Prototyped grafting plate for reconstruction of mandibular defects

To esthetically and functionally restore a 40-mm canine mandibular discontinuity defect using a custom-made titanium bone-grafting plate in combination with autologous iliac bone grafts. Individualized titanium bone-grafting plates were manufactured using a series of techniques, including reverse engineering, computer aided design, rapid prototyping and titanium casting. A 40-mm discontinuous defect in the right mandibular body was created in 9 hybrid dogs. The defect was restored immediately using the customized plate in combination with autologous cancellous iliac blocks. Sequential radionuclide bone imaging was performed to evaluate the bone metabolism and reconstitution of the grafts. The specimens were evaluated by biomechanical testing, 3-dimensional microcomputed tomographic scanning, and histological examination. The results revealed that the symmetry of the mandibles was reconstructed using the customized grafting plate, and the bony continuity of the mandibles was restored. By 12 weeks after the operation, the cancellous iliac grafts became a hard bone block, which was of comparable strength to native mandibles. A fibrous tissue intermediate was found between the remodelled bone graft and the titanium plate. The results indicate that the prototyped grafting plate can be used to restore mandibular discontinuous defects, and satisfactory aesthetical and functional reconstruction can be achieved.     

双功能超声检测输尿管结石患者肾内动脉阻力指数

采用双功能超亏检测３２例输尿和结石患者和３２例正常人肾内动脉阻力指数、结果表明：尿管结石患者的患肾ＲＩ显著高于健肾和正常人肾脏的ＲＩ，患肾与健肾ＲＩ差值较正常人双肾ＲＩＤ显著增高。     

彩色多普勒血流显像在胸廓出口综合症中的应用

目的： 探讨ＣＤＦＩ在胸廓出口综合症 （ＴＯＳ） 中的应用价值。方法： 对 ２５ 例ＴＯＳ患者 Ａｄｓｏｎｓ 试验前后锁骨下动、静脉进行ＣＤＦＩ检查。ＴＯＳ 的超声诊断标准： 左上肢过度外展的情况下, 锁骨下动脉受压处峰速度≥中立位２ 倍或血流完全中止; 锁骨下静脉血流中止或血流波型不受心跳呼吸的影响。结果： 超声Ａｄｓｏｎｓ 试验 （＋ ）１７ 例 （６８％ ）, 其中动、静脉均显著受压 ９ 例, 动、静脉显著压迫分别为３ 例和５ 例。结论： ＣＤＦＩ可检测ＴＯＳ血流动力学变化, 为无创伤性评价ＴＯＳ提供了一项新方法。     

Character of distracted bone in irradiated canine mandibles and electrophysiological changes in the inferior alveolar nerve

Our aim was to explore the character of distracted bone in irradiated canine mandibles and the electrophysiological changes in the irradiated inferior alveolar nerve (IAN). Twelve Chinese dogs were studied, 10 of which were given unilateral irradiation of ⁶⁰Co in the mandible with a total dose of 22.8 Gy in four 5.7 Gy fractions (biologically equivalent to 50 Gy/25 fractions) (experimental group). The other two dogs were not irradiated and served as controls. All had a bilateral corticotomy 3 months after irradiation. After a 1-week latency period distraction of the mandible was activated at a rate of 0.5 mm twice daily for 10 days, followed by a consolidation phase of 8 weeks. New bone was assessed by radiographic, histological, and single-photon electron computed tomographic (SPECT) analysis. The IAN was analysed electrophysiologically. One dog in the experimental group was excluded from the study with anaesthetic problems. After 8 weeks of consolidation there was no difference between the percentage area of new bone in the two groups. New bone was more mature and organised in the control group than in the experimental group. SPECT analysis showed that there was active osteogenic activity in dogs in the experimental group. The action potential of the IAN showed corresponding changes during the irradiation and distraction processes.     

Increased tumor-infiltrating plasmacytoid dendritic cells predicts poor prognosis in oral squamous cell carcinoma

ObjectiveAccumulating evidence suggests that plasmacytoid dendritic cells (pDC) have a dual role not only in initiating anti-tumor immune responses but also in inducing immune tolerance to facilitate cancer development. The aim of this study was to investigate the distribution and function of tumor-infiltrating pDCs in primary oral squamous cell carcinoma (OSCC) and their relation to patient outcome.MethodsThe distribution of pDCs in 10 normal oral mucosa and 60 OSCC tissues was detected by immunohistochemistry. The population of pDCs in six OSCC patients and six healthy donors was evaluated by flow cytometry. The relationship between tumor-infiltrating pDCs and clinicopathological data and patient outcome was analyzed accordingly. The capacity of pDCs to produce cytokines, such as IFN-α, IL-6, IL-8 and TNF-α in response to TLR-9 ligands (CpG-ODN) was measured by ELISA.ResultPDCs were detected at high levels in 38.3% of the OSCC tissues, primarily in the stroma, but were absent in normal oral mucosa. The frequency of pDCs in OSCC tissue was significantly higher than that observed in normal oral mucosa. However, the distribution and population of circulating pDCs was similar between healthy donors and OSCC patients. Kaplan-Meier analysis revealed a significant association of increasing number of tumor-infiltrating pDCs with lymph node metastasis and overall survival. Multivariate analysis confirmed that high levels of tumor-infiltrating pDCs was an independent prognostic factor. Further cytokine analysis revealed a decreased secretion of IFN-α, IL-6 and TNF-α, which indicated an impaired function of tumor-infiltrating pDCs.ConclusionsThe increased number of tumor-infiltrating pDCs correlates with an adverse outcome in primary OSCC patients. This finding is not only suggestive of the contribution of pDCs in the progression of oral cancer but also presents an opportunity and a new target for OSCC immune therapy in oral cancer management.     

Enucleation combined with peripheral ostectomy: Its role in the management of large cystic ameloblastomas of the mandible

AimAggressive resection of a large mandibular cystic ameloblastoma may cause severe deformity and dysfunction, while simple enucleation may carry a high risk of recurrence. The purpose of this study was to evaluate, in terms of both recurrence and the preservation of contour and function, the effectiveness of enucleation combined with peripheral ostectomy (Enu/PO) in managing large mandibular cystic ameloblastomas.Materials and methodsFourteen patients who had large mandibular cystic ameloblastoma (11 unicystic, 3 multicystic) and had been treated with the Enu/PO were reviewed.ResultsThe follow-up period was 19–117 months. Using Enu/PO, mandibular continuity was preserved in all patients, and only one patient complained of permanent lip numbness. With bone regeneration, the thinned bone plate significantly thickened and the residual cavity shrank. No pathological fracture occurred. There was recurrence in 3 patients. Two recurrences were treated with radical surgery, and the other with Enu/PO. No new recurrence was found thereafter. All patients were satisfied with their facial appearance.ConclusionsThe Enu/PO technique is excellent in preserving appearance and functions and with a low risk of recurrence, is a reliable option for the management of large mandibular cystic ameloblastomas.     

Bone regeneration by periosteal elevation using conventional orthodontic wire and uHA/PLLA mesh

This study evaluated bone regeneration by periosteal elevation using conventional orthodontic wire and an unsintered hydroxyapatite (u-HA)/poly-l-lactic acid (PLLA) mesh in rabbit frontal bone. Thirty two rabbits (12–16 weeks: 2.5–3.0 kg) were used in this study. In the experimental group, 1 week after the mesh was inserted under the periosteal membrane, it was elevated by traction using the mesh connected with wire and two anchor screws. In the control group, the mesh was kept inserted under the periosteal membrane. Four animals were killed in each period in both groups, at 2, 3, 5 and 9 weeks postoperatively. Operated parts in the frontal bone were removed and prepared for radiological and histological assessment. The distance between the mesh and pristine bone (elevation length), the bone area and the expression of BMP-2 were evaluated. The value in the experimental group was significantly higher when compared to the control group (length P < 0.0001, bone area P < 0.0010, BMP-2 P = 0.0015). The BMP-2 labelling index after 3 weeks tended to be the largest in both groups. This study suggests that bone regeneration can be induced by periosteal elevation using a conventional orthodontic wire and an uHA/PLLA mesh.     

Perception of oral and maxillofacial surgeons,orthodontists and laypersons in relation to the harmony of the smile

ObjectiveHarmony is one of the main objectives in surgical and orthodontic treatment and this harmony must be present in the smile, as well as in the face. The aim of the present study was to assess the perceptions of professionals and laypersons in relation to the harmony of the smile of patients with or without vertical maxillary alterations.Materials and methodsSixty observers (oral and maxillofacial surgeons, orthodontists and laypersons) reported the degree of harmony of six smiles using an objective questionnaire and the participants indicated if there was a need for corrective surgery or not. The classification of observers was recorded on a Likert scale from 1 to 5. Mixed regression was used to determine differences between the three groups.ResultsStatistically significant differences were found only for the harmony of the smile between the oral and maxillofacial surgeons and laypersons, with laypersons being more critical when assessing the smile. There was no statistical difference between the other groups for the harmony of the smile or the indication of corrective surgery. The patterns of greater or lesser harmony determined by observers during the smile were similar to those found in the literature as the ideal standard in relation to vertical maxillary positioning.ConclusionsLaypersons had a tendency to be more critical in relation to facial harmony than surgeons, although no statistical differences were found in the other groups in relation to the harmony of the smile or indication for the corrective surgery. In addition, the patterns of greater or lesser harmony of the smile determined by the participants were similar to those found in the literature as the ideal standard in relation to vertical maxillary positioning. Overall, the present study demonstrates that adequate interaction between surgeons, orthodontists and laypersons is essential in order to achieve facial harmony with orthodontic and/or surgical treatment.Clinical relevanceOpinion of specialists and laypersons about the smile in relation to the vertical positioning of the maxilla.     

Comparison of lower lip hypoesthesia between hybrid fixation and conventional fixation following sagittal split ramus osteotomy

PurposeThe purpose of this study was to compare the recovery period of lower lip hypoesthesia between hybrid fixation and conventional fixation using absorbable plates and screw systems following sagittal split ramus osteotomy (SSRO).Subjects and methodsThe subjects were 66 patients (132 sides) who underwent bilateral SSRO setback surgery. They were divided into a hybrid fixation group (66 sides, 1 u-HA/PLLA plate and 4 mono-cortical screws and a bi-cortical screw in each side) and a conventional fixation group (66 sides, 1 u-HA/PLLA plate and 4 mono-cortical screws in each side). Trigeminal nerve hypoesthesia at the region of the lower lip was assessed bilaterally by the trigeminal somatosensory-evoked potential (TSEP) method.ResultsThe mean measurable periods were 8.1 ± 10.4 weeks in the hybrid fixation group, 5.1 ± 11.5 weeks in the conventional group with no significant difference. However, the maximum in the hybrid fixation group was 27 sides at 4 weeks postoperative and in the conventional fixation group was 37 sides at 1 week postoperative, and there was significant difference in the distribution of the measurable period (P < 0.0001).ConclusionThis study suggested that additional bi-cortical screws could affect the recovery of lower lip hypoesthesia after SSRO with bent absorbable plate fixation.