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Objectives: The aim of this study was to retrospectively analyze the clinical characteristics, surgical treatment, and prognosis of patients with diffuse-type tenosynovial giant cell tumor (D-TGCT) involving the temporomandibular joint (TMJ) and the skull base.Study Design: A retrospective study was performed in patients with D-TGCT involving the TMJ and the skull base at our institute from April 2009 to August 2018. Data on clinical characteristics, surgical treatment, and prognosis were collected and analyzed. A literature search on D-TGCT involving the TMJ was conducted and the data analyzed.Results: The study included 22 patients (14 males and 8 females), with an average age of 44 years. The main symptoms were headache and hearing limitation, accompanied by a swelling in the TMJ area. Magnetic resonance imaging (MRI) showed low signals on T1- and T2-weighted images. All lesions were completely removed. Temporal bone flap, titanium mesh, and temporal muscle flap were used for reconstruction. The recurrence rate was 4.5%. In the literature, 115 cases were reported. Surgery alone was performed in 88 cases; postoperative radiotherapy was performed in 19 cases; the tumor recurrence rates were 9.1% and 15.8% for the 2 procedures, respectively. All patients were alive at the end of the follow-up period.Conclusions: D-TGCT involving the TMJ and the skull base is a locally aggressive but benign lesion necessitating complete resection and has a good prognosis. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the prognostic value of the body mass index (BMI), as well as the association with docetaxel, cisplatin, and 5-fluorouracil (TPF) induction chemotherapy in patients with locally advanced oral squamous cell carcinoma (OSCC). This retrospective study enrolled 253 patients with locally advanced OSCC between 2008 and 2010 based on our previous prospective, randomized, phase 3 trial (NCT01542931). Univariate and multivariate Cox regression models, and the Kaplan–Meier method were used for survival analyses. Among the 253 patients, the BMI at the time of clinical diagnosis ranged from 13.16 to 34.66 kg/m2. Smoking status among patients showed a marked correlation with a higher BMI status at the time of clinical diagnosis (tobacco status: P < 0.001). The distribution of clinical nodal (cN) stage was significantly different, as patients with higher BMIs generally had earlier cN stages (P < 0.021) among the different BMI groups. The Kaplan–Meier analysis showed that the BMI was significantly correlated with overall survival (OS, P = 0.004), disease-free survival (DFS, P = 0.005), locoregional recurrence-free survival (LRFS, P = 0.003) and distant metastasis-free survival (DMFS, P = 0.007). When the BMI was included in the multivariate Cox regression model adjusted for potentially confounding clinical variables, the BMI was shown to be an independent predictive factor of OS (P = 0.015), DFS (P = 0.015), LRFS (P = 0.009), and DMFS (P = 0.023). The TPF group showed better 5-year clinical survival rates than the control group when analyzing patients with a normal BMI (OS: 64.2% vs. 55.9%; DFS: 54.7% vs. 46.4%; LRFS: 56.6% vs. 49.6%; DMFS: 64.2% vs. 56.0%), but no significant difference was observed. Subgroup survival analysis indicated that patients with a normal BMI and clinical stage IVA disease who accepted TPF induction chemotherapy had a significantly improved OS (HR: 0.425, 95% CI: 0.187–0.966, P = 0.035) and DMFS (HR: 0.425, 95% CI: 0.187–0.966, P = 0.034). The BMI at the time of clinical diagnosis was showed to be an independent predictive factor for patients with locally advanced OSCC. Compared with normoweight patients, underweight patients may have worse clinical outcomes, while overweight and obese patients have a better prognosis. A normal BMI in clinical stage IVA OSCC patients predicts significant OS and DMFS benefits of TPF induction chemotherapy. • BMI is an independent predictive factor for survival in oral cancer patients. • Underweight patients have worse clinical outcomes, but overweight and obese patients have a better prognosis in oral cancer. • A normal BMI in clinical stage IVA oral cancer patients predicts survival benefits from TPF induction chemotherapy. [ABSTRACT FROM AUTHOR]

We aimed to explore whether the anatomic extent of lymph node metastases (AE-LNM) could independently predict prognosis of node-positive major salivary gland carcinoma (MaSGC). A total of 376 pathologically node-positive MaSGC patients were identified from the Surveillance, Epidemiology and End Results database and constituted the training cohort. Using the X-Tile program, these patients were divided into three groups based on AE-LNM degrees. Discrimination of overall survival (OS) and disease-specific survival (DSS) was evaluated and compared with the 8th American Joint Committee on Cancer (AJCC) pN classification. The results were externally validated by 220 patients in a Chinese multicenter cohort (Validation cohort). Using the training cohort, AE-LNM was divided into Extent 1 (spread to parotid LNs or level I), Extent 2 (spread to level II-IV) and Extent 3 (spread to level V or bilateral LNs or rare LNs). Regarding both OS and DSS, the AE-LNM model revealed clear separation of survival curves, while the pN classification failed to discriminate the prognosis of pN1 and pN2 patients. When we incorporated both the AE-LNM model and AJCC pN classification into the same multivariate Cox analyses, AE-LNM was still an independent prognostic factor, while the AJCC pN classification lost its significance. These results were externally validated by the validation cohort. AE-LNM is an independent nodal prognosticator for node-positive MaSGC and may have improved discriminative ability over the current AJCC pN classification. Integration of anatomic extent of LNM into the current AJCC N classification could be considered. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to analyze the reliability of the deep venous drainage system of the free radial forearm flap.Materials and Methods: The authors implemented a retrospective cohort study and enrolled patients admitted for the evaluation and management of head and neck tumors with radial forearm flap reconstruction. The primary predictor variables were the donor site veins, including the deep, dual, and superficial venous drainage systems. The primary outcome measurement was the incidence of venous compromise. Potential confounders included patient demographics, history of chemotherapy with or without radiotherapy, defect sites, and the recipient artery and vein. The χ2 test and logistic regression analysis were used for statistical analysis.Results: The final study population consisted of 520 patients (mean age, 54 years) who underwent head and neck soft tissue reconstruction using the free radial forearm flap. Patients with the deep system (odds ratio [OR] = 0.251; 95% confidence interval [CI], 0.108-0.581) or dual system (OR = 0.197; 95% CI, 0.064-0.605) had a markedly lower risk of venous compromise than those with the superficial system. The overall incidence of inadequate outflow was 2.5% (5 of 204) when the deep system was used alone and 8.9% (19 of 212) when the superficial system was used alone (P = .004).Conclusions: Patients with the deep venous drainage system had a statistically lower risk of venous compromise. This study recommends using the deep system as a drainage vein for the free radial forearm flap. [ABSTRACT FROM AUTHOR]

Purpose: The white blood cell (WBC) indices have been reported to have a prognostic impact in cancer of multiple organs including head and neck cancer; however; site and stage stratification was not attempted, and compelling evidence has shown that early cancers have a different distribution and prognostic ability than late-stage cancers. We studied the prognostic importance of WBC indices in early oral tongue cancers.Patients and Methods: The retrospective data of primary pT1N0 to pT2N0 oral tongue cancers treated between 2009 and 2013 were charted. WBC indices such as the neutrophil count, lymphocyte count (LC), platelet count (PC), and monocyte count, along with derived indices such as the neutrophil-lymphocyte ratio, platelet-lymphocyte ratio (PLR), and lymphocyte-monocyte ratio (LMR), were analyzed by multivariate analysis with other clinicopathologic prognostic factors.Results: A total of 133 patients fulfilled the inclusion criteria; the minimum follow-up period for living patients was 36 months. A total of 22 patients reported disease relapse, and 11 patients died of disease. Multivariate analysis showed LC (hazard ratio [HR], 0.206; 95% confidence interval [CI], 0.092 to 0.46; P < .001), PC (HR, 1.011; 95% CI, 1.001 to 1.021; P = .026), PLR (HR, 1.012; 95% CI, 1.008 to 1.016; P < .001), and LMR (HR, 0.721; 95% CI, 0.596 to 0.872; P = .001) are significant independent prognostic factors for disease-free survival. Distant metastasis (HR, 9.014; 95% CI, 2.303 to 38.914; P = .004), LC (HR, 0.091; 95% CI, 0.015 to 0.558; P = .01), PC (HR, 1.023; 95% CI, 1.006 to 1.041; P = .009), PLR (HR, 1.016; 95% CI, 1.004 to 1.027; P = .002), and LMR (HR, 0.58; 95% CI, 0.387 to 0.868; P = .008) are significant independent prognostic factors for overall survival.Conclusions: Low pretreatment LMR and high PLR indicate poor survival in patients with early tongue cancer. We suggest close follow-up for this subgroup despite radical resection with clear margins. [ABSTRACT FROM AUTHOR]

Purpose: Vascular anastomosis is the most important technical step required for the possibility of free tissue transfer, and mismatch of the donor and recipient vessel size is the most common surgical challenge. As recent reports have described a new method (Ren anastomosis) to resolve this challenge, the goal of this study was to assess these newly described microvascular anastomosis methods.Patients and Methods: The study was conducted at 2 institutes in China in different periods. Patients were recruited from the Second Xiangya Hospital between February and May 2013 and from the Shanghai Ninth People's Hospital between March and May 2015. All patients who participated in this study needed free flaps for oral and maxillofacial defects. Patients were divided into the experimental group and the control group. In the experimental group, isometric double-notch end-in-end microvascular anastomosis (Ren anastomosis) was performed, whereas end-to-end anastomosis was performed in the control group. Statistical differences were assessed by use of χ2 and t tests.Results: A total of 148 patients (108 men and 40 women) were treated over the course of this study. There was a statistically significant difference (P < .001) in the operation time for the microscopic artery anastomosis between the experimental group (70 cases; 5.6 ± 1.8 minutes) and the control group (78 cases; 14.6 ± 3.7 minutes). In each group, 1 case of artery compromise was observed.Conclusions: The Ren anastomosis was time-saving, straightforward, efficient, and easy to learn, with a high patency rate. [ABSTRACT FROM AUTHOR]

Locoregional flaps are widely used for reconstruction of small and medium defects in the oral cavity. The submandibular gland flap is a pedicled flap, which derives its blood supply from the facial artery, based on the submandibular gland. We describe the use of the flap in 20 patients who required oropharyngeal reconstruction with a pedicled submandibular gland flap after resection of a tumour between July 2012 and October 2014. Patients with squamous cell carcinoma were excluded. All flaps were pedicled on the facial vessels (inferiorly in 17 patients and superiorly in 3). The indications were: reconstruction of intraoral mucosal defects (n=13), filling the parapharyngeal dead space (n=6), and obliteration of the mastoid (n=1). All the flaps atrophied, but with no clinical effect. One patient developed partial loss of the flap, and one early leakage. There were no cases of xerostomia, and no signs of recurrence during the postoperative follow-up period of 3-26 months. The flap is useful, as it is simple and reliable for reconstruction of small to medium oropharyngeal defects in carefully selected cases, and gives good cosmetic and functional results. [ABSTRACT FROM AUTHOR]

Objectives To summarize the clinical features, diagnosis, treatment strategies, and prognosis of alveolar soft part sarcoma (ASPS) of the oral and maxillofacial region. Study design We performed a retrospective study in a consecutive series of 18 patients with ASPS of the oral and maxillofacial region between 1995 and 2013. Demographic characteristics, tumor sizes, sites, tumor metastasis, diagnosis, treatments, and overall follow-ups were documented. Results The 18 patients were diagnosed pathologically with primary tumor developed on the tongue (10), the cheek (5), the pharynx (1), and the gingiva (2) with an average tumor size of 4 cm. At the latest follow-up, 1 patient with lung metastases survived for 23 months; 1 died 3 months after the confirmation of local recurrence and multiple pulmonary metastases; the rest of the patients were disease free and remained in good health. Conclusions ASPS of the oral and maxillofacial region appears to have special clinical characteristics. [ABSTRACT FROM AUTHOR]

Purpose To investigate the application of the medial sural artery perforator flap in hemiglossectomy reconstruction and evaluate the value of preoperative computed tomographic angiography (CTA) for perforator location. Patients and Methods Nine patients received medial sural artery perforator flaps for tongue reconstruction from August 2013 to January 2014. Of the 9 patients, 5 were male and 4 were female, with a mean age of 51 years (range 22 to 67). The number, location, and course of the perforators were measured on the CTA preoperatively. Results Of the 9 medial sural artery perforator flaps, 8 survived and 1 had developed necrosis. Thirteen perforators had been visualized by CTA, and 10 of these were used in the operation. No significant difference was found between the CTA location and the intraoperative findings in the perforators' distribution. The mean diameter of the medial sural artery was 1.0 ± 0.3 mm and of the concomitant vein was 2.0 ± 0.7 mm. The mean pedicle length was 9.7 ± 1.0 cm, with 5.1 ± 1.7 cm of the main trunk and 4.6 ± 2.1 cm of the perforator. The average number of muscular vessel branches was 23.9 ± 6.9, with 12.2 ± 5.1 from the main trunk and 10.1 ± 4.4 from the perforators; 1 (10%) perforator was septocutaneous and 9 (90%) were myocutaneous. Conclusions The medial sural artery perforator flap is appropriate for medium-size tongue defect reconstruction, with a long pedicle of matching caliber, adequate tissue volume, and minimal donor site morbidity. CTA is a valuable and necessary method for preoperative assessment of the perforator's location. [ABSTRACT FROM AUTHOR]

Alveolar soft part sarcoma (ASPS) is a rare, histologically distinct, soft tissue malignancy with nonspecific clinical features usually described as a nonulcerated, painless, expanding mass. It has a pseudoalveolar appearance with clustered polygonal cells lacking central cohesion. It accounts for approximately 0.5 to 1% of all soft tissue sarcomas. It has a strong predilection for adolescents and young adults 15 to 35 years old, with a female predominance. In general, ASPS grows slowly, with a predilection for the trunk and extremities and rarely in the head and neck region. A literature review found only 11 cases of cheek ASPS that have been reported since 1952. This report describes the case of an unusually rapidly growing mass in the cheek of a 36-year-old woman. The superficial location of the mass led to early detection and treatment. [ABSTRACT FROM AUTHOR]

PURPOSE: To analyze a single institution's experience of solitary venous malformation (VM) in the accessory parotid region. METHODS: From 2002 to 2009, a total of 10 consecutive patients with solitary venous malformation (VM) in the accessory parotid region were retrospectively analyzed. Clinical records were reviewed for patient demographic data, presenting symptoms and signs, imaging modalities used, histological and immunohistochemical results, surgical data, and clinical outcomes. RESULTS: The sample consisted of 5 males and 5 females with a mean age of 42.8 years. The course of disease ranged from 0.5 to 168.0 months with a mean time of 64.9 months. The mean size of the masses was 1.7 cmx1.5 cm (1.0 cmx0.8 cm to 2.5 cmx2.5 cm). Investigations included Doppler ultrasonography (US) and computed tomography (CT) scanning. Surgical excision using various surgical approaches was performed in all patients. Postoperative pathologic examination confirmed the diagnosis of VM. The mean follow-up period was 41.2 months (range 2 months to 94 months) with no recurrence reported. CONCLUSIONS: For solitary VM in the accessory parotid region, investigations, such as Doppler US or CT scanning or the use of fine needle aspiration cytology, may aid in clinical diagnosis. The primary treatment of these lesions is surgical excision, and the prognosis is good with fewer recurrence. [ABSTRACT FROM AUTHOR]

PURPOSE: To figure out the expression of EGFR in locally advanced oral squamous cell carcinoma and the relationship between EGFR expression and TPF induction chemotherapy. METHODS: Two hundred and fifty-six patients with locally advanced oral squamous cell carcinoma in a prospective randomized controlled trial were included in this study. Using immunohistochemical staining against EGFR, expression of EGFR was detected in the oral squamous cell carcinoma tissues before treatment. The relationship between EGFR expression and clinicopathologie indicators was analyzed as well as the relationship between EGFR expression and TPF induction chemotherapy. Statistical analysis was performed using SPSS18.0 software package. RESULTS: There was a significant correlation between the EGFR positive expression and the age of patients (P=0.015), younger patients had higher EGFR expression level. No significant correlation between EGFR expression and other clinicopathologie indicators was found. According to the pathological and clinical response to TPF induction chemotherapy, there was no significant correlation between EGFR expression level and the response to TPF induction chemotherapy. The correlation between EGFR expression and the prognosis of oral squamous cell carcinoma patients was not significant as regards to tumor recurrence, overall survival, disease free survival, locoregional reccurrence free survival and distant metastasis free survival. CONCLUSIONS: EGFR expression was related to the age of patients with oral squamous cell carcinoma. Further studies are suggested on the clinical application of EGFR expression as target therapy in oral squamous cell carcinoma. [ABSTRACT FROM AUTHOR]

PURPOSE: To establish a rabbit model of micrometastasis in sentinel lymph node (SLN) from tongue carcinoma, so the mechanism of regional lymph node metastasis from tongue carcinoma as well as its management may be studied through this model. METHODS: First, lymph node metastatic specimen of rabbit tongue Vx-2 carcinoma was orthotopically and serially transplanted into the tongue of disease-free rabbit at 4-week interval (8 rabbits for each passage) for screening carcinoma specimens with high lymphatic metastasis potential. Then, the selected specimens were orthotopically re-transplanted into tongues of 40 disease-free rabbits; SLNs of the developed Vx-2 tumor were harvested at 8th, 10th, 12th, 14th and 16th day (8 rabbits for each harvest) respectively after the transplantation, and thorough work-up of the SLNs was done by serial sectioning and immunohistochemistry for evidence of micrometastasis. RxC table Chi-square test was used for comparison among multi-ratio using SPSS 17.0 software package. RESULTS: Increased SLN metastasis was noted with serial passages of transplanting lymphatic metastasis specimens in the tongue: 3/8 (37.5%) in the first passage, 5/8 (65%) in the second, 8/8 (100%) in both the third and the fourth. After orthotopic transplantation of the harvested nodal carcinoma specimen with high metastatic potential, micrometastasis was detected in SLN in 5/8 rabbits (62.5%) of group 8th, day, 8/8 (100%) of both group 10th day and group 12th day, 6/8 (75%) of group 14th day and 3/8 (37.5%) of group 16th day respectively. CONCLUSION: Specimens with high lymphatic metastasis potential can be achieved by serial and orthotopic transplantation of lymphatic metastasis specimens from Vx-2 carcinoma in rabbit tongue; and the rabbit of group 10-12 days after orthotopic re-transplantation of them is an ideal model of micrometastasis in SLN from tongue carcinoma. [ABSTRACT FROM AUTHOR]

Purpose: This study was performed to gain some knowledge on the possible relation between surgical site infection (SSI) and geriatric patients who undergo surgical treatment of oral squamous cell carcinoma and to identify the risk factors in this specific population. Patients and Methods: A retrospective study from 2004 through 2010 at the Department of Oral and Maxillofacial Surgery, Ninth People''s Hospital, Shanghai Jiao Tong University School of Medicine was conducted. The primary outcome variable was the presence of SSIs. Twenty-seven variables of the patients concerning general characteristics, comorbidities, disease information, and treatment options were investigated. A multivariate analysis using logistic regression was implemented to find SSI risk factors. Results: The data of 376 patients (183 men, 48.7%; 193 women, 51.3%) older than 65 years with the diagnosis of oral squamous cell carcinoma were included in the present analysis. In multivariate logistic regression analysis, 6 parameters were identified for a significant and independent association with the development of SSI: body mass index (P = .0086); diabetes (P < .0001); American Society of Anesthesiologists score (P = .0127); Adult Comorbidity Evaluation-27 score (P = .0392); operation time (P = .0003); and reconstruction with pectoralis major myocutaneous flaps or free flaps (P < .0001). Conclusions: Special attention to SSIs should be given to elderly patients with oral squamous cell carcinoma. The authors advocate a preoperative evaluation of comorbidities and the selection of high-risk elderly patients for a more effective prevention of SSIs. [Copyright &y& Elsevier]

PURPOSE: To compare the effectiveness of the tools on assessing quality and risk of bias between Jadad scale and Cochrane collaboration' s tool for assessing risk of bias in randomized controlled trials (RCTs). METHODS: A systematic literature search on induction chemotherapy for head and neck squamous cell carcinoma using the database of MEDLINE and EMBASE was performed as an example for evaluating the quality and risk of bias of RCTs. The Jadad scale and the Cochrane collaboration' s tool for assessing risk of bias were used for evaluating the RCTs, respectively. The different RCTs evaluated by the two kinds of tools were further analyzed on their quality and risk of bias. RESULTS: Thirty-seven RCTs were eligible for this analysis. Using the Jadad scale, 23 trials should be excluded because of the low quality of RCTs; while using the Cochrane collaboration's tool for assessing risk of bias, 7 trials should be exclude because of the high bias of RCTs. Among the 16 low bias RCTs, which were scored as low quality of RCTs by Jadad scale, the most common reasons for exclusion were no description of the blindness and generation of the allocation sequence. However, the quality of these RCTs was good enough for systemic analysis. CONCLUSIONS: In order to improve the quality of systemic analysis, proper tools of assessing quality and risk of bias should be considered, and the Cochrane collaboration' s tool for assessing risk of bias is recommended, especially for open RCTs. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to analyze a single institution''s experience of solitary venous malformation (VM) in the midcheek region. Study design: From 2002 to 2009, a total of 10 consecutive patients with solitary venous malformation in the midcheek region were retrospectively analyzed. Clinical records were reviewed for patient demographic data, presenting symptoms and signs, imaging modalities used, histologic and immunohistochemical results, surgical data, and clinical outcomes. Results: The sample consisted of 5 males and 5 females with a mean age of 42.8 years. The course of disease ranged from 0.5 to 144.0 months with a mean time of 64.9 months. The mean size of the masses was 1.7 × 1.5 cm (range 1.0 × 0.8 cm to 2.5 × 2.5 cm). Investigations included Doppler ultrasonography (US) and computed tomography (CT) scanning. Surgical excision using various surgical approaches was performed in all patients. Postoperative pathologic examination confirmed the diagnosis of VM. The mean follow-up period was 41.2 months (range 2 months to 94 months) with no recurrence reported. Conclusions: For solitary VM in the midcheek region, investigations, such as Doppler US or CT scanning or the use of fine-needle aspiration cytology, may aid in clinical diagnosis. The primary treatment of these lesions is surgical excision, and in our sample, the prognosis of such treatment was good with no recurrence reported. [Copyright &y& Elsevier]

PURPOSE: To investigate the proportion of salivary gland tumors in the elder patients in the past ten years, in order to provide reference for clinical diagnosis and treatment. METHODS: The medical data of salivary gland tumors treated in our department from January 2000 to December 2009 were reviewed and analyzed. The changes of three periods between 21cl0s, 20c90s and 20c80s were compared. RESULTS: The number of salivary gland tumors in elder patients increased rapidly in recent years, especially that of benign tumors. Warthin's tumor was the most common benign tumors, and adenoid cystic carcinoma was most often found in malignant tumors. Carcinoma ex pleomorphic adenoma rose to the third among malignant tumors of salivary gland and first among parotid gland malignancies. The proportion of benign tumor was almost equal to malignant tumor in minor salivary gland. The benign-malignant ratio of palatal salivary gland was 1.34:1, which was opposite to the previous figure. The parotid gland was the most common site, followed by palatal and submandibular gland. CONCLUSIONS: The proportion of salivary gland tumors in elder patients in 2000s was different from that in 1980s and 1990s. The changes should be taken into attention in daily clinical works. [ABSTRACT FROM AUTHOR]

PURPOSE: To analyze a single institution's experience in the clinical management of intraoral lymphoepithelial cyst (LEC) based on clinical examinations differential diagnosis, treatment and prognosis. METHODS: From 1993 to 2010, a total of 120 consecutive patients with intraoral LEC undergoing surgery were retrospectively investigated with regards to gender, age, primary site, symptom, clinical examination, treatment and prognosis. RESULTS: Of the 120 patients, 37 were males and 83 were females, their age ranged from 2 to 75 years with a mean age of 44.1 years. The course of disease ranged from 2 months to 10 years with a mean period of 8.0 months, and 75.8% of the patients had a course of disease shorter than 6 months. The most common location was the tongue (50%) and floor of mouth (38.3%). All patients underwent complete surgical removal of the lesions. During the follow-up period, no lesion recurred. CONCLUSIONS: The clinical characteristics of intraoral LEC are not specific and may be mixed with other intraoral lesions. The first choice of treatment is surgical excision, which results in a good prognosis. Supported by Program for Innovative Research Team of Shanghai Municipal Education Commission and Research Fund of Science and Technology Commission of Shanghai Municipality(1052nm04700, 10140902200). [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to analyze a single institution''s experience in the clinical management of intraoral lymphoepithelial cyst (LEC). Study Design: From 1993 to 2010, a total of 120 consecutive patients with intraoral LEC underwent surgery and were retrospectively investigated regarding its clinical appearance, clinical differential diagnosis, treatment, and prognosis. Results: Of the 120 patients, 37 were male and 83 female, their ages ranging from 2 to 75 years with a mean of 44.1 years. The most common locations were the tongue (50%) and floor of mouth (38.3%). The course of disease ranged from 2 months to 10 years with a mean of 8.0 months, and 75.8% of the patients had a course of disease <6 months. Routine laboratory examinations were within normal limits. All patients underwent complete surgical removal of the lesions. During the follow-up period, no lesion recurrence occurred, and the quality of life of each patient was good. Conclusions: The clinical characteristics of intraoral LEC are not specific and may be confused with other intraoral lesions. The first choice of treatment is surgical excision, which results in a good prognosis. [Copyright &y& Elsevier]

PURPOSE: Primary desmoids type fibroma arising from the oral and maxillofacial region is uncommon. The purpose of this study was to analyze the clinicoepidemiological characteristics of this rare disease. METHODS: Epidemiological and clinicopathological data on 20 patients were reviewed from the hospital records and analyzed accordingly. The data were processed with SPSS 10.0 software package. RESULTS: Twelve males and 8 females with a ratio of 3:2 were involved. The mandible was the most common site of presentation. Suspected malignant change was found in 6 cases and an extremely high recurrence rate was also found in up to 53%. Abnormally high blood levels of alkaline phosphatase were found in 65% of patients, which had a close relation with bone resorption. CONCLUSIONS: Desmoids type fibroma arising from the oral and maxillofacial region hold the character of local invasion and regional recurrence; surgery is chosen as the most effective treatment combined with postoperative radiotherapy; elevated serum alkaline phosphatase levels may be used as an indicator for bone resorption. Supported by Natural Science Foundation of Shanghai Municipality(11ZR1420600) and Shanghai Leading Academic Disciplines Project (S30206). [ABSTRACT FROM AUTHOR]

PURPOSE: To analyze accessory parotid lesions in terms of clinical appearance, clinical differential diagnosis, treatment and prognosis. METHODS: From April 1999 to November 2008, 32 patients with accessory parotid lesions was treated. The patients' general condition, clinical symptoms and signs, preoperative examinations, surgical treatment, and prognosis were recorded and analyzed. RESULTS: Among the 32 patients, there were 8 males and 24 females with an average age of 45 years. The patients always presented without obvious symptoms, and the masses were moderate to hard in hardness without tenderness, mobile with clear boundary. The pathological diagnosis was 24 benign lesions and 8 malignant lesions, including 19 pleomorphic adenomas, 3 benign lymphoepithelial lesions, 1 basal cell adenoma, and 1 chronic inflammation among benign lesions, while 2 acinic cell carcinomas, 2 lymphoepithelial carcinomas, 1 papillary cystadenocarcinoma, 1 basal cell adenocarcinoma, 1 myoepithelial carcinoma, and 1 mucoepidermoid carcinoma among malignant lesions. Surgery and surgery plus radiotherapy were performed in patients with benign and malignant lesions respectively with good prognosis. CONCLUSIONS: Accessory parotid lesions are rare and the clinical manifestations are similar to benign tumors. Surgical resection and surgical resection plus radiotherapy are the primary treatment for benign and malignant lesions, respectively. The prognosis is always good. [ABSTRACT FROM AUTHOR]

PURPOSE: Through three dimensional measurement and analysis of normal adult mandible, to establish the mandibular contour parameters (MCPs) which are applied to conduct the design and fabrication of fibular osteotomy guide (FOG). METHODS: A total of 55 normal mandibular CT data (Dicom) was collected and delivered to the image workstation of Shanghai Jiao Tong University for detailed analysis by use of self-edited software of Surgical Plan of the Jaws. The real-size mandibular model was established on which 7 anatomic bony marks were set up and 14 linear/angular variables were measured. The data was analyzed using SAS8.0 software package. After that, MCPs were established to conduct the design and fabrication of FOG. A female patient with LCL mandibular defect underwent mandibular reconstruction with vascularized fibular flap, where FOG was applied to contour the grafted fibula. RESULTS: There were significant sex and individual differences in the linear variables (P<0.05) of mandible against the angular variables (P>0.05). Meanwhile, the morphological difference of anterior mandible was less than that of posterior mandible. The MCPs were mandibular body anglel40°, mental angle 120° and mental length 30mm which were successfully applied to shape the grafted fibula in an operation of mandibular reconstruction. Postoperatively the patient achieved excellent cosmetic result. CONCLUSION: FOG can rapidly and accurately realize four-segment-osteotomy of fibula in the mandibular reconstruction. However further improvement of the device is needed. [ABSTRACT FROM AUTHOR]

PURPOSE: To evaluate the anti-tumor effect of co-cultured sensitized dendritic cell (DC) and cytokine-induced killer cell (CIK) separated from peripheral blood to human tongue SCC nude mice cancer model in vivo. METHOD: Both DC and CIK were separated and cultured in vitro from peripheral blood of oral tongue cancer patients. The sensitized DC was co-cultured with CIK. Tca8113 cells were injected into the right oxter of 24 BALB/c nude mice which were divided into control group A, experiment group B and group C. 24 hours later, group A received normal saline injection in one site with Tea 8113 transplantation, group B were injected DC-CIK in opposite side, group C were injected the same dose of DC-CIK in right oxter. The number and size of induced tumors were observed in the next 4 weeks. The data was analyzed with SAS 6.12 software package for student's t test, ANOVA and Chi-square test. RESULTS: The average day of tumor induction was 7.63 days, 9.5 days and 12 days for group A, B and C, respectively, which showed significant difference between group A and C (P=0.0132). Two weeks after Tca8113 injection, 100% of mice in group A developed tumors, 87.5% in B and 62.5% in C developed tumors, which showed no significant difference in 3 groups. The curve of induced tumors size showed that group A developed faster, group C was the slowest with significant difference (P= 0.036). CONCLUSION: The co-cultured sensitized DC-CIK showed a certain anti-tumor effect nude mice with Tea 8113 model in vivo. [ABSTRACT FROM AUTHOR]

Objective: Lymphatic mapping with vital dye is often exploited during a sentinel lymph node biopsy (SLNB); however, the time restraints associated with blue dye may limit its efficacy in tongue carcinoma. Using an animal study, this exploration attempted to achieve a rational surgical modality to circumvent this hindrance. Study design: Forty-eight rabbits were divided into 2 equal groups: A and B; 0.2 mL methylene blue (MB) was injected into 4 parts of the tongues of the rabbits in A just after elevating the cervical flap and into the tongues of the rabbits in B just before the elevation. The times when the lymphatic vessel and lymph node turned blue and then returned pale were recorded. Results: Cases in group A had significantly more time left for tracing blue-stained lymphatic vessels than those in group B. Conclusions: Elevating the cervical flap before injecting MB can alleviate the time restraint of MB as a lymphatic tracer in SLNB with tongue carcinoma. [Copyright &y& Elsevier]

Objective: Accessory parotid lesions are clinically rare and its management remains poorly understood. The aim of this study was to analyze the clinical management of accessory parotid lesions. Study design: From April 1999 to November 2008, a retrospective analysis of 32 patients with accessory parotid lesions was performed. The preoperative examinations, surgical treatment, and prognosis were recorded and analyzed. Results: Among the 32 patients, there were 8 men and 24 women with an overall average age of 45 years. These patients always presented without obvious symptoms, and the masses were moderate to hard in hardness without tenderness, mobile, and with clear boundary. The pathologic diagnoses were 24 benign and 8 malignant lesions. Surgery and surgery plus radiotherapy were performed in the patients with benign and malignant lesions, respectively, with good prognosis. Conclusions: Accessory parotid lesions are rare, and the clinical manifestation is always the same for benign tumors. Surgical resection and surgical resection plus radiotherapy are the primary choices of treatment for benign and malignant lesions, respectively. The prognosis is always good. [ABSTRACT FROM AUTHOR]

PURPOSE: To evaluate the distribution of biomechanical stress on the craniofacial skeleton for bilateral maxillectomy reconstruction by using the vascularized fibula graft and zygoma implants,in order to provide theoretical references for restoration of maxillary defects. METHODS: Based on digital imaging and communications in medicine (DICOM) data and the image process technology, a modularized geometrical and finite element model of the human skull was built to simulate the bilateral defect pattern of the maxilla. Biomechanical properties of the zygomatic implants and the connected implants were evaluated by using finite element analysis (FEA) method. RESULTS: The deformation tendency of the zygomatic implants was identical and the displacement of bending was not noticeable. The displacement of the zygoma fixture near the zygoma was close to zero. The neck of the zygoma fixture on the fibula bone and on the zygoma bored the largest stress, while the rest of the peri-implant bones bored a lower stress. CONCLUSIONS: Stress from occlusal forces is mainly supported by the zygomatic bone and the fibular bone. The occlusal force is effectively transmitted and the stress distribution of the peri-implant bone of such reconstruction protocol is reliable. Reconstitution of the buttresses system ensures a stable support for occlusion and stress. This is a safe and effective method to optimize bilateral maxilla rehabilitation. Supported by Combined Engineering and Medical Project of Shanghai Jiao Tong University (YG2010MS56). Dr. WU Yi-qun and YE Chen contributed equally to the study. [ABSTRACT FROM AUTHOR]

PURPOSE: Using the computational fluid dynamics to analyse the alteration of flow field of free forearm flap with 4 different venous anastomotic techniques, and to preliminarily explore its clinical significance. METHODS: Three dimensional geometric models of radial forearm flap with 4 types of anastomotic techniques between radial vein and recipient vessels were established by Pro/E (Wildfire 4.0) as follow: type I (matched anastomosis), type H (stump anastomosis), type III (angular anastomosis) and type IV (end-to-side anastomosis). Then the established geometric models were transferred to the SC/Tetra 8.0 software for mesh generation and calculation. Porous model was applied to the flap to simulate capillary structure as before, inlet velocity of radial artery was set as 20mm/s and outlet pressure of recipient vein as 0 Pa. By comparing pressure and velocity distribution on different cross sections of blood vessels, hemodynamic feature of the flap with 4 types of anastomotic techniques was studied, focusing on the alternation of flow field of drainage system of the flap, especially at the anastomotic sites. The data was analysed using SAS8.0 software package for ANOVA. RESULTS: The pressure on the four sections of the flap circulatory system was significantly higher in type I compared with type II, III and IV (F = 40.99, P < 0.001). Type II presented with vortex in the anastomotic site, and type III, IV with smooth flow. Type IV had an absorption effect at the anastomotic site. The pressure loss of the flap circulation was maximal in the radial vein of vascular pedicle (F = 97.00, P < 0.001). CONCLUSIONS: Type HI and IV are considered appropriate techniques to deal with caliber discrepancy of recipient site. Theoretically, reasonable reduction of the vascular pedicle length and choice of the concomitant radial vein with wider radius for anastomosis can effectively decrease the resistance of circulation in the flap. Supported by Medical and Engineering Project of Shanghai Jiao Tong University (YG2009MS41). [ABSTRACT FROM AUTHOR]

Vagal paraganglioma (VP) is a tumor of very low incidence that often appears as a painless mass in the neck or parapharyngeal space. There are no special symptoms and no cough, hoarseness or other neurological symptoms in early stage, so preoperative diagnosis is difficult. It is easily misdiagnosed as Schwannoma and given mistreatment. MRI is helpful for the diagnosis through distinctive images. Surgical excision is the conventional method, but the patients must take neurotrophic drugs after operation for a long term. Conservative therapy, such as radiotherapy, can slow down the tumor growth and delay the emergence time of neurological symptoms. Supported by Key Project of Biomedicine and Pharmacology of Shanghai Municipality (10DZ1951300). [ABSTRACT FROM AUTHOR]

PURPOSE: To preliminarily establish a hemodynamic 3D numeric model of radial forearm free flap with vascular pedicle of radial artery' and vein, and discuss its scientific workability. METHODS: The 3D geometric model of 50mmx80mmxl0mm radial forearm flap was established by Pro/E(Wildfire 4.0). The vascular pedicle was 50mm in length including radial artery. (inside diameter was 1.9mm) and concomitant radial vein (inside diameter was 0.84mm). The half-embedded vessels went through the flap paralleling the long axis. Then the established geometric model was transferred to the SC/Tetra 8.0 software for mesh generation and calculation. According to the virtual flow volume of the radial artery, the inlet velocity was set as 20mm/s. With the different blood pressure of 53mmHg between the feeding artery and draining vein, the tentative porous values were achieved. Then porous model was applied to the flap to simulate the capillary structure. The pressure distribution on the central axis of radial artery and vein and the radial velocity distribution in three different cross sections of vessels were figured out. RESULTS: A model with 10355473 meshes and 2104014 nodes was built. When porous model was applied, the pressure difference between radial artery and vein was calculated to 7050 Pa (52.8mmHg), which was close to clinical value. The computational fluid dynamic analysis results showed that with porous model, the central pressure of radial artery was continuously kept to a higher level. When blood flowed in and flows out of the flap, the blood velocity decreased and increased greatly. While the central pressure of radial vein significantly decreased at the moment of blood flowing out of the flap. These results basically agreed with the features of normal blood circulation of the forearm flap. CONCLUSIONS: Porous model effectively simulates hemodynamic status of forearm flap, which provides a new method for the study of mechanism of blood circulation in radial forearm flap and also lays a foundation for the following hemodynamic study of vascular anastomosis. Supported by Combined Medical-Engineering Project of Shanghai Jiao Tong University (YG2009MS41). [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to analyze a single institution''s experience in clinical diagnosis, treatment, and prognosis of Castleman disease (hyaline vascular type) in the parotid and neck region. Study design: From 2004 to 2008, a total of 10 consecutive patients with Castleman disease (hyaline vascular type) in the parotid and neck region underwent surgery were included in this retrospective study. The preoperative examinations, clinical diagnosis, surgical treatment, and prognosis were recorded and analyzed. Results: Of the 10 patients, 4 were males and 6 female; their age ranged from 13 to 54 years with a mean of 26.6 years. The lesion occurred in the parotid region in 3 patients, in the neck region in 5 patients, and in both the parotid and neck regions in 2 patients. Their course of disease ranged from 3 months to 48 months with a mean of 12.5 months; 70% of the patients (7 out of 10) had a course of disease of <12 months. The patients always had no obvious complaint, and the laboratory examinations were almost within the normal limits. Magnetic resonance imaging/angiography were valuable on clinical diagnosis and differential diagnosis. All patients underwent surgical removal of the masses completely. During the follow-up period, which ranged from 9 months to 60 months with a mean of 38.9 months, no recurrence of the lesion occurred, and the quality of life of each patient was good. Conclusions: Castleman disease (hyaline vascular type) in the parotid and neck region is rare, with clinical manifestation and physical examination the same as benign lesions. There is no specific indication in the laboratory tests and imaging examinations; however, magnetic resonance imaging/angiography has potential value on clinical diagnosis and differential diagnosis. Surgical resection is the choice of treatment with good prognosis. [Copyright &y& Elsevier]

PURPOSE: To investigate the role of NF-κB signal transduction pathway in apoptosis induced by shikonin in human tongue squamous cell carcinoma Tca-8113 cell line. METHODS: Expression of iκBa, phosphalase-lκBa, bcl-2 and Bax proteins were detected by Western blot, NF-κB DNA-binding activity was detected by electrophoretic mobility shift analysis (EMSA), and activities of caspase 3, caspase 8 and caspase 9 were analyzed by enzyme linked immunosorbent assay (ELISA). The data was analyzed by one-way ANOVA test and / test using SPSS 12.0 software package. RESULTS: The expression of phosphatase-1κBa protein and the nuclear NF-κB DNA-binding activity was significantly decreased in shikonin treated cells by Western and EMSA. Bel-2 protein expression was also decreased in the process. The activity of all the three proteases was elevated and pancaspase inhibitor Z-Asp-CH2-DCB could protect Tca8113 cells from shikonin-induced apoptosis(P=0.02). CONCLUSIONS: Anti-tumor effects of shikonin in Tca-81 13 cells act at least partially through the inactivation of NF-κB pathway and subsequent activation of protease caspase family. Pharmacologic inhibition of the NF-κB activity by shikonin might be a powerful treatment option for OSCC. Supported by National Natural Science Foundation of China (Grant No.30772430) and Research Fund of Excellent Young Teachers of Shanghai Municipality (Grant No.jdy-08). [ABSTRACT FROM AUTHOR]

Total maxillary defects with orbital retention (Brown class 2b) are a challenge to reconstructive surgeons because of the variety of anatomical structures involved. Traditional techniques to reconstruct the orbital floor, zygoma, and maxilla using only a vascularised fibular flap are complicated, as the osteotomy and orientation of bone are difficult. Reconstruction of the orbital floor with titanium mesh may also cause palpable discomfort and increase the risk of secondary infection. We describe a modified technique using a vascularised fibular flap, together with a coronoid temporalis pedicle flap, which we used in two patients in whom we achieved satisfactory aesthetic and functional results. Our technique provides adequate tissue for infraorbital skin defects, provides pedicles of sufficient length, and requires only one fibular osteotomy. To our knowledge this is the first report of this technique. [ABSTRACT FROM AUTHOR]

PURPOSE: To analyze the clinical manifestation, image features, treatment and prognosis of Castleman disease hyaline vascular type in the parotid and neck region. METHODS: From 2004 to 2008, clinical data from ten patients with Castleman disease hyaline vascular type in the parotid and neck region were retrospectively reviewed, including sex, age, primary site, course of disease, symptom, physical examination, image examination, treatment protocol, pathological diagnosis, and follow-up result. RESULTS: Among the ten patients, there were four men and six females, their age ranged from 13 to 54 years with a mean age of 26.6 years. The course of disease ranged from 3 months to 4 years with a mean of 12.5 months. The primary lesions included the parotid region in 3 patients, neck in 5 patients, parotid and neck region in 2 patients. All patients had no obvious complaint and the laboratory examination was within the normal range. Computerized tomography and magnetic resonance imaging /angiography showed some clinical value for differential diagnosis. All patients received surgical operation, during the follow-up period from 6 to 57 months, mean 35.9 months, no recurrence of the lesion occurred. CONCLUSIONS: Castleman disease hyaline vascular type in the parotid and neck region is difficult to be diagnosed clinically, computerized tomography and magnetic resonance/ angiography are somewhat useful for differential diagnosis. Surgical operation is the first-line treatment of choice for this disease with good prognosis. [ABSTRACT FROM AUTHOR]

PURPOSE: To evaluate a reconstructive method in repairing the defect after resection of the osteoradionecrosis of the mandible. METHODS: 12 cases of the osteoradionecrosis of mandible from July 2003 to July 2008, underwent partial mandibulectomy. The reconstructive Ti-plate with pectoralis major myocutaneous flap was used to reconstruct the mandibular defects with or without adjacent soft tissue defects. The post-operative effects and flap successful rate were evaluated with a follow-up period of 3 months to 5 years. RESULTS: All the 12 flaps were 100% survival, and no plate exposure was found after operation in the follow up period. One plate fracture was found 2 and half years after reconstruction. The mouth opening was 2.0-2.5 cm and the occlusive deviation was limited to half to one tooth. 6 patients were satisfactory with the outlook, 4 patients felt fair with the outlook, and 2 patients had a little disappointment with the outlook. CONCLUSION: The reconstructive Ti-plate with pectoralis major myocutaneous flap is a cost-effective, safe method in reconstruction of the mandibular defects from osteonecrosis with or without adjacent soft tissue defects, especially in case of low quality of head and neck vascular donor sites for microsurgical reconstruction. [ABSTRACT FROM AUTHOR]

PURPOSE: To investigate the clinical application value of serum tumor markers detection combined with support vector machine (SVM) model in the diagnosis of oral squamous cell carcinoma. METHODS: Serum levels of neuron-specific enolase (NSE), cancer antigen 242 (CA242), cancer antigen 19-9 (CA199), carcinoembryonic antigen (CEA), tissue polypeptide antigen (TPA), cancer antigen 72-4 (CA724), cancer antigen 21-1 (CA211) and alpha fetoprotein (AFP) were detected with enzyme-linked immunosorbent assay (ELISA} and time-resolved fluoroimmunoassay (TRFIA) in 163 oral squamous cell carcinoma patients and 160 healthy persons. All the data was analyzed with SVM; the SVM models for diagnosis of oral squamous cell carcinoma were created, trained and validated by cross validation. RESULTS: Among the 163 oral squamous cell carcinoma patients, there were 128 males and 35 females with the male-to-female ratio of 3.66 : 1; the age ranged from 30 to 85 years old with a mean age of 59.3 years old; according to the primary site of human, 72 cases in tongue, 34 in gingival, 22 in buccal mucosa, 15 in palatal mucosa, 13 in floor of mouth, 4 in lip and 3 in retromolar region; according to the TNM-UICC classification, there were 33 patients at stage T1, 72 at T2, 44 at T3, 14 at T4, 119 at N0. 42 at N1, 2 at N2, 159 at M0, 4 at M1, 27 at clinical stage I, 51 at stage II, 52 at III, and 33 at IV; according to the pathological differentiation grade, 109 tumors were well differentiated, 42 were moderately differentiated and 12 were poorly differentiated. Five serum tumor markers of CA211, CA199, TPA, CA724 and NSE were selected optimally to create the optimal SVM model for diagnosis of oral squamous cell carcinoma. The accuracy, specificity, sensitivity and positive predictive value of the optimal SVM model were 88.54%, 93.13%, 84.05% and 92.57%, respectively. CONCLUSION: From the results, SVM model combined with 5 optimal serum tumor markers is suggested to be used in the diagnosis of oral squamous cell carcinoma. [ABSTRACT FROM AUTHOR]

PURPOSE: To investigate the clinical manifestation of branchial cleft cyst (fistula) and provide some clinical experience on its diagnosis and treatment. METHODS: From June 1993 to December 2006, two hundred and eighty-four patients with branchial cleft cyst or fistula underwent surgical treatment were retrospectively reviewed, the preoperative examinations, preoperative diagnosis and postoperative pathological diagnosis were recorded, and the data was analyzed with SAS6.12 software package. RESULTS: Among the 284 patients with branchial cleft cyst or fistula confirmed by postoperative pathological diagnosis, there were 132 patients (46.5%) with first branchial cleft cyst or fistula, one hundred and forty-five patients (51.1%) with second branchial cleft cyst or fistula, and 7 patients (2.4%) with third branchial cleft cyst or fistula. First branchial cleft cyst or fistula often occurred in patients older than 40 years, second and third branchial cleft cyst or fistula often occurred in patients younger than 40 years. The pathological diagnosis confirmed 188 primary lesions, thirty-three recurrent lesions, forty-four lesions with internal fistula, fourteen lesions with secondary infection and external fistula, and three lesions with both internal and external fistulae. One patient was found with tuberculosis simultaneously, two patients with multiple cysts, one patient with venous malformation. Six lesions were found malignant, five from first branchial cleft and one from second branchial cleft. The highest accuracy of preoperative diagnosis was 66.20% using ultrasonography. During the follow-up period, 5.98% of patients had recurrence. CONCLUSIONS: First and second branchial cleft cysts (fistula) are the most common lesions. Preoperative ultrasonography is the first choice for diagnosis of branchial cleft cyst (fistula). Complete resection including the cyst and fistula is the key to successful surgical treatment. [ABSTRACT FROM AUTHOR]

PURPOSE: To investigate the clinical application value of serum tumor markers detection combined with support vector machine (SVM) model in the diagnosis of oral squamous cell carcinoma. METHODS: Serum levels of neuron-specific enolase (NSE), cancer antigen 242 (CA242), cancer antigen 19-9 (CA199), carcinoembryonic antigen (CEA), tissue polypeptide antigen (TPA), cancer antigen 72-4 (CA724), cancer antigen 21-1 (CA211) and alpha fetoprotein (AFP) were detected with enzyme-linked immunosorbent assay (ELISA) and time-resolved fluoroimmunoassay (TRFIA) in 163 oral squamous cell carcinoma patients and 160 healthy persons. All the data was analyzed with SVM; the SVM models for diagnosis of oral squamous cell carcinoma were created, trained and validated by cross validation. RESULTS: Among the 163 oral squamous cell carcinoma patients, there were 128 males and 35 females with the male-to-female ratio of 3.66 : 1; the age ranged from 30 to 85 years old with a mean age of 59.3 years old; according to the primary site of tumor, 72 cases in tongue, 34 in gingiva, 22 in buccal mucosa, 15 in palatal mucosa, 13 in floor of mouth, 4 in lip and 3 in retromolar region; according to the TNM-UICC classification, there were 33 patients at stage T1, 72 at T2, 44 at T3, 14 at T4, 119 at N0, 42 at N1, 2 at N2, 159 at M0, 4 at Ml, 27 at clinical stage I, 51 at stage II, 52 at III, and 33 at IV; according to the pathological differentiation grade, 109 tumors were well differentiated, 42 were moderately differentiated and 12 were poorly differentiated. Five serum tumor markers of CA211, CA199, TPA, CA724 and NSE were selected optimally to create the optimal SVM model for diagnosis of oral squamous cell carcinoma. The accuracy, specificity, sensitivity and positive predictive value of the SVM model were 88.54%, 93.13%, 84.05% and 92.57%, respectively. CONCLUSION: From the results, SVM model combined with 5 optimal serum tumor markers is suggested to be used in the diagnosis of oral squamous cell carcinoma. [ABSTRACT FROM AUTHOR]

PURPOSE: To investigate the expression of fibroblast activation protein alpha (FAPA) gene in oral squamous cell carcinoma (OSCC) and paired normal tissue. METHODS: Differential FAPA gene expression paired normal and cancerous tissues from 30 OSCC patients were detected by reverse transcription-PCR (RT-PCR). The data was analyzed with SAS6.12 software for Chi-square test and t Student's test. RESULTS: RT-PCR results demonstrated that the positive rate of FAPA mRNA in 30 cancerous tissues and paired normal samples were 83%(25/30) and 40%(12/30), respectively (P<0.001); the relative expression level of FAPA mRNA in 30 cancerous tissues and paired normal samples were 3.58±0.46 and 1.27±0.21, respectively (P<0.0001), up-regulated 2.82-fold OSCC cancerous tissues. CONCLUSIONS: FAPA mRNA overexpression may play an important role in OSCC carcinogenesis and could be a potential target of OSCC therapy. [ABSTRACT FROM AUTHOR]

PURPOSE: To establish a standardized and modularized finite element model of a normal human skull to simulate the unilateral defect pattern of the maxilla and the stress distribution of craniofacial skeleton with repair subject to the bite force, and to make biomechanical evaluation and functional design of the unilateral maxillary reconstruction method using the microsurgery bone graft and zygomatic implant. METHODS: Based on CT scan and image process technology, a modularized geometrical and finite element model of the human skull was built to simulate unilateral defect pattern of the maxilla and design of the position, direction, length of the zygoma fixture, and the number of the conventional fixtures. Biomechanical properties of the design were evaluated using finite element analysis (FEA) method. RESULTS: The highest stress peaks concentrated at the neck of the zygomatic fixture on the zygoma, while the rest of the peri-implant bone appeared to bear lower stress. The zygomatic fixture played an important role in transmitting the occlusal force substituting the zygomatic process brace. CONCLUSIONS: The transmission of the occlusal force and stress distribution of the peri-implant bone of this reconstruction protocol is satisfied. Reconstitutions of the buttresses system ensure a stable base for occlusion and stress, which is secure and feasible to optimal unilateral maxillary rehabilitation. Supported by Shanghai Leading Academic Discipline Project (Grant No. Y0203). [ABSTRACT FROM AUTHOR]

Objective: To investigate cytokeratin 19 (CK19) expression in oral squamous cell carcinoma (OSCC) tissue as well as its correlation with pathologic differentiation grade and prognosis. Study design: Cancerous and distant tissues from 33 primary OSCC patients were collected during surgery. Each sample was divided into 2 parts, one for CK19 protein detection using immunohistochemistry, and the other for CK19 mRNA-level detection of relative quantification using fluorescent real-time reverse transcriptase polymerase chain reaction (RT-PCR). Results: The CK19 positive rate in cancerous tissue was 90.9% (30 out of 33) detected using immunohistochemistry, which was significantly higher than that in distant tissue (15.2%, 5 out of 33) by chi-square test (P < .001). The CK19 positive score in cancerous tissue was also significantly higher than that in the corresponding distant tissue by paired samples t test (P < .001). Patients with positive CK19 expression in distant tissue had higher tumor recurrence rate (P = .008) and lower survival rate (P = .015) than those with negative CK19 expression in distant tissue. Using fluorescent real-time RT-PCR, CK19 mRNA level in cancerous tissue was 2.21-fold higher than that in distant tissue (P = .020). The CK19 expression correlated significantly with pathologic differentiation grade, which was detected not only using immunohistochemistry (P = .002) but also using fluorescent real-time RT-PCR (P = .025), poorer differentiated indicating higher CK19 positive score and CK19 mRNA level. Conclusions: Increased CK19 protein expression and gene transcription in OSCC tissue correlate significantly with pathologic differentiation grade. Positive CK19 expression in distant tissue suggests a higher tumor recurrence rate and a lower survival rate. [Copyright &y& Elsevier]

Summary: Purpose: To investigate the biomechanics of the mandible following reconstruction with autogenous bone grafts. Material: Computerized tomography scan images of a human mandible, fibula and iliac crest were collected and used to build models on a PC. Methods: Four finite-element analysis (FEA) models of mandibles reconstructed with autogenous bone were created. The principal stresses of marked points, the Von Mises stresses at anatomical index regions, and the force values of temporo-mandibular joints and masticatory muscles were calculated. Results: Compared with the normal mandible, the one repaired with a fibula had greater Von Mises stresses on the grafted bone; the one repaired with iliac crest bone had the similar distribution of the Von Mises stresses as in the normal mandible. The principal stresses in the autograft varied between tensile and compressive stresses from the right graft/bone binding interface to the left in all reconstructed mandibles. On the whole, the maximum Von Mises stress was greater on the mandible reconstructed with fibula than that reconstructed with iliac crest. Conclusion: Mandibles repaired with iliac crest grafts have more mechanical properties similar to normal than those repaired with fibula grafts. [Copyright &y& Elsevier]