Oral carcinoma；Platysma myocutaneous flap；Defect repair
Objective To investigate the possibility of culturing human oral keratinocyte using autologous serum in order to provide theoretical and technical foundation for clinical application of tissue engineering oral mucosa epithelium.Methods The human oral keratinocytes were cultured by the medium containing different concentrations of autologous serum(10%,20%,30%)and fetalbovine serum (10%), respectively. The growth conditions for the cell and the mucosa epithelium in the groups were observed, the cell growth curves were drawn, and the population doubling time (PDT) was counted. Results The results showed that the human oral keratinocyte could proliferate well in the medium containing autologous serum or fetal bovine serum. The differences in the 24hour clone rate and PDT were not significant. Both the area and the thickness of the cultured oral epithelium increased with the increase of the autologous serum concentration, and the difference between autologous serum and fetal bovine serum was significant, especially with the medium containing 20% autologous serum( P＜0.05) . The human nature of the cultured epithelium was demonstrated by the immunofluorescent mouse anti-HLA antigen. Conclusion The autologous serum can replace the fetal bovine serum to culture the oral keratinocyte well, and the cultured oral mucosa epithelium can be better differentiated in the autologous serum than in the fetal bovine serum.
目的 探討股前外側皮瓣用于修復口腔頜面部缺損的護理方法。 方法 對2011年8月－12月行手術治療的42例口腔頜面部缺損患者使用股前外側皮瓣修復，重點加強皮瓣血運的觀察和血管危象的處理。 結果 39例皮瓣成活，1例皮瓣壞死；2例出現血管危象，經積極搶救后成活。 結論 股前外側皮瓣修復口腔頜面部缺損術后加強皮瓣血運的觀察和血管危象的處理對保證皮瓣成活至關重要。
Objective To evaluate the clinical outcome of the buccal fat pad flap in reconstruction of defects of the oral mucosa. Methods From May 1998 to July 2004, 42 patients with oral mucodefects were treated with buccal fat pad flap. Of them, there were 26 males and 16 females, aging 25-76 years. The defect was caused by buccal squamous carcinoma in 7 cases, by buccal leukoplakia in 5 cases, by squamous carcinoma of soft palate in 7 cases, by adenoid cystic carcinoma of palate in 8 cases, by carcinoma of maxillary sinus in 6 cases, by maxillo-alveolar angioma in 5 cases and by keratocyst of maxilla in 4 cases. The locations were buccal mucosa, maxillary sinus and soft palate. The size of defect ranged from 3.0 cm×3.0 cm to 6.5 cm×4.0cm.Results Forty-one cases achieved healing by first intention, except one case because of large defect. Edema faded and epithelization occurred after 4 weeks of operation. Complete epithelization was observed after 6 weeks of operation. Thirty-five cases were followed up 3 months to 5 years. Therewere no obvious differences in layers, color, elasticity, and texture between repaired region and adjacent mucosa. Conclusion The buccal fat pad flap is useful in reconstructing the muco-defects (less than 6.5 cm in diameter) of the posterior maxilla and buccal region without considerable complication. The multiplex blood supply, facility in accessing and minimal donor site morbidity make it a reliable soft tissue graft. The main shortcoming is its limited size.
The booming three-dimensional laser scanning technology can efficiently and effectively get spatial three-dimensional coordinates of the detected object surface and reconstruct the image at high speed, high precision and large capacity of information. Non-radiation, non-contact and the ability of visualization make it increasingly popular in three-dimensional surface medical mapping. This paper reviews the applications and developments of three-dimensional laser scanning technology in medical field, especially in stomatology, plastic surgery and orthopedics. Furthermore, the paper also discusses the application prospects in the future as well as the biomedical engineering problems it would encounter with.
Complete three-dimensional (3D) tooth model provides essential information to assist orthodontists for diagnosis and treatment planning. Currently, 3D tooth model is mainly obtained by segmentation and reconstruction from dental computed tomography (CT) images. However, the accuracy of 3D tooth model reconstructed from dental CT images is low and not applicable for invisalign design. And another serious problem also occurs,i.e. frequentative dental CT scan during different intervals of orthodontic treatment often leads to radiation to the patients. Hence, this paper proposed a method to reconstruct tooth model based on fusion of dental CT images and laser-scanned images. A complete 3D tooth model was reconstructed with the registration and fusion between the root reconstructed from dental CT images and the crown reconstructed from laser-scanned images. The crown of the complete 3D tooth model reconstructed with the proposed method has higher accuracy. Moreover, in order to reconstruct complete 3D tooth model of each orthodontic treatment interval, only one pre-treatment CT scan is needed and in the orthodontic treatment process only the laser-scan is required. Therefore, radiation to the patients can be reduced significantly.
To evaluate the long-term result of free forearm skin flap in the repair of soft tissue defects of the oral and maxillofacial regions, 26 cases which had received radical resection of maxillofacial tumors were follow-up for 4.5 years. Twenty cases, having complete data were analyzed. In this series, There were 8 males and 12 females, with ages ranged from 40 to 69 years old. The size of the flaps ranged from 4 cm x 5 cm-6 cm x 13 cm. The radial artery and the cephalic vein were used as the donor vessels, and the maxillary artery, superior thyroid artery, external jugular vein and the anterior jugular vein were prepared as the recipient vessels. According to the shape, colour, temperature, sensation, mucosoid degree of the flap, the blood supply and function of hand and the configuration of the forearm, the overall results of the recepient regions in 20 cases were all satisfactory and the overall results of 16 cases donor regions were satifactory in 16 cases. The results were poor in 4 cases. The conclusion were: 1. Free forearm skin flap was worth trying in the repair of soft tissue defects of oral region; 2. The radial artery need not to be reconstructed because of the abandant vascular net-work in the upper limb and 3. The residual scar on the forearm was the main shortcoming, but most of the patients could tolerate it because of the obvious advantages received from the operation.
Objective To report 4 methods of reconstructing soft tissue defects in oral and maxillofacial regions after tumors resection using cervical pedicle tissue flaps. Methods One hundred seventy-two soft tissue defects were repaired with cervical myocutaneous flaps after resection of oral and facial cancer( 165 cases of squamous cell carcinoma and 7 cases of salivary carcinoma). The clinical stage of the tumors was stage Ⅰ in 21 cases, stage Ⅱ in 116 cases and stage Ⅲin 35 cases. Primary sites of the lesions were the tongue (59 cases), buccal mucosa (55 cases), lower gingiva (26 cases), floor of the mouth (25 cases), parotid gland (4 cases) and oropharynx (3 cases). Infrahyoid myocutaneous flaps were used in 60 cases, platysma flaps in 45 cases, sternocleidomastoid flaps in 59 cases and submental island flaps in 8 cases. The sizes of skin paddle ranged from 2.5 cm×5.0 cm to 5.0 cm ×8.0 cm. Results Among 153 survival flaps, there were55 infrahyoid myocutaneous flaps, 40 platysma flaps, 52 sternocleidomastoid flaps and 6 submental island flaps. There were 11 cases of total flap necrosis and8 cases of partial flap necrosis. The success rates were 91.67%(55/60) for infrahyoid myocutaneous flap, 88.89%(40/45) for platysma flap, 88.14% (52/59) for sternocleidomastoid flap and 75%(6/8) for submental island flap. After a follow-up of 3 11 years(5.7 years on average) among 101 cases local reccurence in 18 cases, cervical reccurence in 4 cases, distance metastasis in 2 cases. The survical rate at 3 years were 83.17%(84/101). Conclusion Cervical pedicle tissue flaps haveclinical value in reconstruction of small and medium-sized soft tissue defects after resection of oral and maxillofacial tumors.