BACKGROUND:Bilateral-sagitta-split-ramus-osteotomy (BSSRO) has become a conventional method to correct facial deformities, and the finite element method is a significant way to study biomechanics of the mandible and temporomandibular joint (TMJ) after BSSRO. OBJECTIVE: To establish a precise and high simulation model of mandible containing TMJ after BSSRO with internal fixation, which is the base to study the biomechanics of the mandible and TMJ after BSSRO. METHODS: Spiral CT scan was used to get the data of DICOM that were input into MIMICS to establish the three-dimensional model of the mandible. The three-dimensional model was wrapped into a single closed shel for mesh generation and conversion in ANSYS. Then, the model was input into the ANSYS software for temporomandibular joint reconstruction and simulation of BSSRO and internal fixation. RESULTS AND CONCLUSION: The three-dimensional finite element model of mandible containing TMJ after BSSRO was established using MIMICS and ANSYS. This model had biological similarity and geometric similarity in comparison with the human tissues. The model could undergo various internal fixations through antedisplacement, retroposition and rotational movement of the distal end. Based on different experimental purposes, the established model can apply a load to al parts to study changes in stress and displacement of different tissues after BSSRO and internal fixation, and it also can be used to study the effect of different fixation materials on the rear stability after internal fixation.

Objective: To evaluate the surgical prediction accuracy of Proplan CMF software for zygomatic reduction surgery using L-shaped osteotomy. Methods: Pre-and-postoperative 1-year CBCT data of 26 patients with zygomatic arch hypertrophy were imported in Proplan CMF software during 2014 Jan. to 2016 Jun., the 3D models were reconstructed for simulation of L-shaped osteotomy, characteristic landmarks were selected and 3D point measurement system was established. The measurement result were analyzed by one-way ANOVA. Meanwhile, the overlap color grading charts of preoperative and simulated images were also observed. Results: The facial width, bilateral zygomatic process angle and facial width index were [(128.56±2.72) mm, (106.87±2.53)°, (108.56±3.02)°and 1.41±0.03] in postoperative result, [(129.49±2.26) mm, (108.68±2.40)°, (108.85±3.02)°and 1.42±0.03]in simulated result and [(135.45±2.45) mm, (102.50±2.60)°, (103.41±2.56)°and 1.48±0.05] in preoperative result, with significant difference between preoperative and postoperative result, or between preoperative and simulated result (P<0.05), while no significance between postoperative and simulated result (P>0.05). The soft tissue zygomatic process distance was(153.25±2.58) mm in preoperative result, (150.23±2.76)mm in postoperative result , (149.36±3.27)mm in simulated result, with no significance between any of two groups result (P>0.05). The zygomatic process distance and bilateral zygomatic process tragal distance were (126.35±2.56) mm, (68.75±2.15) mm and(68.86±3.21) mm in postoperative result, showing significant differences compared with preoperative result [(120.16±3.18) mm, (74.58±3.19) mm and(76.14±3.15) mm] and simulated result [(118.86±3.45) mm, (73.85±3.57) mm and(76.87±2.58) mm] respectively(P<0.05), while zygomatic arch distance was not statistically different among the three groups(P>0.05). It indicated that predictive accuracy of facial width, facial width index, zygomatic process angle, soft tissue zygomatic arch distance was high but the soft tissue zygomatic process distance and zygomatic process tragal distance was relatively low. Meanwhile, the color overlay image showed that predictive accuracy was not good in the zygomatic region while the zygomatic arch area was high. Conclusions The predictive accuracy of Proplan CMF software for zygomatic arch hypertrophy is relatively high except for the zygomatic region. Further improvement of the CMF software is needed.

Objective To explore the risk factors of aseptic meningitis (AM) after microvascular decompression (MVD) to provide evidence for preventing the occurrence of AM. Methods One hundred and forty-one patients diagnosed as having trigeminal neuralgia or hemifacial spasm, admitted to our hospital from January 2014 to December 2016, were chosen. A retrospective analysis was performed on these clinical data. Eighteen related factors of AM were analyzed by Logistic regression model. Results The result of single analysis of related factors showed that gender, age, diabetes, operation time, skill level of the operator, injection of dexamethasone, and postoperative dressing time were related to AM after MVD (P<0.05). Multifactor Logistic regression analysis showed that gender (OR=2.920, P=0.015), diabetes (OR=0.200, P=0.026), and non-injection of dexamethasone (OR=7.970, P=0.002) were independent risk factors of postoperative AM. Conclusion The male or diabetic patients have high rate of postoperative AM; and the risk of postoperative AM would be reduced if we inject dexamethasone to the cerebellopontine angle cistern at the end of MVD.

0bjective: To establish a three-dimensional finite element model of mandible and study the transverse displacement of proximal segment after Bilateral Sagittal Split Ramus Osteotomy (BSSRO) with different retrogression amounts during mastication. Methods: DICOM data of a skull model were processed with MIMICS and ANSYS software, reconstructing the 3D model including the teeth and temporomandibular joint in order to simulate BSSRO and evaluate the transverse displacement of proximal segment with different retrogression amounts during mastication. Results: The mean of proximal segment width change were 2.955 mm and 3.490 mm, when retrogression amounts of distal segmentwere 3 mm and 8 mm, respectively.No significant difference between the two groups were found (P=0.131). Meanwhile the displacement color scale of the 3D finite element models showed that the apparent transverse displacement distribution of the proximal segment was measured around the gonial area, decreased from the exterior to the interior. Conclusions The mandibular angle width was significantly expanded right after BSSRO. The masticatory muscle system and single cortical fixation system played an important role in expanding the width of proximal segment. However there was no correlation between the widening effect and retrogression amounts of distal segment of mandible.

Objective To investigate the effect of cervical manual stratified anastomosis and anastomosis with tube stapler on the recent complications in thoracic laparoscopy combined with radical resection of esophageal cancer.Methods From February 2019 to April 2022,a total of 196 patients who underwent endoscopic surgery for esophageal cancer who met the study criteria were divided into the manual group(87 cases)and the tubulostomy group(109 cases)according to the different ways of gastro-esophageal cervical anastomosis.The incidence of cervical surgery time,total operation time,postoperative anastomotic fistula,anastomotic stenosis and other complications of the two groups were evaluated,and the differences in treatment effects between the two groups were compared.Results The preoperative basic conditions of patients in the manual group and the tube kiss group were comparable,and the cervical anastomosis time in the tube kiss group[(23±3.57)min]was shorter than that in the manual group[(31±4.5)min](P＜0.05),but there was no statistical significance in the overall operation time between the two groups(P＞0.05).The comparison of postoperative anastomotic fistula and anastomotic stenosis between the two groups showed that the manual group was significantly lower than the tube kiss group,and the difference was statistically significant(P＜0.05).Conclusion In thoracic laparoscopic combined with esophageal cancer surgery,cervical manual stratified anastomosis can reduce the incidence of postoperative anastomotic complications.

Objective To compare the clinical efficacy and imaging results of uniportal interlaminar endoscopy(UIE)and unilateral biportal endoscopy(UBE)for the treatment of lumbar disc herniation.Methods The clinical information for 50 patients diagnosed with lumbar disc herniation was collected,and treated by UIE endoscopic surgery and UBE endoscopic surgery in the The First People's Hospital of Hefei city from March 2021 to October 2022 were retrospectively analyzed.The patients were divided into two groups,UIE group and the UBE group.Perioperative indexes including incision length,operation time,intraoperative blood loss,and surgical complications,clinical efficacy indexes including VAS scores of low back pain and leg pain before surgery,3 days after surgery,3 months after surgery,6 months after surgery,and 12 months after surgery,ODI scores of dysfunc-tion index,and imaging results including spinal canal area,vertebral space height,before surgery and 1 year after surgery were recorded and compared between the two groups.Results Both groups completed the procedure and were followed up for 12～18 months,with an average of 15 months.1 case was dural injury,no nerve root injury,and no nerve root symptoms during the follow-up.The symptoms of lumbar and leg pain were all relieved in both groups after the procedure.The UBE groups hawed larger surgical incisions,more intraoperative blood loss,and shorter operative time compared to the UIE group(P＜0.05,respectively).Both groups had significant develop-ments in the VAS scores,ODI scores of back,and leg pain at 3 days,3 months,6 months,and 12 months after the operation(all P＜0.05).The UIE group showed significant developments in the VAS scores and ODI scores of back and leg pain at 3 days and 3 months after the operation,as compared to the UBE group(P＜0.05).The imaging analysis did not showed significant changes in the height of intervertebral space and the angle of lumbar lordosis,but a significantly larger increase in the dural sac area in both groups one year after the procedure,and the UBE group had even a larger increase than the UIE group(P＜0.05).Conclusion Both UIE and UBE have good clinical efficacy and imaging results in the treatment of lumbar disc herniation via interlaminal approach.However,the UIE group is superior to the UBE group in terms of the operation time,intraoperative blood loss,postoperative VAS score of low back pain as well as the decompression effectiveness.

Tumor microenvironment (TME) is a dynamic network distributed around tumor cells. Cancer-associated fibroblasts (CAFs), as an important component of the TME, are not only closely related to normal fibroblasts, but also can secrete a variety of substances to participate in the regulation of the TME. Exosomes, one of the substances from CAFs, can promote the formation and development of lung cancer, including promoting the formation of TME, increasing pulmonary tumor cell invasion and metastasis, mediating pulmonary tumor immunosuppression and participating in radiotherapy and chemotherapy resistance. This article reviews the current research status and progress of cancer associated fibroblasts-derived exosomes in lung cancer.
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OBJECTIVES: This study aimed to use modified articular disc anchorage in treating old irreducible temporomandibular joint (TMJ) disc displacement with perforation and rupture, as well as to explore its efficacy. METHODS: A total of 31 patients (34 sides) with 47 TMJ disc perforations who underwent surgical treatment in the Affiliated Stomatolo-gical Hospital of Nanchang University from January 2018 to December 2021 were selected. According to the location of disc perforation, it has five types: posterior disc perforation (typeⅠ), anterior disc perforation (typeⅡ), lateral disc perforation (type Ⅲ), composite disc perforation, and destruction disc perforation. The modified methods of disc anchoring were divided into two types according to the location of the perforation. TypesⅠandⅢ disc perforation were trea-ted by posterior anchoring method. For posterior ancho-ring, a screw was implanted into the posterolateral side of the condylar neck, and the disc was fixed on the screw by horizontal mattress suture. TypeⅡdisc perforation and compo-site disc perforation combined typeⅡperforation were treated by anterior and posterior double-anchoring method. For anterior anchoring, anchor screws or holes were placed at the anterior edge of the condylar neck, and horizontal mattress suture was performed at the posterior edge of the anterior perforation with an anchor wire. The articular disc was then fixed on the anchor screws or holes. For the posterior anchoring method, it was the same as the previous one. Paired t test was used to analyze the visual analog scale (VAS), maximum interincisal opening (MIO), and TMJ disorder index (CMI) of the patient before surgery and 1, 3, and 6 months after surgery. Disk-condyle position relationship by magnetic resonance imaging and postoperative quality of life in postoperative were analyzed. RESULTS: The incidence of perforation was 41.2% (14/34) in typeⅠ, 11.8% (4/34) in typeⅡ, 8.8% (3/34) in typeⅢ, 29.4% (10/34) in composite type, and 8.8% (3/34) in destruction type. The VAS, MIO, and CMI at 3, 6 months after operation significantly improved compared with those before operation (P<0.05). The effective reduction rate of disc was 96.77% (30/31). The quality of life at 6 months after surgery was 47.22±2.13, and the rate of excellent evaluation was 96.4% (27/28). CONCLUSIONS Modified articular disc anchorage achieves a good curative effect for treating temporomandibular joint disc perforation and rupture. Nevertheless, its long-term effect requires further observation.
Humans ; Temporomandibular Joint Disc/surgery* ; Quality of Life ; Joint Dislocations/surgery* ; Temporomandibular Joint Disorders/surgery* ; Magnetic Resonance Imaging/methods* ; Temporomandibular Joint/pathology* ; Mandibular Condyle