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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: 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]

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]

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 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]

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]

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 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]

PURPOSE: To explore the efficacy of combination of biological target therapy and chemotherapy in 71 patients with advanced head and neck squamous cell carcinoma(SCC). METHODS: Seventy-one patients (54 men and 17 women, aged from 30 to 83 years, mean 60 years) with locally advanced head and neck SCC (no indication for surgery, radiotherapy ) confirmed by histology and radiology, were enrolled in this study. The chemotherapy regimen was CDDP 75 mg/m² dl, TAX 75 mg/m² dl, 5-Fu 750 mg/m² dl-d5 and nimotuzumab 200 mg/m² per week. RESULTS: The patients completed 2 to 4 cycles of chemotherapy (mean 3 cycles). Nimotuzumab were used for 2 to 8 times (mean 5 times).The prognosis was as follows: CR in 4 cases, PR in 39 cases, SD in 18 cases, PD in 3 cases and 7 cases could not be evaluated. The total effective rate which was calculated by PR plus CR was 61%. Forty cases of them received surgery after bio-chemotherapy. No serious adverse reaction was found during the course of the treatment, only two cases with slight erythra. CONCLUSION: Nimotuzumab was equally effective in the increase of chemosensitivity and good tolerability profiles. Supported by International Co -operative Program from Science and Technology Commission of Shanghai Municipality (10410711200,11495802000). [ABSTRACT FROM AUTHOR]

PURPOSE: To evaluate the role of maxillary wings guiding plate in rehabilitation of combined defects of maxilla and mandible in convalescent stage. METHODS: Combined resection of maxilla and mandible without reconstruction acre performed in 10 patients with oral cancers. The impressions were got in 2 patients preoperatively and 8 patients postoperatively because of preoperative limited mouth opening. The clasps were designed to provide the retentive force according to the remained teeth. The plastic palate baseboard with wings guiding plate was made. The patients wore the plate 1 week after surgery. RESULTS: All the patients get good velopharyngeal competence and occlusion without leakage from nose after using this prosthesis for 1 to 3 months. CONCLUSIONS: Palate baseboard combined with wings guiding plate can not only obstruct the nasal-oral fistula but also correct malocclusion. It's convenient for taking dental prosthesis in late stage and improving patient's quality of life. Supported by Research Fund of Science and Technology Commission of Shanghai Municipality (Grant No.08DZ2271100). [ABSTRACT FROM AUTHOR]

Large general hospitals currently play an increasingly important role in the diagnosis and treatment for acute critical patients and difficult diseases because of the development of dual referral system and hierarchical diagnosis, as well as the formation of medical treatment alliance. Patients with oral cancers are often associated with systemic diseases, which increases the complexity of the condition. Thus, meeting the demand through the traditional single medical model is difficult. As such, a multidisciplinary team (MDT) model has been proposed and has achieved a good clinical effect. To standardize the application of this model, we organized an event in which relevant experts discussed and formulated a consensus to provide standardized suggestions on the MDT process and the diagnosis and treatment of common systemic diseases as reference for clinical practice.

With the increasing maturation of 3D printing technology, as well as its application in various industries, investigation of 3D printing technology into clinic medical education becomes an important task of the current medical education. The teaching content of oromaxillofacial head and neck surgical oncology is complicated and diverse, making lower understanding/memorizing efficiency and insufficient skill training. To overcome the disadvantage of traditional teaching method, it is necessary to introduce 3D printing technique into teaching of oromaxillofacial head and neck surgical oncology, in order to improve the teaching quality and problem solving capabilities, and finally promote cultivation of skilled and innovative talents.

Purpose: To investigate the clinical and pathological features of jaw ameloblastomas in 890 patients, in order to provide reference for clinical diagnosis and treatment., Methods: Eight hundred and ninty cases with jaw ameloblastomas treated in our department from January 2003 to June 2014 were retrospectively analyzed, including their gender, age, primary sites, pathological subtypes and therapies., Results: The age of patients ranged from 6 to 101 years old, with a mean age of 40.15 years. The distribution between males and females were 61.91% (551/890) males to 38.08% (339/890) females (1.62:1). 724 (81.35%) were located in the mandible, 166 (18.65%) were located in the maxilla. The occurrence of jaw ameloblastomas in this series of 890 patients was same in both sides of the jaw. Jaw ameloblastomas occurred in any parts of the jaw. Solid (378/890) and unicystic ameloblastoma (427/890) were the most common pathological subtypes. 414 cases underwent curettage, 212 cases underwent decompression, and 264 cases underwent mandibulectomy or maxillectomy., Conclusions: Jaw ameloblastoma mainly happens in mandible and young people. Men are more vulnerable to suffer from than women. The most common sites are mandibular molar region and ramus. Curettage is the most commonly used treatment for ameloblastomas. Supported by Scientific Research Fund of Oromaxillofacial Head and Neck Surgery of Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine.

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 21c10s, 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.

Objective: This retrospective study is to analyze the outcomes of cN0 stage tongue squamous cell carcinoma and to discuss a reasonable neck management for these cases., Methods: Totally 132 cases of cN0 stage tongue squamous cell carcinomas were included. Seventy-one cases were performed neck dissection(group ND), 61 cases were under wait-and-see (group WS). The clinical, pathological and follow up data of two groups were analyzed., Results: The cumulative three-year-survival between group ND and group WS were 87.3% and 83.4% respectively. In group ND, the survival of T1 and T2 cases were 89.3% and 83.3% respectively, while 89.6% and 58.3% in WS. For T2b cases which the size was larger than 3.0 cm, the survival of group WS was greatly lower than that of group ND. Both in ND and WS groups. The pathologically poor differentiation cases got poor survival than middle and well cases., Conclusion: The wait-and-see policy is recommanded for T1 stage cN0 tongue squamous cell carcinoma. For T2 cases that the tumor size is smaller than 3.0 cm, the wait-and-see is also reasonable, while the neck dissection should be considered in cases of poor differentiation. For large T2 cases, the selective neck dissection should be performed.

Objective: To investigate the mRNA expression of collagen genes in oral squamous cell carcinoma (OSCC) and paired normal oral mucosal tissue., Methods: The differential mRNA expressions of collagen genes between 30 OSCC tissues and the paired normal oral mucosal tissues were detected by RT-PCR., Result: The relative expression level of COL1A1 mRNA in the 30 cancerous tissues was up-regulated by 2.78 folds as compared with its expression in the paired normal samples, suggesting its significant overexpression in OSCC (P<0.001). The expression levels of COL1A2, COL4A1, COL4A2, and COL5A2 mRNA in the cancerous tissues were up-regulated by 1.07, 1.15, 1.27, and 1.16 folds compared to those in paired normal samples (P>0.05)., Conclusion: COL1A1 mRNA overexpression may play an important role in the carcinogenesis of OSCC and can be a potential molecular marker of OSCC.

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 II(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 III 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.

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 50mm×80mm×10mm 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 hrough 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.

Objective: To establish an animal model of widening distraction of tubular bone with dental implant distractor (DID) and investigate radiographical and histomorphological changes of long tubular bone following widening distraction with dental implant., Methods: Twelve Chinese mountain goats were used. Two sets of DID were installed in each goat's tibiae. After an 8-day latency period, nine tibiae were distracted at a rate of 0.35 mm each time and 2 times per day using DID devices. Radiography and histomorphology were used to evaluate the new generated bone in different period after distraction. The other three animals served as sham control., Results: After 10 - 14 days' distraction, the average width of the tibiae increased by 7.83 mm. Digital subtraction angiography (DSA) showed that there was a similarity between goat's tibiae and human's fibula in the blood supply. From the end of distraction to 3-month after the consolidation period, radiography demonstrated that the distraction gaps gradually became vague and filled with newly formed bone. The histomorphological study showed different results of bone formation in both distracted gaps. The osseointegration between bone and implant only occurred at screw-shaped part, while the moving part in tibiae was encapsulated by fibrous tissue., Conclusions: There are lots of similarities between goat's tibiae and human's fibula in anatomy and blood supply. The model of widening distraction osteogenesis of the goat's tibiae is ideal for studying human's fibula.

Purpose: To evaluate the role of maxillary wings guiding plate in rehabilitation of combined defects of maxilla and mandible in convalescent stage., Methods: Combined resection of maxilla and mandible without reconstruction were performed in 10 patients with oral cancers. The impressions were got in 2 patients preoperatively and 8 patients postoperatively because of preoperative limited mouth opening. The clasps were designed to provide the retentive force according to the remained teeth. The plastic palate baseboard with wings guiding plate was made. The patients wore the plate 1 week after surgery., Results: All the patients get good velopharyngeal competence and occlusion without leakage from nose after using this prosthesis for 1 to 3 months., Conclusions: Palate baseboard combined with wings guiding plate can not only obstruct the nasal-oral fistula but also correct malocclusion. It's convenient for taking dental prosthesis in late stage and improving patient's quality of life. Supported by Research Fund of Science and Technology Commission of Shanghai Municipality(Grant No.08DZ2271100).

Purpose: To investigate the role of NF-kappaB signal transduction pathway in apoptosis induced by shikonin in human tongue squamous cell carcinoma Tca-8113 cell line., Methods: Expression of IkappaBa, phosphatase-IkappaBa, bcl-2 and Bax proteins were detected by Western blot, NF-kappaB 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 t test using SPSS12.0 software package., Results: The expression of phosphatase-IkappaBa protein and the nuclear NF-kappaB DNA-binding activity was significantly decreased in shikonin treated cells by Western and EMSA. Bcl-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-8113 cells act at least partially through the inactivation of NF-kappaB pathway and subsequent activation of protease caspase family. Pharmacologic inhibition of the NF-kappaB activity by shikonin might be a powerful treatment option for OSCC.

Langerhans cell histiocytosis is an entity of Langerhans cell with its proto-cell proliferating locally or disseminatively. Children below 3 years old always present an acute disseminated type. The responsible cell involves in multiple systems and the viscera, so it often undergoes a poor prognosis. Without medical interference, the natural course of the disease may be within 6 months. But in this paper, a 19-month-old child was reported who was diagnosed Langerhans cell histiocytosis by biopsy and self-healed without treatment. After over 9 years of follow-up, no recurrence was found.

Objective: To investigate the application of individualized free anterolateral thigh combined flap (ALTCF) for tongue and mouth floor defect resulted from tongue carcinoma., Methods: From 2006 to 2008, individualized ALTCFs were used in 31 cases of tongue and mouth floor defects resulted from tongue carcinoma. The nutritional perforator vessel was musculocutaneous pattern in 22 cases and septocutaneous pattern in 9 cases. The size of the flaps and the included muscle was (4-8) cm x (5-10) cm and (2-5) cm x (3-6) cm, respectively. The length of blood vessel pedicle was (6.81 +/- 3.23) cm., Results: All the 31 free flaps survived with primary healing and no complication. The appearance and function were both satisfactory. During the follow-up period of 1-3 years, 28 cases survived, 2 cases were reoperated due to the neck lymphatic metastasis on the contralateral side. 1 case died of distant metastasis., Conclusions: Individualized ALTCF is a reliable flap for the tongue and month floor defects resulted from tongue carcinoma. Both the cosmetic and functional results are satisfactory with less morbidity in donor site and less complication.

Objective: To construct the tissue-engineered biological small intestinal submucosa(SIS) membrane and evaluate the feasibility of its use as a surrogate of periosteum and its possible role in dental implant distraction (DID)., Methods: The tissue-engineered biological SIS membrane was constructed through the co-culturing of boat bone marrow stromal cells (BMSC) and small intestinal submucosa. The cellular compatibility was evaluated with the phase contrast microscope, SEM, alkaline phosphatase(ALP) activity and histology, and its effect of osteogenesis promotion was detected by Micro-CT and histology after implanted in the exposed side of DID operation., Results: The phase contrast microscope, SEM, ALP activity and histology confirmed that the BMSC could adhere to SIS and proliferate on it normally, the cellular activity and function were not affected by SIS. Three months after the tissue-engineered biological SIS membrane was implanted into the exposed side, some discontinuous new bone in the "biological SIS membrane" group was detected by the Micro-CT under a higher window level. The histology revealed that there was a quantity of new bone in the distracted region and the majority was woven bone. The quantity and quality of the new bone in the "biological SIS membrane" implanted group were similar to the unexposed side, but the bone nonunion was detected in the un-implanted group and the interspace was fixed by fibrous connective tissue., Conclusions: The tissue-engineered biological SIS membrane can provide both daughter cells, guide bone regeneration in DID and promote the osteogenesis. But the outcome of the biological SIS membrane, especially the function of the osteoblast cultured in the SIS in new bone formation, still needs further study.

Objective: To construct a three-dimensional finite element model of reconstructed mandible and analyze the stress distributions of the model., Methods: CT scan and CAD/CAM software was used to develop the three-dimensional finite element model of reconstructed mandible and stress analysis was performend with ANASYS 7.0 software., Results: The three-dimensional finite element models of normal mandible and reconstructed mandible were constructed. The stress analysis discovered an unbalanced stress distribution in the mandible., Conclusion: Reconstructing mandible with fibular flap not only damages its structure, but also induced the badness of its biomechanical environment, in which condyle was the most sensitive region during the stresses in the mandible were changed.

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.

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 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. Supported by Shanghai Leading Academic Discipline Project (Grant No.Y0203).

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. Supported by Shanghai Leading Academic Discipline Project (Grant No.Y0203).

Objective: To investigate the mRNA expression of matrix metalloproteinase 1 (MMP1) gene in oral squamous cell carcinoma (OSCC) and the paired normal tissues., Methods: The differential expression of MMP1 mRNA between 30 OSCC and paired normal tissues were detected with reverse transcription-PCR (RT-PCR)., Results: The relative expression level of MMP1 mRNA in the OSCC tissues showed a 3.26-fold increase in comparison with that in the paired normal tissues (4.06-/+0.52 vs 1.24-/+0.17, P<0.0001). In the 30 OSCC tissues, the relative expression level of MMP1 mRNA was higher in histological grade II/III tissues (4.31-/+0.68) than in grade I (3.87-/+0.57) tissues, higher in OSCC in advanced stages (III/IV) than in tumors in early stages (I/II) (4.18-/+0.67 vs 3.65-/+0.53), and also higher in OSCC with cervical lymph node invasion than in those without cervical lymph node invasion (4.32-/+0.71 vs 3.91-/+0.51), but these differences were not statistically significant (P>0.05)., Conclusion: MMP1 gene may play a role in local invasion of OSCC, and can serve as a potential biomarker molecule for diagnosis, treatment and prognostic evaluation of OSCC, with also clinical value for OSCC classification.

Objective: To investigate osteopontin (OPN) mRNA expression in oral squamous cell carcinoma (OSCC) and normal oral mucosa tissues., Methods: Differential OPN gene expression were detected in 30 cancerous tissues and their paired normal tissues using real-time reverse transcription-PCR (real-time RT-PCR), and the data were analyzed statistically., Results: Real-time RT-PCR results demonstrated that the relative expression level of OPN mRNA in the cancerous tissues were significantly higher than that in paired normal samples (4.17-/+0.51 vs 0.97-/+0.12, P<0.001), showing a 4.3-fold up-regulation. In the 30 OSCC specimens, OPN mRNA expression in the OSCC of histological grades I showed a 3.1-fold down-regulation, significantly lower than the expression in grade II/III tumors (2.16-/+0.17 vs 6.80-/+0.72, P<0.05); its expression was significantly lower in early stage than in advanced stage OSCCs (2.34-/+0.17 vs 4.73-/+0.35, P<0.05). In cases of cervical lymph node metastasis, the expression was significantly higher than that in cases without lymphatic metastasis (6.38-/+0.56 vs 2.89-/+0.32, P<0.05)., Conclusion: OPN mRNA overexpression may play an important role in OSCC carcinogenesis and can be a potential target for OSCC therapy.

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).

Objective: To evaluate the vascularized (deep circumflex iliac vessels) iliac crest graft with internal oblique muscle as a method for reconstruction of composite mandibular defect., Methods: Vascularized iliac crest graft with internal oblique muscle was used to reconstruct the composite mandibular defects in 10 patients. All clinical data were analyzed retrospectively. A detailed inspection of the case-notes was undertaken to ascertain the presenting diagnosis, the surgery, the complications and the outcome. The type of mandibular defect was recorded., Results: Of the 10 patients with composite mandibular defects including mandibular body, mandibular angle, mandibular ramus and the soft tissue around them, 7 patients were recorded with the defects of mandibular condyles. During the follow-up period from 3 months to 24 months, primary wound healing was observed in all patients, except one patient with minor muscular necrosis. All patients were satisfied with their facial contour and mandibular shape, without tumor recurrence. Donor site problems important enough to be recorded in the notes were minimal., Conclusions: The vascularized iliac crest graft with internal oblique muscle offers a useful solution for reconstruction of composite mandibular defect. There is sufficient height and depth of bone to maintain a facial contour and mandibular shape. It can be used as a routine surgical technique to reconstruct composite mandibular defect.

Recently, some reports indicate that osteonecrosis of the jaws could occur after taking drugs containing hisphosphonates, including alendronate, pamidronate and zolendronate, which are widely used to treat osteoporosis and metastatic skeletal lesions in clinic.More and more attentions were given to this new oral complication. This article summarizes some advances in clinical manifestation, diagnosis, prevention and therapy of bisphosphonate -associated osteonecrosis of the jaws as well as the possible mechanisms involved.

Objective: To evaluate the epidemiology and treatment of segmental defect of mandible., Methods: A total of 541 patients were evaluated retrospectively. The character of the mandibular defect and method of reconstruction were analyzed., Results: The majority of segmental defect of mandible were found in 40 - 70 years old males and the leading cause was tumor. The reconstruction methods included soft flap, reconstruction plate and bone grafts. The main complications were infection and fistula., Conclusions: Tumor was the main cause of segmental resection of mandible, which occurs mainly in adult males. The body of the mandible was often involved. Vascularized bone grafts were the main methods in reconstruction of mandible.

Objective: The purpose of this experimental study was to investigate the histomorphological changes of tubular bone following widening distraction osteogenesis., Methods: Twelve Chinese mountain goats were subjected to the study. After the procedure of vertical and horizontal osteotomy, two widening distraction osteogenesis devices were put in each goat's left tibiae. After an 8-day latency period, nine tibiae were widening distracted; another three tibiae served as sham control group. Every three animals from the experimental group were sacrificed in different consolidated periods including 1-month, 2-month, and 3-month. Radiography, tetracycline double labeling, histomorphology, as well as biomechanics were used to evaluate the quality and quantity of new generated bone in different consolidated period after distraction osteogenesis., Results: After a distraction period, the average width of the tibiae is increased 7.83mm. From the end of distraction to 3-month after the consolidation period, radiography demonstrated that the distraction gaps gradually became vague. Tetracycline double labeling showed that the double labeling brands were rarely seen in normal cortex bone, but strongly increased in the distracted callus. Mineralization rates (MR) has a significant difference (P < 0.05) within distracted callus region compared with control cortex bone. Histomorphological study shows that there was a different result in two sides of vertical distracted gaps. The non-exposure side had a good bone formation, while a non-union of bone occurred at the exposure side. Three months after consolidation period, part of the gap in exposure side was filled with dense connection tissue, whereas the distracted callus had been remodeled and become lamellar bone in non-exposure side. The control group showed normal fracture healing procedure., Conclusions: There was a different outcome in two sides distraction gaps of tubular bone following widening distraction osteogenesis. A viable and well-perfused soft-tissue envelope in the area of distraction osteogenesis is important for creation of sufficient amount of new bone during distraction osteogenesis.

Purpose: Using co-culturing of bone marrow stromal cells (BMSCs) and small intestinal submucosa (SIS), to evaluate the cellular compatibility and the osteogenesis ability as well as the feasibility of SIS to serve as a scaffold in tissue engineering., Methods: Bone marrow was aspirated from the healthy adult goat and culture-expanded in vitro by the method of total marrow. The third passage cells were transplanted into SIS after being induced to differentiate into osteoblasts for 4 days and then seeded into SIS for 3 to 10 days. BMSCs alone were cultured at the same condition to act as controls. The cellular morphology and function (attachment, proliferation and differentiation) and the ectopia osteogenesis in vivo were assessed separately by means of phase contrast microscope, SEM and MTT, ALP activity, histology detection. The difference between the two groups were analyzed by Student's t test statistically., Results: The BMSCs could adhere to SIS and proliferate and grow on the surface of SIS normally. The cellular activity and function were not affected by SIS, no statistical difference was found between the two groups (P>0.05). The BMSCs/SIS compounds had good abilities of ectopia osteogenesis in vivo, and with time going on new bone formation increased. There was no bone formation in the control group. The endochondral bone formatin was the main pattern of osteogenesis., Conclusions: As a natural, absorbable, acellular scaffold, SIS is biocompatible and can be used as a tissue engineering scaffold. And for a membrane feature, there is the possibility to construct tissue engineered bone membrane with SIS.