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Mosquera C, Weyh A, Malik M, Fernandes R, Bunnell A, Nedrud S. Comparison of the outcomes of split thickness skin graft versus thickness skin graft for closure of the radial forearm free flap donor site: A systematic review. Microsurgery 2024; 44:e31126. [PMID: 37990820 DOI: 10.1002/micr.31126] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 09/18/2023] [Accepted: 10/05/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Radial forearm free flap (RFFF) donor site closure is traditionally performed with split thickness skin grafts (STSG), which can be associated with poor aesthetics, wrist stiffness, paresthesia, reduced strength, and tendon exposure. Full thickness skin grafts (FTSG) are potentially beneficial as they provide a more durable coverage, and the skin graft donor site can be closed primarily, which is more aesthetic. The aim of this systematic review is to compare the outcomes of STSG versus FTSG for closure of the RFFF donor site. METHODS A systematic review was performed, following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The primary objective was to answer: do subjects undergoing RFFF harvest, utilizing FTSG to close the RFFF donor site, compared to STSG, achieve superior aesthetics at the RFFF donor site? Included papers compared FTSG and STSG with statistical data. Means were compared with t-test and proportions with Fisher's exact test. RESULTS The initial search resulted in 1851 studies. After applying the inclusion/exclusion criteria, the search resulted in eight studies, with 366 total skin grafts, 197 STSG and 169 FTSG. Six studies evaluated aesthetics utilizing a Likert scale, with the scaled average aesthetic score for FTSG being 7.9/10 compared to 6.9/10 for STSG (p < .001). Tendon exposure was measured in five studies, with a rate of 13.1% for STSG versus 10.6% for FTSG (p = .555). No significant difference in function was observed, however, methods to quantify function were heterogeneous. CONCLUSION FTSG compared to STSG, resulted in statistically significant improved aesthetics, with comparable rates of tendon exposure and function.
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Affiliation(s)
- Camilo Mosquera
- Department of Oral and Maxillofacial Surgery, University of Florida College of Medicine, Jacksonville, Jacksonville, Florida, USA
- Department of Surgery, Division of Oral and Maxillofacial Surgery, University of Texas Medical Branch, Galveston, Texas, USA
| | - Ashleigh Weyh
- Department of Oral and Maxillofacial Surgery, University of Florida College of Medicine, Jacksonville, Jacksonville, Florida, USA
- Department of Oral and Maxillofacial Surgery, University of Illinois Chicago, Chicago, Illinois, USA
| | - Michael Malik
- Department of Oral and Maxillofacial Surgery, University of Florida College of Medicine, Jacksonville, Jacksonville, Florida, USA
| | - Rui Fernandes
- Department of Oral and Maxillofacial Surgery, University of Florida College of Medicine, Jacksonville, Jacksonville, Florida, USA
| | - Anthony Bunnell
- Department of Oral and Maxillofacial Surgery, University of Florida College of Medicine, Jacksonville, Jacksonville, Florida, USA
| | - Stacey Nedrud
- Department of Oral and Maxillofacial Surgery, University of Florida College of Medicine, Jacksonville, Jacksonville, Florida, USA
- Private Practice, Jacksonville, FL, USA
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Hanubal KS, Reschly WJ, Conrad D, Festa BM, Weiss JP, Shama M, Danan D, Hughley B, Dziegielewski PT. The beavertail modified radial forearm free flap: Retrospective review of a versatile technique to increase flap bulk in the head and neck. Microsurgery 2023; 43:767-774. [PMID: 36892139 DOI: 10.1002/micr.31028] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 01/07/2023] [Accepted: 02/10/2023] [Indexed: 03/10/2023]
Abstract
OBJECTIVE Utilization of free tissue transfers in head and neck reconstruction has greatly increased due to their dependability and reliability. Anterolateral thigh (ALT) and rectus abdominus (RA) free flaps may provide too much soft tissue bulk, especially in patients with a large body habitus. A radial forearm free flap (RFFF) may be modified with a "beaver tail" (BT), which provides a flap whose bulk may be tailored to a defect. The purpose of this paper is to describe the technique, how it can be used for a variety of defects and the outcomes of these reconstructions. METHODS A retrospective review of prospectively collected data was performed at single tertiary care center between 2012 and 2022. BT-RFFF was designed by leaving a fibroadipose tail vascularized to branches of the radial artery or separated from the vascular pedicle and left attached to the proximal portion of the skin paddle. Functional outcomes, tracheostomy dependence, and gastrostomy tube (G-tube) dependence as well as complications were determined. RESULTS Fifty-eight consecutive patients undergoing BTRFFF were included. Defects reconstructed included: oral tongue and/or floor of mouth 32 (55%), oropharynx 10 (17%), parotid 6 (10%), orbit 6 (10%), lateral temporal bone 3 (5%), and mentum 1 (2%). Indications for BTRFF were: need for bulk when the ALT and RA were too thick (53%) and need for a separate subcutaneous flap for contouring or deep defect lining (47%). Complications directly related to beavertail included a widened forearm scar (100%), wrist contracture (2%) partial flap loss (2%), and flap loss requiring a revision flap (3%). Ninety-three percent of patients with oral/oropharyngeal defects and 12-month follow-up tolerated oral intake without aspiration and 76% were tube-independent. Ninety-three percent were tracheostomy-free at last follow-up. CONCLUSION The BTRFF is a useful tool for reconstructing complex 3D defects requiring bulk where an ALT or rectus would otherwise provide too much bulk.
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Affiliation(s)
- Krishna S Hanubal
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - William J Reschly
- Department of Otolaryngology, University of Florida, Gainesville, Florida, USA
| | - Dustin Conrad
- Department of Otolaryngology, University of Florida, Gainesville, Florida, USA
| | - Bianca Maria Festa
- Department of Otolaryngology, University of Florida, Gainesville, Florida, USA
| | - Joshua P Weiss
- Department of Otolaryngology, University of Florida, Gainesville, Florida, USA
| | - Mohamed Shama
- Department of Otolaryngology, University of Florida, Gainesville, Florida, USA
| | - Deepa Danan
- Department of Otolaryngology, University of Florida, Gainesville, Florida, USA
| | - Brian Hughley
- Department of Otolaryngology, University of Florida, Gainesville, Florida, USA
| | - Peter T Dziegielewski
- Department of Otolaryngology, University of Florida, Gainesville, Florida, USA
- Health Cancer Center, University of Florida, Gainesville, Florida, USA
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Ki SH, Park TJ, Yoon JM. Surgical outcomes of suprafascial and subfascial radial forearm free flaps in head and neck reconstruction. Arch Craniofac Surg 2023; 24:105-110. [PMID: 37415467 PMCID: PMC10365904 DOI: 10.7181/acfs.2023.00171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/19/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Conventional radial forearm free flaps (RFFFs) are known to be safe, but can result in donor site complications. Based on our experiences with suprafascial and subfascial RFFFs, we evaluated the safety of flap survival and surgical outcomes. METHODS This was a retrospective study of head and neck reconstructions using RFFFs from 2006 to 2021. Thirty-two patients underwent procedures using either subfascial (group A) or suprafascial (group B) dissection for flap elevation. Data were collected on patient characteristics, flap size, and donor and recipient complications, and the two groups were compared. RESULTS Thirteen of the 32 patients were in group A and 19 were in group B. Group A included 10 men and three women, with a mean age of 56.15 years, and group B included 16 men and three women, with a mean age of 59.11 years. The mean defect areas were 42.83 cm² and 33.32 cm², and the mean flap sizes were 50.96 cm² and 44.54 cm² in groups A and B, respectively. There were 13 donor site complications: eight (61.5%) in group A and five (26.3%) in group B. Flexor tendon exposure occurred in three patients in group A and in none in group B. All flaps survived completely. A recipient site complication occurred in two patients (15.4%) in group A and three patients (15.8%) in group B. CONCLUSIONS Complications and flap survival were similar between the two groups. However, tendon exposure at the donor site was less prevalent in the suprafascial group, and the treatment period was shorter. Based on our data, suprafascial RFFF is a reliable and safe procedure for reconstruction of the head and neck.
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Affiliation(s)
- Sae Hwi Ki
- Department of Plastic and Reconstructive Surgery, Inha University Hospital, Incheon, Korea
- Department of Plastic and Reconstructive Surgery, Inha University School of Medicine, Incheon, Korea
| | - Tae Jun Park
- Department of Plastic and Reconstructive Surgery, Inha University Hospital, Incheon, Korea
| | - Jin Myung Yoon
- Department of Plastic and Reconstructive Surgery, Inha University Hospital, Incheon, Korea
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“Racing-stripe” Modification of Radial Forearm Free Flap: Technique and Experience (704 Consecutive Cases). PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4682. [PMCID: PMC9699655 DOI: 10.1097/gox.0000000000004682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/29/2022] [Indexed: 11/29/2022]
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Reducing morbidity in radial forearm free flap donor site: a review of closure techniques. Curr Opin Otolaryngol Head Neck Surg 2022; 30:363-367. [PMID: 36004786 DOI: 10.1097/moo.0000000000000834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Radial forearm free tissue transfer (RFFF) has been an extremely reliable reconstructive option for head and neck oncologic defects for over 30 years. With high reliability, interest has shifted in minimizing donor site morbidity, much of which results from closure techniques. RECENT FINDINGS Portable negative pressure wound devices, newer dermal substitutes, and local flap techniques have improved donor site aesthetics and function. SUMMARY Outcomes of the RFFF donor site may benefit from newer techniques in closure.
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Mai L, Mashrah MA, Lin ZY, Yan LJ, Xie S, Pan C. Posterior tibial artery flap versus radial forearm flap in oral cavity reconstruction and donor site morbidity. Int J Oral Maxillofac Surg 2022; 51:1401-1411. [PMID: 35597669 DOI: 10.1016/j.ijom.2022.03.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 03/15/2022] [Accepted: 03/16/2022] [Indexed: 11/29/2022]
Abstract
The repair of soft tissue defects after oral cavity cancer resection is challenging. The aim of this study was to compare the outcomes and donor site morbidity of the radial forearm free flap (RFF) and posterior tibial artery perforator flap (PTAF) for oral cavity reconstruction after cancer ablation. All patients who underwent oral cavity reconstruction with a RFF or PTAF between January 2017 and December 2019 were included retrospectively in this study. All flaps were harvested with a long adipofascial extension. The donor site defects were closed with a triangular full-thickness skin graft harvested adjacent to the flap. Flap outcomes and donor site complications were recorded and compared. The study included 145 patients; 30 underwent reconstruction with a RFF and 115 with a PTAF. No significant difference between the PTAF and RFF was observed concerning the flap survival rate (98.3% vs 96.7%), flap harvest time (53.39 vs 49.28 min), hospital stay (12.3 vs 15.2 days), or subjective functional and cosmetic outcomes. The PTAF showed a larger vascular calibre (P < 0.05), greater flap thickness (P = 0.002), and lower frequency of surgical site infection (P = 0.055) when compared to the RFF. No significant difference was observed between the pre- and postoperative ranges of ankle and wrist movements. The PTAF is an excellent alternative to the RFF for the repair of oral cavity defects, with the additional advantages of a well-hidden scar on the lower extremity, larger vascular calibre, and lower frequencies of postoperative donor site morbidities.
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Affiliation(s)
- L Mai
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - M A Mashrah
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Stomatology Hospital of Guangzhou Medical University, Guangdong, Guangzhou, China
| | - Z Y Lin
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - L J Yan
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Stomatology Hospital of Guangzhou Medical University, Guangdong, Guangzhou, China
| | - S Xie
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - C Pan
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
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Hughes KR, Fong A, Rozen WM, Leong JCS. The arterialised saphenous venous flow-through flap for managing the radial forearm free flap donor site. Microsurgery 2022; 42:333-340. [PMID: 35297112 PMCID: PMC9315149 DOI: 10.1002/micr.30883] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 01/06/2022] [Accepted: 03/10/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND The radial forearm fasciocutaneous flap (RFFF) is a workhorse flap, however concerns with donor site morbidity include tendon exposure, delayed wound healing, impaired sensitivity, and poor cosmesis, have seen it fall out of favor. We present a method of using an arterialised saphenous flow through flap to reconstruct the RFFF donor site. METHOD A cohort study of six patients (five male, one female; mean age 59 [range 19-90]) who had their RFFF donor site reconstructed with an arterialised saphenous flow through flap is presented. The use of multiple peripheral efferent venous anastomoses, flap rotation 180 degrees prior to inset, and the ligation of intra-flap connecting veins were three modifications employed. Primary outcomes include complication rates. Secondary outcomes were patient reported outcome measures via the Michigan Hand Outcomes Questionnaire, and patency and flow through the flap. RESULTS In all six cases, there was flap survival. RFFF dimensions ranging from lengths of 6-15 cm (mean 11.5 cm) and widths of 4-6 cm (mean 5.3 cm), with an average flap area of 58 cm2 (range 24-90). There were no total flap losses, one partial superficial flap loss and one minor donor site delayed healing, over a mean follow-up of 6 months (4-24 months). The average overall patient satisfaction was 91 on Michigan Hand Outcomes Questionnaire. Pain was well tolerated with a low average pain score of 15. CONCLUSION The modified arterialised saphenous flow through flap is a useful option for reconstructing the soft tissue defect and reconstituting the radial artery after RFFF harvest.
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Affiliation(s)
- Kimberley R Hughes
- Department of Plastic & Reconstructive Surgery, Monash Health, Clayton, Victoria, Australia.,Faculty of Medicine, Monash University, Clayton, Victoria, Australia
| | - Alisha Fong
- Department of Plastic & Reconstructive Surgery, Monash Health, Clayton, Victoria, Australia.,Faculty of Medicine, Monash University, Clayton, Victoria, Australia
| | - Warren M Rozen
- Faculty of Medicine, Monash University, Clayton, Victoria, Australia
| | - James C S Leong
- Department of Plastic & Reconstructive Surgery, Monash Health, Clayton, Victoria, Australia.,Faculty of Medicine, Monash University, Clayton, Victoria, Australia.,Department of Surgery, Monash University, Clayton, Victoria, Australia
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Free Lateral Forearm Flap in Head and Neck Reconstruction: An Attractive Alternative to the Radial Forearm Flap. Plast Reconstr Surg 2020; 146:446e-450e. [DOI: 10.1097/prs.0000000000007163] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Potet P, De Bonnecaze G, Chabrillac E, Dupret-Bories A, Vergez S, Chaput B. Closure of radial forearm free flap donor site: A comparative study between keystone flap and skin graft. Head Neck 2019; 42:217-223. [PMID: 31621986 DOI: 10.1002/hed.25977] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 09/16/2019] [Accepted: 09/25/2019] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The aim was to investigate the feasibility of radial forearm free flap (RFFF) donor site closure by keystone flap (KF) and compare its outcomes to those of skin graft (SG) closure. METHODS One hundred and one patients who underwent RFFF for head and neck reconstruction were included (35 KF closure and 65 SG closure). Duration of wound healing and donor site complications was collected. After a minimal follow-up of 1 year, patients were questioned about functional and esthetic impairment. RESULTS Coverage of donor site by KF was successful in all cases. The duration of wound healing was longer after SG than after KF (32 days vs 18 days, P < .001). Healing complications, esthetic and functional results were not statistically different. CONCLUSION Forearm donor site closure by KF is a feasible alternative to the traditional SG. Its main advantages are the reduced wound healing time and the avoidance of a second donor site.
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Affiliation(s)
- Pauline Potet
- Department of ENT and Head and Neck Surgery, Toulouse University Hospital, Hôpital Larrey, Toulouse, France
| | - Guillaune De Bonnecaze
- Department of ENT and Head and Neck Surgery, Toulouse University Hospital, Hôpital Larrey, Toulouse, France
| | - Emilien Chabrillac
- Department of ENT and Head and Neck Surgery, Toulouse University Hospital, Hôpital Larrey, Toulouse, France
| | - Agnès Dupret-Bories
- Department of surgery, Institut Universitaire du Cancer de Toulouse, Toulouse, France
| | - Sébastien Vergez
- Department of ENT and Head and Neck Surgery, Toulouse University Hospital, Hôpital Larrey, Toulouse, France.,Department of surgery, Institut Universitaire du Cancer de Toulouse, Toulouse, France
| | - Benoit Chaput
- Department of Plastic and Aesthetic Surgery, Toulouse University Hospital, Hôpital Rangueil, Toulouse, France
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Thin elevation: A technique for achieving thin perforator flaps. Arch Plast Surg 2018; 45:304-313. [PMID: 30037189 PMCID: PMC6062703 DOI: 10.5999/aps.2017.01529] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 06/26/2018] [Indexed: 11/21/2022] Open
Abstract
Elevating thin flaps has long been a goal of reconstructive surgeons. Thin flaps have numerous advantages in reconstruction. In this study, we present a surgical method for elevating a thin flap and demonstrate the safety of the procedure. A retrospective review was performed of the electronic medical records of patients who underwent thin flap elevation for lower extremity reconstruction from April 2016 to September 2016 at the Department of Plastic Surgery of Asan Medical Center. All flaps included in this study were elevated above the superficial fascia. A total of 15 superficial circumflex iliac artery free flaps and 13 anterolateral thigh free flaps were enrolled in the study. The total complication rate was 17.56% (n=5), with total loss of the flap in one patient (3.57%) and partial necrosis of the flap in four patients (14.28%). No wound dehiscence or graft loss at the donor wound took place. Elevation above the superficial fascia is not inferior in terms of flap necrosis risk and is superior for reducing donor site morbidity. In addition to its safety, it yields good aesthetic results.
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Pabst A, Werkmeister R, Steegmann J, Hölzle F, Bartella A. Is there an ideal way to close the donor site of radial forearm free flaps? Br J Oral Maxillofac Surg 2018; 56:444-452. [DOI: 10.1016/j.bjoms.2018.04.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 04/15/2018] [Indexed: 10/16/2022]
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Wang F, Ding X, Zhang J, Song X, Wu Y, Svensson P, Wang K. Somatosensory changes at forearm donor sites following three different surgical flap techniques. Int J Surg 2018; 53:326-332. [PMID: 29653247 DOI: 10.1016/j.ijsu.2018.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 03/21/2018] [Accepted: 04/02/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND The aim of this study was to investigate the somatosensory changes at the forearm donor region after using different types of modified flap surgical techniques. METHODS Thirty-one patients, who underwent oral and maxillofacial reconstructive surgery involving the use of a traditional radial forearm flap (TRFF) or two modified radial forearm flap techniques (MRFF-I; MRFF-II), participated in the study. Cold detection threshold (CDT), warm detection threshold (WDT), cold pain threshold (CPT), heat pain threshold (HPT), pressure pain threshold (PPT), mechanical detection threshold (MDT), and mechanical pain threshold (MPT) were assessed at four sites of the forearms corresponding to the middle of the vascular pedicle (VP) area, the middle of the forearm flap area, and the corresponding contralateral sites (cVP and cFF) at about 5.0 ± 1.9 months after the surgery. Data were analysed with one-way ANOVA, and post-hoc tests were performed using Tukey's Honest Significant Difference test. RESULTS Significant differences between the VP and cVP sites were detected for WDT (P < 0.001) in TRFF and for WDT (P < 0.001) and MDT (P = 0.006) in MRFF-I. Significant differences among TRFF, MRFF-I, and MRFF-II at the VP site were detected for CDT (P = 0.022), WDT (P < 0.001), and MDT (P = 0.015). MRFF-II was associated with significantly higher sensitivity compared to that of TRFF for WDT (P = 0.017) and higher sensitivity compared to that of MRFF-I for CDT (P = 0.017), WDT (P < 0.001), and MDT (P = 0.013). CONCLUSIONS Significant sensory loss was detected for all types of surgical procedures with free forearm flaps. However, the MRFF-II was associated with a better sensory recovery at short follow-up after surgery. These results suggest that a longer follow-up period and larger sample size should be included in future studies.
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Affiliation(s)
- Fang Wang
- Orofacial Pain & TMD Research Unit, Institute of Stomatology, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China; Institute of Stomatology & Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
| | - Xu Ding
- Institute of Stomatology & Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
| | - Jinglu Zhang
- Orofacial Pain & TMD Research Unit, Institute of Stomatology, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
| | - Xiaomeng Song
- Institute of Stomatology & Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China.
| | - Yunong Wu
- Institute of Stomatology & Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China
| | - Peter Svensson
- Section of Orofacial Pain and Jaw Function, School of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark; Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | - Kelun Wang
- Orofacial Pain & TMD Research Unit, Institute of Stomatology, Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing, China; Center for Sensory-Motor Interaction (SMI), Aalborg University, Aalborg, Denmark
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