Perineural invasion (PNI) by tumor cells is a key phenotype of highly-invasive oral squamous cell carcinoma (OSCC). Since Schwann cells (SCs) and fibroblasts maintain the physiological homeostasis of the peripheral nervous system, and we have focused on cancer-associated fibroblasts (CAFs) for decades, it's imperative to elucidate the impact of CAFs on SCs in PNI⁺ OSCCs. We describe a disease progression-driven shift of PNI^- towards PNI⁺ during the progression of early-stage OSCC (31%, n = 125) to late-stage OSCC (53%, n = 97), characterized by abundant CAFs and nerve demyelination. CAFs inhibited SC proliferation/migration and reduced neurotrophic factors and myelin in vitro, and this involved up-regulated ER stress and decreased MAPK signals. Moreover, CAFs also aggravated the paralysis of the hind limb and PNI in vivo. Unexpectedly, leukemia inhibitory factor (LIF) was exclusively expressed on CAFs and up-regulated in metastatic OSCC. The LIF inhibitor EC330 restored CAF-induced SC inactivation. Thus, OSCC-derived CAFs inactivate SCs to aggravate nerve injury and PNI development.
Schwann Cells/metabolism* ; Mouth Neoplasms/metabolism* ; Humans ; Cancer-Associated Fibroblasts/metabolism* ; Animals ; Carcinoma, Squamous Cell/metabolism* ; Neoplasm Invasiveness/pathology* ; Male ; Female ; Mice ; Cell Movement/physiology* ; Cell Proliferation/physiology* ; Cell Line, Tumor ; Leukemia Inhibitory Factor/metabolism* ; Middle Aged

Objective:To investigate the precise reconstruction method of anterior maxillary defect with fibula musculocutaneous flap assisted by digital surgical technology.Methods:The clinical data of the patients with anterior maxillary defect repaired by fibular free flap from January 2014 to January 2020 in Nanjing Stomatological Hospital were analyzed retrospectively. Mimics 23.0 software was used to perform computer virtual surgery using preoperative CT data of patients. Then the design of the focal osteotomy guide plate, fibular plastic guide plate and fibular reduction guide plate as well as the surgical plan was completed. The navigation registration point was designed by the Accunavi-A navigation system. The surgical guide plates were 3D printed. During the operation, the fibular musculocutaneous flap was harvested to cover the defect after resection of the anterior maxillary lesion with the assistance of the surgical guide plate and navigation technology. The facial appearance and function were followed up after operation.Results:A total of 12 cases, 9 males and 3 females, aged from 33 to 56 years, were included. There were 5 cases of gingival carcinoma, 4 cases of ameloblastoma, 1 case of chondrosarcoma, 1 case of mucoepidermoid carcinoma and 1 case of odontogenic myxoma. The size of the defect after resection was 5 cm×4 cm-6 cm×5 cm. In 12 patients, the focal osteotomy guide plate and fibula plastic guide plate were designed accurately, and the fibular reduction guide plate was successfully placed with accurate navigation and no displacement during the operation. The position of transplanted fibula was consistent with the normal maxillary position. The length of fibula was 8 -10 cm, and the size of the fibular free flap was 5 cm× 4 cm-6 cm×5 cm. All fibular musculocutaneous flaps survived. The patients were followed up for 1 to 72 months, with an average of 24.5 months. The patients had clear pronunciation, no oral and nasal reflux during diets, and presented in good facial appearance. No tumor recurrence occurred in 12 patients during follow-up.Conclusions:It is an accurate and feasible method to repair the anterior maxilla defect with fibula free flap assisted by digital surgical technology. The function of oral and nasal closure and speech was well maintained. A satisfactory facial appearance was obtained.

Objective:To investigate the precise reconstruction method of anterior maxillary defect with fibula musculocutaneous flap assisted by digital surgical technology.Methods:The clinical data of the patients with anterior maxillary defect repaired by fibular free flap from January 2014 to January 2020 in Nanjing Stomatological Hospital were analyzed retrospectively. Mimics 23.0 software was used to perform computer virtual surgery using preoperative CT data of patients. Then the design of the focal osteotomy guide plate, fibular plastic guide plate and fibular reduction guide plate as well as the surgical plan was completed. The navigation registration point was designed by the Accunavi-A navigation system. The surgical guide plates were 3D printed. During the operation, the fibular musculocutaneous flap was harvested to cover the defect after resection of the anterior maxillary lesion with the assistance of the surgical guide plate and navigation technology. The facial appearance and function were followed up after operation.Results:A total of 12 cases, 9 males and 3 females, aged from 33 to 56 years, were included. There were 5 cases of gingival carcinoma, 4 cases of ameloblastoma, 1 case of chondrosarcoma, 1 case of mucoepidermoid carcinoma and 1 case of odontogenic myxoma. The size of the defect after resection was 5 cm×4 cm-6 cm×5 cm. In 12 patients, the focal osteotomy guide plate and fibula plastic guide plate were designed accurately, and the fibular reduction guide plate was successfully placed with accurate navigation and no displacement during the operation. The position of transplanted fibula was consistent with the normal maxillary position. The length of fibula was 8 -10 cm, and the size of the fibular free flap was 5 cm× 4 cm-6 cm×5 cm. All fibular musculocutaneous flaps survived. The patients were followed up for 1 to 72 months, with an average of 24.5 months. The patients had clear pronunciation, no oral and nasal reflux during diets, and presented in good facial appearance. No tumor recurrence occurred in 12 patients during follow-up.Conclusions:It is an accurate and feasible method to repair the anterior maxilla defect with fibula free flap assisted by digital surgical technology. The function of oral and nasal closure and speech was well maintained. A satisfactory facial appearance was obtained.

Objective: To analyze the clinical characters and surgical treatment of primary parapharyngeal space (PPS) tumors. Methods: A total of 23 cases of primary PPS tumors which were treated from November 2011 to December 2017 were included for the retrospective analysis in this study. Results: Twenty-three cases of patients with primary PPS tumors were analyzed in this study. Surgical approach was as follows: transcervial approach applied in 7 cases, transparotid approach in 4 cases, transoral approach in 2 cases, transmandibular approach in 4 cases, and the combined approaches on 6 cases. Besides, among 7 cases with upper PPS tumor, we applied the surgical navigation system in the surgery of 3 cases. The mean surgery duration of these cases, 3.5 h, was shorter than unused ones, while the mean maximum size (MMS) of tumors, 5.7 cm, was also larger. So far, 23 cases had no recurrence and metastasis. The most frequent histopathological type of all the cases was pleomorphic adenoma (8 cases), followed by Schwannoma (5 cases). With an 8-to-72-months follow up, 23 cases had no recurrence, metastasis or death. Conclusions Surgical resection is preferred in the treatment of PPS tumors. In the upper PPS tumor cases, the surgical navigation system could reduce the operative duration significantly and is more suitable for larger tumors.

Surgical resection with adequate margins is an essential component of the treatment for patients with oral squamous cell carcinoma (OSCC). A distance of 5 mm or more between healthy tissue to the tumor front is generally accepted as a safe margin. It is very important for surgeons to precisely evaluate the resection area of tumor both pre- and intra-operatively and try to achieve a safe margin, which will result in a decreased risk of local recurrence. The relationship of surgical margin status to patients' prognosis, and factors which will affect surgical margin distance demand are discussed in this paper. We recommend that adequate margins evaluation should take consideration of many factors such as anatomical location, depth of tumor invasion, pattern of tumor invasion, mucosal dysplasia grade and so on. With the development of molecular biology, surgical margin study at molecular level can give us a new strategy to evaluate its adequacy.

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 mimic oral squamous cell carcinoma(OSCC) cell hypoxia by using chemical agent CoCl2 and to investigate its biological behaviour.Methods Oral squamous cell carcinoma cell lines HSC-3 and SCC-4 were exposed to different concentration of CoCl2.HSC-3 and SCC-4 cells were treated with 50,100,150,200 μ mol/L CoCl2.Expression of hypoxia inducible factor-1α(HIF-1α),vascular endothelial growth factor(VEGF) and B-cell lymphoma-2(BCL-2) were measured by real time polymerase chain reaction(PCR) and Western blotting in both mRNA and protein level.Cell proliferation,cell apoptosis and cell cycle were detected to analyze its biological behaviour.Both wound healing and Transwell assay were applied to test the ability of cell igration.Results The result showed that after treatment of 150 μ mol/L CoCl22 for 24 h,mRNA level of HIF-1α,VEGF and Bcl-2 was increased by 6.00±0.20,5.40±0.40,5.40±0.30 (SCC-4); 5.60±0.30,5.20±0.60,5.80±0.40(HSC-3).OSCC cells treated with 150 μmol/L CoCl2 for 24 h were collected.Compared with control group,the growth rate of cells was significantly decreased,P value was less than 0.05 (when HSC-3,SCC-4 cultured for 2 and 3 days).The apoptosis of OSCC cells was increased when treated with 150 μmol/L CoCl2 for 24 h:HSC-3 2.25％(control group) and 5.82％(treatment group); SCC-4 2.58％(control group) and 10.27％ (treatment group).The migration ablility of OSCC cells was decreased when using 150 μmol/L CoCl2 for 24 h.The migration area ratio was(31.5±2.3) ％(HSC-3),(29.1± 1.5) ％ (SCC-4) in control group and(18.3± 1.9) ％ (HSC-3),(13.2±0.8)％ (SCC-4) in treatment group(P＜0.05).Conclusions The hypoxic cell model of OSCC could be induced by CoCl2.The expression level of hypoxic markers was up regulated significantly and the cells biological behaviour changed including decreased cell proliferation,increased apoptosis and decreased migration.

OBJECTIVETo compare the thin anterolateral flap with forearm flap in tongue defect repairing, and to introduce our methods and experiences in the tongue reconstruction with the thin anterolateral flap.

METHODSThe clinicopathologic data of 46 cases with tongue carcinoma were obtained from School of Stomatology, Nanjing University Medical Center, Nanjing University from December 2009 to December 2011. To compare two methods of incidence of vascular crisis, tongue shape, language and swallowing functional recovery.

RESULTS46 patients with tongue carcinoma were performed the tongue reconstruction in 12 month, which 12 cases were used the thin anterolateral flap and 34 cases were used the forearm flap. In the thin anterolateral flap group, All cases were succeeded. 1 case occurs vascular crisis. In the forearm flap group, 33 cases were succeeded, and 1 case occurs necrosis. 3 cases occurs vascular crisis. The results of comparing two methods showed that: no obvious differences in the tongue shape, and no obvious differences in the function of language and swallowing.

CONCLUSIONSThere no obvious differences in the reconstruction of tongue defect between the thin anterolateral flap and the forearm flap. The thin anterolateral flap have some advantages: little influence is on the donor site, the flap extent is abundant, the donor site is not spectacular. The thin anterolateral flap should be piror method for the tongue defect repairing.

Aged ; Female ; Forearm ; surgery ; Humans ; Male ; Middle Aged ; Surgical Flaps ; Tongue ; surgery ; Tongue Neoplasms ; surgery ; Treatment Outcome

Objective: To identify the different protein expression profiles between human oral squamous cell carcinoma (OSCC) and normal oral mucosa tissues, and provide experimental data for further study of the development mechanism of OSCC. Methods: 10 cases of OSCC and paired normal oral mucosa tissues were collected and analyzed through two-dimensional gel electrophoresis (2-DE) and matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF-MS). Results: (1) The average protein spots of OSCC were 2 325±390, while that of normal oral mucosa tissues were 2 487±281. (2) 29 differential protein spots were found between OSCC and normal oral mucosa. Moreover, these protein spots were all down- regulated in OSCC compared with normal oral mucosa. Among these spots, 3 were identified as fibrin beta, triosephosphate isomerase (TIM) and unknown protein through mass spectrometry and bioinformation. Conclusion: Down-regulation of fibrin beta, Triosephosphate isomerase(TIM) and unknown protein are found in the development of OSCC and the mechanism needs further study.

This paper presents a new method of designing restoration model of maxillectomy defect through Computer aided technology. Firstly, 3D maxillectomy triangle mesh model is constructed from Helical CT data. Secondly, the triangle mesh model is transformed into initial computer-aided design (CAD) model of maxillectomy through reverse engineering software. Thirdly, the 3D virtual restoration model of maxillary defect is obtained after designing and adjusting the initial CAD model through CAD software according to the patient's practical condition. Therefore, the 3D virtual restoration can be fitted very well with the broken part of maxilla. The exported design data can be manufactured using rapid prototyping technology and foundry technology. Finally, the result proved that this method is effective and feasible.
Computer-Aided Design ; Humans ; Imaging, Three-Dimensional ; Maxilla ; diagnostic imaging ; injuries ; Maxillofacial Prosthesis ; Models, Theoretical ; Prosthesis Design ; Software ; Titanium ; chemistry ; Tomography, Spiral Computed