Zhao-hui Yang

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.

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.

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.

Anesthetic efficacy of inferior alveolar nerve block plus buccal infiltration or periodontal ligament injections with articaine in patients with irreversible pulpitis in the mandibular first molar

OBJECTIVE We compared the anesthetic efficacy of inferior alveolar nerve block (IANB) plus buccal infiltration (BI) and IANB plus periodontal ligament (PDL) articaine injections in patients with irreversible pulpitis in the mandibular first molar. STUDY DESIGN Fifty-seven volunteers, patients with irreversible pulpitis in the mandibular first molar admitted to the Department of Stomatology, Second Affiliated Hospital, Sun Yat-Sen University, randomly received conventional IANB, containing 1.7 mL 4% articaine/HCl with 1:100,000 epinephrine, plus either BI or PDL injections containing 0.4 mL articaine/HCl with 1:100,000 epinephrine. The patients recorded the pain of the injections and endodontic access on a Heft-Parker visual analog scale (VAS). RESULTS According to the VAS scores, all patients experienced no or mild pain with BI and PDL injections after the application of IANB. Anesthetic success occurred in 81.48% for IANB plus BI (IANB/BI) compared with 83.33% for IANB plus PDL injection (IANB/PDL injection). None of the observed differences between the 2 groups was significant (P > .05). CONCLUSION Both injection combinations resulted in high anesthetic success in patients with irreversible pulpitis in the mandibular first molar.

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.

Quality of life of patients with tongue cancer 1 year after surgery.

PURPOSE To study the changes and factors affecting the quality of life (QOL) of patients with tongue cancer 1 year after primary surgery. PATIENTS AND METHODS A total of 289 consecutive patients with tongue cancer who had undergone primary surgery from 2003 to 2008 at our hospital were recruited. Patient QOL was evaluated using the University of Washington Quality of Life Questionnaire, version 4. Statistical analysis was conducted using a paired-samples t test and multiple stepwise linear regression with Statistical Package for Social Sciences, version 11.5 (SPSS, Chicago, IL). RESULTS At 1 year after surgery, the appearance, activity, speech, swallowing, shoulder function, salivary, and taste domain scores were significantly lower than the preoperative scores (P < .05). However, the pain, anxiety, and mood scores were significantly better 1 year after surgery (P < .05). The overall QOL had increased greatly 1 year after surgery but did not reach the pretreatment level. Multiple stepwise linear regression analysis showed that the main factors affecting QOL were radiotherapy, advanced clinical stage (P < .05), socioeconomic status, and patient age. Radiotherapy, advanced clinical stage (P < .05), socioeconomic status, and age (P < .05) were independently associated with QOL. CONCLUSIONS The patients with tongue cancer who have been diagnosed and treated early might have a better QOL. A greater socioeconomic status can also improve the QOL of patients with tongue cancer after primary surgery.

SMAS fold flap and ADM repair of the parotid bed following removal of parotid haemangiomas via pre- and retroauricular incisions to improve cosmetic outcome and prevent Frey's syndrome

The growth of parotid haemangiomas during the proliferative phase may be rapid and unpredictable. Involution often takes many years, with attendant psychological sequelae to the child. Although conservative management is usually proposed for parotid haemangiomas occurring in infancy, this may not be particularly helpful and the haemangioma difficult to conceal. The purpose of this study was to evaluate the reliable and aesthetic benefit of using a superficial musculoaponeurotic system (SMAS) fold flap and allograft dermal matrix (ADM) repair of the parotid bed following parotid haemangiomas via pre- and retroauricular incision. Forty-three paediatric patients (33 boys and 10 girls) with haemangiomas involving the parotid gland underwent total parotidectomy using a pre- and retroauricular approach with intraoperative placement of ADM within the parotid bed. They further underwent repair of the parotid bed with SMAS fold flaps. A panel of three plastic surgeons assessed the cosmetic outcomes. All of the patients were evaluated using a short questionnaire; postoperative gustatory sweating was assessed using a modification of Minors starch-iodine test.

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.

Reconstruction of the tongue using an extended vertical lower trapezius island myocutaneous flap after removal of advanced tongue cancer

In this study we explored an effective method to repair defects in the tongue that had been produced during removal of advanced tongue cancer. Eighteen patients with advanced squamous cell carcinoma of the tongue were treated, and extended vertical lower trapezius island myocutaneous flaps based on the transverse cervical artery were used to repair more than half the tongue. No flap failed completely and no shoulder was affected. The lingual contours were excellent. The functional results in terms of speech and swallowing were satisfactory. The patients were followed up for 6 to 24 months. Three of them were alive with disease and two have died of the local recurrence or metastasis at 18 and 20 months, respectively. The extended vertical lower trapezius island myocutaneous flap is a large, simple, and reliable flap, which is preferred for reconstruction of defects of the tongue after removal of advanced tongue cancer.