Mingxing Lu

The treatment of sublingual gland tumours

This study assessed the clinical and histological features and therapeutic efficacy of 25 cases of sublingual gland tumours from 1998 to 2008. There were 17 female patients and 8 male, the ratio of females to males was 2.1:1. The mean age was 48.6 years. 4 cases were benign tumours (16%). 21 cases were malignant sublingual gland tumours (84%) and of these, 18 were adenoid cystic carcinoma (86%). Adenoid cystic carcinoma was mainly of the histological type, and the other histological classifications included mucoepidermoid carcinoma, pleomorphic adenoma, myoepithelioma, oncocytoma and polymorphous low-grade adenocarcinoma. Sublingual gland tumours are rare and most are malignant. For malignant sublingual gland tumours, early diagnosis and aggressive surgical treatment, especially for tumours with nerve involvement, is the key to improving prognosis. Free radial forearm flap or pectoralis major myocutaneous flap are appropriate methods for mouth floor reconstruction. For benign sublingual gland tumours, the resection of tumour and sublingual gland is the preferred treatment.

Clinical application of thin anterolateral thigh flap in the reconstruction of intraoral defects

OBJECTIVE The purpose of this study was to assess the clinical features and therapeutic efficacy of intraoral defect reconstruction with thin anterolateral thigh flaps. METHODS A total of 34 patients underwent simultaneous tumor resection and intraoral defect reconstruction with free thin anterolateral thigh flaps. RESULTS There were 16 male and 18 female patients; the ratio of males to females was 0.9:1; the mean age was 55.4 years. In these 34 patients, 26 flaps were musculocutaneous perforators (76.5%) and 8 flaps were septocutaneous perforators (23.5%). Partial loss of flap occurred in 2 patients (5.9%). CONCLUSIONS The free thin anterolateral thigh flap was the ideal soft tissue flap in intraoral defect reconstruction. This thin flap presents good functional results at the receiving site with the additional advantages of minimal donor-site morbidity and a high level of patient satisfaction.

Palatomaxillary reconstruction with titanium mesh and radial forearm flap

OBJECTIVE The purpose of this study was to assess the treatment and prognosis of the palatomaxillary reconstruction with titanium mesh and the free radial forearm flap. STUDY DESIGN This is a retrospective study of 19 patients with palatomaxillary defects who underwent immediate reconstruction using titanium mesh and a radial forearm flap during the 4-year period from 2004 to 2008. Intraoperatively, the titanium mesh was fixed to the residual bones for the reconstruction of hard-tissue defect after the tumor resection; then the free radial forearm flap was harvested to repair the soft-tissue defect, serving as the intraoral lining and titanium mesh covering. RESULTS Postoperative esthetic appearance and function were followed-up. All of the patients achieved a satisfactory facial appearance. The speech assessment was good, and the oronasal reflux did not occur in all patients. Only 3 patients had titanium mesh exposure during the follow-up period. CONCLUSION The free radial forearm flap with folded titanium mesh is a reliable option for reconstruction of palatomaxillary defects. It is highly effective for swallowing and speech rehabilitation as well as esthetic reconstruction.

Clinical application of free anterolateral thigh flap in the reconstruction of intraoral defects

OBJECTIVE The purpose of this study was to assess the clinical features and therapeutic efficacy of the intraoral defects reconstruction with 3 types of anterolateral thigh flaps. STUDY DESIGN The clinicopathologic data of 39 cases with oral tumors were obtained from the School of Stomatology, Nanjing University Medical Center, from December 2008 to June 2010. These patients underwent the simultaneous tumor resection and intraoral defects reconstruction with free anterolateral thigh flaps. RESULTS There were 22 male and 17 female patients; the ratio of male to female was 1.3:1; the mean age was 56.1 years. Twenty-two of the anterolateral thigh flaps were musculocutaneous flaps (56.4%), 8 were fasciocutaneous flaps (20.5%), and 9 were ultrathin flaps (23.1%). Five patients required operative exploration in the perioperative period. Three flaps were thrombotic events, 1 flap was hematoma, and 1 flap was twisting of perforator. After the salvages, 1 flap was partial failure, 1 flap was total failure, and the other 3 flaps were complete survival. CONCLUSIONS The free anterolateral thigh flap was the ideal soft tissue flap in the intraoral defects reconstruction. This flap presents good functional results at the receiving site with the additional advantages of minimal donor-site morbidity and a high level of patient satisfaction.

Reconstruction of extensive lip and perioral defects after tumor excision.

ObjectiveThe purpose of this study was to assess the clinical features, treatments, and results of extensive lip and perioral defects after tumor excision. MethodsThis is a retrospective study of patients with extensive lip and perioral defects who underwent surgical interventions during the 7-year period from April 2005 to April 2012. The reconstructive procedures of lip and perioral defects were mainly performed with regional flaps or free flaps. ResultsEleven patients with extensive lip and perioral defects were identified, and immediate lip and perioral defects reconstruction was performed with the folded free radial forearm flap in 2 patients, the free radial forearm flap and the forehead island flap in 1 patient, the pectoralis major myocutaneous flap in 2 patients, the submental island flap and the nasolabial flap in 1 patient, the folded thinned anterolateral thigh flap in 4 patients, and double skin paddle anterolateral thigh flaps and adjacent flap in 1 patient. All patients had good oral competence, and the cosmetic results were acceptable. ConclusionsReconstruction of extensive lip and perioral defects after tumor excision is a challenge for the plastic surgeon. It should take into account the patient’s condition, local tissue characteristics, previous treatments, functional needs, cosmetic aspects, and so on. The surgeon might need to reconstruct the lip with regional flaps or free flaps.

Reconstruction of extensive through-and-through cheek defects with free anterolateral thigh flap.

ObjectiveThe purpose of this study was to assess the clinical features and therapeutic efficacy of extensive through-and-through cheek defects reconstruction with free anterolateral thigh flap. MethodsA total of 11 patients underwent simultaneous tumor radical resection and through-and-through cheek defects reconstruction with free anterolateral thigh flap. ResultsIn these 11 patients, 7 patients had undergone the reconstruction of through-and-through cheek defects with the folded anterolateral thigh flap (2 skin islands and an intervening de-epithelialized zone); 4 patients had undergone the reconstruction of through-and-through cheek defects with the 2 separate skin paddles anterolateral thigh flap in 1 single pedicle. All of these 11 flaps were free fasciocutaneous anterolateral thigh flaps. The subcutaneous fat thickness of the anterolateral thigh flap is less than 1.5 cm. ConclusionsThe free anterolateral thigh flap was one of the versatile soft tissue flaps in the extensive through-and-through cheek defects reconstruction.

The Application of Surgical Navigation in the Treatment of Temporomandibular Joint Ankylosis.

Objective:The purpose of this study was to assess the safety and the accuracy of surgical navigation technology in the resection of severe ankylosis of the mandibular condyle with the middle cranial fossa. Methods:The computed tomography scan data were transferred to a Windows-based computer workstation, and the patients individual anatomy was assessed in multiplanar views at the workstation. In the operation, the patient and the virtual image were matched by individual registration with the reference points which were set on the skull bone surface and the teeth. Then, the real-time navigation can be performed. Results:The acquisition of the data sets was uncomplicated, and image quality was sufficient to assess the operative result in 2 cases. Both of the operations were performed successfully with the guidance of real-time navigation. The application of surgical navigation has enhanced the safety and the accuracy of the surgery for bony ankylosis of temporomandibular joint. Conclusions:The use of surgical navigation resulted in the promotion of accurate and safe surgical excision of the ankylosed skull base tissue.

Surgical management of maxillofacial fibrous dysplasia under navigational guidance.

Fibrous dysplasia is a benign and slowly progressive disorder of bone in which normal cancellous bone is replaced by immature woven bone and fibrous tissue. Precise excision of the lesion is crucial to restore function and aesthetics. We present our experience using surgical navigation technology for the recontouring of the faces of 8 patients with maxillofacial fibrous dysplasia who were treated from 2012-2013, all of whom were thought suitable for surgical recontouring. Preoperative computed tomography (CT) scans were used to make a virtual plan based on the patients mirrored anatomy. During the operation we fixed a rigid digital reference frame to the patients forehead or mandible, depending on the site of the lesion. The patient and the virtual image were matched through an individual recording technique. A pointing device was in constant use to find out whether the extent of resection was consistent with the preoperative design, and we assessed the surgical outcome by fusion of the preoperative planning and postoperative CT reconstruction images. The acquisition of the data sets was uncomplicated, and the use of surgical navigation improved the safety and the accuracy of the recontouring. There were no complications during 1-2 years follow up. Navigational guidance based on a virtual plan is safe and accurate, and is of value in the management of maxillofacial fibrous dysplasia.

A salvage operation for flap compromise following internal jugular venous thrombosis.

The internal jugular vein (IJV) has been described as the optimal recipient vessel in oral and maxillofacial microsurgical rehabilitation and reconstruction. However, few studies have been reported on IJV thrombosis, which could compromise flap survival. In the current study, a case of flap vascular crisis following IJV thrombosis is presented, and salvage operation as a management strategy is discussed. Although rare, surgeons specializing in oral and maxillofacial microsurgical reconstruction should be aware of the possibility of the occurrence of this condition, considering early surgical intervention is critical.

Functional assessment: Free thin anterolateral thigh flap versus free radial forearm reconstruction for hemiglossectomy defects

Background To compare free thin anterolateral thigh (ALT) flap with free radial forearm (FRF) flap in the reconstruction of hemiglossectomy defects, and to introduce our methods and experience in the tongue reconstruction with free thin ALT flap. Material and Methods The clinicopathologic data of 46 tongue carcinoma cases hospitalized from December 2009 to April 2014 were obtained from Nangjing Stomatological Hospital, Medical School of Nanjing University. All the subjects were evaluated for the articulation and the swallowing function 3 months after the surgery. Results Among these 46 patients, 12 patients underwent tongue reconstruction after hemiglossectomy with ALT flap; 34 patients underwent tongue reconstruction with FRF flap. The differences in the incidence of vascular crisis, the speech and the swallowing function between two groups were not significant (P>0.05). Conclusions Thin ALT flap could be one of the ideal flaps for hemiglossectomy defect reconstruction with its versatility in design, long pedicle with a suitable vessel diameter, and the neglectable donor site morbidity. Key words:Free thin anterolateral thigh flap, free radial forearm flap, hemiglossectomy, reconstruction, morbidity.