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Zaitoun A, Fata M, Shafei ME, Abdeldayem M, Koraitim M. Application of supraclavicular island flap in oral and maxillofacial reconstruction. Oral Maxillofac Surg 2024; 28:893-908. [PMID: 38355871 DOI: 10.1007/s10006-024-01225-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 02/07/2024] [Indexed: 02/16/2024]
Abstract
Several surgical modalities are available for maxillofacial reconstruction as locoregional or microvascular free flaps. PURPOSE (a) Evaluate the reliability of the supraclavicular flap in cervico-orofacial region; (b) investigate the role of computed tomography angiography (CTA) in predicting the post-operative viability of the flap; (c) assess the speech, feeding, and esthetics after reconstruction using this flap. METHODS Eleven patients included in this study underwent either conventional or delayed harvesting of the supraclavicular flap (SCF). All the patients had diagnostic computed tomography angiography (CTA) of the supraclavicular flap before the surgery. RESULTS The mean harvesting time of the flap was 45.45 ± 4.16 min. The average length of the flap was 22.64 ± 1.12 cm, whereas the mean width of the flap was 6.14 ± 1.14 cm. The flap survived in 9 patients, while two patients had complete flap loss. After the surgery, three patients complained of speech difficulties. Two patients had swallowing problems. After the surgery, three patients complained of speech difficulties. Two patients had swallowing problems. Only two patients complained of weakness in the donor site. None of the patients reported that the weakness or pain at the donor site affected their daily activities or quality of life. CONCLUSION The pedicled SCF represents a safe and feasible option that can be used to reconstruct a wide array of maxillofacial oncologic defects. However, a study with a larger sample size is recommended to achieve more reliable clinical results for the modified delayed technique modification in terms of their effect on the survival of the supraclavicular flap.
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Affiliation(s)
- Abdalla Zaitoun
- Department of Maxillofacial and Plastic Surgery, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.
| | - Mohamed Fata
- Department of Maxillofacial and Plastic Surgery, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Mohamed El Shafei
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mohamed Abdeldayem
- Department of Maxillofacial and Plastic Surgery, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Mohamed Koraitim
- Department of Maxillofacial and Plastic Surgery, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
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Tao X, Pan X, Zhao G, Xue M, Rui Y. Dihydromyricetin regulates KEAP1-Nrf2 pathways to enhance the survival of ischemic flap. Food Sci Nutr 2024; 12:3893-3909. [PMID: 38873488 PMCID: PMC11167164 DOI: 10.1002/fsn3.4049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/02/2024] [Accepted: 02/07/2024] [Indexed: 06/15/2024] Open
Abstract
In clinical flap practice, there are a lot of studies being done on how to promote the survival of distal random flap necrosis in the hypoxic and ischemic state. As a traditional Chinese medicine, dihydromyricetin (DHM) is crucial in preventing oxidative stress and apoptosis in a number of disorders. In this work, we examined the impact of DHM on the ability to survive of ischemia flaps and looked into its fundamental mechanism. Our results showed that DHM significantly increased the ischemic flaps' survival area, encouraged angiogenesis and blood flow, reduced oxidative stress and apoptosis, and stimulated KEAP1-Nrf2 (Kelch-like ECH-associated protein 1-nuclear factor erythroid 2-related factor) signaling pathways. Adeno-associated virus (AAV) upregulation of KEAP1 expression also negated the favorable effects of DHM on flap survival. By activating KEAP1-Nrf2 signaling pathways, DHM therapy promotes angiogenesis while reducing oxidative stress and apoptosis.
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Affiliation(s)
- Xianyao Tao
- Suzhou Medical College of Soochow UniversitySuzhouJiangsuChina
- Department of Hand SurgeryWuxi Ninth People's Hospital Affiliated to Soochow UniversityWuxiJiangsuChina
| | - Xiaoyun Pan
- Department of Hand SurgeryWuxi Ninth People's Hospital Affiliated to Soochow UniversityWuxiJiangsuChina
| | - Gang Zhao
- Department of Hand SurgeryWuxi Ninth People's Hospital Affiliated to Soochow UniversityWuxiJiangsuChina
| | - Mingyu Xue
- Department of Hand SurgeryWuxi Ninth People's Hospital Affiliated to Soochow UniversityWuxiJiangsuChina
| | - Yongjun Rui
- Department of Hand SurgeryWuxi Ninth People's Hospital Affiliated to Soochow UniversityWuxiJiangsuChina
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Mihovilovic A, Martinovic D, Martinic J, Markovic D, Tarle M, Jerkovic D, Vuk S, Dediol E. Dynamometric outcomes of the donor site leg after vastus lateralis free flap harvest. J Craniomaxillofac Surg 2023; 51:755-759. [PMID: 37704506 DOI: 10.1016/j.jcms.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 09/05/2023] [Indexed: 09/15/2023] Open
Abstract
The vastus lateralis muscle is one of the four muscles that make up the quadriceps femoris muscle, and it is also the largest of them. Some studies have shown that patients experience lower quality of life and muscle weakness after surgical treatment of thigh muscles in order to perform reconstructive surgery of the head and neck. The aim of our study was to assess the quantitative and qualitative function of the lower extremities using an isokinetic dynamometer and a validated questionnaire on subjective difficulties in patients who underwent reconstructive surgery with the vastus lateralis free flap. Fourteen participants aged 20-70 years who suffered from malignant tumor in the head and neck region. The free vastus lateralis flap was used for reconstruction. All patients underwent isokinetic dynamometric measurement with the isokinetic dynamometer to test the isokinetic functions of the thigh muscles after surgery. In addition, subjective assessment of the lower extremities was performed using the validated questionnaire Lower Extremity Functional Scale. All isometric dynamometer measurements of the donor leg were compared with those of the unoperated leg. Peak torque and average power were significantly lower in the operated leg compared with the unoperated leg after 60°/s extension (p = 0.018 for peak torque, p = 0.021 for average power) and 180°/s extension (p = 0.019 for peak torque, p = 0.015 for average power). On the other hand, there was no statistically significant difference in dynamometer measurements after 60°/s flexion (p = 0.700 for peak torque, p = 0.854 for average power, and 180°/s flexion (p = 0.634 for peak torque, p = 0.571 for average power). The median value for the LEFS was 65.5 (40.00-71.25). The results of this study showed that there is a significant deterioration regarding the biophysical properties of the operated leg after harvesting vastus lateralis free flap.
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Affiliation(s)
- Ante Mihovilovic
- Department of Maxillofacial Surgery, University Hospital of Split, 21000, Split, Croatia; Department of Maxillofacial Surgery, University of Split School of Medicine, 21000, Split, Croatia.
| | - Dinko Martinovic
- Department of Maxillofacial Surgery, University Hospital of Split, 21000, Split, Croatia; Department of Maxillofacial Surgery, University of Split School of Medicine, 21000, Split, Croatia
| | - Jure Martinic
- Department of Oral Surgery, University of Split School of Medicine, 21000, Split, Croatia
| | - Domagoj Markovic
- Department of Cardiovascular Diseases, University Hospital of Split, 21000, Split, Croatia
| | - Marko Tarle
- Department of Maxillofacial Surgery, University Hospital Dubrava, 10000, Zagreb, Croatia
| | - Daniel Jerkovic
- Department of Oral Surgery, University of Split School of Medicine, 21000, Split, Croatia; Department of Oral Surgery, University Hospital of Split, 21000, Split, Croatia
| | - Sasa Vuk
- Department of Kinesiology of Sport, University of Zagreb Faculty of Kinesiology, 10000, Zagreb, Croatia
| | - Emil Dediol
- Department of Maxillofacial Surgery, University Hospital Dubrava, 10000, Zagreb, Croatia; Department of Maxillofacial Surgery, University of Zagreb School of Medicine, 10000, Zagreb, Croatia
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Battaglia S, Crimi S, Piombino E, Villari L, Maugeri C, Minervini G, Cicciù M, Bianchi A. Nodal frozen section + elective neck dissection as an alternative to sentinel lymph node biopsy for the management of cT1-2N0 oral squamous cell carcinoma patients: a viability and accuracy study. J Cancer Res Clin Oncol 2023; 149:10465-10471. [PMID: 37278829 PMCID: PMC10423153 DOI: 10.1007/s00432-023-04941-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 05/24/2023] [Indexed: 06/07/2023]
Abstract
PURPOSE Oral Squamous Cell Carcinoma (OSCC) is characterized by a high aggressiveness and a tendency to metastasize. The management of the neck in cT1-2N0 patients c follows three strategies: watchful waiting, elective neck dissection (END) or sentinel lymph node biopsy (SLNB). The aim was to assess the viability of intraoperative frozen sections of the nodes of cT1-2N0 to spot occult metastases as an alternative to SLNB, performing a modified radical neck dissection (MRND) in intraoperatively positive patients. METHODS The patients were treated at the Maxillo-Facial Surgery Unit of Policlinico San Marco of Catania between 2020 and 2022. END was performed in all patients, including frozen section examination of at least one clinically suspicious node per level. In case of positivity after frozen section examination, neck dissection was extended to levels IV and V. RESULTS All frozen sections were compared with a definitive test after paraffin inclusion. During surgery, 70 END were performed, and 210 nodes were analyzed with frozen sections. Among the 70 END, 52 were negative after frozen Sects. (156 negative nodes), and surgery was ended. Five of the 52 negative ENDs resulted in pN + after paraffin inclusion (9.6%), which underwent postoperative adjuvant treatment. The sensibility of our END + frozen section method was 75%, while the specificity of our test was 94%. The negative predictive value was 90,4%. CONCLUSIONS Elective neck dissection + intraoperative frozen section could be an alternative to SLNB to spot occult nodal metastases in cT1-2N0 OSCC due to the opportunity to perform a one-step diagnostic/therapeutic procedure.
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Affiliation(s)
- Salvatore Battaglia
- Department of Biomedical and Surgical and Biomedical Sciences, Catania University, 95123 Catania, CT Italy
| | - Salvatore Crimi
- Department of Biomedical and Surgical and Biomedical Sciences, Catania University, 95123 Catania, CT Italy
| | - Eliana Piombino
- Department of Biomedical and Surgical and Biomedical Sciences, Catania University, 95123 Catania, CT Italy
- Pathology Unit San Marco Hospital, San Marco Hospital, Catania, Italy
| | - Loredana Villari
- Pathology Unit San Marco Hospital, San Marco Hospital, Catania, Italy
| | - Claudia Maugeri
- Division of Maxillofacial Surgery Surgical Science dpt., Città Della Salute e Delle Scienze Hospital, University of Turin, Turin, Italy
| | - Giuseppe Minervini
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, University of Campania “Luigi Vanvitelli”, 80121 Naples, Italy
| | - Marco Cicciù
- Department of Biomedical and Surgical and Biomedical Sciences, Catania University, 95123 Catania, CT Italy
| | - Alberto Bianchi
- Department of Biomedical and Surgical and Biomedical Sciences, Catania University, 95123 Catania, CT Italy
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Alhindi N, Mortada H, Alsubhi AH, Alhamed L, Aljahdali FH, Aljindan F. Quality of life in post-tongue reconstruction: a comprehensive systematic review and meta-analysis of radial free forearm flap versus anterolateral thigh flap. EUROPEAN JOURNAL OF PLASTIC SURGERY 2023. [DOI: 10.1007/s00238-023-02066-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
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Reconstruction of an Extensive Maxillofacial Avulsion Injury Caused by Bear Attack With a Double-Island Anterolateral Thigh Free Flap. J Craniofac Surg 2021; 33:1122-1125. [PMID: 34560751 DOI: 10.1097/scs.0000000000008213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Bear attack, a relatively rare cause of maxillofacial trauma, could lead to severe facial deformity as well as functional impairment. A 45-year-old male ranger was attacked by a bear and suffered an extensive maxillofacial avulsion injury, resulting in massive soft tissue loss (17.5 × 10 cm2) on his left temporal-facial region with an intraoral defect (3 × 2 cm2), surrounded by pus and necrotic tissue. Computed tomography revealed a comminuted fracture of the mandible, as well as bone defects in the left zygomatic bone, zygomatic arch, and part of the lateral orbital wall. In contrast with tumor resection, this large defect wound resulting from trauma was an infected wound with extensive loss of soft tissue and bone, which presented many operational challenges. The initial goal was to control local infection and then repair the maxillofacial and intraoral defects simultaneously. The left oral mucosal lining and maxillofacial skin after infection control were repaired by transposition of a double-island anterolateral thigh flap, and the fractured mandible was fixed, achieving primary closure for the reconstruction of large soft and hard tissue injuries in the oral and maxillofacial region. Five months postoperatively, the flap had healed and the patient was satisfied with the profile. This patient demonstrated how a rare severe injury caused by a bear attack was treated by preliminary closure of an extremely large post-traumatic oral and maxillofacial defect. The authors recommend the 1 pedicled double-island free anterolateral thigh flap as a worthwhile choice for the reconstruction of complicated oral and maxillofacial tissue defects combined with an intraoral defect. To our knowledge, this is the largest clinical application reported to date of an anterolateral thigh flap (approximately 200 cm2) for a post-traumatic oral and maxillofacial defect.
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Gholami M, Shaban B, Hejazi A, Sazegar G, Soufizadeh R. Anatomical Variations of Anterolateral Thigh Flap: A Fresh Cadaver Dissection Study. World J Plast Surg 2021; 10:18-24. [PMID: 34912663 PMCID: PMC8662690 DOI: 10.29252/wjps.10.3.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 10/18/2020] [Accepted: 09/02/2021] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND The anterolateral thigh (ALT) flap is one of the fasciocutaneous flaps in the thigh region based on the septocutaneous or musculocutaneous perforators derived from the lateral circumflex femoral artery (LCFA). This cadaveric study aimed to explore the variability of ALT flap anatomy. METHODS Ten ALT flaps were dissected (2016-20117, Mashhad Legal Medicine Organization) in 10 fresh cadavers (7 males and 3 females). Flaps were marked in a 15 cm area centered on the middle point of a line drown from anterior superior iliac spine to the lateral surface of the patella. Dissection began by searching the skin perforators and then continued along the pathway of the vascular pedicle. RESULTS The average distance of ASIS-Patella was 44.6 cm. The mean number of skin perforators was 2.4 (ranged from 0 to 4). In one case, we did not find any skin perforator. The majority of skin perforators were musculocutaneous from descending branch of LCFA (66.7%) and the remaining were septocutaneous (33.3%). The mean length of vascular pedicle was 10.17 cm. The average diameter of vascular pedicle was 2.78 mm for the artery and 3.79 mm for the vein. The average time of flap harvesting was 85.3 min (ranged from 50 to 125 min). CONCLUSION The skin perforators supplying the ALT flap showed significant variability in number, location and course. The cadaveric study could enhance the anatomic knowledge and operative skills of ALT flap harvesting.
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Affiliation(s)
- Mahdi Gholami
- Oral & Maxillofacial Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Baratollah Shaban
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Arya Hejazi
- Legal Medicine, Member of Legal Medicine Research Center, Legal Medicine Organization, Mashhad, Iran
| | - Ghasem Sazegar
- Department of Anatomy and Cell Biology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Rashid Soufizadeh
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
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Anatomical Variations of Anterolateral Thigh Flap: A Fresh Cadaver Dissection Study. World J Plast Surg 2021. [DOI: 10.52547/wjps.10.3.18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Zhang S, Xiong T, Li S, Liu X, Yang Y, Zhao Z. Double Thread Suspension: A Novel Technique to Facilitate End-to-Side Venous Anastomosis With a Microvascular Coupling Device in Head and Neck Reconstruction. J Oral Maxillofac Surg 2021; 79:1954-1962. [PMID: 33901452 DOI: 10.1016/j.joms.2021.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/16/2021] [Accepted: 03/16/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Microvascular free tissue transfer has become a mainstay for head and neck reconstruction, and vascular anastomosis is 1 of the most challenging aspects. This study aimed to explore a safe, convenient, and efficient technique for end-to-side venous anastomosis using the coupling device. MATERIALS AND METHODS We evaluated a novel surgical strategy, double thread suspension (DTS), by reviewing data collected in a consecutive series of 60 patients who underwent free tissue grafting after surgical resection of head and neck tumors. Patients who underwent end-to-side microvascular anastomosis using the microvascular coupler device were randomly divided into the DTS group (n = 30) and the traditional procedure group (TRA, n = 30), the demographic data, coupler size, anastomosis time, microvascular complications, and flap survival were determined. RESULTS The optional size range of coupler devices in the DTS group is better than that of the conventional group, ranging from 1.5 to 4.0 mm compared with 2.0 to 4.0 mm. The average anastomosis time was 4.68 ± 0.43 minutes in the DTS group which was significantly lower than the conventional group that was 9.24 ± 1.46 minutes (P < .0001) . There was no statistically significant difference between the 2 groups in coupler related complications or flap survival. CONCLUSION The novel DTS technique provides the advantages of lowering procedure complexity, reducing operative time, and preventing tearing of vessel wall, therefore making DTS-guided end-to-side anastomosis a safe, relatively straightforward, and reliable technique.
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Affiliation(s)
- Sheng Zhang
- Professor, Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
| | - Tengteng Xiong
- Oral and Maxillofacial Surgery Resident-In-Training, Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
| | - Sainan Li
- Oral and Maxillofacial Surgery Resident-In-Training, Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
| | - Xinyu Liu
- Oral and Maxillofacial Surgery Resident-In-Training, Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
| | - Yan Yang
- Attending Doctor, Xiangya Stomatological Hospital, Xiangya School of Stomatology, Central South University, Changsha, Hunan, P.R. China
| | - Zhili Zhao
- Attending Doctor,Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China.
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Li B, Chen M, Pan MX. Sex determining region Y-box 2 is a prognostic factor for head and neck squamous cell carcinoma: Evidence from 11 published investigations. J Cancer Res Ther 2020; 16:434-439. [PMID: 32719247 DOI: 10.4103/0973-1482.189238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objective The aim of this study was to review the published literature and investigate whether sex determining region Y-box 2 (SOX2) is a prognostic factor in head and neck squamous cell carcinoma (HNSCC) by conduct a meta-analysis. Materials and Methods Trials were identified from the major electronic databases (MEDLINE, EMBASE, and Cochrane Library) using the key words "HNSCC" and "SOX2." The overall survival (OS), disease-specific survival (DPS), and disease-free survival (DFS) were the primary outcome measures. Results We identified 371 articles, 9 articles 11 studies with a total number of 1334 cases were eligible for inclusion of this meta-analysis. The results showed that OS (DPS) in low-expression group was higher than that in high-expression group. However, the difference between the two groups was not significant (hazard ratio [HR] = 1.30, 95% confidence interval [95% CI] = [0.88, 1.91]; P = 0.18), and there was great statistical heterogeneity (I2 = 66%, P = 0.002). After subgroup analysis, the HR for OS of the patients with reduced expression of SOX2 was 1.34 (95% CI = [1.04, 1.74], P = 0.03), and the heterogeneity became acceptable (I2 = 32%, P = 0.16). The HR for DFS of the patients with reduced expression of SOX2 was 1.39 (95% CI = [1.00, 1.93]; P = 0.05). Conclusion The findings of this meta-analysis are indicative of that high SOX2 expression is a negative prognostic factor of HNSCC and exhibit both worse OS and DFS. However, the small sample size available for this systematic review limited the power of this quantitative meta-analysis. It may therefore be too early to place complete confidence in these results.
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Affiliation(s)
- Bo Li
- Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi Zhuang Autonomous Region, 541001, China
| | - Mei Chen
- Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi Zhuang Autonomous Region, 541001, China
| | - Meng-Xiong Pan
- Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi Zhuang Autonomous Region, 541001, China
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Shanti RM, Choi J, Thomas WW, Sheth NP, Cannady SB. Reconstruction of Through-and-Through Composite Segmental Mandibulectomy Defect in a Patient With a Dominant Peroneal Artery Using an Anterior Lateral Thigh Osteomyocutaneous Free Flap: A Case Report and Description of Flap. J Oral Maxillofac Surg 2020; 78:1436.e1-1436.e7. [DOI: 10.1016/j.joms.2020.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 03/06/2020] [Accepted: 03/07/2020] [Indexed: 10/24/2022]
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The vascularized fascia lata free flap: an anatomical study and clinical considerations. Eur Arch Otorhinolaryngol 2020; 277:1733-1739. [PMID: 32100132 PMCID: PMC7198631 DOI: 10.1007/s00405-020-05861-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 02/12/2020] [Indexed: 11/25/2022]
Abstract
Purpose Fascia lata (FL) is often used as fascial component of the anterolateral thigh (ALT) flap in head and neck reconstruction. No distinct data exist on whether the FL has its own reliable vascular supply and whether the fascia alone can be harvested as a fascia lata free flap. Methods We dissected 25 thighs of 15 cadavers. The lateral circumflex femoral artery (LCFA) was identified, and the size of stained fascia and skin were measured after injection of methylene blue into the descending branch (DB). Finally, topography of fascial vessels was determined. Results Staining of fascia and skin paddle was found in all 25 cases. Ascending skin perforators of the DB of the LCFA gave off branches for supply of the FL enabling harvest of a fascia lata free flap. Septo- or musculocutaneous perforators pierced FL and entered skin within the proximal 38.6–60% of the thigh. The mean length and width of stained FL was 15.8 ± 4.1 cm and 8.7 ± 2.0 cm, respectively, and size of stained FL ranged from 40.0 to 336.0 cm2. In 20 cases (80%), skin paddles were 2.4 times larger on average compared to corresponding FL. Conclusion We could demonstrate that the FL receives its own vascular supply from perforators of the DB originating from the LCFA. Hence, harvest of a fascia lata free flap is possible, reliable, and the size of the fascia is suitable for reconstruction of small and large defects of the head and neck.
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Peripheral Pruning: A Safe Approach to Thinning Extra-Large Anterolateral Thigh Flaps. Ann Plast Surg 2019; 80:S164-S167. [PMID: 29553978 DOI: 10.1097/sap.0000000000001401] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Thinning of anterolateral thigh (ALT) flaps has been described to achieve optimal contouring. Previous studies caution against thinning large flaps owing to the risk of vascular compromise leading to partial or total flap necrosis. This study aims to demonstrate a reliably safe method for thinning extra-large (>240 cm) flaps. METHODS A retrospective review of 53 consecutive ALT flaps performed at a single institution was completed. Of these flaps, 18 (34%) were thinned primarily by sharp excision of sub-Scarpa's fat along the periphery of the flap using loupe magnification. A central cuff of fat is left to surround and protect the perforator. RESULTS There were 53 total flaps in our series. Eighteen of the flaps were thinned by peripheral pruning. Eleven (61%) of the flaps reconstructed defects of the lower extremity, whereas 4 (22%) reconstructed upper extremity defects and 3 (17%) reconstructed scalp defects (Table 1). The mean size of the thinned flap group was 35% larger than the nonthinned group (n = 18, 261 cm ± 109 cm vs n = 35, 192 cm ± 146 cm). Ten thinned flaps (55%) were extra large, with flap areas over 240 cm. The average amount of excised fat weighed 41 g ± 18 g. The average body mass index in the thinned flap group was 28.8 kg/m, which is classified as overweight. The average body mass index in the nonthinned flap group was 24.6 kg/m, which is classified as normal weight (Table 2). There were no cases of partial flap necrosis in the thinned flap group. A single case of total flap loss occurred in the thinned flap group secondary to hematoma formation during administration of therapeutic heparin for a mechanical heart valve. There were no other complications in the thinned flap group. CONCLUSIONS This is the first study to demonstrate a reliable technique for primary thinning of extra-large ALT flaps in the Western population. No complications related to thinning were observed. Peripheral pruning of sub-Scarpa's fat is a safe and reliable method of thinning extra-large ALT flaps without increasing the risk of flap necrosis.
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Dai X, Li P, Xu H. Free Flap Transplantation on the repair of defects caused by oral and maxillofacial tumors resection. Pak J Med Sci 2019; 35:1339-1343. [PMID: 31489003 PMCID: PMC6717448 DOI: 10.12669/pjms.35.5.316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To investigate the efficacy of free flap transplantation on the repair of tissue defects after oral and maxillofacial malignant tumor resection and its effects on serum sialic acid (SA) and interleukin-2 (IL-2). Methods Fifty-eight patients with oral and maxillofacial tumors were enrolled and set as the observation group. After the tumor resection, free flap transplantation was performed for postoperative repair. The postoperative efficacy, adverse reactions and follow-up indicators were observed. Moreover, 55 patients with benign tumors were enrolled into the control group, and 55 healthy persons were set as the healthy group. The levels of SA and IL-2 of the three groups were detected. Results In the observation group, 55 patients were successfully repaired (94.83%); 15 patients had adverse reactions after surgery. The follow-up duration was two to four years, and 45 patients survived for three years, with a survival rate of 77.59%. Before treatment, the serum SA level of patients with oral malignant tumor was significantly higher than those of the control group and healthy group, while the IL-2 level was significantly lower than those of the other two groups, and the differences were statistically significant (P<0.05). The serum IL-2 level in the observation group one day and fourteen days after surgery was higher than that before surgery, while the serum SA level was lower than that before surgery; the differences were statistically significant (P<0.05). Conclusion The application of free flap transplantation in the repair of postoperative tissue defects of oral and maxillofacial tumor resection is effective and has less complications, and the determination of both serum SA and IL-2 levels offers important references to recovery of patients with oral and maxillofacial tumors and prognosis evaluation.
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Affiliation(s)
- Xuemei Dai
- Xuemei Dai, Health Management Center, Binzhou People's Hospital, Shandong 256600, China
| | - Pengchong Li
- Pengchong Li, Stomatology Department, Binzhou People's Hospital, Shandong 256600, China
| | - Haiyan Xu
- Haiyan Xu, Endoscopy Room, Binzhou People's Hospital, Shandong 256600, China
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Wu K, Ji T, Cao W, Wu HJ, Ren ZH. Application of a new classification of chimeric anterolateral thigh free flaps. J Craniomaxillofac Surg 2019; 47:1198-1202. [PMID: 30952474 DOI: 10.1016/j.jcms.2019.01.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 09/26/2018] [Accepted: 01/28/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The anterolateral thigh free flap is one of the most commonly used flaps in reconstructive procedures. The purpose of this study was to assess this new classification of chimeric anterolateral thigh free flaps. METHODS Sixty-five patients underwent free anterolateral thigh chimeric free flap reconstruction of defects in the head and neck region. We summarized the anatomic features of perforators, including the number and origin of the perforators. RESULTS Sixty-five cases of femoral anterolateral double island flaps were divided into 3 types: trunk type (type I), 11 cases (16.9%), in which the perforators of two flaps originated in the descending branch and the transverse branch of the lateral femoral circumflex artery; branch type (type II), 45 cases (69.3%), in which both the perforators originated in the descending branch or the transverse branch of the lateral femoral circumflex artery; and bifurcation type (type III), 9 cases (13.8%), in which two perforators originated in the bifurcation of one perforator that originated in the descending branch or the transverse branch of the lateral femoral circumflex artery. All 65 flaps survived and none showed partial necrosis. CONCLUSIONS The anterolateral thigh chimeric flap can be divided into 3 types: trunk type (I type), branch type (II type) and bifurcation type (III type).
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Affiliation(s)
- Kun Wu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, No.639, Zhizaoju Road, Shanghai, 200011, PR China; Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, School of Medicine, Shanghai Jiao Tong University, No.639, Zhizaoju Road, Shanghai, 200011, PR China.
| | - Tong Ji
- Department of Oral and Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, No.639, Zhizaoju Road, Shanghai, 200011, PR China
| | - Wei Cao
- Department of Oral and Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, No.639, Zhizaoju Road, Shanghai, 200011, PR China
| | - Han-Jiang Wu
- Department of Oral and Maxillofacial Surgery, Second Xiangya Hospital of Central South University, Renmin Road, No. 139, Changsha, Hunan, 410011, China.
| | - Zhen-Hu Ren
- Department of Oral and Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, No.639, Zhizaoju Road, Shanghai, 200011, PR China.
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Aesthetic and Functional Evaluation of Large Full-Thickness Vermilion and Lower Lip Defects Reconstruction. J Craniofac Surg 2019; 30:e36-e39. [PMID: 30376500 DOI: 10.1097/scs.0000000000004952] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND It is hardly to reconstruct a huge defect of lower lip by using of partial flap which brings no mouth closing functional problem. In this study, we would like to introduce our experience in large full-thickness vermilion and lower lip/chin defects reconstruction, and also focus on the evaluation of the surgery effects. METHODS The large lower lip and chin (include vermilion) reconstruction were performed in Sichuan Provincial People's Hospital (2012-2015). The surgery experience was introduced in this study first. In the following section, after a statement of these basic problems, various situations involving are investigated, such as the surgical effects of aesthetic and function that were evaluated through a visual analogue scale (VAS) by doctors and patients separately. The VAS score assessments of 2 kinds of surgery were collected and compared. RESULTS A total of 7 patients use the tongue flap alone. Four patients use the combination of the free forearm flap and the anterior ventral tongue flap (COMBO flap). The VAS score of doctors group was significantly lower than the patients group (P < 0.05), and the aesthetic appearance was excellent (>90 points). Language features were not affected (>90 points). Slight mouth opening problems exist on these patients who were used COMBO flaps (>80 points; <90 points). The drooling and drumming gas problems were not observed. These 11 patients had no recurrence within 12 months after the operation. CONCLUSION The 1:1 ratio between upper and lower lip is crucial to the design of anterior ventral tongue flap which brings with an excellent 3-dimensional morphologic and anatomic structure outcome. The bite block might become an essential operation step for vermilion reconstruction by using of tongue flap. And the COMBO flap may enhance the facial aesthetics and oral function for the reconstruction.
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Ren ZH, Wu K, Wang Y, Tian ZW, Hu JZ. Role of a two-step suture in the prevention of postoperative transoral salivary fistulas during reconstruction of the oral cavity. Br J Oral Maxillofac Surg 2019; 57:164-168. [PMID: 30686575 DOI: 10.1016/j.bjoms.2019.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 01/11/2019] [Indexed: 11/29/2022]
Abstract
Transoral salivary fistulas are one of the most serious postoperative complications after operations for oral cancer, and we propose a new, two-step suture method to avoid them. From January 2005 to September 2017, 240 patients were recruited at the Shanghai Ninth People's Hospital and divided into experimental (n=89) or control (n=151) groups. The experimental group was treated by a two-step suture technique, while the control group had conventional sutures. Statistical differences were assessed using the chi squared and t tests, as appropriate. Only two patients developed transoral salivary fistulas in the experimental group, while in the control group there were 14 (9%). The incidence of fistulas in the experimental group was significantly lower than that in the control group (p=0.035). Regression analysis showed that there was a significant correlation between the groups and the incidence of salivary fistulas (p=0.032). The two-step suture technique is safe, effective, and easy to learn, and could reduce the incidence of postoperative salivary fistulas.
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Affiliation(s)
- Z-H Ren
- Department of Oral and Maxillofacial & Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639, Zhizhaoju Road, Shanghai 200011, China.
| | - K Wu
- Department of Oral and Maxillofacial & Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639, Zhizhaoju Road, Shanghai 200011, China.
| | - Y Wang
- Department of Oral and Maxillofacial & Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639, Zhizhaoju Road, Shanghai 200011, China.
| | - Z-W Tian
- Department of Oral and Maxillofacial & Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639, Zhizhaoju Road, Shanghai 200011, China.
| | - J-Z Hu
- Department of Oral and Maxillofacial & Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639, Zhizhaoju Road, Shanghai 200011, China.
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Sharma A, Kim JW, Paeng JY. Clinical analysis of neck node metastasis in oral cavity cancer. J Korean Assoc Oral Maxillofac Surg 2018; 44:282-288. [PMID: 30637242 PMCID: PMC6327011 DOI: 10.5125/jkaoms.2018.44.6.282] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 03/12/2018] [Accepted: 03/22/2018] [Indexed: 11/17/2022] Open
Abstract
Objectives The purpose of this study was to evaluate the neck node metastasis pattern and related clinical factors in oral cavity cancer patients. Materials and Methods In total, 76 patients (47 males, 29 females) with oral squamous cell carcinoma (OSCC) who had no previous malignancies and were not undergoing neoadjuvant concomitant chemoradiotherapy or radiotherapy were selected for analysis. Results Occult metastases were found in 8 of 52 patients with clinically negative nodes (cN0, 15.4%). Neck node metastases were found in 17 patients (22.4%). There was a statistically significant relationship between neck node metastasis and T stage (P=0.014) and between neck node metastasis and distant metastasis (Fisher's exact test, P=0.019). Conclusion Neck node metastasis was significantly related to tumor size and distant metastasis during follow-up.
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Affiliation(s)
- Aditi Sharma
- Department of Oral and Maxillofacial Surgery, Kyungpook National University School of Dentistry, Daegu, Korea
| | - Jin-Wook Kim
- Department of Oral and Maxillofacial Surgery, Kyungpook National University School of Dentistry, Daegu, Korea
| | - Jun-Young Paeng
- Department of Oral and Maxillofacial Surgery, Samsung Medical Center, Seoul, Korea
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Wu K, Lei JS, Mao YY, Cao W, Wu HJ, Ren ZH. Prediction of Flap Compromise by Preoperative Coagulation Parameters in Head and Neck Cancer Patients. J Oral Maxillofac Surg 2018; 76:2453.e1-2453.e7. [PMID: 30076809 DOI: 10.1016/j.joms.2018.07.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 07/01/2018] [Accepted: 07/01/2018] [Indexed: 02/08/2023]
Abstract
PURPOSE Studies on coagulation parameters (including activated partial thromboplastin time, prothrombin time, thrombin time, fibrinogen [FIB], platelet count, and D-dimer) in flap compromise are limited. The aim of the present study was to compare coagulation parameter variables in patients with and without flap compromise. MATERIALS AND METHODS In this retrospective cohort study, patients were recruited from the Department of Oral and Maxillofacial Surgery at the Second Xiangya Hospital (Changsha, Hunan, China) from July 2016 through July 2017. The primary predictor variable was a set of coagulation parameters. The primary outcome variable was flap compromise. The other variables were age, gender, tumor stage, smoking, and prior radiotherapy. Descriptive, bivariate, receiver operating characteristic (ROC) curves and regression statistics were computed. Statistical significance was set at less than .05 with 95% reliability. RESULTS A total of 503 patients with 42 compromised flaps were identified in this study. Venous thrombosis, arterial thrombosis, or no confirmed reason for compromise was observed in 28, 5, or 9 compromised flaps, respectively. Only FIB was associated with flap compromise or venous thrombosis at adjusted analyses, although the predictive values were low at ROC analysis. For patients with D-dimer lower than 0.4 μg/mL, the likelihood of venous thrombosis was greater than that for patients with D-dimer of at least 0.4 μg/mL (P = .0414). For patients with FIB lower than 3.5 g/L, the likelihood of venous thrombosis was greater than that for patients with FIB of at least 3.5 g/L (P = .0336). CONCLUSION Decreased FIB was associated with a higher rate of flap compromise. In patients with D-dimer lower than 0.4 μg/mL or FIB lower than 3.5 g/L, the risk of venous thrombosis was higher.
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Affiliation(s)
- Kun Wu
- Resident, Department of Oral and Maxillofacial and Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing-Shi Lei
- Resident, Department of Oral and Maxillofacial Surgery, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yuan-Yuan Mao
- Resident, Department of Anesthesiology, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Wei Cao
- Associate Professor, Department of Oral and Maxillofacial and Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Han-Jiang Wu
- Department Head, Department of Oral and Maxillofacial Surgery, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Zhen-Hu Ren
- Resident, Department of Oral and Maxillofacial and Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Christianto S, Lau A, Li K, Yang W, Su Y. One versus two venous anastomoses in microsurgical head and neck reconstruction: a cumulative meta-analysis. Int J Oral Maxillofac Surg 2018; 47:585-594. [DOI: 10.1016/j.ijom.2018.01.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 12/24/2017] [Accepted: 01/09/2018] [Indexed: 11/15/2022]
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Lóderer Z, Vereb T, Paczona R, Janovszky Á, Piffkó J. An anterolateral thigh chimeric flap for dynamic facial and esthetic reconstruction after oncological surgery in the maxillofacial region: a case report. Head Face Med 2018; 14:7. [PMID: 29642922 PMCID: PMC5896052 DOI: 10.1186/s13005-018-0164-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 03/28/2018] [Indexed: 11/10/2022] Open
Abstract
Background The surgical management of malignant tumors in the head and neck region often leads to functional and esthetic defects that impair the quality of life of the patients. Reconstruction can be solved with prostheses in these cases, but various types of microsurgical free flaps can provide a better clinical outcome. Case presentation In this case report, the tumor and parts of the involved facial muscles and nerve were excised surgically from a 42-year-old patient after a third relapse of basal cell carcinoma in the left midface. The tissue defect was reconstructed with an anterolateral thigh chimeric type I fascio-myocutaneous flap, where the facial palsy was restored with a segmental branch of the femoral nerve and the involved mouth corner elevator muscles for the segmented vastus lateralis muscle. The 6-month follow-up revealed a good esthetic outcome, the soft tissue defect reconstruction with good functional activity of the reconstructed facial nerve and with acceptable mimic movements. There has been no subsequent recurrence. Conclusions It is concluded that the chimeric type I anterolateral fascio-myocutaneous free flap can offer a good option for the esthetic and functional reconstruction of an extensive tissue defect in the maxillofacial region.
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Affiliation(s)
- Zoltán Lóderer
- Department of Oral and Maxillofacial Surgery, University of Szeged, Kálvária 57, Szeged, H-6725, Hungary
| | - Tamás Vereb
- Department of Oral and Maxillofacial Surgery, University of Szeged, Kálvária 57, Szeged, H-6725, Hungary
| | - Róbert Paczona
- Department of Oral and Maxillofacial Surgery, University of Szeged, Kálvária 57, Szeged, H-6725, Hungary
| | - Ágnes Janovszky
- Department of Oral and Maxillofacial Surgery, University of Szeged, Kálvária 57, Szeged, H-6725, Hungary.
| | - József Piffkó
- Department of Oral and Maxillofacial Surgery, University of Szeged, Kálvária 57, Szeged, H-6725, Hungary
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Yang X, Wu K, Li S, Hu L, Han J, Zhu D, Tian X, Liu W, Tian Z, Zhong L, Yan M, Zhang C, Zhang Z. MFAP5 and TNNC1: Potential markers for predicting occult cervical lymphatic metastasis and prognosis in early stage tongue cancer. Oncotarget 2018; 8:2525-2535. [PMID: 27713166 PMCID: PMC5356821 DOI: 10.18632/oncotarget.12446] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 09/20/2016] [Indexed: 12/27/2022] Open
Abstract
The purpose of this study is to identify candidate genes that could predict prognosis of early-stage tongue squamous cell carcinoma (TSCC) and its occult cervical lymphatic metastasis by large-scale gene expression profiling. Tumor tissue and matched normal mucosa samples were collected from patients with TSCC and analyzed with Affymetrix HTA2.0 high-density oligonucleotide array. Differentially expressed genes in TSCC with cervical lymph node metastasis (CLNM) were further analyzed with Gene Ontology and Kyoto Encyclopedia of Genes and Genomes for their functions and related pathways. A total of 107 differentially expressed genes (p < 0.05) were identified by microarray in TSCC samples with CLNM (n = 6) compared to those without CLNM (n = 6). Genes involved in the cell-matrix adherens junction and migration function including MFAP5, TNNC1, MGP, FBFBP1 and FBXO32 were selected and validated by RT-PCR in TSCC samples (n = 32). Of the five genes, MFAP5 and TNCC1 expressions were further validated by immohistochemistry (n = 61). The significant positive correlation between MFAP5 and TNNC1 expression (p<0.001) was observed. Notably, over-expression of MFAP5 and TNNC1 were correlated with CLNM, metastasis relapse-free survival and overall survival. Our findings indicated that MFAP5 and TNNC1 may be potential markers for predicting occult cervical lymphatic metastasis and prognosis of oral tongue carcinoma.
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Affiliation(s)
- Xi Yang
- Department of Oral & Maxillofacial - Head & Neck Oncology, Shanghai Key Laboratory of Stomatology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200011, China
| | - Kailiu Wu
- Department of Oral & Maxillofacial - Head & Neck Oncology, Shanghai Key Laboratory of Stomatology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200011, China
| | - Siyi Li
- Department of Oral & Maxillofacial - Head & Neck Oncology, Shanghai Key Laboratory of Stomatology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200011, China
| | - Longwei Hu
- Department of Oral & Maxillofacial - Head & Neck Oncology, Shanghai Key Laboratory of Stomatology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200011, China
| | - Jing Han
- Department of Oral & Maxillofacial - Head & Neck Oncology, Shanghai Key Laboratory of Stomatology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200011, China
| | - Dongwang Zhu
- Department of Oral & Maxillofacial - Head & Neck Oncology, Shanghai Key Laboratory of Stomatology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200011, China
| | - Xuerui Tian
- Department of Oral & Maxillofacial - Head & Neck Oncology, Shanghai Key Laboratory of Stomatology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200011, China
| | - Wei Liu
- Department of Oral & Maxillofacial - Head & Neck Oncology, Shanghai Key Laboratory of Stomatology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200011, China
| | - Zhen Tian
- Department of Oral Pathology, Shanghai Key Laboratory of Stomatology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200011, China
| | - Laiping Zhong
- Department of Oral & Maxillofacial - Head & Neck Oncology, Shanghai Key Laboratory of Stomatology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200011, China
| | - Ming Yan
- Department of Oral & Maxillofacial - Head & Neck Oncology, Shanghai Key Laboratory of Stomatology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200011, China
| | - Chenping Zhang
- Department of Oral & Maxillofacial - Head & Neck Oncology, Shanghai Key Laboratory of Stomatology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200011, China
| | - Zhiyuan Zhang
- Department of Oral & Maxillofacial - Head & Neck Oncology, Shanghai Key Laboratory of Stomatology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200011, China
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Use of Integra in oral reconstruction: a case series. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 125:e72-e75. [PMID: 29248423 DOI: 10.1016/j.oooo.2017.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 10/24/2017] [Accepted: 11/04/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Small intraoral defects are usually reconstructed using skin autografts. However, the goal of this research was to describe an alternative to classic techniques using artificial dermis (Integra) in the reconstruction of these types of injuries. MATERIALS AND METHODS Four patients with small intraoral lesions in different locations underwent resection. The created defects were covered with a bilayer of Integra; then, a chlorhexidine stent cure (Laboratorios Salvat, Barcelona, Spain) was applied. The patients were followed up daily during the first week to detect any signs of infection, dehiscence, or loss of the lamina. Thereafter, they were followed up once a week for 1 month. RESULTS None of the patients presented with infections or loss of the dermis. When the silicon sheet was detached, granulation tissue was detected, with complete re-epithelialization of the lesion in the postoperative weeks 3 to 4. CONCLUSIONS The use of the Integra allowed for the rapid reconstruction of slight intraoral defects while preventing the morbidity associated with classic techniques. In this study, no complications were observed.
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Gong ZJ, Ren ZH, Wang K, Tan HY, Zhang S, Wu HJ. Reconstruction design before tumour resection: A new concept of through-and-through cheek defect reconstruction. Oral Oncol 2017; 74:123-129. [DOI: 10.1016/j.oraloncology.2017.09.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 08/29/2017] [Accepted: 09/28/2017] [Indexed: 10/18/2022]
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Stranix JT, Lee ZH, Lam G, Mirrer J, Rapp T, Saadeh PB. Limb-sparing sarcoma reconstruction with functional composite thigh flaps. Microsurgery 2017; 38:466-472. [DOI: 10.1002/micr.30254] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 08/26/2017] [Accepted: 09/18/2017] [Indexed: 12/29/2022]
Affiliation(s)
- John T. Stranix
- Hansjorg Wyss Department of Plastic Surgery; NYU Langone Medical Center; New York NY
| | - Z-Hye Lee
- Hansjorg Wyss Department of Plastic Surgery; NYU Langone Medical Center; New York NY
| | - Gretl Lam
- Hansjorg Wyss Department of Plastic Surgery; NYU Langone Medical Center; New York NY
| | - Joshua Mirrer
- Hansjorg Wyss Department of Plastic Surgery; NYU Langone Medical Center; New York NY
| | - Timothy Rapp
- Department of Orthopedic Surgery; NYU Langone Medical Center; New York NY
| | - Pierre B. Saadeh
- Hansjorg Wyss Department of Plastic Surgery; NYU Langone Medical Center; New York NY
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Yao Z, Huang K, Luo S, Sun L, Zhou H, Wu S, Xiao J. [Reconstruction of oral and maxillofacial soft tissue defects with anterolateral thigh (myocutaneous) flap assisted by computed tomography angiography]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2017; 31:702-708. [PMID: 29798652 DOI: 10.7507/1002-1892.201612132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the efficacy of anterolateral thigh (myocutaneous) flap designed with computed tomography angiography (CTA) to reconstruct oral and maxillofacial soft tissue defects. Methods Between January 2011 and December 2015, 23 cases of oral and maxillofacial tumors were treated. There were 14 males and 9 females with the age range from 45 to 72 years (mean, 56.8 years). There were 12 cases of tongue carcinoma, 5 cases of buccal mucosa carcinoma, 4 cases of mouth floor carcinoma, and 2 cases of oropharynx carcinoma; all were squamous cell carcinoma. According to standard TNM staging of the Union for International Cancer Control (UICC), 8 cases were rated as T 2N 0M 0, 3 cases as T 2N 1M 0, 1 case as T 2N 2M 0, 4 cases as T 3N 0M 0, 2 cases as T 3N 1M 0, 2 cases as T 3N 2M 0, 2 cases as T 4N 1M 0, and 1 case as T 4N 2M 0. The course of disease was 1-6 months (mean, 2.4 months). CTA was performed before operation to locate the perforator vessel and its surface projection of emerging point and to design anterolateral thigh (myocutaneous) flap by computer. The defects of soft tissue ranged from 6 cm×4 cm to 11 cm×7 cm after resection of tumor. The flap was used to repair defects, including 14 thinned anterolateral thigh flaps, 7 anterolateral thigh myocutaneous flaps, and 2 anterolateral bilobed flaps; and the flap area ranged from 7 cm× 5 cm to 12 cm×8 cm. The donor sites were sutured directly. Results CTA showed that myocutaneous perforators penetrated at the fascias of the vastus lateralis muscles in 22 cases with a location rate of 95.7% (22/23). Submandibular fistula occurred in 1 case at 5 days after operation and fistula healed after changed dressings. Other wounds at recipient site and donor site healed at primary stage. Anastomose with 2 vein was performed because of poor venous return in 1 case, and the flap survived. The other flaps survived well. All the patients were followed up 6-36 months (mean, 16.4 months). At 3 months after operation, the simplified recovery standard of speech function and swallow function was established according to the University of Washington Quality of Life Scale (UW-QOL). The speech and swallow function recovered satisfactorily in 22 cases, and not very satisfactorily in 1 case of well differentiated squamous cell carcinoma of the right mouth floor (T 4N 1M 0). No obvious tissue atrophy was observed in 23 cases. No dysfunction was found at the donor site. There was no tumor recurrence in 21 patients; 1 patient accepted the second operation due to lymphonodi metastasis of contralateral neck at 6 months after first operation, who died after 23 months; 1 patient died of distant metastasis at 10 months after first operation. Conclusion The anterolateral thigh (myocutaneous) flap designed with CTA could well recover the morphology and function of the recipient site.
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Affiliation(s)
- Zhihao Yao
- Department of Oral and Maxillofacial Surgery, Southwest Medical University Affiliated Stomatological Hospital, Luzhou Sichuan, 646000, P.R.China
| | - Kui Huang
- Department of Oral and Maxillofacial Surgery, Southwest Medical University Affiliated Stomatological Hospital, Luzhou Sichuan, 646000, P.R.China
| | - Shihong Luo
- Department of Oral and Maxillofacial Surgery, Southwest Medical University Affiliated Stomatological Hospital, Luzhou Sichuan, 646000, P.R.China
| | - Libo Sun
- Department of Oral and Maxillofacial Surgery, Southwest Medical University Affiliated Stomatological Hospital, Luzhou Sichuan, 646000, P.R.China
| | - Hangyu Zhou
- Department of Oral and Maxillofacial Surgery, Southwest Medical University Affiliated Stomatological Hospital, Luzhou Sichuan, 646000, P.R.China
| | - Shuangjiang Wu
- Department of Oral and Maxillofacial Surgery, Southwest Medical University Affiliated Stomatological Hospital, Luzhou Sichuan, 646000, P.R.China
| | - Jingang Xiao
- Department of Oral and Maxillofacial Surgery, Southwest Medical University Affiliated Stomatological Hospital, Luzhou Sichuan, 646000,
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Ren ZH, Gong ZJ, Wu HJ. Unit resection of buccal squamous cell carcinoma: Description of a new surgical technique. Oncotarget 2016; 8:52420-52431. [PMID: 28881740 PMCID: PMC5581039 DOI: 10.18632/oncotarget.14191] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 11/20/2016] [Indexed: 12/18/2022] Open
Abstract
This study characterized the infiltration of primary tumors along the muscles, fascia and spaces of the maxillofacial region in buccal squamous cell carcinoma (BSCC) and suggested a new surgical strategy that is suitable for most stages. Based on the anatomic characteristics and infiltration of the primary tumor a new surgical approach - unit resection buccal surgery (URBS) - was developed. We evaluated this new surgical strategy, across a cohort of 127 BSCCs: 60 cases treated with URBS and 67 cases treated with conventional surgery. Notably there was no statistical difference in the clinicopathological variables between the two groups. After initial treatment with curative intent, the patients were regularly followed-up with clinical examination and imaging. URBS proved suitable for almost all stages of BSCC, and was particularly advantageous for advanced stages of BSCC. At 2 years post-treatment, the rates of overall survival were 83.3% in the URBS group and 60.1% in the conventional surgery group, respectively (hazard ratio 0.38; 95% CI 0.20 to 0.75; P=0.005). Similarly, the rates of disease-free survival were 76.6% and 51.9% in the URBS group and the conventional surgery group, respectively (hazard ratio 0.42; 95% CI 0.23 to 0.75; P=0.003). The principles of URBS are suitable for almost all stages of BSCC, especially advanced stages. URBS may improve the prognosis of BSCC patients.
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Affiliation(s)
- Zhen-Hu Ren
- Department of Oral and Maxillofacial surgery, Second Xiangya hospital of Central South University, Changsha, Hunan, 410011, China.,Department of Oral Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Zhao-Jian Gong
- Department of Oral and Maxillofacial surgery, Second Xiangya hospital of Central South University, Changsha, Hunan, 410011, China
| | - Han-Jiang Wu
- Department of Oral and Maxillofacial surgery, Second Xiangya hospital of Central South University, Changsha, Hunan, 410011, China
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Ren ZH, Wu HJ, Ji T, Wang K, Gokavarapu S, Zhang CP. Clinical Application of an Original Vascular Anastomosis: A Clinical Multicenter Study. J Oral Maxillofac Surg 2016; 74:2288-2294. [DOI: 10.1016/j.joms.2016.04.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 02/25/2016] [Accepted: 04/15/2016] [Indexed: 10/21/2022]
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Gong ZJ, Chen YR, Wang K, Zhang S, Ren ZH, Wu HJ. Longitudinal Contraction Venoplasty in Prevention of Internal Jugular Vein Thrombosis After Free Flap Vascular Anastomosis. J Oral Maxillofac Surg 2016; 74:1277-83. [DOI: 10.1016/j.joms.2016.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 01/01/2016] [Accepted: 01/03/2016] [Indexed: 12/01/2022]
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Paydarfar JA, Freed GL, Gosselin BJ. The anterolateral thigh fold-over flap for total and subtotal glossectomy reconstruction. Microsurgery 2016; 36:297-302. [PMID: 26880059 DOI: 10.1002/micr.30033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 12/19/2015] [Accepted: 01/22/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND We present a fold-over technique for total and subtotal glossectomy reconstruction utilizing the ALT flap with the goal of increasing soft tissue bulk. METHODS Retrospective review of total and subtotal glossectomy patients undergoing ALT fold-over flap reconstruction from January 2007 to December 2012. RESULTS Eight patients fit inclusion criteria. Average length of follow-up was 35 months. There were no flap failures. At last follow-up, no patients were tracheostomy dependent. Six out of 8 patients (75%) did not require a g-tube and were able to maintain their weight. Speech intelligibility was good in 6/8 patients (75%). CONCLUSIONS The ALT fold-over flap technique provides sufficient bulk to allow decannulation and airway protection as well as PO intake in most patients. Given the minimal donor site morbidity, it is our technique of choice for total and subtotal glossectomy defects. © 2016 Wiley Periodicals, Inc. Microsurgery 36:297-302, 2016.
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Affiliation(s)
- Joseph A Paydarfar
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Gary L Freed
- Division of Plastic Surgery, Department of Surgery, Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Benoit J Gosselin
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH
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Ren ZH, Zhang CP, Ji T. Expression of SOX2 in oral squamous cell carcinoma and the association with lymph node metastasis. Oncol Lett 2016; 11:1973-1979. [PMID: 26998109 DOI: 10.3892/ol.2016.4207] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 12/18/2015] [Indexed: 12/14/2022] Open
Abstract
Oral squamous cell carcinomas (OSCCs) are a growing problem in the world. The various existing treatments have not markedly improved the survival rate of patients with OSCC during the past three decades. Novel treatment strategies are required. Sex determining region Y-box 2 (SOX2) is a transcription factor that is involved in the maintenance of embryonic stem cell pluripotency and in multiple developmental processes. SOX2 expression was indicated to act as a prognostic factor in various types of tumors, including breast, colorectal, gastric and lung cancer and glioblastoma, and as a link between malignancy and stemness. Cancer stem cells (CSCs) may be responsible for the genesis, growth and metastatic spread of tumors. The poor survival outcomes for OSCC patients may be attributable to a poor selection of target cells for treatment, as current oral cancer therapies are generally aimed at the global mass of tumor. Therefore, the consideration that novel approaches to oral cancer may be targeted using SOX2 and CSCs appears reasonable. In order to better understand the oncogenic roles and the corresponding signal transduction pathways of the SOX2 protein, the present study emphasizes the role of SOX2 in OSCC, including the proteins associated with OSCC, and reviews the literature regarding the role of SOX2 in lymph node metastasis. The aim of the present study is to provide a reference for future studies that engage in research on the aforementioned subject.
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Affiliation(s)
- Zhen-Hu Ren
- Department of Oral and Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, P.R. China; Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China
| | - Chen-Ping Zhang
- Department of Oral and Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, P.R. China
| | - Tong Ji
- Department of Oral and Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, P.R. China
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Elective versus therapeutic neck dissection in node-negative oral cancer: Evidence from five randomized controlled trials. Oral Oncol 2015; 51:976-981. [PMID: 26321080 DOI: 10.1016/j.oraloncology.2015.08.009] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 08/10/2015] [Accepted: 08/13/2015] [Indexed: 12/19/2022]
Abstract
The aim of this study was to compare the outcomes of elective neck dissection (END) with that of a more conservative approach comprising of observation plus therapeutic neck dissection for nodal relapse (OBS), by conducting a meta-analysis of randomized controlled trials (RCTs) that compare these two surgical approaches in patients. RCTs conducted prior to May 2015 were identified from electronic databases such as MEDLINE EMBASE and Cochrane Library. Reference lists within the retrieved articles were used as secondary reference sources. Disease-free survival (DFS) and overall survival (OS) were the primary outcome measures. Five RCTs with a combined subject population of 779 patients were included. Meta-analysis of these 5 RCTs showed that DFS in END group was higher than that in the OBS group with a significant inter-group difference (Risk Ratio [RR]:1.33; 95% Confidence Interval [CI] 1.06, 1.66); P=0.01; five trials, 779 participants]. However, there was a significant statistical heterogeneity among the studies (I-squared=56%, P=0.06). Four studies had reported on OS. Meta-analysis of these 4 RCTs revealed a higher OS in the END group as compared to that that in the OBS group with a significant inter-group difference (RR: 1.18; 95% CI 1.07, 1.29); P=0.0009; four trials, 708 participants]. The statistical heterogeneity of these 4 studies is small (I-squared=14%, P=0.32). The results of this meta-analysis suggest that END at the time of resection of the primary tumor confers a DFS and OS benefit in patients with clinically node-negative oral cancer.
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Ren ZH, Wu HJ, Zhang S, Wang K, Gong ZJ, He ZJ, Peng J. A new surgical strategy for treatment of tongue squamous cell carcinoma based on anatomic study with preliminary clinical evaluation. J Craniomaxillofac Surg 2015; 43:1577-82. [PMID: 26321124 DOI: 10.1016/j.jcms.2015.07.034] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 07/17/2015] [Accepted: 07/29/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND This study characterized the infiltration of primary tumors along the intrinsic and extrinsic muscles of the tongue in oral tongue squamous cell carcinoma (OTSCC), to create a new surgical strategy that is suitable for most stages. A preliminary evaluation of this novel surgical approach was also conducted. METHODS An anatomic study of macroscopic specimens from 10 human cadavers and 100 OTSCC patients was conducted. The anatomic characteristics of the primary tumors and the origin and distribution of fibers of the intrinsic and extrinsic tongue muscles were observed and measured. After initial treatment with curative intent, the 100 patients were regularly followed-up with clinical examination and imaging. RESULT Based on the anatomic characteristics of the primary tumors and tongue muscles, a new surgical approach was developed, and was described as muscle anatomy tongue surgery (MATS). MATS proved suitable for almost all stages of OTSCC. According to the morphology of the invasive tumor front, the 100 cases were divided into four types. The rate of 2-year local disease control was 98%, locoregional control 86%, disease-free survival 85%, and overall survival 89%. Tongue functions were perfectly recovered in more than 60% of the patients. CONCLUSION Application of the principles of MATS to the treatment of OTSCC proved suitable for almost all stages of the disease. MATS is a novel surgical technique that may improve outcomes in tongue cancer surgery.
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Affiliation(s)
- Zhen-Hu Ren
- Department of Oral & Maxillofacial-Head & Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhizaoju Road, Shanghai, 200011, China; Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, No. 139 Renmin Road, Changsha, Hunan, 410011, China.
| | - Han-Jiang Wu
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, No. 139 Renmin Road, Changsha, Hunan, 410011, China.
| | - Sheng Zhang
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, No. 139 Renmin Road, Changsha, Hunan, 410011, China
| | - Kai Wang
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, No. 139 Renmin Road, Changsha, Hunan, 410011, China
| | - Zhao-Jian Gong
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, No. 139 Renmin Road, Changsha, Hunan, 410011, China
| | - Zhi-Jing He
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, No. 139 Renmin Road, Changsha, Hunan, 410011, China
| | - Jie Peng
- Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, No. 139 Renmin Road, Changsha, Hunan, 410011, China
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