Da-ming Zhang

A review of clinical and histological parameters associated with contralateral neck metastases in oral squamous cell carcinoma.

Oral squamous cell carcinoma (OSCC) has a high incidence of cervical micrometastases and sometimes metastasizes contralaterally because of the rich lymphatic intercommunications relative to submucosal plexus of oral cavity that freely communicate across the midline, and it can facilitate the spread of neoplastic cells to any area of the neck consequently. Clinical and histopathologic factors continue to provide predictive information to contralateral neck metastases (CLNM) in OSCC, which determine prophylactic and adjuvant treatments for an individual patient. This review describes the predictive value of clinical‐histopathologic factors, which relate to primary tumor and cervical lymph nodes, and surgical dissection and adjuvant treatments. In addition, the indications for elective contralateral neck dissection and adjuvant radiotherapy (aRT) and strategies for follow‐up are offered, which is strongly focused by clinicians to prevent later CLNM and poor prognosis subsequently.

Extended supraclavicular fasciocutaneous island flap based on the transverse cervical artery for head and neck reconstruction after cancer ablation.

PURPOSE This clinical study assessed a pedicled supraclavicular fasciocutaneous island flap (SFIF) based on the transverse cervical artery that was extended to include shoulder skin for reconstructing the head and neck. PATIENTS AND METHODS Pedicled SFIFs extended to include the shoulder skin based on the cutaneous feeder vessels and perforator vessels in the deep fascia of the transverse cervical artery were designed for 24 patients with defects of the head and neck after cancer ablation. Preoperative 3-dimensional computed tomographic angiography was performed in all patients. The patients consisted of 15 men and 9 women ranging in age from 24 to 73 years. RESULTS The primary lesions included squamous cell carcinoma of the tongue, buccal mucosa, floor of the mouth, oropharynx, palate, and lower gingiva. Three-dimensional computed tomographic angiography showed that the transverse cervical artery arose from the thyrocervical trunk in 13 cases and from the subclavian artery in 11 cases. The diameter of the artery ranged from 0.15 to 0.24 cm. The size of flaps ranged from 4 × 8 cm to 6 × 12 cm, and the mean length of the vascular pedicle was approximately 18.5 cm. Of the flaps, 23 survived completely, for a success rate of 95.8%. Three patients underwent radiotherapy, and the follow-up period ranged from 3 to 12 months. One patient died of local tumor recurrence, and cervical recurrences developed in 3 patients. CONCLUSION An SFIF extended to include the shoulder skin based on the cutaneous feeder vessels and perforator vessels in the deep fascia of the transverse cervical artery is a useful, viable option for defects of the head and neck after cancer ablation.

A role for cancer-associated fibroblasts in inducing the epithelial-to-mesenchymal transition in human tongue squamous cell carcinoma

OBJECTIVES Lymph node metastasis is a prominent clinical feature of tongue squamous cell carcinoma (TSCC) and is associated with a higher mortality rate. Carcinoma-associated fibroblasts (CAFs), a major component of the tumor microenvironment (TME), play an important role in tumor progression, and are associated with a poor prognosis. The aim of this study was to examine the role of CAFs in promoting the invasion of TSCC through the epithelial-to-mesenchymal transition (EMT). MATERIALS AND METHODS A series of matched CAF and normal fibroblast (NF) pairs were assessed for cell morphology and for the expression of alpha smooth muscle actin (α-SMA), stromal cell-derived factor-1 (SDF1), fibroblast-activating protein (FAP), vimentin, and cytokeratin (CK) markers. Transwell assays, Western blot analysis, reverse transcription-PCR, and immunofluorescence staining were used to assess the role of CAFs, as compared to that of NFs, in promoting proliferation, migration, invasion, and EMT in TSCC. RESULTS Both CAF and NF primary cultures expressed vimentin but not CK. CAFs showed significantly higher α-SMA protein levels, SDF1 secretion, and mRNA levels of α-SMA, SDF1, and FAP. We also found that co-culture with CAFs enhanced the proliferation and invasion of SCC9 cells. Moreover, co-culture with CAFs induced upregulation of the EMT markers fibronectin and vimentin, downregulation of E-cadherin, and enhanced invasion in SCC9 cells. CONCLUSION These results suggest that CAFs induce EMT marker expression and functional changes in TSCCs.

Percutaneous sclerotherapy of massive venous malformations of the face and neck using fibrin glue combined with OK‐432 and pingyangmycin

Surgical excision is useful only for localized and limited lesions. The purpose of this study was to evaluate the clinical curative effect of percutaneous sclerotherapy of massive venous malformations of the face and neck using fibrin glue combined with OK‐432 and pingyangmycin.

A multidisciplinary approach to treating maxillofacial arteriovenous malformations in children

OBJECTIVE Congenital arteriovenous malformations (AVMs) in the maxillofacial region are rare, potentially life-threatening, vascular lesions. This study reviewed our experience with a multidisciplinary approach to treating maxillofacial AVMs in children. STUDY DESIGN Thirteen patients (10 boys and 3 girls) with AVMs involving the facial soft tissues or jaws were treated using a multidisciplinary approach that included: 1) superselective intra-arterial embolization (SIAE); 2) bone wax packing (BWP) of the bone cavity and curettage; and 3) compartmentalization and sclerotherapy. RESULTS The mean follow-up was 13.5 months, with a range of 6-22 months. The following outcomes were obtained: 9 lesions (69.2%) were completely involuted, 3 lesions (23.1%) were mostly involuted, and 1 lesion (7.7%) was partially involuted. The rates of completely and mostly involuted AVMs involving the jaws treated using SIAE, BWP, and curettage were 80% and 20%, respectively. The rates of completely, mostly, and partially involuted AVMs involving soft tissues treated by compartmentalization and sclerotherapy were 60%, 30%, and 10%, respectively. CONCLUSION SIAE was reliable for controlling bleeding and as adjunctive treatment for maxillofacial AVMs in children. SIAE followed by BWP of the bone cavity and curettage was a simple, safe, and effective method for treating AVMs of the jaws; SIAE followed by compartmentalization and the injection of OK-432 and pingyangmycin was a reliable alternative treatment for AVMs of the soft tissues in the maxillofacial region.

Reverse facial artery–submental artery mandibular osteomuscular flap for the reconstruction of maxillary defects following the removal of benign tumors

Functional and aesthetic restoration in maxillary reconstruction remains a challenge. Although many free flap procedures have become popular in maxillary reconstruction, these microsurgical methods have certain limitations and risks. This study assessed the reliability of the reverse facial artery–submental artery mandibular osteomuscular flap for reconstructing maxillary defects.

Surgical excision of cervicofacial giant macrocystic lymphatic malformations in infants and children.

OBJECTIVES Various modalities have been used to treat lymphatic malformations, such as steroids, the injection of sclerosing agents, aspiration, and surgery. Giant macrocystic lymphangiomas involving the cervicofacial region in infants and children constitute a major therapeutic challenge. METHODS This was a retrospective review of 47 pediatric patients with giant macrocystic lymphatic malformations of the cervicofacial region that underwent surgical resections. There were 27 males and 20 females; 25 were newborns, 9 were infants, 8 were of preschool age, and 5 were school age. Of the patients, 72.4% was presented before 3 years of age. The neck was involved in 48.9% of the patients, followed by the parotid region and parapharynx (34.0%), lingual base and oral floor (12.8%), and face and cheek (4.3%). The lesions ranged from 4 x 3 to 15 x 10 cm in size. All cases showed symptoms of space-occupying lesions preoperatively. RESULTS Hemorrhage within the lessons was the most common preoperative symptom, and dysphasia and airway obstruction are serious preoperative symptoms. Nine (19.1%) minor surgical complications occurred. The mean follow-up was 9.6 months; five patients had recurrent lesions, while surgical radicality was achieved in 89.4% of the cases. A significantly higher rate of residual or recurrent lesions was noted in the newborn group, as compared with the other age groups (P=0.04; chi(2) test). CONCLUSIONS Surgical dissection of giant macrocystic lymphatic malformations involving the cervicofacial region in infants and children is safe and gives satisfactory esthetic and functional results, including lesions in the newborn.

Reconstruction of large defects of the neck using an extended vertical lower trapezius island myocutaneous flap following salvage surgery for neck recurrence of oral carcinoma

This article describes the extended vertical lower trapezius island myocutaneous flap for reconstructing large defects of the neck. A total of 11 patients with neck recurrence of oral carcinoma were treated using salvage surgery and an extended vertical lower trapezius island myocutaneous flap based on the transverse cervical artery was used to repair the large defect in the neck. No major flap failure occurred. No disabilities were observed in terms of shoulder motion. The patients were followed up for 6-22 months. Four patients developed local recurrence: two of them are still alive with the disease and two have died. The extended vertical lower trapezius island myocutaneous flap is a large, simple and reliable flap, which is a salvage flap preferred for reconstructing large defects of the neck following the ablation of neck recurrence of oral carcinoma.

Reconstruction of Major Full Cheek Defects With Combined Extensive Pedicled Supraclavicular Fasciocutaneous Island Flaps and Extended Vertical Lower Trapezius Island Myocutaneous Flaps After Ablation of Advanced Oral Cancer

PURPOSE The present clinical study assessed the feasibility of extensive pedicled supraclavicular fasciocutaneous island flaps combined with extended vertical lower trapezius island myocutaneous flaps for large, full-thickness cheek defect reconstruction after ablative oral cancer surgery. PATIENTS AND METHODS A retrospective review of data from consecutive patients requiring extensive pedicled supraclavicular fasciocutaneous island flaps and the extended vertical lower trapezius island myocutaneous flap to provide both an inner and an outer lining for major full-thickness cheek defects after oncologic resection. RESULTS Eight patients had advanced oral squamous cell carcinoma. All patients had combined bone and extensive soft-tissue defects. The extensive pedicled supraclavicular fasciocutaneous island flap with a skin paddle measuring 10 × 8 cm to 14 × 10 cm and the extended vertical lower trapezius island myocutaneous flap with a skin paddle measuring 25 × 10 cm to 15 × 8 cm were used to reconstruct the major through-and-through defects. No major complications occurred in any patient. The patients were followed up for 6 to 20 months; 6 patients were living with no evidence of disease, 1 was living with disease, and 1 had died of local recurrence. CONCLUSIONS The combined use of the extensive pedicled supraclavicular fasciocutaneous island flap with an extended vertical lower trapezius island myocutaneous flap to reconstruct major through-and-through cheek soft defects is reliable and an excellent alternative to other pedicles, even microsurgical free flaps, for patients who have previously undergone radiotherapy and surgery of the head and neck.

Maxillary Functional Reconstruction Using a Reverse Facial Artery–Submental Artery Mandibular Osteomuscular Flap With Dental Implants

PURPOSE This clinical study assessed the reverse facial artery-submental artery mandibular osteomuscular flap with titanium dental implants for the functional reconstruction of maxillary defects. PATIENTS AND METHODS Class 2a defects in 5 patients were repaired with a reverse facial artery-submental artery mandibular osteomuscular flap with titanium dental implants (n = 21). All patients received a fixed partial denture after a 3- to 6-month healing period. RESULTS All lesions were widely excised in an area extending to the maxilla. Of the implants, 20 (95.2%) were loaded and 1 was lost before loading. Reconstruction with a fixed partial denture was successful in all patients. The patients were followed up for 12 to 20 months (mean, 15.8 months), and no recurrence was observed. CONCLUSION The reverse facial artery-submental artery mandibular osteomuscular flap with titanium dental implants is safe, quick, and simple to elevate and is reliable for the functional reconstruction of maxillary defects.