC are experiencing new changes, facing more options and challenges. In this article, we will review some major clinical studies of immune checkpoint inhibitor therapy in squamous cell carcinoma of the head and neck in recent years.

Objective:To investigate the diagnostic value between CBCT and MSCT in the styloid process syndrome. Method:One case with styloid process syndrome is selected examination of CBCT and MSCT in the patient's position of styloid process. The length and the angle of the styloid process in the picture of CBCT and MSCT were measured and had a construct with each other. Result:MSCT is slightly clearer than CBCT in the imaging of styloid process, but there is no obvious difference in the length and angle measurement of styloid process between them. Conclusion:Except for MSCT, CBCT is another important means in the diagnosis of styloid process syndrome, CBCT has a great clinical application value.