Shanghai Journal of Stomatology

Renewed ISSVA classification for vascular anomalies

ZHENG Jia-wei, ZHANG Ling, CHEN Zheng-gang

2015, 24 (5): 385-388.

Abstract ( 365 )

The biologic classification of vascular anomalies proposed by Mulliken and Glowacki in 1982 had been widely accepted. In April 2014, a renewed ISSVA classification for vascular anomalies was approved by General Assembly of ISSVA in Melbourne, Australia at the 20th ISSVA International Workshop. The new system expanded and updated the classification in more details based on advances in basic and clinical researches, including newly named anomalies and identified genes, as well as coagulopathies. This paper introduced the new classification for clinical and research reference.

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High concentration of zoledronate inhibits osteogenesis differentiation and promotes apoptosis of human osteoblasts

HU Long-wei, HAN Jing, PAN Hong-ya, XU Li-qun

2015, 24 (5): 389-394.

Abstract ( 364 )

PURPOSE:To investigate the influence of zoledronate on osteoblasts isolated from human jaw in vitro. METHODS: Osteoblasts were isolated from health human mandible. Third passage of osteoblasts were exposed to zoledronate with different concentrations 0 μmol/L,1 μmol/L,5 μmol/L in vitro. Cell proliferation ability was detected using CCK-8 kit and flow cytometry method was applied to identity cell apoptosis. ALP staining and quantitative analysis were used to evaluate the osteogenesis differentiation of osteoblasts. Real-time PCR were used to measure the gene expression of ALP,OPN and Runx2 and western blotWB was used to detect OPN expression.The difference between each group was analyzed with SPSS 16.0 software package. RESULTS: Cell growth curve indicated that zoledronate treatment groups showed slower growth compared with control group and flow cytometry results indicated higher proportion of apoptosis cells in zoledronate treated groups. ALP staining and quantitative analysis both revealed decreased osteogenesis differentiation ability in zoledronate treated groups. These effect were more obvious in 5 μmol/L treated group than 1μmol/L treated group. Significant down-regulation of of ALP, Runx2 and OPN gene expression were also found in zoledronate treated groups.WB results revealed the decreased expression of OPN in zoledronate treated groups. CONCLUSION: High concentration of zoledronate inhibits osteogenesis differentiation and proliferation ability of human osteoblasts and facilitate their apoptosis.

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A electron microscope study of bone tissue in mandibular osteoradionecrosis

LI Song, FANG Dian-ji, WANG Zhan-yi, ZHAI Lu-lu, NING Zhao-rong, GUO Yan-wei

2015, 24 (5): 395-399.

Abstract ( 263 )

PURPOSE:After establishing the animal model, electron microscope was used to observe the dynamic ultrastructural changes during the process of mandibular osteoradionecrosis (ORN) for investigation of the possible pathogenesis. METHODS: A single dose of irradiation (IR25Gy, 28Gy) was delivered via a electronic liner accelerator to right mandible of 6 miniature pigs by utilizing the 3D-CRT technique. Samples of sequestrations were extracted at 3, 4 and 5 months after irradiation for electron microscopic analysis. RESULTS: Osteocollagenous fibers were destroyed shortly after irradiation. Cellular membrane was destroyed at early stage. Then vacuole formed in the cytoplasm and organelle began to split. At last, nucleus disaggregated. CONCLUSIONS: Doses of irradiation are closely related to degree of sequestration. Cellular membrane and cytoplasm are more sensitive to the irradiation than cellular nucleus which is different from the previous findings.

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Cyclic mechanical strain induces osteogenic differentiation in the coculture system of BMSCs and VECs

WANG Yu, TANG Guo-hua

2015, 24 (5): 400-404.

Abstract ( 330 )

PURPOSE:To detect the effects of cyclic mechanical strain on the coculture system of bone marrow stromal cells(BMSCs)and vascular endothelial cells(VECs)and to clarify the related mechanism. METHODS: Primary BMSCs and VECs were isolated from Sprague-Dawley rats. BMSCs and VECs coculture group, BMSCs monoculture group and VECs monoculture group were exposed to cyclic mechanical strain(6%) by Flexcell 5000 mechanicl loading system. After mechanical loading for 6, 12, 24 and 48h, the mRNA expression of Runx2 and vascular endothelial growth factor(VEGF)were tested by real-time quantitative PCR. VEGF protein in cell culture supernate was quantified using Elisa Kit and alkaline phosphatase(ALP)activity was examined. The VEGFR inhibitor Tivozanib was used to analyze the paracrine role of VEGF. Statistical analysis was performed using SAS 8.0 software package. RESULTS: ①The mRNA expression of Runx2 of coculture group subjected to 6% strain was increased significantly at 6h with 4.3 folds (P<0.05) and ALP activity at 48h with 1.5 folds(P<0.05). ②The mRNA expression of VEGF of coculture group subjected to 6% stain was increased significantly at 12h with 2 folds (P<0.05) and the content of VEGF in cell culture supernate at 12h with 10 folds (P<0.05). Plenty of VEGF was secreted by BMSCs but little by VECs. ③After being subjected to Tivozanib, the expression of Runx2 VECs. ③After being subjected to Tivozanib, the expression of Runx2 of coculture group was decreased by 90% (P<0.05) and ALP activity was decreased by 48% (P<0.05), while those of BMSCs monoculture group were decreased by 30% and 18%, respectively. CONCLUSIONS: Cyclic mechanical strain promotes osteogenic differentiation of BMSCs in the coculture system of BMSCs and VECs, possibly by a paracrine VECs-mediated effect of VEGF on BMSCs.

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Expression of long non-coding RNA MALAT1 gene in tongue squamous cell carcinoma and cell lines and its biological significance after knockdown the expression of MALAT1

ZHANG Shan-shan, YANG Hong-yu, WANG Yu-fan, YANG Hui-jun, SHEN Shi-yue, WANG Feng, XIE Shu-le, JIN Long

2015, 24 (5): 405-409.

Abstract ( 239 )

PURPOSE:To explore the expression of MALAT1 in tongue squamous cell carcinoma and cell lines and its biological significance after knockdown the expression of MALAT1. METHODS: Real-time PCR was used to detect the expression of MALAT1 in tongue squamous cell carcinoma and cell lines SCC9, SCC15, SCC25 and CAL27. The expression of MALAT1 was knocked down by the lentivirus expression vectors GV248 built by biological company in 4 cell lines, which were handed over to another biological company for analysis by gene chip with GraphPad. Prism.v5.0 software. RESULTS: Compared with the control group, the expression of MALAT1 was significantly higher in tongue squamous cell carcinoma tissues and 4 cell lines. After transfection, the expression of MALAT1 was shown more than 75% decrease in CAL27 and SCC25 cell lines. The expression of apoptosis associated genes BNIP3L, NRG1 was down regulated. CONCLUSIONS: MALAT1 gene can be a marker as tumor and regulate the expression of apoptosis associated genes BNIP3L, NRG1, which can be a potential target for treatment of tongue squamous cell carcinoma.

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A comparative study of goat models for trans-alveolar sinus floor lift

DAI Ye-yang, WANG De-fang

2015, 24 (5): 410-414.

Abstract ( 302 )

PURPOSE:To explore the suitability of Shanghai local goats and Boer goats as animal models for trans-alveolar sinus floor elevation and dental implants in posterior maxilla. METHODS: Ten heads of Shanghai local goats and 10 heads of Boer goats were included in this study. Their maxillary sinuses were investigated by cone-beam CT (CBCT) scan. The width and available height of lateral part of the sinus were recorded. The membrane of sinus was examined by histological analysis. Independent samples t test was performed using SPSS21.0 software package. RESULTS: Both goats had maxillary sinus similar to that of humans. The sinus floor was divided into two parts by an anteroposterior bone crest. The width and available height of the lateral part of the sinus for Bore goats were significantly higher than for Shanghai local goats (P<0.05). CONCLUSIONS: As an animal model, Boer goat is more suitable for trans-alveolar sinus floor elevation. The midpoint of the maxillary first molar is an ideal site for trans-alveolar sinus floor elevation and implantation.

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Effect of TPF induction chemotherapy on quality of life in patients with locally advanced oral squamous cell carcinoma

YU Cong, LIU Ying, QIAO Jin-ke, TAN Yi-ran, MA Jie, YIN Qiu-ming, CAI Yi-li, SUN Jian, ZHANG Chen-ping, ZHANG Zhi-yuan, ZHONG Lai-ping

2015, 24 (5): 415-419.

Abstract ( 342 )

PURPOSE:To evaluate the effect of TPF (docetaxel, cisplatin, and 5-fluorouracil) induction chemotherapy on quality of life (QOL) in patients with locally advanced oral squamous cell carcinoma (OSCC). METHODS: Two hundred and fifty-six primary OSCC patients in stage Ⅲ or ⅣA recruited from March 2008 to December 2010 were randomized into 2 groups, 128 in each group. The experimental group underwent TPF induction chemotherapy followed by radical surgery and postoperative radiotherapy, the control group underwent radical surgery and postoperative radiotherapy. The QOL was assessed using the questionnaire of EORTC QLQ-C30 and QLQ-HN35. The data was analyzed using SAS 9.2 software package. RESULTS: Among 256 patients enrolled in this trial, 243 patients had at least one valid QOL form. There was no significant difference between the patients in the experimental group and control group on the global health status in the QLQ-C30 and the symptoms of pain, swallowing, sense, speech, eating, social contact, and sexuality in the QLQ-HN35 questionnaire. Although the symptom of mouth opening in the QLQ-HN35 was better in the control group than the experimental group at the third month after treatment, the final difference of mouth opening between the 2 groups was not significant (P>0.05). CONCLUSIONS: The addition of TPF induction chemotherapy has not significant effect on the QOL in patients with locally advanced OSCC when treated by radical surgery and postoperative radiotherapy.

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Long-term effectiveness of periodontal micro-osteotomy assisted orthodontic treatment of adult patients with malocclusion alveolar defect

WANG Bo, YU Hong-bo, SUN Liang-yan, SHEN Guo-fang, WANG Xu-dong, FANG Bing, LIU Jia-qiang, OU YANG Ning-juan, GUO Qiu-man

2015, 24 (5): 420-424.

Abstract ( 402 )

PURPOSE:To investigate the long-term effectiveness of periodontal micro-osteotomy assisted orthodontic treatment of adult patients with malocclusion and alveolar defect. METHODS: A joint orthodontic and orthognathic consultation was performed on 3 adult patients with malocclusion and alveolar defect with an average age of 29 years. Periodontal micro-osteotomy assisted orthodontic treatment and combined orthodontic and orthognathic therapy were carried out with long-term follow-up of 2-3 years. RESULTS: Periodontal micro-osteotomy assisted orthodontic treatment and combined orthodontic and orthognathic therapy resulted in normal facial appearance and occlusal relationship without the occurrence of periodontal iatrogenic sequelae. The long-term effectives of alveolar augmentation were maintained at the surgical sites. CONCLUSIONS: Periodontal micro-osteotomy assisted orthodontic treatment was a promising technique for the treatment of adult patients with malocclusion and alveolar defect.

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The significance of alteration of the oropharyngeal airway after bilateral sagittal split ramus osteotomy

MA Jia, YAN Xiu-lin

2015, 24 (5): 425-428.

Abstract ( 215 )

PURPOSE:Using X-ray cephalometrics to analyze the alteration of adult patients' oropharyngeal airway with mandibular prognathism after bilateral sagittal split ramus osteotomy, in order to provide some essentials for treatment and prevention of recurrence. METHODS: Twenty adult patients with mandibular prognathism underwent mandibular setback by way of sagittal split ramus osteotomy. Lateral cephalometrics X-ray films were taken 1 week before treatment, 1 week and 6 months after treatment. The data was collected and analyzed using SPSS 17.0 software package. RESULTS: The patients with skeletal mandibular prognathism underwent orthognathic surgery successfully. The length of soft palate increased and the space of oropharyngeal airway reduced significantly 1 week after surgery (P<0.05); six months after surgery, the length of soft palate reduced and the space of oropharyngeal airway increased significantly (P<0.05). There was no significant difference in the length of soft palate and space of oropharyngeal airway between 1 week before operation and 6 months after operation. CONCLUSIONS: Bilateral sagittal split ramus osteotomy reduced the oropharyngeal airway of patients with skeletal mandibular prognathism significantly in short time, which may cause sleep apnea syndrome. But after a period of adaptation and tissue remodeling, the patients' oropharyngeal airways are inclined to return to the original position.

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Risk and prevention of adjacent tooth traumatisation in impacted mandibular third molar surgery

YE Zhou-xi, YANG Chi, FAN Lin-feng

2015, 24 (5): 429-434.

Abstract ( 316 )

PURPOSE:To propose an imaging risk classification of adjacent tooth traumatisation in impacted mandibular third molar surgery for prognosis estimation and surgical design. METHODS: The impacted mandibular third molars contacting the adjacent teeth in panoramic radiographs were collected and scored using two methods. Impacting depth scoring method: position A, B, C were scored 1, 2, 3 (score A). Contacting area scoring method: the contacting area accounting for ≤1/3, >1/3~≤2/3, >2/3 of the crown were scored 1, 2, 3 (score B). Score A plus score B represented the total score. Total score 3 was classified into risk degree I (low risk), total score 4 was classified into risk degree II (moderate risk), total score ≥5 was classified into risk degree III (high risk). Cone-beam CT was used for evaluation in the same way, Kappa test and youden index were used to compare two imaging results. K-W test was used to analyze the correlations of impacting depth, contacting area and impacting direction. All statistical analyses were performed using the SAS 8.2 software package. RESULTS: 96.25% (1359/1412) of impacted teeth contacted adjacent teeth, 17.88% of them had low risks, 13.63% of them had moderate risks, 4.86% of them had high risks. The concordance of two imaging results was better after Kappa test (Kappa=0.7844). Using CBCTs as gold standard, youden index value=0.8889 when score B=1 in panoramic radiographs; youden index value=0.6781 when score B=2, youden index value=0.5560 when score B=3. The horizontally impacted teeth

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Analysis of quality of life for oral and oropharyngeal cancer patients using three methods for reconstruction of defects at one year after surgery

YOU Qiang, YANG Zhao-hui, ZHANG Da-ming, FAN Song, WANG You-yuan, XU Yi-na, CHEN Wei-liang

2015, 24 (5): 435-440.

Abstract ( 521 )

PURPOSE:The aim of this study was to evaluate quality of life of oral and oropharyngeal cancer patients who underwent reconstruction with three methods. METHODS: Forty-seven patients with oral and oropharyngeal squamous cell carcinoma who underwent primary surgery in Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University from January 2012 to October 2012 were recruited. University of Washington Quality of Life Questionnaire version 4 (UW- QOL V4), European Organization for Research and Treatment of Cancer Quality of Life Questionnaire version 3(EORTC QLQ-C30 v3) and Head and Neck version 1(EORTC H&N35 v1) were used as questionnaires for this study.The patients were divided into primary closure, submental island pedicled flap (SIPF), radial forearm free flap (RFFF) group according to reconstruction techniques. Statistical analysis was conducted using SPSS 20.0 software package. RESULTS: Forty-seven patients completed the questionnaires. Patients who underwent RFFF had higher QOL in swallowing, chewing and speech and overall score compared with primary closure group (P<0.05). There was no significant difference (P>0.05) between RFFF and SIPF groups in overall QOL one year after surgery. Furthermore, the QOL of SIPF group was better than primary closure group in chewing, speech and appetite loss. CONCLUSIONS: Swallowing, chewing and speech were major factors that affect recent QOL of oral and oropharyngeal cancer patients one year after surgery. Training of speech and swallowing should be addressed for postoperative patients.

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Comparative clinical and MRI study on two methods for treatment of patients with temporomandibular joint internal derangement of Wilkes Ⅲ—Ⅴ stages

ZHANG Nan, ZHANG Xiao-hong, JIAO Guo-liang, LI Yan, FANG Yuan, WU Zhong-yin

2015, 24 (5): 441-445.

Abstract ( 436 )

PURPOSE: To evaluate the effectiveness of arthrocentesis vs disc anchorage for treatment of temporomandibular joint internal derangement of Wilkes Ⅲ-Ⅴ stages. METHODS: From January 2011 to January 2014,286 patients who accepted arthrocentesis and disc anchorage were included in this study and were divided into 2 groups according to the treatment modality: 164 patients in group A ( arthrocentesis),122 patients in group B(disc anchorage). MRI and clinical examination including crepitus, opening degree between incisors, VAS and headache were taken pretreatment and 6 months postoperatively and the follow-up time was 6 to 42 months. SPSS 13.0 software package was used for statistical analysis. RESULTS: There were significant differences in crepitus, opening degree, headache and VAS between group A and group B(χ²₁=14.33and χ²₂=57.24,P<0.05; t₁=30.30, t₂=21.37, P<0.05). The follow-up MRI showed no disc reduction in group A, except 5.5% of the patients experienced adaptive remodeling (disc-like changes) in bilaminar zone of the disc, while normal disc-condyle relationship was found in all patients of group B. CONCLUSIONS: As the symptoms disappeared, adaptive remodeling(disc-like changes) in bilaminar zone of the disc could occur but only in 5.5% of the patients after arthrocentesis. Combined clinical effect and MRI findings we conclude that disc anchorage is superior to arthrocentesis for treatment of TMJID of Wilkes Ⅲ-Ⅴ stages .

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Flow cytometry analysis and eIF4E expression of para-tumor tissues of oral squamous cell carcinoma

XU Bo, CHEN Jin-qiang, RAN Hong-bing

2015, 24 (5): 446-451.

Abstract ( 259 )

PURPOSE:To explore the surgical safe margin of oral squamous cell carcinoma (OSCC), the expression of eIF4E, DNA content and ploidy of para-tumor tissues were analyzed using immunohistochemistry and flow cytometry. METHODS: The specimens were embedded, cut and separated into 5 regions with the labels of T (center of the tumor), P₁ (0-0.5 cm to tumor center), P₂ (0.5-1 cm to tumor center), P₃ (1-1.5 cm to tumor center), and P₄(1.5-2 cm to tumor center). Twenty normal oral mucosal specimens were selected as control and labeled as N. Immunohistochemistry was employed to detect the expression of eIF4E. Moreover, flow cytometer (FCM) was used to assess the DNA content and type. The data was analyzed with SPSS13.0 software package. RESULTS: Ratio of heteroploidy, SPF and PI dropped gradually with the increment of distance of regions to tumor center. But, statistical differences were still observed between para-tumor tissues and normal tissues. eIF4E decreased from center to outer regions but still had 30% of significantly positive expression at P₄ region. CONCLUSIONS: Ratio of heteroploidy, SPF, PI and the expression of eIF4E dropped gradually with the increment of distance of regions to tumor center. Significant difference could still be noticed at the region 2 cm away from tumor tissues, which indicated that if possible 2 cm clinical boundary should be ensured during operation. Otherwise, post-operational chemical-and radio-therapies should be provided.

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Application of vacuum sealing drainage in submandibular fistula after reconstruction with free or pedicled flap following maxillofacial malignant tumors ablation

ZHANG Da-ming, WANG You-yuan, LIANG Qi-xiang, LIN Zhao-yu, CHEN Wei-liang, ZHANG Bin

2015, 24 (5): 452-455.

Abstract ( 238 )

PURPOSE:To assess the reliability and usefulness of vacuum sealing drainage (VSD) in submandibular fistula after reconstruction with free or pedicled flap following maxillofacial malignant tumor ablation. METHODS: Twelve submandibular fistulas were randomly divided into the experimental group and control group. The experimental group were given VSD treatment, while the control group was given conventional treatment combined with rhEGF treatment. RESULTS: The VSD were removed after one week of treatment in the experimental group, the fistula was convergent and full of benign granulation tissue. The patients were followed up for 4-14 months, the fistula was closed and the wound healed well. The fistula in the control group was closed after 15 days to 3 months of treatment and the wound healed after 3-21 months. CONCLUSIONS: VSD is an effective method for treatment of submandibular fistula after reconstruction with free or pedicled flap following maxillofacial malignant tumor ablation.

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Anatomical reduction of high condylar fractures by using a modified towel

forceps HUANG Wei-cheng, WU Ze-jian, CHEN Wei-sheng

2015, 24 (5): 456-459.

Abstract ( 329 )

PURPOSE:To evaluate the clinical effects of anatomic reduction of high condylar fractures by using a modified towel forceps. METHODS: Twenty-eight patients with high condylar fractures were treated with anatomic reduction and internal fixation. All cases were evaluated by clinical examination and imaging examination 6 months after operation. RESULTS: Two patients had limited mouth opening, one patients developed mandible deviation during mouth opening, and 3 patients presented joint clicking symptom, no absorption or deformation of the condylar process was found by imaging examination 6 months postoperatively. The cure rate by clinical examination was 78.6%, and 92.8% by imaging examination. CONCLUSIONS: Anatomic reduction of high condylar fractures by using a modified towel forceps is an useful method. It can reduce the incidence of absorption and deformity of the condyle, and help to restore the function of the temporomandibular joint.

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The specialty of oral and maxillofacial surgery in the United States: history and current status

LU Chuan, HE Dong-mei, ELLIS Edward Ⅲ

2015, 24 (5): 460-464.

Abstract ( 339 )

This article introduced the developing history and present status of oral and maxillofacial surgery specialty in the United States of America based on an interview of Professor Edward Ellis, who is Chair of the Department of Oral and maxillofacial Surgery (OMS) at The University of Texas Health Science Center at San Antonio, Texas and director of the OMS residency program. This article is aimed to provide references for Chinese oral and maxillofacial surgery education.

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Progress of tongue flap in reconstruction of oral soft tissue defects

LU Jun-qin, SUN Jian

2015, 24 (5): 465-469.

Abstract ( 290 )

Although nowadays free flaps are popular to be used in restoration of intraoral defects, the tongue flap, when indicated, is still a safe, reliable reconstructive option with low morbidity. The dorsal or lateral tongue flap is particularly useful for moderate defects in the palate, retro-molar area, back buccal mucosa, lower vermilion and defects after partial glossectomy. This paper reviewed the anatomical basis of tongue flap and clinical application in reconstruction of intraoral defects.

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Four genetic syndromes associated with arteriovenous malformations: an overview

HUANG Zi-xian, HUANG Zhi-quan

2015, 24 (5): 470-473.

Abstract ( 248 )

Arteriovenous malformations (AVMs), are the most dangerous type of vascular malformations, which may occurred as one of the performance of certain genetic syndromes, found in various parts of the body. In this review, we focused on arteriovenous malformation related with genetic syndromes and their clinical manifestation, pathogenesis, diagnosis and therapeutic strategies were discussed, including hereditary hemorrhagictelangiectasia, capillary malformation-arteriovenous malformation, Parkes-Weber syndrome and Cobb syndrome.

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Vascularized fibula flap reconstruction of the mandible defect resulting from bisphosphonate-related osteonecrosis of the jaws: case report and literature

review GUO Yu-xing, WANG Dian-can, WANG Yang, PENG Xin, GUO Chuan-bin, MAO Chi

2015, 24 (5): 474-477.

Abstract ( 318 )

Bisphosphonates have been used in clinic for over 30 years as a potent of bone resorption inhibitors, which are widely prescribed in diseases related to bone turnover change. In recent years, many authors found that long-term application of bisphosphonates can lead to osteonecrosis of the jaws. The treatment proposal has not reached consensus, including conservative treatment, surgical curettage and bone resection (reconstruction or without reconstruction). This paper reported a case with mandibular defect resulting from bisphosphonate related osteonecrosis of the jaws, repaired with vascularized fibular flap subsequently. The final functional and aesthetic outcomes were satisfied.

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A case report of imperforate submandibular duct

GUO Xiao-ke, ZOU Hai-xiao, ZHAO Yi-fang, LI Chen

2015, 24 (5): 478-480.

Abstract ( 244 )

Congenital imperforate submandibular duct is one of developmental abnormalities of the salivary duct. Swelling in the mouth floor along the submandibular gland duct is the major clinical manifestations. MRI is of important value for the diagnosis of this lesion. We reported one case and reviewed the literatures regarding to its etiology, symptom, diagnosis, and therapy.

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