Objective To evaluate the effect of 8% emulsified isoflurane preconditioning on renal ischemia-reperfusion (I/R) injury in rats.Methods Thirty-two male Sprague-Dawley rats,aged 10-13 weeks,weighing 220-300 g,were randomly divided into 4 groups (n =8 each):sham operation group (group S); I/R group;emulsified isoflurane preconditioning group (group E) ; intralipid preconditioning group (group I).Renal ischemia was induced by occlusion of the left renal pedicle for 45 min with atraumatic microclips followed by 3 h reperfusion.8 % emulsified isoflurane and 30 % intralipid 4 ml· kg-1· h-1 were infused intravenously for 30 min followed by 15 min washout before renal UR in groups E and I,respectively.Arterial blood samples were taken at 3 h of reperfusion to determine the concentrations of serum creatinine (Cr),cystatin C (Cys C),TNF-α,IL-6 and IL-10.The animals were then sacrificed and left kidneys were removed and stained with hematoxylin-eosin for microscopic examination and assessment of necrosis of renal proximal convoluted tubules (0 =normal,4 =necrosis of whole segment of proximal convoluted tubules).Results Compared with group S,the serum Cr,Cys C,TNF-α,IL-6 and IL-10 concentrations and severity of necrosis of renal proximal convoluted tubules were significantly increased in groups I/R,E and I (P ＜ 0.05).The serum Cr,Cys C,TNF-α and IL-6 concentrations and severity of necrosis of renal proximal convoluted tubules were significantly lower,while the serum IL-10 concentration was higher in group E than in groups I/R and I (P ＜0.05).There was no significant difference in the indexes mentioned above between groups L and I/R (P ＞ 0.05).The damage to renal tissues was less serious in group E than in groups I/R and L.Conclusion Preconditioning with 8 % emulsified isoflurane can attenuate renal I/R injury by inhibiting inflammatory responses in rats.

To evaluate the clinical effect of digital assisted chimeric deep circumflex iliac artery perforator flap (DCIAPF) in the reconstruction of mandibular composite defects. Methods From January, 2018 to January, 2019, 6 cases of mandibular tumor patients with postoperative defect within side were treated. Preoperative CTA was used to evaluate the deep branches of spin iliac artery.Digital simulation software and 3D printing technolo-gy was taken, vascularized iliac flap of the design guide of bone was made, and the rebuilding effect was simulated. DCIAPF was used to repair the defect of lower jawbone. The donor sites were sutured directly. The patients were fol-lowed-up in outpatient department for 3-6 months to evaluate the recovery of the patient′s shape, jaw height and oc-clusal function, as well as the complications in the donor area. Results Postoperation pathological examination re-sults: ameloblastoma in 2 cases, 4 cases of gingival cancer. The length of cut out ilium was 6.0-13.0 cm, carrying the flap area of 3.0 cm×1.0 cm-6.0 cm×5.0 cm.Six cases of DCIAPF and iliac bone flap survived.The shape, mandibular height and occlusal function were satisfactory.And no obvious complications were found in the donor area. Conclu-sion The blood supply of DCIAPF is rich with enough bone mass and height. The position of terminal skin perfora-tors is invariant. The complications of donor sites is less. With the help of digital technology, the accuracy of mandibular defect repair and the 3-dimensional wound repair can be realized, and provides an advantage condition for subsequent dental implant.It is one of the ideal method of reconstruction of mandibular defect.

Objective:To investigate the clinical application of 3-dimensional CT angiography(3D-CTA) in the repair of mandibular defects with deep circumflex iliac arterial flaps.Methods:From January 2019 to January 2020, 5 patients with postoperative defects of mandibular tumors were treated in the Department of Stomatology of the First Affiliated Hospital of Bengbu Medical College, including 2 males and 3 females. The ages of the patients ranged from 30 to 70 years, with an average of 52 years. CT angiography of both lower limbs was performed before operation. Data were processed using the CT workstation. According to the size and shape of the defect in the recipient site, the 3D model of the deep circumflex iliac arterial flap(DCIA) was constructed. the contour of the DCIA was observed and measured, and the data was recorded, including the diameter of the vassel at the starting point, the angle between the line from the starting point to the anterior superior iliac spine and the line between the bilateral anterior superior iliac spine, and the distance from the starting point to the anterior superior iliac spine. According to the 3D model, a composite tissue flap pedicled with DCIA was designed and prepared for mandibular defect repair. The actual situation during the procedure was compared with the preoperative 3D model simultaneously.Results:The diameter of the DCIA at the starting point was (2.30±0.24) mm. The angle between the line from the starting point to the anterior superior iliac spine and the line between the bilateral anterior superior iliac spine was 39.3°±6.1°, and the distance from the starting point to the anterior superior iliac spine was (5.83±0.24) cm. The shape and position of the DCIA were basically consistent with the three-dimensional model. All the flaps survived well after operation. All the patients were followed up for 3 to 6 months, the bilateral maxillofacial region were basically symmetrical. The postoperative imaging examination showed that the iliac osteocutaneous flap healed well, and the height and width of mandibular alveolar ridge were restored satisfactorily. There were no complications such as numbness in the donor site, abdominal hernia and gait abnormality.Conclusions:The 3D model of the DCIA produced by 3D-CTA can accurately locate the position and route of the vessel, clearly display the three-dimensional spatial relationship between the skin, muscles and bones around the target blood vessel, and significantly reduce the complications and operative time.

Objective:The aim of this study was to explore the application of maxillary osteotomy plate and positioning guide plate in maxillary Le Fort Ⅰ osteotomy to eliminate the postoperative error caused by condylar displacement.Methods:Patients suffered from skeletal malocclusion and needed Le Fort Ⅰ osteotomy between January 2018 and November 2020 were selected from the Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Bengbu Medical College. All patients were scanned with 64 slice spiral CT. The DICOM format data were analyzed using the Simplant software to reconstruct the virtual three-dimensional model of the jaw before operation. Then, the measurement of indexes and the maxillary Le Fort Ⅰ osteotomy were carried out on the virtual three-dimensional model, respectively. 3D-printed osteotomy guide plate and positioning guide plate were used to determine the osteotomy line and the position of maxillary advancement. 3D-printed tooth supported occlusal plate was used to support the mandibular sagittal split and retraction. The differences of 10 indexes between the two groups (virtual operation and surgery) were analyzed by paired t test using SPSS 22.0. Results:A total of 8 patients (5 males and 3 females) needed maxillary Le Fort Ⅰ osteotomy aged from 18 to 39 years old were recorded. The deviation of age in these patients was 24.8. The 3D-printed guide plate and tooth supporting occlusal plate were positioned accurately in surgery. All the operations were successful with primary healing of the incision and stable occlusion, and without joint clicking. There was no significant difference on the 10 indexes between the groups of virtual operation and surgery ( P>0.05). Conclusions:The application of maxillary osteotomy plate and positioning guide plate can effectively and accurately control the three-dimensional movement of the maxilla and improve the precision of maxillary Le fort Ⅰ osteotomy in orthognathic surgery, making the surgical effect highly consistent with the preoperative design.

Objective:To analyze the long-term quality of life of patients with Brown Ⅱ maxillary defect repaired by tissue flap or prosthesis.Methods:Patients who underwent surgery for maxillary malignant tumors in the First Affiliated Hospital of Bengbu Medical College from 2014 to 2017 were selected to investigate the postoperative long-term (>5 years) quality of life using the fourth edition of the University of Washington quality of life questionnaire (UW-QOL). Mann Whitney U test was used to examine the differences between two groups. Results:In this study, 4 cases were lost to follow-up, 9 died, and a total of 46 valid questionnaires were collected, including 24 males and 22 females, aged 19-86 years. There were 26 cases of class Ⅱb/c and 20 cases of class Ⅱd. Tissue flap reconstruction was performed in 29 cases (tissue flap group) and prosthesis restoration in 17 cases (prosthesis group). The score of chewing QOL in the prosthesis group was higher than that in the tissue flap reconstruction group ( Z=-2.787, P=0.005), but the scores of entertainment, swallowing, speech and emotion QOL in the former group were respectively lower than those in the latter group ( Z=-3.185, -2.091, -2.556 and -1.996, respectively, all P values<0.05). In patients with Brown Ⅱb/c defect, the prosthesis repair could improve the chewing QOL score ( Z=-2.830, P=0.005), but no statistically significant differences in other QOL scores between two groups. In patients with Brown Ⅱd defect, the tissue flap reconstruction could improve the scores of pain, entertainment, swallowing and speech QOL ( Z=-2.741, -2.517, -2.320 and -2.843, respectively, all P values<0.05), and the average QOL score in tissue flap reconstruction group was also higher than that of the prosthesis group ( Z=-2.276, P=0.023). Conclusion:For postoperative long-term quality of life, both prosthesis and tissue flap reconstruction can offer satisfactory results in patients with Brown Ⅱb/c defect, and patients with Brown Ⅱd defect repaired by tissue flap reconstruction have better speech and swallowing functions. Tissue flap reconstruction may bring more entertainment and emotional benefits.

Objective:To investigate the clinical application of 3-dimensional CT angiography(3D-CTA) in the repair of mandibular defects with deep circumflex iliac arterial flaps.Methods:From January 2019 to January 2020, 5 patients with postoperative defects of mandibular tumors were treated in the Department of Stomatology of the First Affiliated Hospital of Bengbu Medical College, including 2 males and 3 females. The ages of the patients ranged from 30 to 70 years, with an average of 52 years. CT angiography of both lower limbs was performed before operation. Data were processed using the CT workstation. According to the size and shape of the defect in the recipient site, the 3D model of the deep circumflex iliac arterial flap(DCIA) was constructed. the contour of the DCIA was observed and measured, and the data was recorded, including the diameter of the vassel at the starting point, the angle between the line from the starting point to the anterior superior iliac spine and the line between the bilateral anterior superior iliac spine, and the distance from the starting point to the anterior superior iliac spine. According to the 3D model, a composite tissue flap pedicled with DCIA was designed and prepared for mandibular defect repair. The actual situation during the procedure was compared with the preoperative 3D model simultaneously.Results:The diameter of the DCIA at the starting point was (2.30±0.24) mm. The angle between the line from the starting point to the anterior superior iliac spine and the line between the bilateral anterior superior iliac spine was 39.3°±6.1°, and the distance from the starting point to the anterior superior iliac spine was (5.83±0.24) cm. The shape and position of the DCIA were basically consistent with the three-dimensional model. All the flaps survived well after operation. All the patients were followed up for 3 to 6 months, the bilateral maxillofacial region were basically symmetrical. The postoperative imaging examination showed that the iliac osteocutaneous flap healed well, and the height and width of mandibular alveolar ridge were restored satisfactorily. There were no complications such as numbness in the donor site, abdominal hernia and gait abnormality.Conclusions:The 3D model of the DCIA produced by 3D-CTA can accurately locate the position and route of the vessel, clearly display the three-dimensional spatial relationship between the skin, muscles and bones around the target blood vessel, and significantly reduce the complications and operative time.

Objective:The aim of this study was to explore the application of maxillary osteotomy plate and positioning guide plate in maxillary Le Fort Ⅰ osteotomy to eliminate the postoperative error caused by condylar displacement.Methods:Patients suffered from skeletal malocclusion and needed Le Fort Ⅰ osteotomy between January 2018 and November 2020 were selected from the Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Bengbu Medical College. All patients were scanned with 64 slice spiral CT. The DICOM format data were analyzed using the Simplant software to reconstruct the virtual three-dimensional model of the jaw before operation. Then, the measurement of indexes and the maxillary Le Fort Ⅰ osteotomy were carried out on the virtual three-dimensional model, respectively. 3D-printed osteotomy guide plate and positioning guide plate were used to determine the osteotomy line and the position of maxillary advancement. 3D-printed tooth supported occlusal plate was used to support the mandibular sagittal split and retraction. The differences of 10 indexes between the two groups (virtual operation and surgery) were analyzed by paired t test using SPSS 22.0. Results:A total of 8 patients (5 males and 3 females) needed maxillary Le Fort Ⅰ osteotomy aged from 18 to 39 years old were recorded. The deviation of age in these patients was 24.8. The 3D-printed guide plate and tooth supporting occlusal plate were positioned accurately in surgery. All the operations were successful with primary healing of the incision and stable occlusion, and without joint clicking. There was no significant difference on the 10 indexes between the groups of virtual operation and surgery ( P>0.05). Conclusions:The application of maxillary osteotomy plate and positioning guide plate can effectively and accurately control the three-dimensional movement of the maxilla and improve the precision of maxillary Le fort Ⅰ osteotomy in orthognathic surgery, making the surgical effect highly consistent with the preoperative design.

Objective: To investigate the effect of elective neck dissection on the 5-year survival rate of patients with early oral squamous cell carcinoma. Methods: The data of 100 patients with early oral squamous cell carcinoma (cT1-2N0M0) were retrospectively analyzed. In 61 cases, the primary tumor was subjected to elective neck dissection (END). Neck observation and follow-up (NOF) were performed in 39 cases with enlarged resection of primary lesions. Clinicopathological data such as pT staging, pathology classification,the rate of cervical lymph node metastasis and the 5-year survival rate of the patients were statistically analyzed. Results: The 5-year survival rates of the END and NOF groups were 86.9% and 69.2%, respectively, and the difference was statistically significant (P=0.028). END treatment was significantly better than NOF in controlling cervical lymph node metastasis in early oral squamous cell carcinoma (P=0.009). After stratified analysis of histopathological features, the 5-year survival rate of patients with pathological T2 (pT2) stage OSCC in the END group was significantly higher than that in the NOF group (P=0.020). The 5-year survival rate of patients with moderate and poorly differentiated pathological grade OSCC in the END group was significantly higher than that in the NOF group (P=0.013). Conclusion END is effective for the management of the cervical lymph node metastasis rate in early OSCC patients. For patients with pT2 stage or low differentiation pathological grade, active END can significantly improve the 5-year survival rate.