With the increasing proportion of human papilloma virus(HPV)infection in the pathogenic factors of oro-pharyngeal cancer,a series of changes have occurred in the surgical treatment.While the treatment mode has been im-proved,there are still many problems,including the inconsistency between diagnosis and treatment modes,the lack of popularization of reconstruction technology,the imperfect post-treatment rehabilitation system,and the lack of effective preventive measures.Especially in terms of treatment mode for early oropharyngeal cancer,there is no unified conclu-sion whether it is surgery alone or radiotherapy alone,and whether robotic minimally invasive surgery has better func-tional protection than radiotherapy.For advanced oropharyngeal cancer,there is greater controversy over the treatment mode.It is still unclear whether to adopt a non-surgical treatment mode of synchronous chemoradiotherapy or induction chemotherapy combined with synchronous chemoradiotherapy,or a treatment mode of surgery combined with postopera-tive chemoradiotherapy.In order to standardize the surgical treatment of oropharyngeal cancer in China and clarify the indications for surgical treatment of oropharyngeal cancer,this expert consensus,based on the characteristics and treat-ment status of oropharyngeal cancer in China and combined with the international latest theories and practices,forms consensus opinions in multiple aspects of preoperative evaluation,surgical indication determination,primary tumor re-section,neck lymph node dissection,postoperative defect repair,postoperative complication management prognosis and follow-up of oropharyngeal cancer patients.The key points include:① Before the treatment of oropharyngeal cancer,the expression of P16 protein should be detected to clarify HPV status;② Perform enhanced magnetic resonance imaging of the maxillofacial region before surgery to evaluate the invasion of oropharyngeal cancer and guide precise surgical resec-tion of oropharyngeal cancer.Evaluating mouth opening and airway status is crucial for surgical approach decisions and postoperative risk prediction;③ For oropharyngeal cancer patients who have to undergo major surgery and cannot eat for one to two months,it is recommended to undergo percutaneous endoscopic gastrostomy before surgery to effectively improve their nutritional intake during treatment;④ Early-stage oropharyngeal cancer patients may opt for either sur-gery alone or radiation therapy alone.For intermediate and advanced stages,HPV-related oropharyngeal cancer general-ly prioritizes radiation therapy,with concurrent chemotherapy considered based on tumor staging.Surgical treatment is recommended as the first choice for HPV unrelated oropharyngeal squamous cell carcinoma(including primary and re-current)and recurrent HPV related oropharyngeal squamous cell carcinoma after radiotherapy and chemotherapy;⑤ For primary exogenous T1-2 oropharyngeal cancer,direct surgery through the oral approach or da Vinci robotic sur-gery is preferred.For T3-4 patients with advanced oropharyngeal cancer,it is recommended to use temporary mandibu-lectomy approach and lateral pharyngotomy approach for surgery as appropriate;⑥ For cT1-2N0 oropharyngeal cancer patients with tumor invasion depth＞3 mm and cT3-4N0 HPV unrelated oropharyngeal cancer patients,selective neck dissection of levels ⅠB to Ⅳ is recommended.For cN+HPV unrelated oropharyngeal cancer patients,therapeutic neck dissection in regions Ⅰ-Ⅴ is advised;⑦ If PET-CT scan at 12 or more weeks after completion of radiation shows intense FDG uptake in any node,or imaging suggests continuous enlargement of lymph nodes,the patient should undergo neck dissection;⑧ For patients with suspected extracapsular invasion preoperatively,lymph node dissection should include removal of surrounding muscle and adipose connective tissue;⑨ The reconstruction of oropharyngeal cancer defects should follow the principle of reconstruction steps,with priority given to adjacent flaps,followed by distal pedicled flaps,and finally free flaps.The anterolateral thigh flap with abundant tissue can be used as the preferred flap for large-scale postoperative defects.

Objective To investigate the clinical treatment of patients with refractory plasma cell mastitis by fistulectomy combined with nipple correction,observe its clinical efficacy,and analyze its clinical practicability.Methods Nine patients with refractory plasma cell mastitis were treated from August in 2020 to March in 2022.Before operation,fistulectomy and nipple correction were performed after the local inflammation was controlled by oral Chinese medicine.After operation,routine surgical dressing changes were performed,and the clinical efficacy,satisfaction evaluation of postoperative breast appearance and recurrence rate were observed.Results All the nine patients were cured after operation and they were satisfied with their breast shape,and there was no recurrence within one year after operation.Conclusion Fistulectomy combined with nipple correction is a safe and effective method for the treatment of patients with refractory plasma cell mastitis.

Facial paralysis causes both physical pain and psychological distress to patients. It is difficult for a patient with facial paralysis to engage with a normal social life and at work. Progresses have been made in recent years in the treatment of facial paralysis. More attentions have been caught by masseteric to facial nerve transposition, which has advantages of adjacency in location, abundancy in nerve supply and reliability in the outcome and now has deemed an important option of facial reanimation. It has not been long since the application of the technique of masseteric to facial nerve transposition in China, therefore it still lacks a universal guidance on practice. In order to achieve the aim of better quality control and popularisation of the technique, hereby a consensus with suggestions on facial reanimation with masseteric to facial nerve transposition is proposed as the reference for surgeons specialised in facial reanimation. This consensus is proposed, discussed and drafted by experts from plastic and reconstructive surgery, oral and maxillofacial surgery, head and neck surgery and neurosurgery.

Objective:To explore the application of the the anterolateral thigh flap (ALTF) with vascularized fascia lata in repairing large lower lip defects.Methods:From January 2013 to June 2020, the clinical data of the cases with large complex lower lip defect due to extensive resection of lip tumor treated in the Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine were analyzed retrospectively. The patients were immediately reconstructed using ALTF with vascularized fascia lata. The flap was used for shape reconstruction, and the fascia lata with residual orbicularis muscle was used for functional reconstruction via simulating the "closed-loop structure" of orbicularis. All these patients were followed up by regular visit. The survival of flap, mouth opening and closing were recorded.Results:All the 4 patients were successfully repaired through the above methods. The ALTF area was 18 cm×7 cm-26 cm×8 cm, with (5-8) cm ×1 cm fascia lata at both sides of the flap. The survival rate of ALTF was 100%. After 6-80 months’ follow-up, the ALTF was in good shape, and the mouth opening degree was 2-3 fingers. When the mouth was closed, the upper and lower lip could be sealed completely, and the drinking water is basically watertight.Conclusions:The shape and dynamic reconstruction could be completed in large complex lower lip defects through ALTF with vascularized fascia lata. The clinical effects were satisfying, and it’s an ideal option for repairing large complex lower lip defects.

Objective:To explore the application of the the anterolateral thigh flap (ALTF) with vascularized fascia lata in repairing large lower lip defects.Methods:From January 2013 to June 2020, the clinical data of the cases with large complex lower lip defect due to extensive resection of lip tumor treated in the Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine were analyzed retrospectively. The patients were immediately reconstructed using ALTF with vascularized fascia lata. The flap was used for shape reconstruction, and the fascia lata with residual orbicularis muscle was used for functional reconstruction via simulating the "closed-loop structure" of orbicularis. All these patients were followed up by regular visit. The survival of flap, mouth opening and closing were recorded.Results:All the 4 patients were successfully repaired through the above methods. The ALTF area was 18 cm×7 cm-26 cm×8 cm, with (5-8) cm ×1 cm fascia lata at both sides of the flap. The survival rate of ALTF was 100%. After 6-80 months’ follow-up, the ALTF was in good shape, and the mouth opening degree was 2-3 fingers. When the mouth was closed, the upper and lower lip could be sealed completely, and the drinking water is basically watertight.Conclusions:The shape and dynamic reconstruction could be completed in large complex lower lip defects through ALTF with vascularized fascia lata. The clinical effects were satisfying, and it’s an ideal option for repairing large complex lower lip defects.

Malignant tumors in the head and neck seriously threaten the physical and mental health of patients. After treatment, they may cause many complications, such as facial deformity, difficulties with chewing, dysphagia and asaphia. Among them, trismus (restricted mouth opening) is one of the most common complications after treatment of malignant oral-maxillofacial tumors. In severe cases, patients may even suffer from trismus and eating difficulties, finally leading to malnutrition and even cachexia. Therefore, it not only affects the quality of life of patients and even endangers their lives but also brings heavy social and economic burdens. How to effectively prevent and treat posttreatment trismus is a clinical problem that is easily ignored by head and neck surgeons and urgently needs to be solved. The results of a literature review showed that trismus may be related to the tumor clinical stage, tumor site, treatment used, radiotherapy site, radiotherapy dose, radiotherapy type, and other factors. The incidence of trismus tends to be significant 6 months after treatment. Without early intervention, the resulting dysfunction may become more severe. Current studies have shown that the prevention and treatment of restricted mouth opening is based on controlling the progress of restricted mouth opening and restoring function. Exercise intervention for trismus can significantly improve the restricted mouth opening of patients with malignant head and neck tumors after treatment.

Oral and maxillofacial reconstruction is an important method to ensure the radical cure, functional and psychological rehabilitation of tumors. This article reviews and compares the development history of oral and maxillofacial reconstruction at home and abroad, summarizing the current status and hotspots from multiple perspectives such as digital surgery, multidisciplinary team, talents training, aesthetic restoration and function rehabilitation, etc. aiming at providing reference for the development direction of oral and maxillofacial reconstructive surgery.

Objective:To evaluate the performance and the accuracy of surgical robot for mandibular reconstruction based on intelligent surgical planning.Methods:115 CT scanning images of normal mandible (57 males, 48 females, 40.3±9.1 years old, from February 2010 to May 2019) and 115 CT scanning images of mandible with tumor (62 males, 53 females, 55.6±7.2 years old, from March 2008 to August 2019) from Shanghai Ninth People’s Hospital were selected. The surgical robot system including work station, UR robot, optical navigation system, 6 dimensional force senor and surgical instrument. A 3D V-Net for mandible preoperational segmentation from CT scans was proposed and used to segment the mandible of a 54-year-old male patient who received mandible reconstruction with fibular flaps. The machine learning algorithm was used to aid surgical planning for maxillo-mandibular defect by detecting landmarks. The accuracy was defined as the distance between corresponding landmarks on the intact mandible. The robot could locate the target according to surgical planning and perform fibula osteotomy through force-motion control. The CT scanning of limb and head from the patient (male, 54 years old) was used for phantom experiments. 30 osteotomies on 5 3D-priented resin phantom were carried out. The pre- and post-operative images were compared to calculate the accuracy. The descriptive results were in the format of Mean±SD.Results:The average accuracy of V-Net for mandible segmentation was 96.581% and the time cost was less than 30 seconds. The average error of feature points on mandible was (2.24±1.74) mm. The residual length error was (1.02±0.45) mm and angle error was (0.96±0.42) degree in robotic-assisted osteotomy according to 3 cases of phantom experiments. The surgical robot could perform osteotomy safely and steadily within 15 min.Conclusions:Intelligent surgical planning can precisely segment the mandible and determine its landmarks. Robot for mandibular reconstruction can perform fibular osteotomy precisely with the pre-operative planning.

Oral and maxillofacial microsurgery has its own characteristics, including high precision, complicated operation, and long learning curve. It is important for young oral and maxillofacial surgeons to master the basic operation skills through standardized and systematic training.Department of Oral & Maxillofacial-Head & Neck Oncology of Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine gives systemic teaching course for senior resident doctors or young attending surgeons. The teaching teams make an intensive course organization and focus on the practical training. They integrat theoretical teaching, basic skill training, gross anatomy training as well as operation observation into a systematic "four-stage ladder approach" , which make a better teaching effect in promoting the oral and maxillofacial surgeons to master the practical and correct microsurgery technique.

Oral and maxillofacial microsurgery has its own characteristics, including high precision, complicated operation, and long learning curve. It is important for young oral and maxillofacial surgeons to master the basic operation skills through standardized and systematic training.Department of Oral & Maxillofacial-Head & Neck Oncology of Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine gives systemic teaching course for senior resident doctors or young attending surgeons. The teaching teams make an intensive course organization and focus on the practical training. They integrat theoretical teaching, basic skill training, gross anatomy training as well as operation observation into a systematic "four-stage ladder approach" , which make a better teaching effect in promoting the oral and maxillofacial surgeons to master the practical and correct microsurgery technique.