Repair of large orbito-maxillofacial defects following resection of tumors with temporalis myofascial flap and facial-cervico-pectoral flap

PURPOSE: To evaluate the results of facial-cervico-pectoral rotation flap (FRF) and temporalis myofascial flap (TMF) in the repair of large soft tissue defect in oral and maxillofacial regions. METHODS: Six patients with malignant orbital tumors and/or maxillofacial tumors invading the orbital regions were treated with extensive resection. The major midfacial soft tissue defects were repaired by temporalis myofascial flap and facial-cervico-pectoral rotation flap. RESULTS: All flaps were successfully transferred; the result of facial aesthetics was satisfactory in all patients. Follow-up periods varied from 9 to 20 months (mean follow up period: 13.2 months) and all of the patients were alive during the follow-up period with one recurrence. CONCLUSIONS: The TMF and the FRF are easy to harvest, have low donor site morbidity, and are compatible with the principles of oncologic resection. It is the method of choice for repairing major orbito-maxillofacial skin defects following resection of the tumors.     

正常(牙合)青年(牙合)平面与咀嚼运动轨迹的相关性分析

Objective To investigate the characteristics of and relationship between occlusal plane and masticatory path in young adults with individual normal occlusion, and to provide clinical implications on both morphological and functional reference of occlusal plane location Methods Forty-three young adults with individual normal occlusion were included. Lateral projections of cephalometric radiographs were taken. The parameters of anatomical landmarks were analyzed. The BioEGN mandibular kinesiography analyzer was used to record the path of incisal edge of mandibular central incisor movement during mastication. The Pearson's linear correlation analysis was performed to analyze the relationship of inclination of occlusal plane and data mentioned above with SPSS13. 0 software. Results The inclination of occlusal plane (the angle between occlusal plane and Camper's line OP-CP) was (2. 1 ± 3. 8) ° in youth with normal occlusion. Means of maximal distances of 3-dimensional masticatory mandibular movement paths were as follow; the vertical length was ( 20. 22 ± 4. 28) mm, the anterior-posterior width was ( 11.42 ± 2. 45) mm, and the lateral width was (8. 62 ± 1. 52) mm. The inclination of occlusal plane was negatively correlated to the lateral width of masticatory path in frontal plane (r = -0. 39, P <0. 05). Occlusal plane was approximately vertical to the opening and closing path in the vicinity of intercuspal position during mastication. The inclination of occlusal plane was positively related to occlusal plane-closing angles in the upper segments of closing path during mastication(P<0. 05). Masticatory axis angle was (66. 50 ±7. 98)° with no significant correlation to the inclination of occlusal plane (P >0. 05).Conclusions These results suggest that the sagittal inclination of occlusal plane can influence 3-dimensional morphology of masticatory path. The inclination of occlusal plane has a guiding effect on masticatory movement in the upper segments of closing path.     

正常(牙合)青年(牙合)平面与咀嚼运动轨迹的相关性分析

Objective To investigate the characteristics of and relationship between occlusal plane and masticatory path in young adults with individual normal occlusion, and to provide clinical implications on both morphological and functional reference of occlusal plane location Methods Forty-three young adults with individual normal occlusion were included. Lateral projections of cephalometric radiographs were taken. The parameters of anatomical landmarks were analyzed. The BioEGN mandibular kinesiography analyzer was used to record the path of incisal edge of mandibular central incisor movement during mastication. The Pearson's linear correlation analysis was performed to analyze the relationship of inclination of occlusal plane and data mentioned above with SPSS13. 0 software. Results The inclination of occlusal plane (the angle between occlusal plane and Camper's line OP-CP) was (2. 1 ± 3. 8) ° in youth with normal occlusion. Means of maximal distances of 3-dimensional masticatory mandibular movement paths were as follow; the vertical length was ( 20. 22 ± 4. 28) mm, the anterior-posterior width was ( 11.42 ± 2. 45) mm, and the lateral width was (8. 62 ± 1. 52) mm. The inclination of occlusal plane was negatively correlated to the lateral width of masticatory path in frontal plane (r = -0. 39, P <0. 05). Occlusal plane was approximately vertical to the opening and closing path in the vicinity of intercuspal position during mastication. The inclination of occlusal plane was positively related to occlusal plane-closing angles in the upper segments of closing path during mastication(P<0. 05). Masticatory axis angle was (66. 50 ±7. 98)° with no significant correlation to the inclination of occlusal plane (P >0. 05).Conclusions These results suggest that the sagittal inclination of occlusal plane can influence 3-dimensional morphology of masticatory path. The inclination of occlusal plane has a guiding effect on masticatory movement in the upper segments of closing path.     

口腔鳞癌组织中尿激酶型纤溶酶原激活剂及其抑制剂活性与颈淋巴结转移的关系

Chromogenic substrate assay was used to determine the activity of uPA and PAI-1 in tumor extract, their relationship with clinlcal and pathological parameters were analysed. It was found that activity of uPA and PAI-1 in tumor tissue was much higher than those in the corresponding normal tissue(P＜0.01); There was no relationship between activity of uPA and PAI-1 and size, histalogical classification of tumor, but the activity of uPA had positive relation to clinical stage; The uPA and PAI-1 activity in tumor with metastasis were significantly higher than those in nonmetastasis tumor(P＞0.01),furthermore, it was shown that uPA and PAI-1 in metastastic lymphnode were greatly higher than that in primary tumor. The result indicated elevation of activity of uPA and PAI-1 might be responsible for the metastasis to neck lymphnode.     

Application of cone beam computed tomography in facial imaging science

Facial imaging is used to study the facial shapeand its developmental changes over time.This isimportant to diagnose acquired malformations,to studynormal and abnormal growth and to differentiatebetween the results of treatment and normal growth,and to validate facial recognition.The two mainmethods to study and record facial imaging are bymeans of cephalometry and anthropometry[1].Cephalometrics is the scientific study of themeasurements of the head’s     

变形链球菌luxS基因在硫代谢中的功能研究

Objective To investigate the function of luxS in sulfurmetabolism of Streptococcus mutans (Sm). Methods The growth with absorbency(A) of the standards and mutant strains was measured and analyzed in the sulfur-limited defined medium at different periods. The laser scanning confocal microscopy( LSCM ) was used to observe and compare the biofilm thickness of the two kinds of strains at different culture conditions. Results The significant increases in the thickness of mutant strain biofilm and its growth were observed after the addition of cysteine, but did not reach the standards strain levels ( P ＜0. 05). The growth and the biofilm thickness of the mutant strains were ( 1. 301 ±0. 009) and (45.009 ±0. 429) μm. When methionine and S-adenosylhomocysteine of certain concentrations were respectively added, the biofilm thickness and the growth of mutant strain were raised but did not reach the level of the standards strain at 24 h( P ＜0. 05 ), but at 48 h they did. When the methionine was added in the mutant strains for 24 h, the biofilm thickness and the growth of mutant strain were (0. 448 ± 0. 028 ) and ( 37. 068 ± 2. 392 ) μm, as for the adding of S-adenosylhomocysteine were (0. 460 ± 0. 005 ) and ( 27. 343 ±1. 107 ) μm. When adding the supernatant fluid of standard strains, the biofilm thickness and the growth levels of mutant strain were much higher than those of the standards strain. The biofilm thickness and growth of both kinds of strains decreased after the addition of S-adenosylmethionine. Conclusions luxS gene plays not only a role in quorum sensing but also a role in sulfurmetabolism.     

SMAS folded flap and allograft dermal matrix repairing parotid bed following parotidectomy to prevent facial deformity and Frey''''s syndrome

PURPOSE:This study evaluates the outcome of superficial musculoaponeurotic system(SMAS) and allograft dermal matrix(ADM) in preventing facial deformity and Frey's syndrome following parotidectomy.METHODS:Forty-six patients with benign parotid tumors were randomly assigned to 4 groups.The control group consisted of 12 patients who underwent a total parotidectomy;The AMD group consisted of 10 patients who underwent a total parotidectomy and underwent intraoperative placement of ADM within the parotid bed;SMAS group consisted of 11patients who underwent a total parotidectomy and SMAS folded flaps to repair parotid bed;and SMAS plus AMD group consisted of 13 patients who underwent a total parotidectomy and intraoperative placement of ADM to repair parotid bed with SMAS folded flaps.All 46 patients were evaluated via a short questionnaire regarding perception of a facial contour deformity,Frey's syndrome,modified Minor's starch-Iodine test(MSIT) ,and clinical examination.RESULTS:Twelve months of follow-up was conducted after the treatment,the rates of satisfaction with the post-operative facial contour were 33.3%(4/12) ,40.0%(4/10) ,91.9%(10/11) and 100%(13/13) respectively in the control group,AMD group,SMAS group and SMAS plus AMD group,and the difference between the SMAS plus AMD group and the former two groups was statistically significant(P< 0.05) .The incidences of objective Frey's syndrome by MSIT were 50.0 %(6/12) ,20.0%(2/10) ,27.3%(3/11) and 7.7%(1/13) respectively,and the difference between the SMAS plus AMD group and the control groups was statistically significant(P<0.05) .CONCLUSION:The SMAS folded flap is clinically simple to perform,which can prevent depressed facial deformity.Combination of SMAS folded flap and ADM can reduce the incidence of Frey's syndrome in patients undergoing parotidectomy.     

SMAS folded flap and allograft dermal matrix repairing parotid bed following parotidectomy to prevent facial deformity and Frey＇s syndrome

PURPOSE： This study evaluates the outcome of superficial musculoaponeurotic system （SMAS） and allograft dermal matrix （ADM） in preventing facial deformity and Frey＇s syndrome following parotideetomy. METHODS： Forty-six patients with benign parotid tumors were randomly assigned to 4 groups. The control group consisted of 12 patients who underwent a total parotidectomy; The AMD group consisted of 10 patients who underwent a total parotidectomy and underwent intraoperative placement of ADM within the parotid bed; SMAS group consisted of 11 patients who underwent a total parotidectomy and SMAS folded flaps to repair parotid bed; and SMAS plus AMD group consisted of 13 patients who underwent a total parotideetomy and intraoperative placement of ADM to repair parotid bed with SMAS folded flaps. All 46 patients were evaluated via a short questionnaire regarding perception of a facial contour deformity, Frey＇s syndrome, modified Minor＇s starch-Iodine test （MSIT）, and clinical examination. RESULTS： Twelve months of follow-up was conducted after the treatment, the rates of satisfaction with the post-operative facial contour were 33.3% （4/12）,40.0% （4/ 10）,91.9% （10/11） and 100%（13/13） respectively in the control group, AMD group, SMAS group and SMAS plus AMD group, and the difference between the SMAS plus AMD group and the former two groups was statistically significant （P〈 0.05）. The incidences of objective Frey＇s syndrome by MSIT were 50.0 % （6/12）, 20.0% （2/10）, 27.3% （3/11） and 7.7% （1/13） respectively, and the difference between the SMAS plus AMD group and the control groups was statistically significant （P〈0.05）. CONCLUSION： The SMAS folded flap is clinically simple to perform, which can prevent depressed facial deformity. Combination of SMAS folded flap and ADM can reduce the incidence of Frey＇s syndrome in patients undergoing parotidectomy.     

颈椎骨龄定量分期法在评估前后面高生长发育中的初步应用

目的 以颈椎骨龄定量分期法（quantitative cervical vertebral maturation,QCVM）为划分标准,探讨QCVM Ⅰ至Ⅳ期前后面高生长发育的纵向变化特点.方法 从901位中小学生中挑选87位（女55,男32）正常（牙合）个体,每年定期拍摄正中（牙合）位头颅侧位片及手腕骨片,连续6年,组成8-18岁混合纵向资料,比较QCVM Ⅰ至Ⅳ期前后面高的生长量、相对生长速率和生长完成百分比.结果 ①所有面高参数最大平均生长量均处于高峰期（第Ⅱ期）,最小生长量均处于结束期（第Ⅳ期）;第二大生长量除下颌升支高度及男性后面高处于减速期（第Ⅲ期）,其余均为加速期（第Ⅰ期）;②所有参数从QCVM Ⅰ至Ⅳ期呈现加速→高峰→减速→结束的生长趋势,最大相对生长速率均发生在第Ⅱ期（高峰期）,第Ⅰ期（加速期）次之;③虽然在生长量和相对生长速率上存在男女性别差异,但男女在颈椎发育的不同阶段完成相似的生长百分比.结论 颈椎骨龄定量分期法能评估前后面高的发育阶段、估计生长速率、预测生长剩余百分比,有重要的临床应用价值.     

透明质酸酶诱导兔颞下颌关节骨关节病的实验研究

目的：建立兔颞下颌关节骨关节病动物模型。方法：将不同浓度透明质酸酶（ＨＤ）一次性注入两组兔颞下颌关节下腔内,分别于注射后２４ｈ、１、４、８、１２周后处死动物,对颞下颌关节标本进行组织学观察。结果：注射ＨＤ４周后出现关节软骨破坏,关节盘腔原纤维暴露,滑膜慢性炎症等骨关节病表现。结论：本实验研究建立了颞下颌关节骨关节病模型可用于颞与颌关节骨关节病早、中期病变的研究 。     

影像学对滑膜软骨瘤病的诊断价值

目的 探讨影像学对颞下颌关节滑膜软骨瘤病的诊断价值。方法 对北京大学口腔医学院1989～2003年6例(7侧)手术患者临床、病理及影像学进行综合对照分析。结果 滑膜软骨瘤病在临床上无特征性改变，术前诊断主要依靠影像学检查，而多个游离体的存在为最重要的诊断依据。本组病例普通X线检查发现2侧(2／7)，CT检查发现3侧(3／5)，MRI检查发现3侧(3／4)存在多个游离体，均为Milgram病理分期Ⅱ、Ⅲ期病例：而在2侧CT(2／5)、1侧MRI(1／4)上未发现游离体者均为Ⅰ期病例。结论影像学检查对于滑膜软骨瘤病MilgramⅡ、Ⅲ期有重要诊断价值，而对于其Ⅰ期病例往往术前无法做出诊断。     

幽门螺杆菌在干槽症发病中的意义初探

目的：初步探讨幽门螺杆菌（Hp)在干槽症（DS）发病中的作用,方法：通过对20例DS患者拔牙窝和对侧相应部位牙齿龈下菌班的Hp－PCR检测了解Hp感染情况;并分组治疗观察抗幽门螺杆菌（抗（Hp)治疗DS的效果。结果：20例DS患者中有19例（95．0％）拔牙窝Hp-PCR检测阳性,其对侧相应部位牙菌斑阳性率亦高达65．0％,分组治疗结果两组差异显著（P＜0．05）。结论Hp可能与DS发病有关,其致病机理的研究尚待深入。     

正常成人颞颌关节的CT和MRI影相分析

本文对10名正常成人双侧TMJ进行了CT扫描,其中3名作了MRI扫描。对所有CT片作了TMJ骨性结构的三维分析,观察了正常人髁状突和关节凹的形态类型,并发现双侧形态均为同型,双侧髁状突运动范围一致。同时,还用CT软组织窗位相(闪烁相)对关节盘进行了正中(牙合)位和尽力开口位的观察,并用MRI对其结果加以证实。本研究所得结果较其它方法准确,更具有可比性。因为本研究选用CT对双测TMJ进行同时扫描,消除了以往X光片需分侧和多种投照检查所造成的误差。     

双侧拉杆式口腔矫治器治疗阻塞性睡眠呼吸暂停综合征的临床应用

目的探讨双侧拉杆式口腔矫治器在阻塞性睡眠呼吸暂停综合征（OSAS）治疗中的应用价值。方法用双侧拉杆式阻鼾器治疗OSAS患者18例，3-5个月后复查主观症状及多导睡眠图（PSG）。结果该矫治器的耐受率为89％，鼾声、白日嗜睡、夜间憋醒、口干及咽痛等症状改善或消失，PSG五项监测结果治疗前后有显著性差异，症状明显改善。结论该矫治器制作简单，戴用舒适，易于推广应用。     

Oral lichen planus: an immunohistochemical study of heat shock proteins (HSPs) and cytokeratins (CKs) and a unifying hypothesis of pathogenesis

The expression of heat shock proteins HSP60 and HSP70 and cytokeratins CK1/10 and CK7/18 were compared in epithelium of oral lichen planus (OLP) lesions and oral fibromas using an avidin-biotin-peroxidase complex (ABC) immunohistochemical method. An immunostaining intensity distribution (IID) index was developed to assess staining intensity and the proportion of positively stained cells in different layers of the epithelium. The expression of HSP60 in the basal layer was significantly higher in OLP than in fibromas. No difference in HSP70 expression was evident between OLP and fibromas. The expression of CK1/10 in the epithelial basal and suprabasal layers was significantly higher in OLP than in fibromas. There was no demonstrable staining for CK7/18 in either OLP or fibromas. A significant correlation was evident between the expression of HSP60 and CK1/10 in the basal epithelial cells in OLP. The findings support a role for HSP60 in the pathogenesis of OLP. A unifying hypothesis of the pathogenesis of OLP, involving two sequential immune reactions, is proposed.     

牙周韧带细胞与骨髓基质细胞表面抗原表达的比较

目的：比较骨髓基质细胞与正常人牙周韧带细胞表面抗原的表达情况,探讨牙周韧带细胞与骨髓基质细胞的关系。方法：体外培养人牙周韧带细胞及骨髓基质细胞,采用免疫组化SP法检测细胞中CD14、CD44、CD105、CD34的表达,并进行图像分析。结果：与骨髓基质细胞相似,人的牙周韧带细胞上表达CD44、CD105,不表达CD34、CD14结论：人的牙周韧带细胞与骨髓基质细胞在表面抗原特性上有相似性。     

Low stimulation of peripheral lymphocytes, following in vitro application of Emdogain®

Abstract. Fast tissue regeneration after therapeutic manipulations is a central problem of periodontology, oral surgery and trauma of the periodontal tissues, including bone. Several products, which augment tissue regeneration, have been manufactured and assayed in clinical practice with positive results. Emdogain® is a recent addition in this field, as a tissue-regenerating product. The substance is a derivative of amelogenin, obtained from porcine embryonic tissues. At the present time, it is not known whether the substance can induce a local (due to the uptake of the substance) or systemic immune response. The aim of the present study was to evaluate, in vitro, the ability of Emdogain® to influence, in vitro, the immune system. Peripheral blood lymphocytes, isolated for 10 healthy donors, were cultured in the presence of various concentrations of the substance, in order to determine the rate of cell proliferation, the expression of surface antigens and the production of cytokines and immunoglobulins. Under our experimental conditions, Emdogain® produced a slight increase of the proliferation of lymphocytes, restricted to the CD25 (IL-2 receptor) fraction of the CD4 positive T-lymphocytes, and a concomitant decrease of CD 19 positive B-lymphocytes. Other cell fractions (CD8 positive T-cells. B-cells and NK-cells) were not affected. Under our conditions too, immunoglobulin and cytokin (IL-2 and IL-6) production was not modified, even after a 3-day application of concentrations much higher than those used in clinical practice. Our data suggest that Emdogain® slightly induce an immune response, restricted to the activated fraction of CD4 T-lyniphocytes in vitro.     

杀灭幽门螺旋杆菌是治疗扁平苔藓的一种有效方法

为了探索扁平苔藓（ＬＰ）与系统疾病的关系，本研究以系统因素中的消化系统为背景，对１５０例ＬＰ患者进行严格分组进行治疗，结果显示：（１）病理性舌苔１４６例（９７．３％），其中１２０例伴有不同程度的口臭（８０％）。（２）在１５０例胃粘膜活检标本中，１２０例为ＨＰ阳性（８０％）。据此，我们采用杀灭幽门螺旋杆菌（ＨＰ）治疗以观察疗效，其中，单纯铋剂疗法呈联合疗法组怀传统疗法组在显效率与总有效率方面均有显著     

牙龈卟啉单胞菌超声提取物对人牙周膜干细胞骨向分化的影响

目的 本研究目的是检测牙龈卟啉单胞菌(Porphyromonas gingivalis,P.gingivalis)2561超声提取物对人牙周膜干细胞(Human periodontal ligament stem cells,hPDLSCs)的增殖及其骨向分化相关蛋白表达的影响.方法 标准厌氧培养环境下培养P.gingivalis.收集细菌菌落,离心,制备细菌的超声提取物,然后以不同的浓度加入hPDLSCs的培养液中.培养六天后观察hPDLSCs的增殖及碱性磷酸酶(Alkaline phosphatase,ALPase)的表达.提取蛋白并用Western Blotting检测骨黏结蛋白(Osteonectin,ON)的表达.结果 与对照组相比,P.gingivalis明显抑制hPDLSCs的生长(P＜0.05),显著降低了hPDLSCs中ALPase的表达(P＜0.05);1μg/ml P.gingivalis上调ON的表达,而100μg/ml P.gingivalis明显下调ON的表达.结论 这些结果提示作为牙周炎病原菌,大量的P.gingivalis可能,至少部分通过抑制hPDLSCs的增殖及其骨向分化能力,抑制了牙周炎症所致牙周组织破坏后牙周组织的自我修复能力.