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Objectives: The objective of this study was to identify the factors that influence free flap survival after head and neck reconstructive surgery in pediatric patients.Methods: One hundred thirty consecutive cases of head and neck reconstruction with free flaps in pediatric patients at the Department of Oral and Maxillofacial Surgery at Peking University School and Hospital of Stomatology, Beijing, People's Republic of China, between 1999 and 2017 were reviewed. A single head and neck surgical team performed all the included surgeries. Demographic and surgical patient data with possible associations with free flap survival were recorded. Relevant influencing factors were determined using the χ2 test and logistic regression analysis.Results: There were 135 free flap transfers performed in the patients, with an overall success rate of 95.6%. Free flap failure occurred in six flaps (4.4%). Arterial crisis was the main cause of flap failure. The overall complication rate was 7.0%. Patient age (5-9 years old; odds ratio, 13.397; 95% confidence interval, 1.167-153.838; P = 0.037) was a statistically significant risk factor influencing free flap survival. Donor site, defect region, recipient vessel, and surgery time were not associated with free flap outcome.Conclusion: Free flap transfer for head and neck reconstruction in pediatric patients is safe and reliable. However, special attention should be paid to pediatric patients under 9 years of age when performing head and neck reconstruction.Level Of Evidence: 4 Laryngoscope, 129:1915-1921, 2019. [ABSTRACT FROM AUTHOR]

Background: Selective tracheostomy is an effective but invasive airway management method for patients undergoing head and neck free flap reconstruction. Studies have shown that not all patients need tracheostomy. Several systems evaluating the need for tracheostomy have been proposed, but none is used clinically. Methods: A total of 533 cases underwent head and neck free flap reconstruction at Peking University School of Stomatology were reviewed for system development. Another 131 cases undergone the same surgery were included for system verification. Patients' demographic and surgical‐related information were analyzed. Result: A total of 321 cases in the development cohort and 68 cases in the system cohort underwent tracheostomy. The score was estimated: score = ∑(|log2OR|). Patients scoring >3 required tracheostomy, those scoring <2 should avoid tracheostomy, and those scoring 2 or 3 need further evaluation. Conclusion: This scoring system can help determine the need for selective tracheostomy in patients undergoing head and neck free flap reconstruction. [ABSTRACT FROM AUTHOR]

Deformities of the maxillofacial region following trauma and ablative surgery are devastating and not uncommon. Reconstruction of such defects is a surgically challenging procedure. Conventionally, reconstruction of dental arch defects lacks preoperative customised planning and relies heavily on the surgeon experience to ensure optimum surgical outcomes. The restoration of the dental arch shape and function has taken precedence after an extensive tumour resection surgery, especially in the current age of technological advancement. Thus, personalised and accurate reconstruction of dental arch defects has become a new goal. Computer-assisted surgery, especially navigation-assisted surgery, has gained popularity of late, in reconstructing deformities and restoring facial symmetry, appearance and function in the maxillofacial region. This technology provides a clearer three-dimensional visualisation of the area of interest and its relationship with the adjacent vital structures. Together with preoperative virtual surgical planning, it allows more specific and accurate osteotomies, thus reducing the ischemia and total operating times substantially. The risk of complications is also minimised whilst improving the final surgical outcomes. The use of the intraoperative navigation system and other computer-assisted surgical techniques during surgery can significantly improve the precision of the reconstruction of dental arch deformities, and achieve personalised and functional reconstructive goals while enhancing the quality of life of patients postoperatively. The Society of Oral and Maxillofacial Surgery, Chinese Stomatological Association provides the present professional perspective and treatment protocol for navigation-guided reconstruction of dental arch defects, to allow standardisation of the technique while promoting its application among oral and maxillofacial surgeons. [ABSTRACT FROM AUTHOR]

Skull base surgery is an interdisciplinary subject. The anatomical structures in the skull base related to oral and maxillofacial surgery include the parapharyngeal space, the pterygopalatine fossa and the infratemporal space. This operative area is one of the most challenging surgical areas in oral and maxillofacial surgery due to its deep site, complex anatomy and high risk. Obtaining pathological information of the tumour preoperatively may help surgeons optimise their treatment plan. Needle biopsy is one of the major minimally invasive techniques that allows preoperative pathological results to be obtained. The navigation technology, which is developing rapidly nowadays, provides a reliable assistance for deep tissue biopsy surgery. Experts from the Society of Oral and Maxillofacial Surgery, Chinese Stomatological Association formulated an expert consensus on the procedures and operations of navigation-guided needle biopsy techniques for skull base tumours, so as to standardise and promote the application and operation of navigation-guided needle biopsy for skull base tumours. [ABSTRACT FROM AUTHOR]

Orbital fracture and orbital floor reconstruction surgery is characterised by limited surgical exposure and high risks. Before the advent of digital technology, the design and implementation of the surgical scheme for orbital floor reconstruction surgery mainly depended on the intuitive understanding of imaging and the clinical experience of surgeons, with strong unpredictability and experience dependence. Surgical navigation systems with real-time positioning and imaging functions, when used in orbital reconstruction surgery, can detect the real-time intraoperative position, avoid risks, and assist in locating the reconstruction position to ensure the accuracy of orbital reconstruction, with the help of a preoperative surgical plan. Many studies have confirmed its effect. Unilateral orbital fracture and orbital floor reconstruction surgery is one of the earliest and most widely used surgical techniques in maxillofacial surgery. Experts from the Society of Oral and Maxillofacial Surgery, Chinese Stomatological Association have fully discussed and formulated this expert consensus on navigation-guided unilateral orbital fracture and orbital floor reconstruction techniques to standardise the clinical surgical procedures and promote its application. [ABSTRACT FROM AUTHOR]

The zygoma is located in the medial and lateral parts of the face, supporting the midfacial contour. The forward projection of the zygoma and the zygomatic arch often expose them to injury. Fractures of the zygoma can lead to the displacement of the zygoma and the zygomatic arch, causing facial collapse deformity. For delayed zygomatic fractures, the loss of normal anatomical landmarks caused by the malunion of the fracture lines and remodelling of the bony contour makes it difficult to determine the correct positions of the zygomatic bones. In such cases, ideal and steady outcomes with satisfactory midface symmetry have been difficult to obtain using traditional surgical methods. Nowadays, the application of digital surgical software and surgical navigation helps surgeons to perform accurate preoperative simulations to obtain ideal three-dimensional virtual surgical plans and achieve accurate reduction by intraoperative navigation systems, which increase the accuracy and predictability of fracture reduction outcomes. Experts from the Society of Oral and Maxillofacial Surgery, Chinese Stomatological Association have fully discussed and formulated an expert consensus on navigation- guided unilateral delayed zygomatic fracture reconstruction techniques to standardise the clinical operation procedures and promote the application. [ABSTRACT FROM AUTHOR]

Diabetes is often accompanied by dysfunction of salivary glands. However, the molecular mechanism remains unclear. The mechanisms that underlie diabetic hyposalivation were studied by db/db mice and SMG‐C6 cells. We found morphological changes and decreased stimulated salivary flow rates of the submandibular gland (SMG) in diabetic mice. We observed structural changes and dysfunction of mitochondria. More mitophagosomes and higher expression of autophagy‐related proteins were detected. Increased levels of proteins PINK1 and Parkin indicate that PINK1/Parkin‐mediated mitophagy was activated in diabetic SMG. Consistently, high glucose (HG) induced mitochondrial dysfunction and PINK1/Parkin‐mediated mitophagy in cultivated SMG‐C6 cells. HG also increased reactive oxygen species (ROS) and lessened activation of antioxidants in SMG‐C6 cells. In addition, HG lowered ERK1/2 phosphorylation and HG‐induced mitophagy was decreased after ERK1/2 was activated by LM22B‐10. Altogether, these data suggest that ROS played a crucial role in diabetes‐induced mitochondrial dysfunction and PINK1/Parkin‐mediated mitophagy and ERK1/2 was required in HG‐induced mitophagy in SMG. [ABSTRACT FROM AUTHOR]