砄bjective:To study the effects of superlong pedicled latissimus dorsi muscle transplantation (SPLDMT) in the treatment of facial paralysis.Method: 16 cases of unilateral long standing facial paralysis were treated with SPLDMT in 1991～1998;follow up was conducted and the effects were analysed. Results:After operation satisfied movement recovery of the facial muscles was observed in 12 and improvenent in 3 of the 16 patients,no change was found in only 1 case. Conclusion: SPLDMT is effective in the treatment of unilateral long standing facial paralysis.

Objective:To evaluate functional recovery of nerve and muscle after end-to-side neurorrhaphy.Methods:10 SD rats were randomly and evenly devided into group A and group B.Right common peroneal nerve was amputated in all the rats.Then the distal stump was sutured to the ipsilateral tibial nerve by the end-to-side way through a epineurial window in group A. The right common peroneal nerve was severed in group B as denervated control.After 1.5 months all the rats were subjected to walking track analysis,histological and ultrastructure observation.Results:In group A peroneal nerve index (PFI) achieved -41.634,density of collateral axons 51.437?12.041/1 000 ?m 2,synapsin (SYP) 439?120.5.In group B PFI was -100,SYP 0. In normal control PFI was 0, density of collateral axons 18.847?1.078/1 000 ?m 2,SYP 842?84.7.Conclusion:End-to-side neurorrhaphy may induce nerve sprout plenty of collateral axons.The axons can reach target muscle to reconstruct functional neuromuscular junction,and recover the function of the muscle in some degree.

To evaluate the incidence of sub-clinical neck metastasis and its surgical treatment in patients with oral squamous cell carcinoma (OSCC) without clear evidences for lymph nodes metastasis, a total of 205 patients with OSCC in N0 and N1 stage(UICC 1987′s classification) were included in the study.Their clinical and histopathological files were retrospectively studied and patients were followed up after operation. Histopathological positive lymph nodes were found in 10.8%(13/120) of patients,and postoperative lymph nodes metastasis occurred in 16.5%(14/85) of patients without neck dissections.There were no significant differences between N0 and N1 groups.Neck recurrence occurred in 11.9%(5/42) of patients after functional neck dissections.The rate was higher in patients with bucal lesions.Patients undergoing radical neck dissections also had neck recurrence with an incidence of 6.4%.But most of them occurred on contralateral side. It suggested that subclinical metastasis of OSCC with clinically negative neck lymph nodes could not be neglected.Functional neck dissection should include the lymph nodes of level Ⅲ,especially for cancers located on bucca mucosa and tongue.Bilateral neck dissection is necessary for large primary lesions spreading to the contralateral side.

Objectives: To study the treatment outcome of mucoepidermoid carcinoma(MEC).Methods:128 cases of MEC with definite pathologic diagnosis treated in our hospital during the past 15 years were investigated. The relationship between the effects of the therapy and the prognosis was analysed.Result:Treatment with surgical operation only was used in 99 cases,radiotherapy after operation was applied in 26 cases and follow-up was carried out in 76 cases. 5-year survival rate was 90.7%.5 patients who died within 5 years after operation were all with the diagnosis of MEC in clinical stage Ⅳand poor differentiaton.Conclusion:The local extensive excision for the well differentiated MEC,the radiotherapy after operation for poorly differentiated or that of clinical stage Ⅳ,especially in maxilla,may increase 5-year survival rate.Since there were cases of recurrences of MEC 13 years after surgical treatment,long-term follow-up is necessary.

Objective:To evaluate the effect of iliac bone graft and radial forearm flap in the reconstrucion of maxilla.Methods:Maxilla defects were reconstructed using iliac bone graft and radial forearm flap in 4 patients.The effects were evaluated clinicaly.Results:In all the 4 cases,palatal defects resulted from maxillectomy were optimally reconstructed with non-vascularized iliac graft and radial forearm flap.The masticatory function of the upper jaw,intelligible speech,swallow and natural facial appearance were recovered.As a result,quality of life of the patients was improved.Conclusion:Iliac bone graft and radial forearm are feasible in the reconstruction of maxilla defects.

?Objective: To study the methodology of the culture of Schwann cells derived from degenerated peripheral nerve. Method: Sciatic nerve of adult rats was surgically cut. 14 days after operation, the degenerated nerve tissue was obtained and treated with trypsin and collagenase typeⅡ to prepare single cell suspension,the cells were purified by different speed of attachment and digestion, and incubated on ZQ membrane in the presence of 10 -5 mol/L cytosine arabinoside. The growth of the cells of passage 2 was studied by MTT assay. Schwann cells were identified with anti S100 immumohistochemistry. Results: The cultured cells were spindly in shape and 95% of them were S100 positive. The population doubling time of passage 2 cells was 72 h.The cells attached and stretched on ZQ membrane as well as on the culture vessel surface. Conclusion: Schwann cells can be cultured and purified by predegeneration of the peripheral nerve,different speed of attachment and digestion and the presence of cytosine arabinoside. The cells can grow well on ZQ membrane.

Objective: To sammarize the methodology of the treatment of alveolar cleft by autogenous cancellous bone graft obtained with mini incision(ABGM).Methods: 22 cases of alveolar cleft received ABGM by one operator. The cleft area was restored with autogenous cancellous bone from iliac crest by cylinder osteotomes for extraction of bone transplants(COEBT) with mini incision. All the patients were follow up for at least six months postoperatively. The result of the bone grafting was evaluated on the radiographs. Results: ①The overall survival rate of ABGM was 95.8%,and clinical successful rate was 91.7%;②The successful rate of ABGM in group of patients above 18 year old, or with complete cleft palate or bilateral cleft lip and palate was lower than that in other groups.③The wound for extracting autogenous cancellous bone from iliac crest by COEBT with mini incision was smaller than that by osteotomy. Conclusion: ABGM with COEBT is an effective way in the treatment of alveolar cleft. The successful rate of ABGM is related with the age and cleft style of the patients.

Objective :To study the effects of NO precursor, L-arginine(L-Arg) and constitutive nitric oxide synthase(cNOS) inhibitor, L-nitroarginine(L-NNA)) on the expression of cNOS in facial nerve and surrounding tissues in traumatic facial paralysis rats. Methods:Facial paralysis was surgicaly created by impact in 57 SD rats. The rats were divided into 3 groups with 18 in each group, another 3 rats were used for morphological study. L-Arg at 40 mg/kg or L-NNA at 50 mg/kg were intraperitoneally injected into rats 2 times a day, from 4 days before untill 14 days after surgery(group L-Arg and group L-NNA). In control group(NS) same volume of normal saline was given to the rats after creation of facial paralysis. The facial nerve and surrounding tissue samples were obtained at different time. Immunohistochemical ABC method was used to examine cNOS and inducible NOS (iNOS) expression in facial nerve and surrounding tissues. Results:cNOS immunoreactivity was observed in traumatic facial nerve in L-Arg group 7 days after trauma and in the adjacent muscle in the 3 groups from 6 h to 3 d after trauma. iNOS was found in the paralyzed nerves from 1 d to 7 d after trauma in the 3 groups, and in the adjacent tissues from 6 h to 3 d after trauma in the 3 groups. Conclusions:L-Arg may stimulate constitutive NOS expression in facial nerve and probably promote the nerve regeneration.

Objective To investigate the causes and preventive measures for failure and complications of minimally invasive percutaneous nephrolithotomy (mPCNL). Methods From January 2005 to October 2008,totally 353 cases of mPNCL were performed in our hospital. Among the cases,30 patients experienced failure of the surgery or postoperative complications. The data of the 30 patients were analyzed retrospectively in this study. Results Of the 30 cases,puncture failure occurred in 5 patients,while 2 of them were converted to open surgery,and the other 3 were treated by a second puncture successfully; Zebra wire extrusion was found in 5 cases,who were then cured by re-puncture or a second operation; in 3 patients,the wire or PCN tube was moved into the renal vein (2 cases) or the colon (1 case) without causing bleeding or intestinal fistula,the cases were cured afterwards by a second operation; 3 patients developed hydrothorax and then was cured by chest drainage; postoperative arteriovenous fistula was detected in 2 patients,who were cured by interventional therapy; in 5 days after the operation,one patient developed massive hemorrhage from the PCN tube when driving cars,and then recovered by clipping the PCN tube and hemostasis; another patient showed hemorrhage and infection due to extraction of the PCN tube,and open surgery was carried out to cure this patient. Conclusions Failure of puncture and Zebra wire extrusion are most common causes of failure of mPCNL. Whereas,post-mPCNL complications is often caused by unskillful surgeons or noncompliant patients.

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