Jian-guang Wang

Two Submental Island Flaps for Reconstructing Oral and Maxillofacial Defects Following Cancer Ablation

PURPOSE The purpose of this study was to assess the reliability of 2 patterns of submental island flaps--the facial-submental artery island flap and the reverse facial-submental artery island flap--used for reconstruction of oral and maxillofacial defects following cancer ablation. PATIENTS AND METHODS Thirty-eight soft tissue defects were repaired with facial-submental artery island flaps and reverse facial-submental artery island flaps following cancer surgery. The ages of the patients ranged from 28 to 90 years; 24 were male and 14 were female. The primary lesions included squamous cell carcinoma of the tongue (8 cases), buccal mucosa (16), floor of the mouth (4), lower gingiva (3), oropharynx (2); recurrent squamous cell carcinoma of the palate (3); and basal cell carcinoma of the facial skin (2). The clinical stage of the tumors was stage I in 5 cases, stage II in 25, and stage III in 8. Facial-submental artery island flaps were used in 20 cases, reverse facial-submental artery island flaps in 18. The size of the skin paddle varied from a minimum of 4 cm x 8 cm to a maximum of 5 cm x 15 cm. Direct closure was achieved at all donor sites. RESULTS The postoperative outcome for 2 patterns of submental flaps was 36 cases surviving, 2 of complete necrosis, and one other of temporary palsy of the marginal mandibular branch of the facial nerve. The success rate was 95% and 94.4% for the facial-submental artery island flap and the reverse facial-submental artery island flap, respectively. The form and function of recipient sites were well recovered. The donor site leaves a well-hidden scar. The follow-up period was 3 to 24 months, 1 patient died of tumor local recurrences and 2 cases of cervical recurrence were observed. CONCLUSION Two patterns of submental island flaps are safe, rapid, and simple to elevate. The facial-submental artery island flap can reliably be used for reconstruction of the lower and middle thirds of the medium-sized oral and maxillofacial defects and the reverse pattern for reconstruction of the middle and upper thirds of the medium-sized oral and maxillofacial defects.

Application of CAD/CAM-assisted technique with surgical treatment in reconstruction of the mandible.

OBJECTIVE The purpose of this clinical study was to explore the optimal method of reconstruct mandible defects individually and immediately. STUDY DESIGN Three-dimensional model simulation technique and vascularized fibular osteomyocutaneous flap were used to repair 15 cases of mandible defects, which were caused by ameloblastoma. A three-dimensional computed tomography (CT) images were converted to a virtual model using CAD software and the 3-dimensional (3D) simulated resin models of skeleton and fibula were used to design the osteotomies, bone segment replacement and titanium mesh shaping preoperatively. RESULTS Fibula flaps were alive and no complication occurred. The patients were satisfied with the results both esthetically and functionally. CONCLUSIONS This preliminarily clinical study and case demonstrated that CAD/CAM-assisted technique with surgical treatment offers an individual anatomical reconstruction of the mandible in ameloblastoma patients. The procedures guarantee intraoperatively an exact placement of the preformed mesh even for precise reconstruction of extensive mandible defects.

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.

miR-181a-Twist1 pathway in the chemoresistance of tongue squamous cell carcinoma.

Although many researches have been undertaken to disclose the mechanisms of chemoresistance, the mechanisms remain unclear. The aim of this study is to elucidate the role of miR-181a-Twist1 pathway in the chemoresistance of tongue squamous cell carcinoma (TSCC). We found that cisplatin-induced chemoresistance in TSCC cell lines underwent EMT (epithelial-mesenchymal transition) and was accompanied by enhancing metastatic potential (migration and invasion in vitro), miR-181a downregulation and Twist1 upregulation. Functional analyses indicated that miR-181a reversed chemoresistance, inhibited EMT and metastatic potential in TSCC cells. Twist1 was confirmed as a direct miR-181a target gene by luciferase reporter gene assays. Twist1 knockdown by siRNA led to a reversal of the chemoresistance, inhibited EMT and metastatic potential in TSCC cells. Our study demonstrates that miR-181a-Twist1 pathway may play an important role in the development of cisplatin-chemoresistance, with EMT and an increase the metastatic potential of TSCC cells.

Dendrimers-delivered short hairpin RNA targeting hTERT inhibits oral cancer cell growth in vitro and in vivo

Promising therapeutic application of RNA interference (RNAi) depends on the availability of safe and efficient intracellular delivery systems. Human telomerase reverse transcriptase (hTERT), the catalytic subunit of telomerase complex, is an attractive therapeutic target for oral cancer. Here we investigated the characteristics and anticancer effect of polyamidoamine (PAMAM) dendrimer-mediated short hairpin RNA (shRNA) against hTERT in oral cancer. Dendrimer-mediated shRNA efficiently silenced the hTERT gene in vitro, resulted in cell growth inhibition and apoptosis. Treatment with the shRNA dendriplex attenuated tumor growth in a xenograft model. These studies suggest that RNAi-mediated hTERT gene silencing, coupled with dendrimer delivery, may provide a promising approach for the treatment of oral cancer, in which hTERT is abundantly expressed.

Expression of inducible nitric oxide synthase and vascular endothelial growth factor in ameloblastoma.

The purposes of this study were to determine the correlation between the expression of inducible nitric oxide synthase (iNOS) and vascular endothelial growth factor (VEGF) in ameloblastoma and to examine the relationships of this expression to angiogenesis and the clinical and biological behaviors of the tumor. Immunohistochemical staining with streptavidin peroxidase was used to analyze iNOS and VEGF expression, and CD34 was used to evaluate microvascular density (MVD) in 35 ameloblastomas (24 primary tumors and 11 recurrences) and 5 malignant ameloblastomas. Ten odontogenic keratocysts (OKCs) served as controls. On relational analysis, positive and VEGF expression and MVD counts increased in this order: OKCs, primary ameloblastoma, recurrent ameloblastoma, and malignant ameloblastoma. Differences between the ameloblastomas and OKCs were significant (P < 0.05). Among ameloblastomas, MVD counts increased with increasing expression of iNOS and VEGF (P < 0.05), and iNOS expression and VEGF expression were positively correlated (r = 0.66, P < 0.05). Inducible nitric oxide synthase expression and VEGF expression may be closely related to the angiogenesis and invasive biological behavior of ameloblastomas.

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.

Reverse facial artery-submental artery deepithelialised submental island flap to reconstruct maxillary defects following cancer ablation

OBJECTIVE The present study assessed the reliability of the reverse facial artery-submental artery deepithelialised submental island technique to reconstruct maxillary defects. METHODS The study included 13 patients (9 men and 4 women; 43-62 years) with maxillary defects resulting from cancer ablation. Ten patients presented with maxillary gingival squamous cell carcinoma and the remaining 3 cases were hard palate squamous cell carcinomas. The maxilla was resected and the remaining defects were classified as Class 2a. Reverse facial artery-submental artery deepithelialised submental island flaps measuring 8-10 cm in length and 4-5 cm in width were used to reconstruct the defects. RESULTS Twelve of the 13 flaps survived. No donor-site problems or palsy of the marginal mandibular branch of the facial nerve occurred. The follow-up period ranged from 8 to 24 months, 1 patient died as a result of local tumour recurrence and 2 patients developed cervical recurrence. CONCLUSION The reverse facial artery-submental artery deepithelialised submental island flap is safe, quick and simple to use or elevate. The flap is a reliable technique for reconstructing maxillary defects following cancer ablation.

Expression of the membrane-cytoskeletal linker Ezrin in salivary gland adenoid cystic carcinoma

OBJECTIVE The aim of this study was to investigate the relationship between membrane cytoskeleton linker protein Ezrin and CD44v6, iNOS, Ki-67, and clinicopathologic characteristics, and the prognostic significance of Ezrin expression in salivary gland adenoid cystic carcinoma (SACC). STUDY DESIGN Immunohistochemistry and reverse-transcription polymerase chain reaction were used to quantify the expression of Ezrin, CD44v6, inducible nitric oxide synthase (iNOS), and Ki-67 in 75 primary SACCs, 25 tumor-free salivary tissues, and 2 SACC cell lines (ACC-M and ACC-2). Survival analysis was performed to find the prognostic significance of Ezrin expression. RESULTS Expressions of Ezrin, CD44v6, iNOS, and Ki-67 in SACC tissues, especially with distant metastasis, were significantly higher than in tumor-free tissues. Ezrin mRNA and protein levels in ACC-M cells were significantly higher than in ACC-2 cells. Ezrin, CD44v6, iNOS, and Ki-67 expressions were significantly higher in solid pattern than in cribriform and tubular patterns. Ezrin and its partners, CD44v6, iNOS, and Ki-67, were significantly related to tumor size, clinical stage, perineural and vascular invasion, and recurrence. Furthermore, Ezrin had an independent prognostic effect on overall survival. CONCLUSIONS The increased expression of Ezrin and its partners, CD44v6, iNOS, and Ki-67, in SACC correlated with histologic patterns, may play a role in distant metastasis, and might indicate poor clinical outcome.