Xiaobing Cheng

Bleomycin A5 sclerotherapy for cervicofacial lymphatic malformations

OBJECTIVES The purpose of this study was to document the results of bleomycin A5 sclerotherapy for cervicofacial lymphatic malformations (LMs), and the clinical data of 65 patients between October 2004 and October 2007 were reviewed. METHODS Of the 65 patients in the study, 60 patients were given intralesional injection of bleomycin A5. Five patients underwent partial resection, and then an injection of bleomycin A5 for the remaining lesion. The outcomes were assessed by physical examination and Doppler ultrasonography scan. The follow-up time was from 6 months to 3 years after the last injection (mean, 16 months). RESULTS Among the 65 patients, 41 were men and 24 were women (1.7:1 male:female ratio), the age range was 3 months to 45 years (mean, 12 years). Thirty-two lesions (49%) were macrocystic, 30 (46%) were microcystic, and 3 (5%) were combined. Each patient received 1 to 10 injections (mean, 3.0 injections) for the whole course of treatment, and the total dose of bleomycin A5 was from 8 to 80 milligrams (mean, 24.0 mg). Twenty-six of 32 macrocystic lesions (81%) showed greater than 90% reduction, whereas another 6 (19%) exhibited 50% to 90% reduction. Nineteen of 30 microcystic lesions (63%) showed greater than 90% reduction; 10 (33%) had 50% to 90% reduction; and 1 (4%) had less than 50% size reduction. Of the 3 combined lesions, 2 (67%) had greater than 90% shrinkage, and 1 (3%) had less than 50% reduction. The complications included ulceration of oral mucosa, minor soft tissue atrophy, mild fever, and hematoma. There was no recurrence throughout the follow-up period. CONCLUSION These data suggest bleomycin A5 is a safe and effective intralesional agent for the treatment of macrocystic LMs, superficial oral mucosa LM, and localized deep microcystic lesions. For extensive macrocystic LMs involving contiguous anatomic areas and diffuse microcystic lesions involving deep tissues, bleomycin A5 injection combined with resection is necessary.

Diagnosis and management of intraparotid facial nerve schwannoma

OBJECTIVE Our objective was to provide the management guidelines for facial nerve schwannomas (FNSs) presenting as a parotid mass. STUDY DESIGN The study is a case report and literature review. METHODS Four clinical cases of patients with an asymptomatic parotid mass diagnosed as FNS are presented. The patients presentation, the diagnostic algorithm and surgical rationale are discussed. A review of the literature on FNSs is presented. CONCLUSIONS Intraparotid FNSs are an extremely rare entity and are rarely diagnosed preoperatively. Intraoperatively, conservative biopsy in a non-functional part of the lesion can be used to make the diagnosis. Most of the FNSs of patients with normal facial nerve function could be dissected off the nerve trunk without losing FN function. FNS patients with preoperatively abnormal FN function should be managed conservatively or undergo reconstruction with nerve graft after tumour resection.

Application of nerve growth factor by gel increases formation of bone in mandibular distraction osteogenesis in rabbits.

The long period of bony consolidation is a concern in mandibular distraction osteogenesis (DO). We have previously shown that repeated local injections of human nerve growth factor beta (NGFβ) can appreciably improve bony consolidation in a rabbit model of DO. The present study was designed to test the effect of a single injection of human NGFβ delivered by collagen/nano-hydroxyapatite/kappa-carrageenan gels to sites of new bony formation in DO. Rabbits underwent mandibular DO at a rate of 0.75 mm/12h for 6 days. At the end of the distraction period, the following injections were given percutaneously into the callus (n=6 in each of the four groups): human NGFβ in the gel; human NGFβ in saline; the gels alone; and saline alone. Fourteen days after the end of distraction, mechanical testing, histological and histomorphometric variables of the new bone were evaluated. Histologically, the NGFβ group had more advanced consolidation than the other three groups. Both maximal load and bone volume/total volume in this group were significantly higher than in the other three (P<0.05). In conclusion, the delivery of human NGFβ in the gels results in better acceleration of new bone formation than when it is given in saline, and may be a possible way to shorten the duration of craniofacial DO.

Effects of locally applied nerve growth factor to the inferior alveolar nerve histology in a rabbit model of mandibular distraction osteogenesis.

Distraction osteogenesis (DO) is widely used in deformities and defects of the craniofacial bone. Accelerating inferior alveolar nerve (IAN) recovery would aid the process. Nerve growth factor (NGF) plays a vital role in peripheral nerve regeneration. In this study, the ability of locally applied human NGF beta (hNGFbeta) to enhance the morphological recovery of the IAN in a rabbit model of mandibular DO was studied. Rabbits underwent bilateral DO with a rate of 0.5mm per 12h. Two doses of 40 microg hNGFbeta in buffer were injected into callus at the beginning the of consolidation time. The contralateral side received injections of placebo. Rabbits were killed at 14 and 28 days. IAN specimens were subjected to histological and histomorphometric analysis. In both 14 and 28 days consolidation experiments, nerve histological analysis showed less degeneration and more regeneration in nerve fibers on the hNGFbeta treated side than the control side. Histomorphometric analysis showed that the myelinated fiber density on the hNGFbeta treated side was significantly higher than on the control side (p<0.01). The data indicate that locally applied hNGFbeta can accelerate the morphological recovery of the IAN and may play a role in reducing nerve injury in mandibular DO clinically.

Bleomycin A5 plus dexamethasone for control of growth in infantile parotid hemangiomas

OBJECTIVE The purpose of this study was to evaluate the efficacy of bleomycin A5 (pingyangmycin) plus dexamethasone for control of growth in infantile parotid hemangiomas. STUDY DESIGN We reviewed and analyzed the data of 31 cases undergoing therapy of intralesional injection with small-dosage and low-concentration bleomycin A5 plus dexamethasone between June 2004 and October 2007. Clinical manifestations, image characteristics, and therapeutic outcomes were reviewed. The therapeutic outcomes were evaluated by physical examination, photographs, and Doppler ultrasonography. The follow-up was from 6 months to 3 years after ending treatment. RESULTS Twenty-five patients (80.6%) had a response rate greater than 90% reduction in tumor size. Three patients (9.7%) had a response rate between 75% and 90% reduction in tumor size. Another 3 patients (9.7%) had a response rate between 50% and 75% reduction in size. No patients had less than a 50% response rate. There was no recurrence, allergic reaction, pulmonary fibrosis, fever, or other complication during or after the course of treatment. CONCLUSIONS The controlling therapy with small-dosage and low-concentration bleomycin A5 plus dexamethasone can treat the parotid hemangiomas of infants effectively, especially for lesions in the early phase and proliferative phase. Early control and long-term observation are the key aspects of treatment.

Preliminary Study of Fibrin Glue Combined With Pingyangmycin for the Treatment of Venous Malformations in the Oral and Maxillofacial Region

PURPOSE To observe the outcome of using fibrin glue (FG) combined with Pingyangmycin (Tianjin Taihe Pharmaceutical Co Ltd, Tianjin, China) in the treatment of venous malformations (VMs) in the oral and maxillofacial region. MATERIALS AND METHODS The treatment data of 7 patients with VMs from January 2005 to January 2006 were reviewed. All these patients were injected with FG combined with Pingyangmycin. The vital signs and symptoms were observed and recorded immediately after injections. Radiographic examination was used for the evaluation of pulmonary conditions. The therapeutic effect was evaluated by clinical examination and Doppler ultrasonography. The follow-up time was from 1 to 2 years. RESULTS Of the 7 patients, 4 were male and 3 were female, with ages ranging from 10 to 62 years. Four of the 7 recovered to near-normal appearance, without any abnormal bloodstream detectable within the lesions. Two lesions were slightly asymmetrical in appearance, but no abnormal bloodstream could be detected in the lesions. Two patients had a fever during treatment, and one of them stopped treatment because of continuous high fever. No allergic reactions, pulmonary embolisms, or other complications were found during or after treatment. CONCLUSION The therapeutic modality of FG combined with Pingyangmycin for VMs in the oral and maxillofacial region was effective, and the extent of morbidity was acceptable. However, the further long-term observation of severe complications such as deep venous thrombosis and pulmonary embolism should be performed in additional biological and clinical studies.

Effects of nerve growth factor delivery via a gel to inferior alveolar nerve in mandibular distraction osteogenesis.

Inferior alveolar nerve (IAN) injury is a concern in mandible distraction osteogenesis (DO). We have previously demonstrated that repeated local injections of human nerve growth factor &bgr; (NGF-&bgr;) have significantly enhanced the histologic recovery of the IAN in a rabbit model of DO. This study was to further test the effect of a single injection of human NGF-&bgr; delivered via a collagen/nanohydroxyapatite/&kgr;-carrageenan gel to the recovery of the IAN in DO. Rabbits underwent mandibular DO at a rate of 0.75 mm/12 h for 6 days. At the end of the distraction period, injections were performed near the IAN percutaneously as follows: group 1, human NGF-&bgr; in the gel; group 2, human NGF-&bgr; in saline; group 3, the gel alone; and group 4, saline alone. At 14 days after the end of distraction, IAN histologic findings and histomorphometric parameters were evaluated. Histologically, there were less myelin debris and more abundant regenerating nerve fibers in group 1 than the other groups. Both the myelinated fiber density and the myelinated axon area in group 1 were significantly higher than groups 3 and 4 (P < 0.01); the myelinated axon area in the group 1 was significantly higher than group 2 (P < 0.01). In conclusion, the delivery of human NGF-&bgr; in the gel leads to a better acceleration of the IAN injury recovery over the saline delivery. It provides a possible way to enhance the recovery of nerve injuries in craniofacial DO clinically.

Sympathetic Denervation-Induced MSC Mobilization in Distraction Osteogenesis Associates with Inhibition of MSC Migration and Osteogenesis by Norepinephrine/adrb3

The sympathetic nervous system regulates bone formation and resorption under physiological conditions. However, it is still unclear how the sympathetic nerves affect stem cell migration and differentiation in bone regeneration. Distraction osteogenesis is an ideal model of bone regeneration due to its special nature as a self-engineering tissue. In this study, a rat model of mandibular distraction osteogenesis with transection of cervical sympathetic trunk was used to demonstrate that sympathetic denervation can deplete norepinephrine (NE) in distraction-induced bone callus, down-regulate β3-adrenergic receptor (adrb3) in bone marrow mesenchymal stem cells (MSCs), and promote MSC migration from perivascular regions to bone-forming units. An in vitro Transwell assay was here used to demonstrate that NE can inhibit stroma-derived factor-1 (SDF-1)-induced MSC migration and expression of the migration-related gene matrix metalloproteinase-2 (MMP-2) and downregulate that of the anti-migration gene tissue inhibitor of metalloproteinase-3 (TIMP-3). Knockdown of adrb3 using siRNA abolishes inhibition of MSC migration. An in vitro osteogenic assay was used to show that NE can inhibit the formation of MSC bone nodules and expression of the osteogenic marker genes alkaline phosphatase (ALP), osteocalcin (OCN), and runt-related transcription factor-2 (RUNX2), but knockdown of adrb3 by siRNA can abolish such inhibition of the osteogenic differentiation of MSCs. It is here concluded that sympathetic denervation-induced MSC mobilization in rat mandibular distraction osteogenesis is associated with inhibition of MSC migration and osteogenic differentiation by NE/adrb3 in vitro. These findings may facilitate understanding of the relationship of MSC mobilization and sympathetic nervous system across a wide spectrum of tissue regeneration processes.

Surgical resection of a huge cemento-ossifying fibroma in skull base by intraoral approach.

Cemento-ossifying fibroma, also known as ossifying fibroma, usually occurs in the mandible and less commonly in the maxilla. The huge example in the skull base is even rare. We present a case of a huge cemento-ossifying fibroma arising below the skull base of a 30-year-old woman patient. Radiologic investigations showed a giant, lobulated, heterogeneous calcified hard tissue mass, which is well circumscribed and is a mixture of radiolucent and radiopaque, situated at the rear of the right maxilla to the middle skull base. The tumor expands into the right maxillary sinus and the orbital cavity, fusing with the right maxilla at the maxillary tuberosity and blocking the bilateral choanas, which caused marked proptosis and blurred vision. The tumor was resected successfully by intraoral approach, and pathologic examination confirmed the lesion to be a cemento-ossifying fibroma. This case demonstrates that cemento-ossifying fibroma in the maxilla, not like in the mandible, may appear more aggressive because the extensive growth is unimpeded by anatomic obstacles and that the intraoral approach can be used to excise the tumor in the skull base.

Surgical treatment of a giant neurofibroma.

AbstractNeurofibromatosis type 1, an autosomal dominant inherited disease, presents pathologic symptoms of multiple systems, including neurofibromatosis, skeletal dysplasia, café-au-lait spots in skins, and so on. A 45-year-old man with neurofibromatosis type 1 was reported in this article. The patient presented a giant neurofibroma in his head and neck, dysplasia of skull, facial bones and spinal columns, and multiple café-au-lait spots in systematic skins. Satisfactory curative effects were obtained in this case after tumor resection and prosthesis implantation.