The oral cancer microbiome contains tumor space–specific and clinicopathology-specific bacteria

The crosstalk between the oral microbiome and oral cancer has yet to be characterized. This study recruited 218 patients for clinicopathological data analysis. Multiple types of specimens were collected from 27 patients for 16S rRNA gene sequencing, including 26 saliva, 16 swabs from the surface of tumor tissues, 16 adjacent normal tissues, 22 tumor outer tissue, 22 tumor inner tissues, and 10 lymph nodes. Clinicopathological data showed that the pathogenic bacteria could be frequently detected in the oral cavity of oral cancer patients, which was positively related to diabetes, later T stage of the tumor, and the presence of cervical lymphatic metastasis. Sequencing data revealed that compared with adjacent normal tissues, the microbiome of outer tumor tissues had a greater alpha diversity, with a larger proportion of Fusobacterium, Prevotella, and Porphyromonas, while a smaller proportion of Streptococcus. The space-specific microbiome, comparing outer tumor tissues with inner tumor tissues, suggested minor differences in diversity. However, Fusobacterium, Neisseria, Porphyromonas, and Alloprevotella were more abundant in outer tumor tissues, while Prevotella, Selenomonas, and Parvimonas were enriched in inner tumor tissues. Clinicopathology-specific microbiome analysis found that the diversity was markedly different between negative and positive extranodal extensions, whereas the diversity between different T-stages and N-stages was slightly different. Gemella and Bacillales were enriched in T1/T2-stage patients and the non-lymphatic metastasis group, while Spirochaetae and Flavobacteriia were enriched in the extranodal extension negative group. Taken together, high-throughput DNA sequencing in combination with clinicopathological features facilitated us to characterize special patterns of oral tumor microbiome in different disease developmental stages

Quality of life in osteoradionecrosis patients after mandible primary reconstruction with free fibula flap

Objectives: To evaluate the quality-of-life outcomes in osteoradionecrosis patients undergoing primary mandible reconstruction with free fibula flap, and to analyze the association between quality of life and demographic and medical characteristics of osteoradionecrosis patients. Study design: Quality-of-life outcomes of 15 patients after primary mandible reconstruction with free fibula flap for osteoradionecrosis were assessed using a modified University of Washington Quality of Life Questionnaire, version 4. Results: The best-scoring domain was pain, whereas the lowest scores occurred in chewing, swallowing, speech, and saliva. More than 70% of patients perceived improved health-related quality of life after reconstruction. Men scored significantly higher than women in speech domain, recreation domain, activity domain, and "social function." The time elapsed from radiotherapy was significantly and negatively correlated with the score of speech, recreation, and global question. Conclusion: Mandible reconstruction with fibula flap effectively eliminates pain and controls local infection even though radiotherapy-induced complications still influence the quality of life of osteoradionecrosis patients. © 2009 Mosby, Inc. All rights reserved.link_to_subscribed_fulltex

Stereolithographic cutting guide in mandible reconstruction

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Sialendoscopy-based diagnosis and treatment of salivary ductal obstructions.

Salivary gland ductal obstruction is traditionally treated by sialoadenectomy when conservative measures fail. During the last decade, sialendoscopy has become the preferred approach in the management of salivary ductal obstructions. Sialendoscopy can provide direct, accurate and reliable visualisation of the salivary duct lumen and ductal pathologies, and can eliminate pathologies with miniaturised instrumentation. Now, sialendoscopic surgery is a promising option for patients who can be offered a satisfactory clinical outcome while avoiding sialoadenectomy. The present article briefly outlines sialendoscopy-based diagnosis and treatment of salivary ductal obstructions.link_to_subscribed_fulltex

Application of magnetic resonance virtual endoscopy as a presurgical procedure before sialoendoscopy

OBJECTIVES: The objectives of this study were to investigate the feasibility of clinical application of magnetic resonance (MR) virtual endoscopy as a presurgical procedure before sialoendoscopy and to evaluate its value in the diagnosis of obstructive salivary gland diseases and preoperative visualization of endoluminal views. STUDY DESIGN: This study presents our initial experience to use MR virtual endoscopy for the presurgical visualization of salivary duct lumen and ductal pathologies in comparison to the sialoendoscopy findings in a feasibility study. METHODS: Six consecutive patients with suspected obstructive salivary gland diseases underwent MR sialography with a three-dimensional fast imaging using steady-state acquisition. The three-dimensional MR data were transferred to an independent workstation and were postprocessed with navigator software to generate three-dimensional reconstruction and virtual endoscopic images. The fly-through mode was used to imitate the sialoendoscopic exploratory procedure. Then the patients underwent sialoendoscopy and the endoscopic findings were compared with the preoperative virtual endoscopic images. RESULTS: The MR data acquisition and postprocessing protocol were feasible. The virtual endoscopy created clear endoluminal views of salivary duct and the ductal pathologies. The diagnoses were all confirmed by surgical sialoendoscopy. The virtual endoscopic images showed close resemblance to the sialoendoscopic findings. CONCLUSIONS: MR virtual endoscopy is an effective and noninvasive diagnostic method for evaluating the endoluminal anatomy and pathologies of the salivary duct. The clinical application of MR virtual endoscopy as a presurgical procedure before sialoendoscopy is a valuable and promising approach, which can provide surgeons useful morphologic and pathologic information. © The American Laryngological, Rhinological & Otological Society, Inc.link_to_subscribed_fulltex

Neoadjuvant chemotherapy of cisplatin and fluorouracil regimen in head and neck squamous cell carcinoma: A meta-analysis

Background: The benefit of neoadjuvant chemotherapy in the management of head and neck squamous cell carcinomas (HNSCC) still remains controversial. The aim of this meta-analysis is to evaluate the role of the neoadjuvant chemotherapy with the cisplatin and fluororacil (PF) regimen in enhancing the overall survival of and decreasing locoregional relapse and distant metastasis in HNSCC patients. Methods: Medline and manual searches were performed to identify all published randomized controlled trials (RCTs) investigating the efficacy of the neoadjuvant chemotherapy with the PF regimen. Outcomes assessed by meta-analysis included locoregional relapse, distant metastasis, and overall survival. The odds ratio was the principle measurement of effect, which was calculated as the treatment group (chemotherapy plus locoregional treatment) versus the control group (locoregional treatment alone) and was presented as a point estimate with 95% confidence intervals (CI). Results: Eight RCTs were adopted for analysis. The meta-analysis showed that the odds ratio for the locoregional relapse was 0.92 (0.70-1.22, 95%Cl), which was not statistically significant. The odds ratios for distant metastasis and overall survival were 0.47 (0.33-0.68, 95% Cl) and 1.28 (1.01-1.62, 95% Cl) respectively, which were both statistically significant. Conclusions: Neoadjuvant chemotherapy with the PF regimen in HNSCC patients has no effect on locoregional relapse. However, it shows a small but significant benefit in reducing distant metastasis and improving the overall survival.link_to_OA_fulltex

Healing masseter entheses of mandibular reconstruction with autograft - Raman spectroscopic and histological study

Autogenous bone graft represents the gold standard for mandibular reconstruction. The authors used a beagle mandibular defect model and reconstructed with iliac crest and ulna graft. Healing masseter entheses were harvested 24 weeks after surgery and analyzed by histology and Raman microspectroscopy. The intensity ratio of 960/2940 was to document mineral-to-collagen ratio as degree of mineralization. Pearson correlation was used to evaluate the association between the intensity ratios of 960/2940 and the tendon-to-bone insertion site. In the normal control group (n = 4) and the experimental control group with detached masseter muscle (n = 4), the degree of mineralization at the insertion site increased linearly from tendon to bone. In the iliac graft (n = 4) and ulna graft groups (n = 4), healing entheses were far less mature than controls and a linear trend was not observed. There was no significant correlation between degree of mineralization and insertion site in the ulna group (rspearman = 0.519, P > 0.001). These results indicate that transplanted bone plays a critical role in healing of entheses and healing enthesis to reconstructed mandible is inferior to normal. Raman spectroscopy provides quantitative information about different healing entheses and gives valuable insight into mechanical properties of entheses in functional mandibular reconstruction. © 2013 International Association of Oral and Maxillofacial Surgeons.link_to_subscribed_fulltex

Sialoendoscopically Assisted Open Sialolithectomy for Removal of Large Submandibular Hilar Calculi

Purpose: The management of large hilar calculi is a technically challenging issue during sialoendoscopic surgery. The aim of the present study was to evaluate the clinical efficacy of sialoendoscopically assisted open sialolithectomy for the removal of large submandibular hilar calculi to avoid sialoadenectomy. Patients and Methods: The present study was undertaken among patients with sialolithiasis scheduled for sialoendoscopic surgery from August 2005 to October 2008. When we failed to remove large submandibular hilar stones intraductally, we performed sialoendoscopically assisted open sialolithectomy. The clinical characteristics, pre- and intraoperative data, and outcomes were documented in a prospective fashion. Results: Of 78 consecutive patients with submandibular sialolithiasis, 18 were treated with sialoendoscopically assisted open sialolithectomy immediately after failure of intraductal removal of calculi by sialoendoscopy. For 17 patients, large hilar sialoliths were successfully removed using this surgical technique. The surgery failed in 1 patient with multiple sialoliths, and the procedure was converted to open sialoadenectomy. Temporary numbness of the tongue for 1 week postoperatively was documented in 3 patients. The patients were followed up for a median period of 18 months without any symptoms or signs of recurrence. Conclusion: Our results suggest that sialoendoscopically assisted open sialolithectomy is an effective and safe surgical technique to remove large submandibular hilar calculi. © 2010 American Association of Oral and Maxillofacial Surgeons.link_to_subscribed_fulltex

Sialoendoscopic management of submandibular gland obstruction caused by intraglandular foreign body

Objective: Submandibular gland obstruction caused by foreign body is relatively uncommon. We discuss the diagnosis and management of foreign body-induced submandibular sialadenitis by an illustrative case report and review of the literature. Study Design: We report a case of a patient who suffered from obstructive submandibular sialadenitis caused by an intraglandular fish bone, indicating the benefits of sialoendoscopy in diagnosis and treatment of such diseases. A search of the Medline database (from 1967 to February 2011) for foreign body-caused submandibular sialadenitis was performed. Results: The clinical outcome was satisfactory during a 14 months' follow-up, with no evidence of recurrence. Literature review showed that obstructive submandibular sialadenitis originating from a foreign body is relatively rare, and successful removal of an intraglandular foreign body with gland preservation had never been reported before. Conclusions: Sialoendoscopy can be served as an organ-preserving approach for diagnosis and treatment of foreign body-induced obstructive salivary diseases. © 2012 Elsevier Inc. All rights reserved.link_to_subscribed_fulltex

[Reconstruction of the tongue with lateral arm free flap after hemiglossectomy].

To investigate the value of microsurgical reconstruction of the tongue after hemiglossectomy with lateral arm free flaps in the treatment of tongue cancer. From October 2006 to April 2007, ten patients underwent simultaneous reconstruction of the tongue and oral floor defects with lateral arm free flaps after resection of squamous cell carcinoma of tongue in our hospital. The flaps ranged from 8 cm x 5 cm to 9 cm x 6 cm in size, and were adjusted to the defect of the tongue. The vascular pedicle included the posterior radial collateral artery and the accompanying veins. The outcome of reconstruction was evaluated by follow-up examinations, including the contour and mobility of the reconstructed tongue, the swallowing function and the speech function. All patients recovered uneventfully from surgery, without any major postoperative complications. The transplanted flaps survived. During follow-up period the contour of the reconstructed tongues was satisfactory. The patients demonstrated good functional mobility of the reconstructed and remaining tongue. Postoperatively, the swallowing and speech function was nearly at normal levels and the patients could ingest a solid or semisolid diet. Microvascular reconstruction of the tongue with lateral arm free flaps after hemiglossectomy is an ideal and safe method, but long term results need to be further studied.link_to_subscribed_fulltex