[Show abstract][Hide abstract] ABSTRACT: Migration and invasion of tumor cells are essential prerequisites for the formation of metastasis in malignant diseases. Previously, we have reported that CC chemokine receptor 7 (CCR7) regulates the mobility of squamous cell carcinoma of head and neck (SCCHN) cells through several pathways, such as integrin and cdc42. In this study, we investigated the connection between CCR7 and mitogen‑activated protein kinase (MAPK) family members, and their influence on cell invasion and migration in metastatic SCCHN cells. Western blotting, immunostaining and fluorescence microcopy were used to detect the protein expression and distribution of MAPKs, and the Migration assay, Matrigel invasion assay and wound‑healing assay to detect the role of MAPKs in CCR7 regulating cell mobility. To analyze the correlation between CCR7 and MAPK activity and clinicopathological factors immunohistochemical staining was emplyed. The results showed stimulation of CCL19 and the activation of CCR7 could induce ERK1/2 and JNK phosphorylation, while it had no efect on p38. After activation, ERK1/2 and JNK promoted E‑cadherin low expression and Vimentin high expression. The MAPK pathway not only mediated CCR7 induced cell migration, but also mediated invasion speed. The immunohistochemistry results showed that CCR7 was correlated with the phosphorylation of ERK1/2 and JNK in SCCHN, and these molecules were all associated with lymph node metastasis. Therefore, our study demonstrates that MAPK members (ERK1/2 and JNK) play a key role in CCR7 regulating SCCHN metastasis.
[Show abstract][Hide abstract] ABSTRACT: Purpose
Our goal was to evaluate whether elderly patients can benefit from free flaps.
Clinical information of the included patients was reviewed, and these patients were asked to complete the University of Washington Quality of Life (UW-QoL) version 4 questionnaire. Comparisons regarding different scales between the two groups were performed.
The difference in mouth-opening width before and after surgery did not differ significantly (P=0.621) in patients with or without free flap reconstruction; however, free flap placement tended to preserve the original mouth-opening width. There were no significant differences in recurrence-free survival or disease-specific survival rates between the two groups. The mean QoL score of the two groups was 77.5 (SD: 10.4) and 72.1 (SD: 10.8). There were significant differences in chewing domain scores between the two groups (P=0.039). Patients with free flap reconstruction tended to score better in the appearance and taste domains (P=0.073 and P=0.053), but required longer surgery times, longer postoperative hospital stays and higher hospital costs.
Free flap reconstruction could not benefit elderly patients in mouth-opening width or survival analyses, the only QoL domain that was significantly improved in patients undergoing free flap reconstruction was chewing. Free tissue transfer should be cautiously suggested for elderly patients with advanced oral cancer.
No preview · Article · Jul 2014 · Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons
[Show abstract][Hide abstract] ABSTRACT: Objective: To compare the platysma flap with submental flap in terms of tumor and flap characteristics, operative properties and the functional outcomes.
Methods: A total of 65 patients presented with tumors of head and neck and underwent curative tumor resection with different neck dissections at the Department of Oromaxillofacial-Head and Neck Surgery, School of Stomatology of China Medical University; from March 2005 to December 2012 were included in the study. After radical tumor excision and neck dissection the resultant complex defects were reconstructed with either platysma flap or the submental flap. The extent of surgical resection, the type of neck dissection and choice of flap reconstruction was at the discretion of the surgical team. The functional outcomes, operative time and characteristics of both platysma and submental flaps were compared and the statistical tests of significance were applied accordingly.
Results: The mean age was 60 years. The complex facial defects of 30 patients were reconstructed with platysma flap and of 35 patients with submental flap. Mean operation time of submental flap including flap harvesting (5.58±1.96hrs) was shorter than platysma flap (6.2±1.4hrs). The majority of the flaps (88-93%) were taken successfully in both groups. Submental flap was associated with significantly higher patients’ satisfaction regarding acceptable functional outcomes (p-value 0.027). The mean reduction in mouth opening was significantly smaller in platysma group (0.37 ±0.18cms) than the submental group (0.47±0.16).
Conclusion: This study demonstrates that both platysma and submental flap techniques can be used for the reconstruction of complex facial defects with the acceptable functional outcome. The platysma flap can be harvested to medium size defects up to 70cm2 with good mouth opening. The submental flap is simpler, faster with a wider range of application and more acceptable functional outcomes.
Preview · Article · Jul 2014 · Pakistan Journal of Medical Sciences Online
[Show abstract][Hide abstract] ABSTRACT: Smoking is associated with oral cancer, and to adopt a more healthy lifestyle, increasing numbers of people are choosing to give up the habit. However, the occurrence of oral cancer in ever smokers is still apparent. In this study, we investigated the survival of ever smokers with oral squamous cell carcinoma compared with nonsmokers and current smokers with oral squamous cell carcinoma. A matched-pair study was performed between 2005 and 2012, which matched 66 ever smoker patients with oral cancer to both current smokers and never smokers: each ever smoker was matched with 1 never smoker and 1 current smoker. A Chi-squared test was used to evaluate the significance of the variables, and the Kaplan-Meier method was used to analyze the recurrence-free survival and disease-specific survival rates. The recurrence-free survival (P = 0.006) and disease-specific survival (P = 0.027) rates were worse for ever smokers compared with never smokers, but the former group shared a similar prognosis with current smokers. The matched-pair analysis showed that smoking was associated with an approximately 2-fold increase in the risk for recurrence and 5-fold increase in risk for disease-related death. Ever smokers and current smokers had a similar chance of recurrence and disease-related death, but ever smokers had a poorer prognosis than never smokers do and they tended to have a local recurrence. The recurrence-free survival and disease-specific survival rates did not differ between ever and current smokers, and smoking cessation did not affect the chance of recurrence and diseases-related death in ever smokers compared with current smokers.
No preview · Article · May 2014 · The Journal of craniofacial surgery
[Show abstract][Hide abstract] ABSTRACT: The purpose was to evaluate our 20-year experience of pediatric odontogenic lesions. Pediatric patients with a diagnosis of odontogenic lesion were identified. Three hundred ten patients were odontogenic; dentigerous cyst was seen in 62.0% of the cases. Most (70.2%) of them occurred in mixed dentition period, and it had a male preponderance. Odontogenic keratocystic tumor occurred in the permanent dentition period. It had an equal site distribution. Odontoma was seen in 20.0% of the cases. Its site of predilection was the mandible. Ameloblastoma was the most common odontogenic tumor. Most of the cases occurred in the permanent dentition period. It affected the male and female equally. Calcifying epithelioma odontogenic tumor was seen in 11.8% of the cases. All the lesions occurred in the primary dentition period. It had no sex or site preponderance. Myxoma was seen in 3.6% of the cases. It was most common in the permanent dentition period, and it was more frequent in the male. Iliac crest bone graft was successfully performed in 28 patients, postoperative infection occurred in 2 patients, and no donor-site dysfunctions were reported. The observed differences in lesion type and distribution in this study compared with previous researches may be attributable to genetic and geographic variation in the populations studied. Iliac crest bone graft was suggested for pediatric mandible reconstruction.
No preview · Article · Apr 2014 · The Journal of craniofacial surgery
[Show abstract][Hide abstract] ABSTRACT: Parotid gland metastasis in lung cancer is extremely rare, very few cases have been reported.
We report on the case of a 61-year-old Chinese male patient who presented with parotid swelling metastasizing from advanced lung cancer. We therefore performed an operation of partial parotidectomy with preservation of the facial nerve and advised the patient receive chemotherapy, however, the patient died four months later.
Although it is extremely rare, a potential metastasis of lung cancer should not be ignored in the diagnosis of parotid tumor. Preoperative routine examination, such as a chest X-ray and lung computational tomography scan, may play an important role in differential diagnosis. The management of the metastatic tumor to the parotid gland was controversial however, despite combined treatment modalities, long-term survival was not attained.
Preview · Article · Apr 2014 · World Journal of Surgical Oncology
[Show abstract][Hide abstract] ABSTRACT: Our study investigated the quality of life (QoL) of Chinese patients after immediate reconstruction surgery on individuals with head and neck cancer. In addition, we compared the differences between pectoralis major myocutaneous flap (PMMF) and anterolateral thigh free flap (ALTFF). The University of Washington Quality of Life questionnaire, version 4, was used to assess the QoL. Assessments were performed at least 24 months postoperatively. A total of 110 patients' records were obtained. Among them, 86 patients completed a QoL questionnaire (78.2%). No significant differences could be found in age, primary site, T stage, N stage, and postoperative radiotherapy between PMMF and ALTFF groups. However, there were significant differences between both groups in sex, operation time, and complication. A matched analysis was performed to compare the differences in QoL between patients with head and neck cancers reconstructed with PMMF or ALTFF. Patients reconstructed with ALTFF had better shoulder but worse speech functions. There was a significant effect on the QoL of head and neck cancer patients who had undergone either PMMF or ALTFF reconstruction. The result of this study provide useful information for physicians and patients during their discussion of treatment modalities for head and neck cancers.
No preview · Article · Apr 2014 · The Journal of craniofacial surgery
[Show abstract][Hide abstract] ABSTRACT: To assess the effectiveness of double mental V-Y island advancement flaps for total lower lip reconstructions.
During a 6-year period, from 2006 to 2012, total lower lip reconstruction was performed in 12 patients using double mental V-Y island advanced flaps. The resulting lip function and superiority of each flap were analyzed. To assess any cosmetic implications, patients were asked to answer the Appearance Domain section from the University of Washington Quality of Life Questionnaire at least 12 months after discharge from the hospital.
All flaps survived completely and no short-term postoperative complications occurred. The mean follow-up time was 34.5 months (range, 15 to 69 months) and there was no recurrence of disease. All patients were capable of consuming a regular oral diet and no patients complained of an inability to eat in a public setting, drooling, or microstomia. The mean preoperative and postoperative open-mouth widths were 4.1 and 3.7 cm, respectively, and the mean reduced open-mouth width was 10%. The intercommissural width varied from 4.6 to 6.8 cm (mean, 5.5 cm). The mean postoperative 2-point discrimination was 11.2 mm (range, 9 to 13 mm). The mean score for the Appearance Domain section was 93.8 (range, 75 to 100).
The mental V-Y island advancement flap reconstruction is a reliable procedure for total lower lip reconstruction.
No preview · Article · Apr 2014 · Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons
[Show abstract][Hide abstract] ABSTRACT: Primary orofacial tuberculosis (TB) is uncommon, especially with regard to the jaw. We report an unusual case for which the final diagnosis was tuberculous osteomyelitis of the mandible with cervical tuberculous lymphadenitis. The follow-up examinations for our patient showed complete regression of the swelling and healing of the mandibular lesion after 4 months of TB antibiotic therapy. The purpose of the present study was to alert clinicians to our findings and encourage them to consider oral TB in the differential diagnosis for jaw lesions with multiple enlarged cervical lymph nodes.
Full-text · Article · Apr 2014 · Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons
[Show abstract][Hide abstract] ABSTRACT: To investigate the expression of gene DEK in oral squamous cell carcinoma, and explore the role of DEK in the development and metastasis of oral squamous cell carcinoma.
Thirty-three specimens of oral squamous cell carcinoma (OSCC), 28 specimens of cervical lymph nodes metastasis, and 33 specimens of normal oral mucosal tissues adjacent to the cancerous lesions were examined. Polymerase chain reaction with reverse transcription (RT-PCR) and immunohistochemistry were used to detect mRNA and protein expression of DEK, respectively.The results were analysed with SPSS17.0 software package.
RT-PCR and immunohistochemistry showed that the expression of DEK mRNA and DEK protein in metastatic lymph nodes (82.1%, 82.1%) and cancerous tissues (81.2%, 76.8%) of OSCC were significantly higher than in the adjacent tissues (27.3%, 18.2%). The difference between cancerous tissues and adjacent tissues was significant (P<0.05).
DEK may play an important role in the occurrence and metastasis of OSCC.
No preview · Article · Feb 2014 · Shanghai kou qiang yi xue = Shanghai journal of stomatology
[Show abstract][Hide abstract] ABSTRACT: To systematically summarize the association between the X-ray repair cross complementing 3 (XRCC3) gene polymorphism and oral cancer susceptibility by meta-analysis.
Databases including PubMed, EMbase, CNKI, VIP and WanFang Data were searched to identify case-control studies concerning the association between an XRCC3 gene polymorphism and the risk of oral cancer from the inception to June 2014. Two reviewers independently screened the literature according to the criteria, extracted the data and assessed the quality. Then meta-analysis was performed using Stata 11.0 software.
Seven published case-control studies including 775 patients with oral cancer and 1922 controls were selected. Associations between the rs861539 polymorphism and overall oral cancer risk were not statistically significant in all kinds of comparison models (CT vs CC: OR=0.94, 95%CI=0.74-1.18; TT vs CC: OR=0.94, 95%CI=0.64- 1.38; dominant model: OR=0.95, 95%CI=0.76-1.18; recessive model: OR=0.94, 95%CI=0.69-1.29; allele T vs C: OR=0.97, 95%CI=0.84-1.11). In the stratified analysis by ethnicity, no significant associations were found among Asians and Caucasians. On stratification by tumor type, no significant associations were found for cancer and oral premalignant lesions.
The XRCC3 gene polymorphism was not found to be associated with the risk of oral cancer. Considering the limited quality of the included case-control studies, more high quality studies with large sample size are needed to verify the above conclusion.
No preview · Article · Jan 2014 · Asian Pacific journal of cancer prevention: APJCP
[Show abstract][Hide abstract] ABSTRACT: To determine the effect of radial forearm free (RFF) flap harvest on patient-reported postoperative upper extremity disability.
Patients undergoing RFF flap reconstruction following resection of head and neck cancer were recruited and matched with similar patients undergoing non-RFF reconstruction. All subjects completed the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire preoperatively and at least 1 year postoperatively.
Postoperative DASH scores were significantly higher (more severe disability) in patients undergoing RFF flap reconstruction (6.93 ± 5.54; n = 52) compared with those undergoing non-RFF flap surgeries (2.95 ± 4.42; n = 52). Preoperative DASH score, flap size, patient age and tumour stage were significantly correlated with postoperative DASH score.
Excluding the effect of neck dissection, RFF flap reconstruction has a significant deleterious effect on upper extremity function.
Preview · Article · Dec 2013 · The Journal of international medical research
[Show abstract][Hide abstract] ABSTRACT: A clinical study was undertaken to define the vascular anatomy of anteromedial thigh perforator flap (AMT) and evaluate the outcomes of the flap in head and neck reconstruction.
The sizable perforators of AMT flaps and their origins were prospectively explored in 54 patients. For each patient, we recorded the sizable perforators' location, diameter, source vessel, numbers and anatomical types. Among them, 14 cases underwent head and neck reconstruction with AMT flaps. The complications and functions of donor and recipient sites were recorded and the operative techniques of AMT were described. Statistical analysis was performed with SPSS 13.0 software package.
Eight of fifty-four thighs had no sizable AMT perforators. AMT flap was based on the medial branch of descending branch of lateral circumflex femoral artery (d-LCFA) and shared the same vascular pedicle with anterolateral thigh flap (ALT). The total sizable perforators were 56. Among them, 40.9%(25/61) were direct septocutaneous perforators, the remaining perforators were all musculocutaneous. Most of the sizable perforators (58/61, 95.1%) were located in the middle one-third of the thigh, with an average of (3.9±0.72) cm medial to a line connecting the anterior superior iliac spine and the superolateral patella and an average of (22.5±2.38) cm to anterior superior iliac spine. There was an negtive relationship between the number of sizable perforators of AMT and ALT flaps (P<0.01). 14 flaps survived completely. No complications were observed in recipient and donor site.
The pedicle of AMT flap is the medial branch of d-LCFA. The AMT flap may be useful if ALT flap is without sizable perforators. AMT flap may be as a primary or an alternative choice of anterolateral thigh flap for head and neck reconstruction.
No preview · Article · Dec 2013 · Shanghai kou qiang yi xue = Shanghai journal of stomatology
[Show abstract][Hide abstract] ABSTRACT: To study the effect of pituitary tumour transforming gene (PTTG) on invasion and metastasis of salivary adenoid cystic carcinoma.
The expression of PTTG and bFGF was investigated in 40 salivary adenoid cystic carcinoma tissues and 20 normal salivary tissues by immunohistochemistry. Pearson's Chi-square test and Spearman correlation analysis were used to analyze the data using SPSS 11.5 software package.
The expression of PTTG and bFGF were significantly higher in salivary adenoid cystic carcinoma tissues than in normal salivary gland tissues (P<0.01) and their expression levels were positively correlated (P<0.01).
PTTG and bFGF are highly expressed in salivary adenoid cystic carcinoma. The invasion and metastasis of salivary adenoid cystic carcinoma are correlated with the expression of PTTG. Supported by National Natural Science Foundation of China (81102058).
No preview · Article · Dec 2013 · Shanghai kou qiang yi xue = Shanghai journal of stomatology
[Show abstract][Hide abstract] ABSTRACT: This study investigated the quality of life (QoL) of patients with head and neck cancer undergoing immediate reconstruction of the mandible with free fibula flap. From March 2006 to January 2011, the QoL of 42 patients was assessed using the Medical Outcomes Study Short Form 36 and the University of Washington QoL (version 4) questionnaires. The assessments were performed at least 24 months after surgery. A total of 31 of the 42 questionnaires (73.8%) were returned. The length of harvested fibula varied from 17.5 to 26.1 cm. In the Short Form 36, the lowest-scoring domain was vitality, whereas the highest scores occurred in physical role. According to the University of Washington QoL, the key domains affected by surgery are chewing, speech, and appearance. The domain of pain has the best score. There was a significant effect on the QoL of patients with head and neck cancer with resections of the mandible who had undergone free fibula flap reconstruction. Data from this study may provide useful information for physicians and patients, which may be of value during discussion of treatment modalities for head and neck cancers.
No preview · Article · Nov 2013 · The Journal of craniofacial surgery
[Show abstract][Hide abstract] ABSTRACT: The aim of the present study was to evaluate the quality of life (QoL) of patients with oral cancer who had undergone resection of the tongue and floor of the mouth and reconstruction with the pectoralis major flap.
The present study assessed 21 patients who had undergone pectoralis major flap reconstruction using the University of Washington QoL, version 4, questionnaire. A nonparametric Mann-Whitney U test was used to analyze the data.
Of the 12 disease-specific domains, the best 3 scores from the patients were for pain, saliva, and anxiety, and the worst 3 scores were for taste, chewing, and swallowing. The mean UW-QoL composite score was 73.4. Swallowing was considered to be the most important issue within the previous 7 days, followed by chewing and speech. Those patients who had undergone wider excision had poorer speech.
A significant effect was found on the QoL of patients with oral cancer who had undergone resection of the tongue and floor of the mouth with pectoralis major flap reconstruction.
No preview · Article · Nov 2013 · Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons
[Show abstract][Hide abstract] ABSTRACT: This study investigated the quality of life in patients younger than 40 years with tongue squamous cell carcinoma. We used the University of Washington Head and Neck Quality of Life scale to compare the quality of life outcomes between young and old patients. Cases were patients younger than 40 years who were treated for anterior tongue squamous cell carcinoma. Controls were patients older than 40 years who were matched to the cases regarding diagnosis, sex, and TNM classification. Two controls were matched for each case; thus, 21 cases and 42 controls were selected. Twenty-one of 33 questionnaires (63.6%) were returned. The median follow-up duration was 3.7 years (range, 1-12 y). In the group of young patients, the best-scoring domains were pain, chewing, and swallowing, whereas the lowest scores were for appearance, mood, and anxiety. Young patients (40 years or younger) reported better function, notably regarding activity, recreation, shoulder, taste, and saliva compared with the old patients with anterior tongue squamous cell carcinoma. The patients younger than 40 years tend to have a good quality of life. Most of them were not significantly affected by pain. Quality of life should be used as part of our treatment of anterior tongue squamous cell carcinoma.
No preview · Article · Nov 2013 · The Journal of craniofacial surgery
[Show abstract][Hide abstract] ABSTRACT: The usage of submental flap is a good method for head and neck reconstruction, but it has some risk also, such as anatomical variations and surgical errors. In this article, we present a modified incision design for the submental flap.
We designed a modified submental flap incision method based on the overlap of the incision outline of the submental flap, platysma myocutaneous flap and infrahyoid myocutaneous flap. If we found that the submental flap was unreliable during the neck dissection at the level III, II and Ib areas, the infrahyoid myocutaneous flap or platysma myocutaneous flap was used to replace it. Between 2004 and 2012, we performed 30 cases using this method. As control, 33 radial forearm free flaps were counted. Significant differences were evaluated using the χ(2) test and Mann-Whitney U. Survival and recurrence were analyzed using the Kaplan-Meier method.
Of the 30 patients, 27 finally received a submental flap, 1 patient received an infrahyoid myocutaneous flap, and 2 patients received a platysma myocutaneous flap. In patients who received the submental flap, the average operation time was 5.9 hours, 2.4 hours shorter than the radial forearm free flap group; the average age was 61.8, 6.1 years older than the radial forearm free flap group; the survival time and recurrence time did not significantly differ with those of the forearm free flap group; and the success rate was higher than traditional methods.
The wider indications, less required time, the similar low risk of recurrence and death as radial forearm free flap, higher success rate than traditional submental flap harvest methods, and ability to safely harvest a submental flap make the modified incision design a reliable method.
[Show abstract][Hide abstract] ABSTRACT: Our purpose was to evaluate the feasibility of radial forearm free (RFF) flap, platysma myocutaneous (PM) flap, and anterolateral thigh (ALT) flap in buccal reconstruction. This study consisted of 56 patients who were categorized into 3 groups. The Student t test was used to analyze the variables. Patients in group platysma flap were significantly older, the dissection of platysma flap was easier, and the defect was significantly smaller than those in group radial forearm flap and group ALT flap. The reduction in the widths of mouth opening between group PM, group RFF, and group ALT were compared. However, the reduction of mouth-opening widths in group RFF and group ALT was significantly less than that in group PM. Platysma myocutaneous flap may be more suitable in patients with small to middle-size defect and poor status, although the flap cannot achieve a reliable result; anterolateral thigh flap and radial forearm flap can preserve the interincisal distance well even for large buccal defect, but it takes more time and skills in the operation.
No preview · Article · Sep 2013 · The Journal of craniofacial surgery
[Show abstract][Hide abstract] ABSTRACT: Reconstruction of defects of the lip caused by cancer with its requirements of a complicated anatomical structure, important physiological function, and acceptable cosmetic result, is a challenge for oral and maxillofacial and plastic surgeons. A method that combines rotation and advancement flaps was described by Yu in 1989 for the reconstruction of defects of the lower lip. In our department between January 1992 and December 2012, 8 patients had reverse Yu flaps for the reconstruction of upper lip defects and 56 patients had classic Yu flaps for lower lip defects. Patients with defects located laterally to the upper lips, ranging from ⅓ to ½, had unilateral reverse Yu flaps, and bilateral procedures were done for defects of less than ⅔ of the lips. However, if the defects were located in the centre of the upper lips, between ⅓ and ½, they were treated with bilateral reverse Yu flaps. Patients with defects between⅓ and ⅔ of lower lips had unilateral Yu flaps, and if the defects were wider than ⅔ of the lower lips, the procedure was bilateral. No flap failed and desirable functional and aesthetic outcomes were recorded in all cases. Here we report our experience with the Yu flap for the benefit of other surgeons.
No preview · Article · Aug 2013 · British Journal of Oral and Maxillofacial Surgery