Objective:To assess regional occult metastases on clinical negative neck node [cN0] in patients with buccal mucosal squamous cell carcinoma. Methods:69 patients (31males and 38 females ) with cN0 buccal mucosa squamous cell carcinoma who underwent a lymph node dissection (at the Department of Oral and Maxillofacial Surgery, Affiliated Stomatological Hospital, Nanjing University Medical School) between 1992 and 2004, were retrospectively reviewed. The patients ranged in age from 31 to 79 years with a mean age of 58.2 years. All patients received radical neck dissection(RND), functional neck dissection (FND) or supraomohyoid neck dissection (SOND). Results:The incidence of occult metastases for patients with cN0 buccal mucosa squamous cell carcinoma was 14.49% (10/69).The distribution of the positive nodes was as follows: Level I,10.14%(7/69); Level II, 5.80% (4/69); Level III, 2.90%(2/69). The occult metastasis rate for patients with T1, T2, T3 and T4 was 9.52% (2/21), 15.38%(6/39), 25.00%(1/4), and 20.00%(1/5), respectively. In patients with well differentiated carcinoma,the occult metastasis rate was 14.89%(7/47); moderate differentiated,10.00%(2/20); and poorly differentiated,50.00%(1/2). Conclusion:The assessment of regional occult metastases for patients with cN0 buccal mucosa squamous cell carcinoma may play an important role in deciding treatment approaches of neck.

Objective:To evaluate the shoulder functions of four groups of patients who underwent different kinds of neck dissections.Methods:40 patients who underwent neck dissection were included,7 patients preserved both accessory nerve and the cervical branches,8 preserved accessory nerve,11 preserved cervical branches and 14 sacrificed both of them.All patients were assessed subjectively at 2 weeks and 6 months after operation,using a questionnaire and an electromyograghy method.Results:The patients whose accessory nerves were preserved had a significant functional rehabilitation of the shoulder,while those who preserved only the cervical branches had a better result than the RND 6 months postoperation.Conclusion: Preservation of the branches from C2-C4 to trapezius muscle during the modified neck dissection should be taken into consideration to improve shoulder functions.

Objective: To evaluate the result of distraction osteogenesis in patients with pretnaxillary deficiency using a self-made tooth-borne distraction device. Methods: A self-made tooth-bome distraction device was used for advancement of the maxillary anterior segment in 28 patients. Results; 26 cases were corrected satisfactorily and have no any complications. In 2 cases the distraction device did not work during distraction. Conclusion: This device can improve the soft tissue profile and correct the space deficiency of the maxilla.

Objective:To investigate the incidence of cervical metastasis of oral and maxillary squamous cell carcinoma(SCC)and to define its impact factors.Methods:A retrospective study of patients with SCC of hard palate and maxillary alveolus treated by surgery from 2002 to 2011.Results:The incidences of cervical metastasis and occult metastasis were 17.2%(11 /64)and 9.8%(5 /51)re-spectively.pT classification and vascular invasion were correlated with cervical metastasis.Occult metastatic risk was significantly higher in pT4 patients.Presence of positive nodes impaired prognosis significantly.Conclusion:Overall and occult metastasis of oral and maxillary SCC were highly associated with pT classification.Routine and synchronous elective neck dissection(END)is recomend for the treatment of T4 lesions while observation is alternative for T1 -T3 lesions.

Objective:To investigate the clinical value of decompression in the treatment of jaw large cystic lesions.Methods:42 patients with jaw large cystic lesions were treated with decompression.Imaging examination was taken and compared before and after the treatment.The influence of frequency of cyst cavity washing on the effect of decompression was observed.Results:3 moths after de-compression the border of the cyst cavity became ambiguous and the size of the cavity reduced.12 months after decompression the size of cyst cavity was stable,when second surgery was taken to remove the left cyst wall.There was no recurrence of the cystic lesion after 1 ~2 year follow-up.Cyst cavity was washed everyday,but the effect and treatment course were not influenced by the daily washing times.Conclusion:Decompression is effective in the treatment of the jaw large cystic lesions.

OBJECTIVETo assess the safety and the accuracy of surgical navigation technology in the resection of severe ankylosis of the mandibular condyle with the middle cranial fossa.

METHODSThe CT scan data was transferred to a Windows-based computer workstation, and the patient' s individual anatomy was assessed in multiplanar views at the workstation. In the operation, the patient and the virtual image were matched by individual registration with the reference points which were set on the skull bone surface and the teeth. Then the real time navigation can be performed.

RESULTSThe acquisition of the data sets was uncomplicated, and image quality was sufficient to assess the operative result in three cases. The operations were performed successfully with the guidance of real-time navigation. The application of surgical navigation have enhanced the safety and the accuracy of the surgery for bony ankylosis of temporomandibular joint.

CONCLUSIONSThe application of surgical navigation can improve the accuracy and safety of surgical excision of the ankylosed skull base tissue.

Anatomic Landmarks ; anatomy & histology ; Ankylosis ; surgery ; Humans ; Skull ; diagnostic imaging ; surgery ; Surgery, Computer-Assisted ; methods ; Temporomandibular Joint ; surgery ; Temporomandibular Joint Disorders ; surgery ; Tomography, X-Ray Computed

Objective To assess the clinical features and therapeutic efficacy of extensive full thickness cheek defects reconstruction with free anterolateral thigh flap.Methods From December,2008 to June,2014,a total of 17 patients underwent simultaneous tumor radical resection and full thickness cheek defects reconstruction with free anterolateral thigh flap.In these 17 patients,12 patients had undergone the reconstruction of full thickness cheek defects with the folded anterolateral thigh flap (two skin islands and an intervening de-epithelialized zone); 5 patients had undergone the reconstruction of full thickness cheek defects with the two separate skin paddles anterolateral thigh flap in one single pedicle.Results All of 17 free anterolateral thigh flaps survived,besides 1 case resulted in partial loss of flap adge due to diabetes.After 3 to 12 months' follow-up,all cases of free anterolateral thigh flap were good in color,shape and texture,and patients were satisfied with oral morphological and functional reconstruction.Conclusion The free anterolateral thigh flap is one of versatile soft tissue flaps in the extensive full thickness cheek defects reconstruction.

5 patients with chronic prolonged mandibular dislocations(CPMD)were examined by CT scan.The patients were treated by manual reduction under general anaesthesia and muscle relaxants.Traction was performed with ligaturing steel wires on fixation titanium screws intermaxillaryly and wrapping up the skull-jaw bone with elastic bandages for 3 weeks.After 1 month,a maximal mouth opening of o-ver 30 mm was noted and no episode of redislocation occurred in 3 -34 month follow-up.

Objective To investigate the effect of adenovirus-bone morphogenic protein 9 ( Ad-BMP9 ) on osteogenic differentiation of immortalized calvarial mesenchymal progenitor cells ( iCALs ) .Methods iCALs were infected with adenoviral vectors encoding BMP-9 or green fluorescent protein ( GFP) and the early osteogenic differentiation was assessed by detecting alkaline phosphatase (ALP) activity after being cultured for 3, 5 and 7 days.14 days after infection, alizarin red S staining was performed to study the formation of osteogenic calcium nodules .The expression of osteogenic marker genes Runx2 and OCN was assessed by quantitative real-time ( RT )-PCR and Western blotting .Results Significant increases in ALP activity and in the expressions of Runx 2 and OCN were detected in BMP-9 treated iCALs compared with GFP-treated cells(P<0.05).Meanwhile, alizarin red S staining showed that more mineralized nodules were found in the BMP-9 induced group .Conclusion BMP-9 can promote the osteogenic differentiation of iCALs .

A patient suffering Madelung's disease was treated and the literatures were reviewed in this article. The cause, the clinical features and treatment were discussed. The cause of this disease is unknown, and it is characterized by symmetrical accumulation of fat around the neck,nape and armpit having a appearance of "horse collar"or "hump back". Histological analysis revealed typical fat tissue depositing around the structures. Surgery is the main means of treatment, and prognosis is good.