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To understand the clinical features of osteonecrosis of the jaw after bisphosphonates use for therapy of breast cancer patients with bone metastasis.The cases diagnosed as bisphosphonates-related osteonecrosis of the jaws (BRONJ) were retrospectively analyzed from January 2011 to August 2015 in the Peking University School and Hospital of Stomatology, and those breast cancer patients with bone metastasis were selected. The clinical symptoms, imaging characteristics and treatment results were summarized.A total of 14 cases of breast cancer patients with bone metastasis were selected, with an average age of 60.21 years. The average time of suffering from breast cancer was 9.77 years, and the average time of bone metastasis and bisphosphonates drugs use was 5.67 and 3.29 years individually. There was no patient with systemic application history of hormone therapy, and no history of diabetes. There were 9 patients with tooth extractions history, and the mean time of bone necrosis symptoms was 8.58 months. There were 10 cases with bone necrosis occurring on mandible, 3 cases on maxilla, and one case with both upper and lower jaws involved. Among the 10 patients with surgical treatment, there were 3 cases cured, and 6 cases improved. However, the clinical symptoms of 2 cases with conservative treatment were significantly aggravated.The medication time between the bisphosphonates use beginning and the occurrence of BRONJ is relatively long. The history of diabetes and long-time hormone use did not exist in this group. Tooth extraction itself does not determine the severity of BRONJ. Mandible is the most common site involved by BRONJ. Surgical treatment can alleviate the clinical symptoms of BRONJ with breast cancer to some extent.

To investigate the defect types and reconstruction methods of maxillary defects.The database of 1,107 cases with maxillary defects in Peking University School and Hospital of Stomatology from January 1985 to December 2010 was established. There construction methods were reviewed. The defect types were classified according to Brown classification system.In the 1,107 cases, 1,104 cases could be classified according to Brown classification system. The most common type was 2a with 559 cases (50.6%). Among all the 1,107 cases, 349 cases were reconstructed with autotransplantation, 443 cases with prosthesis, 107 cases untreated, and 208 patients lost to the follow-up. There was a significant growing trend over time for the application of free flaps and a downward trend of prosthesis. The most popular free flaps were fibular flap (88 cases) and radial forearm flap (75 cases). Rectus abdominis flap and anterolatreal thigh flap were fit for extensive maxillary defects.The most common defect type is 2a. Free flap has become the dominant option for maxillary reconstruction. Free flaps could be selected according to the maxillary defect types.

To analyze the predilection of metastasis at levels I, II, III, IV, V for oral and maxillary squamous cell carcinoma on different primary sites.A retrospective review was conducted of the records of 1 233 patients (1 340 necks) from January 2000 to December 2011 with squamous cell carcinoma simultaneously underwent primary tumor resection and neck dissection in Department of Oral and Maxillary Surgery, Peking University School and Hospital of Stomatology. The topography of positive neck node was recorded, and the calculation was performed for the metastasis rate of levels I, II, III, IV, V based on the primary site, respectively.There were 557 necks with positive node (41.57%), and the metastasis rate for level I, II, III, IV, and V were 27.61%, 22.91%, 9.18%, 4.99%, 3.24%, respectively. Those in level III were at high risk for metastasis from carcinoma of tongue and the floor of mouth. The positive rate in level II was more than that in level I for tongue carcinoma, but for inferior gingiva carcinoma, bucca carcinoma, upper gingiva carcinoma, palatine carcinoma, maxillary sinuse carcinoma, intraosseous carcinoma of mandibular, the positive node was more likely to happen at level I compared with level II.Most metastases happen in levels I-III for patients with oral and maxillary squamous cell carcinoma, but the predilection of metastasis in level I, II or III is varied with the primary sites.

To give a reference for the early diagnosis and treatment of the cysts arising from the temporomandibular joint.Nine patients finally diagnosed as temporomandibular joint cysts at the Peking University Hospital of Stomatology from May 1998 to August 2013 were selected and reviewed. Their clinical manifestations, imaging features, diagnoses and differential diagnoses, treatments and follow-ups were summarized and discussed.In the 9 patients, 3 were males and 6 females. Their ages ranged from 33 to 62 years with a median age of 39 years; the course of the disease ranged from 2 weeks to 3 years with a median of 4 months. The image examinations were performed with conventional X-ray examinations in 7 cases, CT scans in 8 cases, MRI in 6 cases and ultrasound in one case. Of the 9 cases, 7 were finally diagnosed as ganglion cyst and 2 as synovial cyst. Ganglion cysts mainly presented as the mass of preauricular area or joint area, with no obvious symptoms or only local discomfort, occasionally with pain. The synovial cysts manifested as the painful swelling of preauricular area and limited mouth-opening, accompanying with occlusal disorders. The treatments included surgical resection in 8 cases, repeated arthrocenteses and lavages in one case. The follow-ups were from 3 months to 9 years, one case with recurrence, and the remaining eight cases without recurrence.MRI examinations are very helpful in the early diagnosis and treatment planning of temporomandibular joint cysts. Surgical resection can have good results. Repeated arthrocenteses and lavages also have a good result, which may be an alternative choice for synovial cyst, but more accumulation of clinical experience is further needed.

To evaluate the clinical effect of the combined pre- and retro-auricular incision used in superficial parotidectomy.The clinical data of 30 patients with benign tumors in the superficial parotid were collected. All the patients received the parotidectomy using the combined incision (15 cases) and the standard bayonet-shaped incision (15 cases) respectively. The data of operating time, amount of bleeding, the rate of complication, score of patients' satisfaction were recorded and compared between the two groups.No difference was found between the two groups in the operating time, amount of bleeding and the rate of complication (P0.05), while the score of patients' satisfaction in combined group was significantly higher than the other group (P0.01).The combined pre- and retro-auricular incision is clinically viable and provides satisfactory cosmetic results in patients undergoing conservative parotidectomy.

To reconstruct three-dimensional CT image of the skull, the blood vessels and the infratemporal fossa and parapharyngeal space tumors using Mimics software, and to discuss the clinical significance of the three-dimensional CT in diagnosis and preoperative surgical design.Four infratemporal fossa and parapharyngeal space tumors were studied using spiral CT Siemens 16 scanning technology, based on 2 mm thickness, and Mimics software was used to directly read the original image, and surface shaded technology was applied for reconstructing the spatial relationship of the vascular, skull and tumor structures.The three-dimensional reconstruction images can clearly demonstrate the extent of the tumor size, location, and its relation to blood vessels and the skull.The three-dimensional reconstruction of enhanced CT image is conducive to operation plan designed to avoid damaging important anatomical structures.

Maxillary defects resulting from tumor resection or trauma can cause severe functional and cosmetic deformities. Maxillary reconstruction has long been a challenge for oral maxillofacial surgeons. Functional maxillary reconstruction with vascularized composite bone flap and osseointegrated implants is one of the most important improvements in head and neck reconstructive surgery. Since 1999, our research group has performed a comprehensive research on functional maxillary reconstruction with free composite fibula flap. Clinical data of the patients with maxillary reconstruction using free fibula flap were analyzed to describe the indications and principles of perioperative period of this technique. The modified free fibula flexor-hallucis longus myofascial flap was introduced, which could overcome the disadvantages of traditional free composite fibula flap. The donor site morbidity, post-operative speech outcome, mastication function, and quality of life were evaluated objectively. The biomechanical effects of stress distribution on maxilla reconstructed by free fibula composite flap were analyzed by three-dimensional finite element analysis. These studies demonstrated maxillary defects can be reconstructed successfully using free fibula flaps. This procedure also allows dental implant or conventional denture rehabilitation, which can improve the patient's appearance and oral function and enhance the overall quality of life. The fibula free flap transfer has a high success rate and low perioperative complication rate, making it an ideal choice for maxillary defect reconstruction.

To investigate the osteoclastic activity in oral squamous cell carcinoma (OSCC) invading the jaws and to observe the expression of RANKL and OPG, the two bone resorption related cytokines, in these cases.Twelve cases of OSCC invading the mandible were studied. After pathological diagnosis, operations were done to remove part of the mandible depending upon the X-ray findings. Fresh soft tissue specimens were frozen-sectioned and other specimens with the bone tissue were fixed and decalcified to make paraffin sections. Tartrate-resistant acid phosphatase(TRAP) staining and immunohistochemical staining were then applied to observe the location of osteoclasts and the expression of RANKL and OPG.TRAP positive multinuclear cells were detected near the interface between the bone and tumor. RANKL positive cells were commonly seen on the endothelium of blood vessel and basement membrane of the epithelium. But OPG reactivities were not seen in these sections.The bone destruction caused by OSCC is mediated by osteoclasts but not by cancer cell itself. It appears that the differentiation and activation of osteoclasts were induced by OSCC through cytokines like RANKL.