Maxillofacial Malignant Tumors Research Articles

Comparison of the Efficacy of Indwelling Gastric Tubes in Preoperative and Postoperative Patients With Oral and Maxillofacial Malignancies

PurposeTo explore the optimal plan for the timing of indwelling gastric tube placement in oral and maxillofacial malignant tumor patients. DesignA prospective randomized controlled trial. Methods80 patients with oral and maxillofacial tumor were selected, and 40 patients were Pre-operative group. The remaining 40 patients were the control group, called Postoperative group. The body weight and hospital stay of the two groups were observed before and after surgery. Blood samples were taken before surgery and 1, 3 and 7 days after surgery to detect hemoglobin and plasma albumin. FindingsThe number of postoperative hospitalization days in the pre-operative group was significantly lower than that in the post-operative group; postoperative hemoglobin and plasma albumins were lower in both groups compared with the preoperative level. ConclusionsPreoperative nasogastric tube ensured early postoperative administration of gastrointestinal nutrition, promoted postoperative plasma albumin recovery, and shortened the days of hospitalization.

A novel multifunctional microneedle patch for synergistic photothermal- gas therapy against maxillofacial malignant melanoma and associated skin defects

Considering the high recrudescence and the long-lasting unhealed large-sized wound that affect the aesthetics and cause dysfunction after resection of maxillofacial malignant skin tumors, a groundbreaking strategy is urgently needed. Photothermal therapy (PTT), which has become a complementary treatment of tumors, however, is powerless in tissue defect regeneration. Therefore, a novel multifunctional sodium nitroprusside and Fe2+ ions loaded microneedles (SNP-Fe@MNs) platform was fabricated by accomplishing desirable NIR-responsive photothermal effect while burst releasing nitric oxide (NO) after the ultraviolet radiation for the ablation of melanoma. Moreover, the steady releasing of NO in the long term by the platform can exert its angiogenic effects via upregulating multiple related pathways to promote tissue regeneration. Thus, the therapeutic dilemma caused by postoperative maxillofacial skin malignancies could be conquered through promoting tumor cell apoptosis via synergistic PTT—gas therapy and subsequent regeneration process in one step. The bio-application of SNP-Fe@MNs could be further popularized based on its ideal bioactivity and appealing features as a strategy for synergistic therapy of other tumors occurred in skin.Graphical

Evaluation of Postoperative Psychological Distress and Its Driving Factors in Patients with Oral and Maxillofacial Malignant Tumors

Objective: To explore and analyze the evaluation and driving factors of postoperative psychological pain inpatients with oral and maxillofacial malignant tumors. Methods: Relevant data were collected from 80 patients with oral and maxillofacial malignant tumors who attended the outpatient clinic for follow-up consultations between May 2021 to May 2023. The patients used the psychological distress thermometer (DT) to circle words that best described their experiences in the past week, assigning a numerical value (0–10) to indicate their pain level on each day. The scoring results were employed to assess the psychological pain in these patients. A self-developed patient basic information questionnaire was utilized to record demographic details. Logistic regression analysis was employed to evaluate patients two weeks after surgery, focusing on the assessment of psychological distress and the identification and location of driving factors. Results: Following evaluation, the results revealed that the average postoperative DT score for the 80 patients with oral and maxillofacial malignant tumors was 4.53 ± 1.98 points. Scores < 4 points indicated no psychological pain (Group N) in 48 cases, while scores ≥ 4 points indicated psychological pain (Group Y) in 32 cases. The differences in postoperative DT scores among patients with varying educational levels, fears and worries about disease progression, economic problems, sleep problems, level of hope, and oral pain were statistically significant (P < 0.05). Multiple linear regression analysis results indicated that education level, fear and worry about disease progression, economic problems, sleep problems, level of hope, and oral pain are driving factors of postoperative psychological pain in patients with oral and maxillofacial malignant tumors (P < 0.05). Conclusion: The postoperative psychological pain level in patients with oral and maxillofacial malignant tumors is at a moderate level. Educational level, fear and worry about disease progression, economic problems, sleep problems, level of hope, and oral pain were identified as driving factors for postoperative psychological pain in these patients.

Application of Midline Catheter Placed Under Ultrasound Guidance in Intravenous Therapy for Oral and Maxillofacial Tumor

To examine the application effect of ultrasound-guided placement of midline catheter and to select the appropriate placement method of intravenous catheter for patients with oral and maxillofacial tumors. We retrospectively analyzed the general data and venous catheter-related information of 143 oral and maxillofacial tumor patients who received treatment between June 2019 and December 2021. There were two patient groups, a control group of patients with inserted peripheral venous catheters (PVC) and an observation group of patients with midline catheters placed under ultrasound guidance. We made a comparative analysis of the incidence of catheter-related complications, including bleeding at the insertion site, phlebitis, catheter blockage, extravasation, etc., in the two groups. When the baseline data from the two groups were not balanced, we used propensity score matching (PSM) to match the general data before comparing the complication incidence between the two groups. There were 71 patients who underwent 215 times of PVC placement in the control group and 72 patients who underwent 72 times of midline catheter placement in the observation group. There was no significant difference between the patients in the two groups in terms of age, sex, diagnosis, or the use of anticoagulant medication ( P>0.05) . The observation group had longer average length-of-stay than the control group did ( P<0.01). The cost of catheter placement in the observation group was 1080 yuan per set, with the average daily cost being about (56.27±20.23) yuan. Patients in the control group had PVC placement for an average of (3.03±0.93) times. The cost for PVC placement was 96 yuan per time and the average daily cost was about (19.94±7.50) yuan. There was significant difference in the average daily cost between the observation group and the control group ( P<0.01). PSM was performed for the two groups. Before PSM, the incidence of catheter-related complications in the observation group (8.3%, 6/72) was lower than that of the control group (30.2%, 65/215) and the difference was statistically significant ( P<0.01). After PSM, 72 times of catheter placement from each group were included in comparative analysis. The incidence of catheter-related complications in the observation group (8.3%, 6/72) was lower than that of the control group (54.2%, 39/72) and the difference was statistically significant ( P<0.01). Patients have low incidence of catheter-related complications when they have midline catheter placed under ultrasound guidance, which helps reduce the pain of repeated venous insertion that patients incur and the workload of clinical nurses. The use of midline catheters is appropriate for and should be popularized among patients with oral and maxillofacial malignant tumors, especially patients who have poor peripheral venous conditions and those who are undergoing repair and reconstruction surgeries.

Analysis of Survival Quality of Peroneal Artery Perforator Flap in Immediate Repairment and Reconstruction of Oral and Maxillofacial Malignancies.

This study aimed to investigate the survival quality of peroneal artery perforator flap in the reconstruction of oral and maxillofacial malignant tumors. Thirty-two cases with a diagnosis of oral and maxillofacial malignant tumors admitted to our hospital from January 2019 to December 2019 were randomly divided into 2 groups. The observation group was reconstructed with free open artery perforator flaps, and the control group was repaired with free forearm flaps. The observation group had significantly lower scores in terms of postoperative pain, appearance, and anxiety, compared with the control group ( P <0.05). Both groups had high scores on taste, saliva, and shoulder function although there was no significant difference ( P >0.05). The scores of the observation group were significantly higher than those in the control group in terms of chewing, swallowing, speech, activity, mood, and entertainment ( P <0.05). There was 1 case accompanied by postoperative wound dehiscence and 2 cases with wound infection in the observation group while there were 3 cases with wound dehiscence and 2 cases with wound infection in the control group ( P >0.05). Compared with the forearm flap, the peroneal artery perforator flap can improve the survival quality of patients, especially in postoperative function with the fibula joint to repair the oral and maxillofacial defects. It has a wide application prospect as one of the ideal flaps in oral and maxillofacial postoperative repair and reconstruction.

Application of infrared thermography technique to assist peroneal artery perforator flap in the repair of oral and maxillofacial defects

To explore the application value of infrared thermography (IRT) technique assisted peroneal artery perforator flap in repairing oral and maxillofacial defects. The clinical data of 20 patients with oral and maxillofacial malignant tumors treated with peroneal artery perforator flap between October 2020 and December 2021 were retrospectively analysed. There were 13 males and 7 females, with an average age of 56.5 years (range, 32-76 years). There were 8 cases of tongue cancer, 5 cases of parotid gland cancer, 4 cases of buccal cancer, and 3 cases of mandibular gingival cancer; and 12 cases of squamous cell carcinoma, 3 cases of adenoid cystic carcinoma, and 5 cases of mucoepidermoid carcinoma. Color Doppler ultrasound (CDU) and IRT technique were performed before operation to locate the peroneal artery perforator and assist in the design of the flap. The sensitivity, specificity, positive predictive value, and negative predictive value of CDU and IRT technique were compared with the actual exploration during operation. The accuracy of CDU and IRT technique in detecting the number of peroneal artery perforator and the most viable perforating points was compared. The patients were followed up regularly to observe the recovery of donor and recipient sites, the occurrence of complications, and the recurrence and metastasis of tumors. The sensitivity, specificity, positive predictive value, and negative predictive value of peroneal artery perforators detected by IRT technique before operation were 72.22%, 50.00%, 92.86%, and 16.67% respectively, which were higher than those by CDU (64.17%, 33.33%, 84.62%, and 14.29% respectively). Forty-five peroneal artery perforators were found by CDU before operation, and 35 were confirmed during operation, with an accuracy rate of 77.8%; 43 "hot spots" were found by IRT technique, and 32 peroneal artery perforators were confirmed within the "hot spots" range during operation, with an accuracy rate of 74.4%; there was no significant difference between the two methods ( χ²=0.096, P=0.757). The accuracy rates of the most viable perforating points found by CDU and IRT technique were 80.95% (17/21) and 94.74% (18/19), respectively, and there was no significant difference between them ( χ²=0.115, P=0.734). The localization errors of CDU and IRT technique were (5.12±2.10) and (4.23±1.87) mm, respectively, and there was no significant difference between them ( t=1.416, P=0.165). All the perforator flaps survived, and the incisions of donor and recipient sites healed by first intention. All patients were followed up 5-18 months, with an average of 11 months. The skin flap was soft and had good blood supply, and the lower limb scar was concealed and the lower limb had good function. No lower limb swelling, pain, numbness, ankle instability, or other complications occurred, and no tumor recurrence and metastasis were found during the follow-up. Compared with the CDU, using the IRT technique to assist the preoperative peroneal artery perforator flap design to repair the oral and maxillofacial defects has a high clinical application value.

The progress of post-treatment restricted mouth opening in oral and maxillofacial malignant tumor patients

: Oral and maxillofacial malignant tumor seriously threaten the physical and mental health of patients, especially advanced malignant tumor requiring a comprehensive sequence of surgery-based treatment, resulting in facial deformity, difficulties with chewing, dysphagia and asophia. Among them, trismus (restricted mouth opening) is one of the most common complications after treatment of oral and maxillofacial malignant tumor. In severe cases, they may even suffer from trismus and eating difficulties, finally leading to malnutrition and even cachexia. Therefore, it not only affects the quality of life of the patients and even endangers their lives, but also brings heavy social and economic burden. How to effectively prevent and treat posttreatment trismus is a clinical problem which is easy to be ignored by oral and maxillofacial surgeons and needs to be solved urgently. In recent years, restricted mouth opening (trismus) after post-treatment of oropharyngeal, nasopharyngeal and other head and neck malignant tumors have been widely studied, but restricted mouth opening after comprehensive treatment of oral cancer has been neglected. We therefore conducted a systematic review with 3 aims: (I) to clear the definition of restricted mouth opening and trismus; (II) to identify epidemiology and pathogenesis of restricted mouth opening or trismus; and (III) to summarize the methods of interventions or treatment of oral and maxillofacial malignant tumor patients with restricted mouth opening or trismus.

MR-guided 125I seed implantation treatment for maxillofacial malignant tumor.

PurposeThis study assessed the therapeutic efficacy of postoperative magnetic resonance (MR)‐guided interstitial 125I seed implantation for treatment of oral and maxillofacial malignant tumors.Methods and MaterialsA total of 127 patients with oral or maxillofacial malignant tumors were included in this study who received interstitial 125I treatment after the surgery resection. Before implantation, all the patients received MR scans to assess the lesion scope, extent, and nature. 125I implantation target regions were based on the pre‐operative imaging. 125I seeds were delivered to target regions via puncture needles under the real‐time guidance of MR. Computed tomography (CT)or MR was performed immediately after implantation and again every 3 months later.ResultsAfter successful 125I implantation, all patients were also examined regularly to detect tumor recurrence, lymphatic, and distant metastases. To date, CT or MR verification showed that 13/127 patients experienced tumor recurrence or lymphatic metastasis or distant metastasis. No seeds migration was observed, no serious treatment‐related complications affected patient quality of life, and no important organ (such as major cervical vessels, spinal cord, etc.) injuries were observed.ConclusionOur results show that MR‐guided 125I implantation is an effective approach to site‐specific treatment for oral and maxillofacial tumor, which could potentially reduce postoperative complications and tumor recurrence rates, increase patient survival, and improve quality of life.

Application of high frequency color Doppler ultrasonography combined with microvascular stapler in maxillofacial defect repair

Objective:To evaluate the clinical application value of high frequency color Doppler ultrasound（HFCUS） combined with microvascular stapler in the repair of oral and maxillofacial defects with the anterolateral thigh perforator flap. Method:Forty maxillofacial malignant tumor patients were divided into HFCUS+stapler group（23 cases） and control group（17 cases）. All of cases used anterolateral thigh flap without fascia lata to repair the soft tissue defect in the operative area. One artery and two veins were anastomosed during the operation. The flaps were harvested from 6.0 cm×7.0 cm to 10.0 cm×12.0 cm, and the donor sites were closed and sutured at the same time. In group HFCUS+stapler, HFCUS was used to locate the perforating vessels and mark the location on the body surface the operation, and the vein was anastomosed intraoperatively with a stapler. In the control group, only iliac patella line was fixed before operation, and the vein was manually sutured during operation. The clinical data of 2 groups was evaluated by comparing the time consumption of flap harvest, the vascular anastomosis, the incidence of postoperative venous crisis, and the long-term survival rate of flap. Result:In the HFCUS+stapler group, a total of 27 perforators were found before the operation, 24 perforators within 1.0 cm from the preoperative marker were actually detected during the operation, and the remaining 3 perforators were about 1.7 cm, 2.0 cm and 2.5 cm from the marker respectively, with an accuracy rate of 88.9%. HFCUS+stapler group used （63.17±7.80） min to harvest the flap, while the control group used （85.47±7.41） min HFCUS+stapler group took significantly less time than the control group（P<0.001）. The arterial anastomat time in the HFCUS+stapler group was （9.48±1.20） min and it was （9.18±1.13） min in the control group. The difference between the two groups was not statistically significant（P=0.426）. The total anastomosis time of the two veins was （14.87±2.62） min in the HFCUS+stapler group and （33.06±3.86） min in the control group. The HFCUS+stapler group had significantly less anastomosing time than the control group（P<0.001）. In HFCUS+stapler group, no arteriovenous crisis occurred after operation, and all flaps survived well 15 days after operation. In the control group, 2 cases had venous crisis after operation（P=0.091）. Conclusion:HFCUS combined with iliac patellar line can improve the accuracy of anatomical perforated vessels, reduce the time of flap harvesting, and reduce the possibility of accidental injury of perforated vessels. The use of microvascular stapler for vein anastomosis can reduce the operation time and improve the survival rate of flap. The combination of the two can significantly reduce the operation time of microsurgical repairing maxillofacial soft tissue defect, improve the operation quality, and has higher clinical application value.

RETRACTED ARTICLE: Circular RNA hsa_circ_0055538 regulates the malignant biological behavior of oral squamous cell carcinoma through the p53/Bcl-2/caspase signaling pathway

BackgroundOral squamous cell carcinoma (OSCC) is a common oral and maxillofacial malignant tumor with high rates of metastasis and mortality. Circular RNAs (circRNAs), a type of non-coding RNA, are involved in the development of a variety of tumors. The roles of circRNAs in OSCC are unclear; in this study, the correlation between the circRNA hsa_circ_0055538, previously identified by high-throughput sequencing, and the biological behavior of OSCC was evaluated.MethodscircRNA expression was evaluated using patient tissue samples and various OSCC cell lines. The effects of overexpression and knockdown were evaluated by lentiviral infection and siRNA transfection of the SCC9 and CAL27 cell lines. Migration, invasion, apoptosis, and the expression of proteins in the p53 signaling pathway were evaluated. Infected cells were injected into nude mice to evaluate tumorigenesis.ResultsLow hsa_circ_0055538 expression levels were verified in tumor tissues and OSCC cell lines. Clinical data analysis showed that the expression level is related to the degree of tumor differentiation. Lentiviral infection and siRNA transfection of SCC9 and CAL27 cell lines revealed that changes in circRNA expression significantly affected the malignant biological behavior of OSCC cells. Importantly, nude mouse experiments showed that high expression of hsa_circ_0055538 inhibited tumor growth. Finally, hsa_circ_0055538 may affect the development of OSCC via the p53/Bcl-2/caspase signaling pathway.ConclusionsOur results indicated that hsa_circ_0055538 is involved in OSCC via the p53 signaling pathway and may be a diagnostic and/or prognostic marker as well as a therapeutic target.

Accuracy of magnetic resonance imaging in evaluating the depth of invasion of tongue cancer. A prospective cohort study

ObjectivesThis study compared the consistency of depth of invasion (DOI) measurements by magnetic resonance imaging (MRI) and intraoperative and postoperative pathological sections due to a lack of large sample studies. Materials and methodsFrom April 2015 to December 2017, patients with squamous cell carcinoma of the tongue were included in the study. Different invasion depths were measured by MRI and on intraoperative and postoperative pathological sections. The differences between two-dimensional tumor margins were analyzed using Mimics 15.0 and Geomagic Control 16.0. Statistical analyses were performed using IBM SPSS software version 25.0 (IBM Corp., Armonk, NY). ResultsThis study included 150 patients, the overall difference between MRI and postoperative pathological sections (DMP) and the overall difference between intraoperative and postoperative pathological sections (DIP) based on pathological specimens were 2.32 ± 1.68 mm and 0.68 ± 0.99 mm. The overall difference between MRI and intraoperative pathological sections (DMI) based on intraoperative specimens was 1.64 ± 1.32 mm. The tumor growth pattern and T stage were significantly correlated with measurement differences. The cutoff value of MRI depth that could identify nodal metastasis was 8 mm, and were both 11 mm for OS and DSS. ConclusionClinicians performing T staging on patients with tongue cancer based on MRI measurements must consider the false-positive mean depth of 2.3 mm as well as the growth pattern and specific infiltration depth. The prognostic MRI depths that enabled the identification of nodal metastasis, OS and DSS were 8 mm, 11 mm and 11 mm, respectively. Clinical trial registrationName: A Prospective, Observational, Real-world Study Based on the Register System of Oral and Maxillofacial Malignant Tumors. (ClinicalTrials.gov ID: NCT02395367)

Analysis of M1 and M2 tumor associated macrophages in tongue squamous cell carcinomas.

Analysis of M1 and M2 tumor associated macrophages in tongue squamous cell carcinomas.

Relationship between the maximum standardized uptake value of fluoro-2-deoxyglucose-positron emission tomography/computed tomography and clinicopathological characteristics in tongue squamous cell carcinoma.

Tongue carcinoma is one of the most common oral and maxillofacial malignant tumors worldwide, maximum standardized uptake value (SUVmax) in 18 F-fluoro-2-deoxyglucose-positron emission tomography/computed tomography (PET/CT) has been widely used in cancer research; however, there are few systematical reports on the relationship between SUVmax and clinicopathological characteristics in tongue squamous cell carcinoma (TSCC). This study aimed to investigate the relationship between them and whether SUV parameters can predict lymph node metastasis. PET/CT manifestations and clinicopathological features of 52 patients with TSCC confirmed by pathology were retrospectively analyzed. Single-factor and multiple regression analyses were conducted on possible factors influencing TSCC SUVmax, including sex, age, smoking history, tumor location and size, histological differentiation, and tumor node metastasis (TNM) stages, T stages, and N stages. Diagnostic performance of SUVmax for lymph node metastasis was measured by the area under the receiver operating characteristic curve, and sensitivity and specificity were determined by Youden's J statistic. SUVmax was correlated with sex, tumor location and size, and TNM stages, T stages, and N stages (P < 0.05) but was not correlated with histological differentiation, smoking history, and age (P > 0.05). Sex, tumor location, tumor size, and N stage were influencing factors independent of TSCC SUVmax (P < 0.05). TSCC SUVmax had predictive value for lymph node metastasis. When the cutoff value was 6.57, the diagnostic efficiency was the highest, with the sensitivity being 79.2% and the specificity being 85.7%. SUVmax was higher among male patients with TSCC with posterior tumor location, larger tumor size, and lymph node metastasis, and TSCC SUVmax was important in predicting lymph node metastasis.

Free Flap Transplantation on the repair of defects caused by oral and maxillofacial tumors resection.

Objective:To investigate the efficacy of free flap transplantation on the repair of tissue defects after oral and maxillofacial malignant tumor resection and its effects on serum sialic acid (SA) and interleukin-2 (IL-2).Methods:Fifty-eight patients with oral and maxillofacial tumors were enrolled and set as the observation group. After the tumor resection, free flap transplantation was performed for postoperative repair. The postoperative efficacy, adverse reactions and follow-up indicators were observed. Moreover, 55 patients with benign tumors were enrolled into the control group, and 55 healthy persons were set as the healthy group. The levels of SA and IL-2 of the three groups were detected.Results:In the observation group, 55 patients were successfully repaired (94.83%); 15 patients had adverse reactions after surgery. The follow-up duration was two to four years, and 45 patients survived for three years, with a survival rate of 77.59%. Before treatment, the serum SA level of patients with oral malignant tumor was significantly higher than those of the control group and healthy group, while the IL-2 level was significantly lower than those of the other two groups, and the differences were statistically significant (P<0.05). The serum IL-2 level in the observation group one day and fourteen days after surgery was higher than that before surgery, while the serum SA level was lower than that before surgery; the differences were statistically significant (P<0.05).Conclusion:The application of free flap transplantation in the repair of postoperative tissue defects of oral and maxillofacial tumor resection is effective and has less complications, and the determination of both serum SA and IL-2 levels offers important references to recovery of patients with oral and maxillofacial tumors and prognosis evaluation.

Relationship between thrombospondin-1 and the occurrence and development of oral and maxillofacial malignancy

Thrombospondin-1 (TSP-1) is widely distributed in human tissues and is important in inhibiting angiogenesis.It also occupies an indispensable position in the formation, growth, differentiation, and metastasis of tumors in different tissues.TSP-1 plays an important role in the occurrence and development of various types of tumors. The inhibitory effect of TSP-1 on the angiogenesis and tumor development of oral and maxillofacial malignant tumors has been demonstrated in recent years. This paper reviews the findings and progress of TSP-1 research involving all kinds of tumors as well as oral and maxillofacial malignancies.

Comparison of the Outcomes of Three Different Nutritional Supports in Patients with Oral and Maxillofacial Malignant Tumors following Surgery.

Objective. This study aimed to compare the physical and mental states and the clinical effects of parenteral nutrition combined with enteral nutrition (PN+EN), total enteral nutrition (TEN), and total parenteral nutrition (TPN) after surgery in patients with maxillofacial malignant tumors. Methods. A total of 112 patients were divided into three groups, with 58, 33, and 21 patients in the PN+EN, TPN, and TEN groups, respectively. The psychological survey contained the Faces Pain Scale-Revised (FRS-R), visual analog scale (VAS), numerical rating scale (NRS), Hamilton anxiety rating scale (HAMA), and short-form 36 health survey questionnaire (SF-36). Spirit symptoms, length of hospital stay, nutritional assessments, and related biochemical indices were recorded and compared. Results. The traditional Chinese medicine (TCM) symptoms of anxiety and dysphoria were least frequently identified in the TPN group. The levels of lymphocytes, hemoglobin (HB), albumin (ALB), and prealbumin (PA) were significantly higher in the PE+EN group, whereas white blood cell count, neutrophil count, HB, PA, and ALB were significantly lower in the TPN group. Better psychological scores were observed in the TPN group. The PE+EN group had a shorter length of stay and higher SGA categories. Potassium, sodium, and chlorine levels were significantly lower in the TEN group (all P < 0.05). Conclusions. As an auxiliary method, TCM symptoms can help to identify spirit disequilibrium earlier and are associated with blood indices. Without the consideration of cost and long length of hospital stay, patients in the TPN group had the best mental status, with PN+EN therapy being an alternative.

Influences of the cognitive behavior therapy on anxiety for postoperative patients with oral and maxillofacial malignant cancer in surgery intensive care unit

Objective To investigate the effects of the cognitive behavior therapy on anxiety for postoperative patients with oral and maxillofacial malignant cancer in surgery intensive care unit. Methods A total of 82 patients with oral and maxillofacial malignant tumor who accept surgery from January 2014 to September 2016 were chosen and averagely divided into intervention group with cognitive behavior therapy based on control group and control group taking routine nursing and general psychological care by random number table in SICU. The application of self-evaluation of anxiety scale (SAS) evaluation of anxiety level before and after the intervention in patients with and without improvement, and compare the two groups of stay in SICU patients satisfaction evaluation intervention is effective. Results Compared with control group, the cognitive behavioral therapy, after intervention group patients with SAS scoring[(50.56±6.52)]points SAS scores than the control group [(57.51 ± 6.11)] points decrease, the difference was statistically significant (P < 0. 01); intervention group check in SICU satisfaction (97.6%,40/41) also better than the control group (90.2%, 37/41), the difference was statistically significant (χ2=7.527, P < 0.05). Conclusion cognitive behavioral therapy can effectively reduce the anxiety of postoperative patients with oral and maxillofacial malignant cancer in SICU, and effectively improve the comfort level and satisfaction in SICU. Key words: Oral and maxillofacial surgery; Malignant cancer; Surgery intensive care unit nursing; Cognitive behavior therapy; Anxiety

Computed Tomographic findings of maxillofacial SCC and Undifferentiated carcinoma

Abstract: Objective s: Tomographic findings contribute enormously to the accurate diagnosis of malignant lesions in due time and/or at imminent stages. This study investigates CT-scan findings of maxillofacial SCC and undifferentiated carcinoma. Study design : CT images of 61 maxillofacial malignant tumors included 42 SCCs and 19 undifferentiated carcinomas were evaluated based on the location, internal density, border, bone destruction and expansion, periosteal reaction, emphysema, calcification, loss of facial and fat plane, and fat plane reticulation, by two expert radiologists separately. The data were analyzed, using Chi-square and Fisher’s exact test. Results : Isodense/homogeneous (78.7%) and total heterogeneous enhancement (87.8%) appearance were the most common internal patterns detected before and after injection of contrast, respectively. There was a significant association between borders and pathology of our two lesions (p= 0.007). Conclusions : It is highly unlikely to diagnose the tumor histopathology based merely on its tomography patterns; however it is feasible to determine its aggressive nature. Key words : Computed tomography, SCC, undifferentiated carcinoma, maxillofacial region

Platelets Levels before and after Surgical Intervention in Patients with Oral and Maxillofacial Tumors at MNH, Tanzania

Background: There are documented effects of platelets on the solid tumors which need further study. The elevated platelet counts have been described for majority of cancers. There is inadequate information of effect of benign and malignant oral and maxillofacial tumors on the regulation of platelets. The aim of this study was to investigate the changes in platelet counts among patients with oral and maxillofacial benign and malignant tumors following surgical interventions. Methods: A descriptive postoperative study was done whereby patients with benign and malignant oral and maxillofacial tumors who met the inclusion criteria were included. The included patients were those who had no history of blood transfusion prior, during or after surgery, not on haemoglobin-boosting or bone marrow suppressing medications, not seropositive to human immunodeficiency virus also without clinical findings suggestive of lymphadenopathy, splenomegaly, ecchymosis and petechiae. Demographic data, Platelet counts and haemoglobin levels before and after surgery were documented and analysed by chi-square test and values were considered to be significant if p < 0.05. Results: A total of 61 patients were included in the study. The mean age of participants was 37.03 ± 16.6 years with range of 7 to 77 years. Majority 82.5% (n = 52) had benign tumors with a leading diagnosis of ameloblastoma followed by ossifying fibroma. In general there was an increase of platelet counts following surgery from the mean of 276.38 ± 109.40 K/uL to 308.51 ± 117.24 K/uL. Looking at benign and malignant separately, following surgery there was an increase of platelet counts for benign tumors (278.87 ± 106.37 to 305.96 ± 123.12) but a decrease for malignant tumors group (282.33 ± 147.03 to 232 ± 78.48). The haemoglobin level changed from the mean of 12.60 ± 1.71 g/dl before surgery to 11.69 ± 1.70 g/dl after surgery. Conclusion: The mean postoperative increase in platelet counts in benign and malignant tumors was due to healing process of the wound following surgery while the postoperative decrease in platelets counts in malignant tumors was due to effect of tumor removal which diminished the production of platelets activating factors. Malignant tumors produce platelets activating factors which are necessary for them to grow. Also, the difference in postoperative platelets counts in benign and malignant oral and maxillofacial tumors could be attributed by different biological behavior of benign and malignant tumors and hence different interactions of platelets to these tumors.

Measurement for Subcutaneous Fat and Clinical Applied Anatomic Studies on Perforators in the Anterior Thigh Region

To discuss the feasibility of making anterolateral thigh flaps of different thicknesses in the anterior thigh region and to provide clinical guidance on raising anterior thigh polyfoliate (myocutaneous) flaps. Sixty-six patients who underwent oral and maxillofacial malignant tumor resection and reconstruction with left anterior thigh flaps from October 2008 to April 2009 in the Second Xiangya Hospital were selected as the subjects. The thickness of subcutaneous fat in different parts of the anterior thigh region was measured and the distribution, number, type, and origin of cutaneous perforators in the left anterior thigh region were explored by anatomic observation. The thickness of subcutaneous fat in the anterior thigh region was thinnest in the lower part, medium in the middle part, and thickest in the upper part. The probabilities of cutaneous perforators in the upper, middle, and lower parts of the anterolateral thigh region were 83.3%, 97%, and 89.4%, respectively, and those in the anteromedial thigh region were 51.5%, 84.9%, and 95.5%. On average, there were 4.4 cutaneous perforators in the anterolateral thigh region and 3.3 cutaneous perforators in the anteromedial thigh region of each patient. In addition, 57.6% of patients had cutaneous perforators arising from the descending branch of the lateral circumflex femoral artery in the anteromedial thigh region. Flaps with different thicknesses could be harvested in different parts of the anterolateral thigh region and polyfoliate (myocutaneous) flaps could be conveniently raised in the anterior thigh region.